AFRICA NEWSLETTER 4
1. Sector – Health.. 1
1.1. Health sector reforms in Nigeria.. 1
1.2. PSI Health Network.. 3
2. Sector – Local Government.. 5
2.1. Regional body established.. 5
2.2. PSI Local Government Network (AMALGUN) 5
3. Labour Issues. 6
3.1. Health sector: 6
3.2. Local government: 8
- 1. Sector – Health
1.1.Health sector reforms in Nigeria
Health indicators for Nigeria highlight a country with many health problems. Life expectancy is 53 years of age for males and 54 for females; maternal mortality is 840 per 100 000 live births; and the mortality rate for children younger than 5 is 138 per 1000 live births (the global average is 60). More than 1 million children die each year from preventable diseases, and it is the only country in Africa not to have eradicated poliomyelitis, with a vaccination programme that only covers about 70% of those it is intended for. Not only is the proportion of the GDP spent on health only 5.8%, but there are enormous inequalities in the amount spent on health services between different parts of the country. There are also differences in the capacity of local governments across the country to provide primary health care – which is meant to be the cornerstone of the health system.
Only about a quarter of health spending in Nigeria is through the public sector – so it is not surprising that the poor suffer the most from lack of access to health services. They cannot afford the costs of direct payments – not only must people pay for health services in the private sector, but many public health services charge a fee as well. A high proportion of the total spending on health is done by households – between 1998 and 2002, an average of 64.5% of the total health expenditure on health came from households. This is a very high amount – effectively, in over a quarter households, about 12% of total household expenditure is spent on health. A particular problem facing Nigeria is the number of health workers who have left the country to work elsewhere.
It is not surprising that Nigeria is not on track towards achieving all of the health-related Millennium Development Goals.
There have been various attempts to reform the health system over the years. In 1988 a National Health Policy was developed, but was not turned into legislation. One of the elements of this policy was to make clear the different responsibilities of the three tiers of government. In 1996, the policy was updated, but again, nothing further happened. Then in 2004 a new National Health Bill was proposed. The Bill:
- Provides a framework for the development and management of a national health system.
- Sets out guidelines for the formulation of a national health policy, with an emphasis on the provision of essential drugs and a comprehensive vaccination programme for pregnant women and children under the age of 5.
- Stipulates that all Nigerians are entitled to a guaranteed minimum package of services. However, this minimum package is not defined – but will be prescribed by the Minister in consultation with the National Council on Health. It is however noted that this basic package of services will be provided “within available resources”. Beyond this minimum package, whatever it is, there is a provision for categories of persons to be exempt from paying for health care services at public health institutions. Again, who exactly would be eligible is not defined.
- Reaffirms the importance of Primary Health Care by setting up a National Primary Health Care Development Fund, which will be financed by not less than 2% of the consolidated fund of the Federation, as well as by funding from other sources such as grants from international donor partners.
- Defines the rights of health workers and users. It attempts to deal with the problem of the brain drain by providing for ongoing education and training of health workers.
- Establishes the National Tertiary Hospital Commission, which is meant to regulate specialist care.
While the Bill was first passed in May 2009, it was then withdrawn for bureaucratic reasons. Finally in June 2011, it was revived and passed by the two Houses of the National Assembly. However, the Bill has still not become law. It was not signed by the President within the legally-required 30-day period, which means that it has lapsed. A copy of the Bill can be found at http://www.herfon.org/docs/Harmonised-NATIONAL-HEALTH-BILL-2011%20doc.pdf
According to the Minister of Health, Professor Onyebuchi Chukwu, the reason the President did not sign the Bill was that a number of different groups and organisations wrote to the President, protesting about different aspects of the Bill. Some organisations, such as UNICEF, are arguing that the Bill should be passed as soon as possible because it will assist the poor and marginalised get access to health care through provisions such as the fund for primary health care, which allows for all Nigerians to access, free of charge, a basic package of health services. UNICEF argues that the Bill will help reduce infant and maternal mortality.
However, other organisations, such as the PSI affiliate, the Medical and Health Workers Union of Nigeria (MHWUN) argue that, while they recognise the importance of national health legislation to systematise and provide a framework for the health system in the country, the problems of the Bill must first be sorted out before it is passed.
