Government says it has one option now: sack the striking health workers and hire new ones. But that option is not that easy or cheap either.
An analysis by The Observer shows it would be the expensive option that would cause irreparable damage to an already seriously sick sector given what knowledgeable observers say. President Museveni said last week that he was ready to hire new health workers if those on strike don’t go back to work.
The president did not say from where though, and even his promised army replacement doctors are yet to report for duty at public hospitals. There are about 1,000 health workers on strike under the auspices of the Uganda Medical Association. Ivan Engoru, a labour law don at Makerere University, said withdrawing labour has got both international and national dimensions.
“In the international dimension, we are talking about the legal framework with the International Labour Organisation (ILO) which sets standards for labour-related matters. Then locally, we have the Constitution that has provisions that deal with economic rights, the Employment Act and the Labour Union Act,” Engoru said.
“But engagement in labour is generally treated as a private matter that two parties can agree; that one is providing labour and the other hiring pays for the labour. That, in effect, gives the person who is giving the labour the right to withdraw it,” he added.
This is exactly what the doctors did. Government must either meet their demands or decide that it no longer needs them and, therefore, hires other professionals. Is it a feasible idea? It comes at a huge cost – bigger than meeting the current demands.
First, according to a doctor familiar with the sector, Uganda’s health sector is already short of the health workers needed for it to function well.
Uganda’s doctor-to-patient ratio is estimated at 1:25,725, with a nurse to patient ratio of 1:11,000. The World Health Organisation (WHO) recommends one physician per 1,000 people. Uganda needs to hire more doctors instead of firing the few in place.
“A patient comes to a hospital and there is just one health worker. He/she has to attend to the children, the expectant mothers. That’s the reality. That’s how our public hospitals run,” a health worker told us.
Another cost is in terms of experience that would be lost if these health workers are let go. Uganda Medical Association (UMA) accounts for most of the senior professionals Uganda has. For instance, the association has 712 of the 1,300 doctors in public service. At least 152 of them are senior consultants, with another 171 being senior house officers.
“We analyzed the deficit of doctors and found that about 50 per cent of the established posts aren’t filled in our [public] hospitals. There is still room to recruit another 1,000 doctors to deploy in hospitals like Kabale Regional hospital which has six doctors out of the recommended 20,” one doctor told The Observer.
The second cost would be lost trust in government on health workers’ job security.
“If you fired my predecessor for demanding better working conditions, how sure am I that you will not humiliate me with ease?” another doctor said.
There is also a cost to the taxpayers. Uganda currently spends at least Shs 70 million to train a doctor. Firing at least 1,000 and denying Ugandans an opportunity of getting services from them means the country will lose at least Shs 70 billion in the money that was spent to train them, according to one analyst.
When let go, more doctors will seek greener pastures in the neighbouring countries where they are on high demand. Another loss could stem from potential mass class action lawsuits filed against the government for wrongful dismissal.
Another health worker said: “We have consulted our lawyers and they advised us that industrial action is justified if the safety of the worker is at risk. Doctors were exposed to various occupational risks hence triggering the strike. Summary dismissal from employment during a strike is contrary to the law hence it is likely attract litigation.”
Engoru said ILO rules give workers rights to association and the right to collective bargaining. In the same instrument, is embedded obligations on the part of an ILO member state not to victimize or discriminate against any employees on the basis of their participation in an industrial action.
Then there is the extremely high human cost. A lot of ordinary people are losing their lives from treatable diseases because there are either no health workers or essential supplies in hospitals. From Kiruddu to Jinja to Masaka, there have been people claiming their loved ones died after they found no one to take care of them at the hospitals.
When The Observer visited several hospitals on Saturday, skeleton staff attending to emergency cases said they were also withdrawing their labour to let the army do the work. Museveni said last week that he would deploy the army, police, and prisons doctors to work in public hospitals.
But these institutions can only deploy less than 50 medical doctors, a hopelessly inadequate number. At Kawempe General Referral Hospital and Naguru’s China-Uganda Friendship hospital, by Saturday, there were no army doctors or nurses in sight.
Kawempe offers vital gynaecology and obstetrics services and treatment of cervical cancer. On average, the hospital receives 100 patients daily, mainly mothers who come to give birth.
Hadijah Namugala, a patient who was found outside the postnatal ward, had waited for a security guard for over two hours to stamp her discharge letter. She said medical workers discharged her and told her that they were stopping to work on Saturday to allow the army take over.
“But I haven’t seen any army doctor or nurse around the ward since I was admitted here on Sunday (Nov 12) to give birth. I was referred from Kasangati Health Centre because my high blood pressure was not stabilizing and I needed specialised doctors to help me deliver,” she said.
“Of course when I reached, they kept me waiting and didn’t work on me that day. The following day when I gave the nurses Shs 100,000, they took me to the theatre and I was operated very fast. I gave birth to a baby boy,” she said.
Namugala, like many Ugandans, said she had been buying drugs from the pharmacies outside the hospital and also paid nurses Shs 10,000 to administer the drugs until she was discharged on Saturday.
“Even removing the catheter, which is the bag that collects urine after operation, you pay Shs 5,000 to nurses. If you don’t, you remain with it. So, government should help us address the doctor’s problems because people are going to die,” she said.
The doctors and nurses who didn’t want to disclose their names at Kawempe General hospital said they are all going to lay down their tools by Sunday to let army doctors and nurses to take over since government failed to address their problems.
Dr Ekwaro Obuku, the UMA president that spearheading the strike, said government should not bury its head in the sand.
“There should be efforts to sidestep legalese and instead look at the legitimate issues that are being raised,” he said.
“Government, for example, has an issue when it says it has no money. I think also having a comprehensive review of the salaries of all public servants is a good thing so that you don’t sort this group then the other comes up. But in the interim, there must also be identification of critical issues raised by the doctors so that they are worked on and the rest await the outcome of the committee on salary review.”
Jane Ruth Aceng, the Health minister, told The Observer on Saturday: “I have nothing else to discuss on the subject just wait for a communication from the prime minister.”