The key concerns raised by MHWUN are:
- The Bill attempts to take away the power of existing regulatory bodies for different groups of health professionals.
- The Bill specifies that various head administrative positions, such as the chair of the National Tertiary Hospitals Commission, must be filled by medical doctors. MHWUN argues that these positions should be open to any health professionals.
- MHWUN, despite organizing at least 60% of the entire workforce in the health sector has been excluded from membership of the National Council on Health, established by the Bill.
For a more detailed statement see http://allafrica.com/stories/201110041180.html.
Another area of concern would be the limited amount of funding made available for the basic package of services through the National Primary Health Care Development Fund; and the fact that beyond this basic package fees will continue to be charged for health services in the public sector. Charging for health services, as well as increasing the involvement of the private sector, are strategies promoted by the World Bank and the International Finance Corporation (IFC). Currently in Nigeria it is estimated that about 70% of healthcare services are being provided by private hospitals, with many people not able to afford to pay for these services.
Health sector workers face numerous problems – these include under-staffing (not least because of the brain drain), low pay, wages not always being paid on time, and so on. The result is that there have been numerous strikes and labour disputes over the years. See the section on “labour issues” in this newsletter for news of two recent worker actions.
The lack of clear policy direction, legislation, sufficient funding for public sector delivery and a reliance on the privatisation and commercialisation of healthcare in the country has led to a situation in Nigeria where the health sector is unable to effectively meet the vast needs of the country.
See: The Lancet “Hope for health in Nigeria” vol 377, Issue 9781, 4 June 2011 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60791-5/fulltext
Daily Trust “Nigeria: Country’s Public Health Law and the Lancet” 16 June 2011 http://allafrica.com/stories/201106240500.html
Leadership “Health playing second fiddle to security, infrastructure – Chukwu” 27 February 2012 http://www.leadership.ng/nga/articles/17468/2012/02/27/health_playing_second_fiddle_security_infrastructure_%E2%80%93_chukwu.html
Daily Trust “Nigeria: Journalists assess options to push health bill” 9 May 2012 http://allafrica.com/stories/201205100249.html
Leadership “Experts score healthcare system low on World Health Day” 7 April 2012 http://allafrica.com/stories/201204080162.html
1.2.PSI Health Network
PSI affiliates who organise health workers in West Africa have formed a network, the West African Health Sector Unions Network (WAHSUN), to share experience, learn from each other and co-ordinate their work across affiliates. The aim is for the network to contribute towards better health services in the sub-continent. The following key issues emerged out of the last meeting of WAHSUN, who took place in November 2011:
- WAHSUN condemns recovery policies and programmes for the global economy that do not put jobs and the defence of public services at their core and calls for the adoption of a new pro-people development paradigm and the abandoning of neo-liberalism.
- WAHSUN noted efforts of the West African Health Organisation towards improving health indices within the sub-region through collaboration with the ministries of health of ECOWAS member-states and the civil society and resolved to deepen relations with the organisation. However, despite these efforts, ECOWAS countries will not be able to meet the health specific targets of the MDGs due to inadequate funding and the furtherance of a neoliberal strategy which stunts public healthcare delivery. 15% of all national budgets should be allocated for public healthcare services as recommended in the Abuja declaration of African ministers of health to ensure significant improvement in healthcare.
- The state of Occupational Health and Safety in workplaces across West Africa leaves a lot to be desired, particularly in the health sector. WAHSUN reiterates its call for the institutionalisation of OHSE policies and programmes in the workplace across the countries in the region. WAHSUN stresses the need for trade unions to be very much part of the policy-formulation and implementation processes for this through the formation of bi-partite OHS committees.
On the situation in specific countries, WAHSUN said the following:
- Liberia: The passage of the Decent Work bill by the Liberian parliament is a step in the right direction towards establishing a robust industrial relations system in the country, although the delay in the President assenting to the bill is a worry.
- Ghana: Despite the picture of relative macroeconomic stability in the country, the state of the living conditions of working people in Ghana has not improved - unemployment remains high and wages low. WAHSUN thus calls for the immediate commencement of negotiation between the social partners in the country towards establishing a living wage for workers and for instituting pro-people policies that would foster increased employment.
- Sierra Leone: The terms and conditions of work in Sierra Leone’s public sector is appalling, with Sierra Leonean public sector workers about the least paid in the world. Gross under-staffing of the public health facilities, which is worsened by a very high rate of migration due to poor wages and terrible working conditions have resulted in serious overworking of health workers. WAHSUN demands the urgent upward review of wages in the Sierra Leonean public sector; a mass employment scheme, particularly within the health sector and; enthronement of Occupational Health and Safety procedures in the workplace.
- Nigeria: While WAHSUN recognises that National Health Acts are important in harnessing the resources of countries for improved healthcare delivery, WAHSUN considers the National Health Bill in Nigeria to be retrogressive as it fosters schisms instead of promoting unity within the human resource for health in the country. It does this by promoting the professional chauvinism of medical practitioners, even in fields of other health workers’ expertise.
If you would like more information on this meeting/network, or are a PSI affiliate in the health sector but not yet a member of this network, please contact the Sub-Regional Secretary for English-speaking (East and West) Africa, Sani Baba at email@example.com.
- 2. Sector – Local Government
2.1.Regional body established
A new regional local government body has been established in West Africa. The Council of Local Governments (CCT), established on April 11 2012, falls under UEMOA, the West African Economic and Monetary Union. It brings together the national local government associations of Benin, Burkina Faso, Cote D’Ivoire, Guinea Bissau, Mali, Niger, Senegal, and Togo.
The establishment of the CCT was supported by the United Cities and Local Government (UCLG), and by the European Union project on “Support to decentralization in the developing countries”. UCLG is an international organisation linking local authorities. It has a regional affiliate in Africa – UCLGA. See the PSIRU document “Municipal services: organisations, companies and alternatives” at http://www.psiru.org/publications for more information on UCLG and UCLGA.
2.2.PSI Local Government Network (AMALGUN)
PSI affiliates organising in local government, specifically Sierra Leone Local Government Workers Union, Ghana Local Government Workers Union, South Africa Municipal Workers Union, Nigeria Union of Local Government Employees, Kenya Local Government Workers Union, Tanzania Local Government Workers Union and Ivory Coast Local Government Workers Union agreed to form a municipal and local government network.
The theme of this network is “Promoting Quality Municipal and Local Government Services in Africa”.
One of the key motivations for forming the network was the recognition by the affiliates that they are faced with serious challenges in the name of reforms which if not checked, will destroy the very existence of municipal and local government service. Other challenges identified by the network include:
- An over-reliance of local governments/municipalities on external funding;
- The growth of unnecessary bureaucracy, fragmentation and division in leadership struggles caused by external pressures;
- Inadequate funding and difficulties in revenue collection accruing to local government/municipalities;
- Conflicting legislations and undue political interference facing local government.
The objectives of the network were outlined as follows:
- All municipal/local government unions shall ensure compliance to fair trade union practices.
- Build partnership and unity amongst unions and workers in municipalities/local governments.
- Lobby for improved funding and autonomy of municipalities/local government through democratic process.
- Advocacy for conflicting laws in the municipal/local government to be streamlined.
- Engage in policy intervention and reform process.
- Ensure transparency and accountability.
- Build strong, viable and democratic trade union movement.
If you would like more information on this meeting/network, or are a PSI affiliate in local government but not yet a member of this network, please contact the Sub-Regional Secretary for English speaking (East and West) Africa, Sani Baba at firstname.lastname@example.org.
- 3. Labour Issues
There have been numerous strikes and other actions by workers in the health sector in Nigeria over the last few years. In the last two months alone there have been two major strikes.
In April, doctors in Lagos went on a two-week pay strike. The strike started on Monday 24 April, soon after they had concluded a three day warning strike earlier in April, and sometime after a three month strike in September 2010 on the same issues. After the three day warning strike, doctors were summoned to appear before a disciplinary panel – a move that only escalated tensions between the government and the doctors.
The main demand of the doctors was the full implementation of the agreed-to Consolidated Medical Salary Structure (CONMESS). After the three month strike in 2010, the Lagos State Governor agreed to implement 75% of the salary increase demanded. Now the doctors were demanding the full implementation.
On May 7 2012, the Lagos State Government embarked on a mass dismissal of 788 of the striking doctors. The government immediately started recruited 373 doctors to fill the gap. They also issued an eviction order to remove the doctors from their quarters, but this was immediately overturned by the Governor of Lagos. The dismissed doctors are now taking the government to court over their dismissals.
The strike, and subsequent dismissal of the doctors has caused an uproar in Nigeria. The NLC has come out in support of the doctors, saying ``We strongly condemn the purported sack as the action is reminiscent of the military era in which rules and laws were violated with impunity.We call on Gov. Babatunde Fashola to retrace his steps and go into negotiation and meaningful discussion with the doctors.'' (Mr Chris Uyot, Head, Information and Public Relations of the NLC).
The Joint Health Sector Unions (JOHESU), which includes the Medical and Health Workers’ Union of Nigeria (MHWU) and National Association of Nigeria Nurses and Midwives, both PSI affiliates, embarked on a national strike from 7 – 14 May 2012. Some of the issues that the health workers went on strike over are the same as those of the Lagos doctors. In particular, workers are dismayed at the ongoing non-implementation of the Consolidated Medical Salary Scale (CONMESS) 10 salary scale. Other demands include:
- The implementation of the presidential committee report on Harmonious Work Relationship among Health Professional and Workers;
- The promotion of health professionals from CONHESS 14 – 15;
- Issues around the National Health Bill to be sorted out;
- Payment of consultancy/specialist allowances;
- Allowances for shift workers;
- A shift away from only appointing medical doctors as Ministers of Health.
According to JOHESU, these are issues they have been raising with the government since 1980, but particularly in the last three years, without achieving anything. According to the National Coordinator of JOHESU, Comrade Faniran Felix Olukayode, "we are hereby informing the good people of Nigeria that having presented our demands to the Federal Government through various Health Ministers since 1980 and especially the past three years without any serious commitment to meet them, we have no other option other than to embark on an indefinite strike to press home our demands as a last resort.”
JOHESU suspended the strike on Monday May 14 2012, until July 31. During this period, JOHESU will continue to negotiate with the government in an attempt to reach an agreement.
See: This Day “Lagos fires 788 doctors over strike, recruits 373” 8 May 2012 http://www.thisdaylive.com/articles/lagos-fires-788-doctors-over-strike-recruits-373/115371/
Leadership “NLC calls on Lagos govt., doctors to resume negotiation’ 10 May 2012 http://leadership.ng/nga/articles/24276/2012/05/10/nlc_calls_lagos_govt_doctors_resume_negotiation.html
Daily Trust “Health workers embark on national strike as Lagos sacks striking doctors” 7 May 2012 http://allafrica.com/stories/201205080160.html
Vanguard “Health workers begin strike nationwide” 8 May 2012 http://allafrica.com/stories/201205090019.html
The Nation “Health Workers suspend strike” 15 May 2012 http://www.thenationonlineng.net/2011/index.php/news/46665-health-workers-suspend-strike.html
As reported in the previous newsletter (newsletter 3 http://www.psiru.org/node/16098 ), nurses and other health professionals in Kenya were threatening to go on strike over the government’s failure to implement a wage agreement, and the conditions in the public-sector hospitals. The strike, called by the Union of Kenya Civil Servants (UKCS) and the Kenya Health Professionals Society (KHPS) started on March 1, and had a major effect on the health services in the country. When the unions called off the strike on Sunday 4 March 2012, after having negotiated an agreement with the government, many of the striking workers were reluctant to return to work and carried on striking. The agreement was that a 12 member team would be set up to begin negotiations on the demands of the workers. One of the concerns of the workers was that the government has, in the past, failed to honour agreements it has made. On Thursday 8 March, 25 000 nurses who were still on strike were dismissed. However, a week later the government rescinded this decision, and these nurses, together with the rest of the 40 000 health workers who were on strike returned to work on Friday 16 March 2011 after finally reaching agreement with the government. This agreement makes provision for the workers’ extraneous allowances to be increased 100%; and for a task force to be set up which will develop a plan on increasing other allowances and employing more workers to reduce a shortfall of 30 000 health workers.
Health workers in Uganda were meant to have their salaries increased by 100% - but the implementation of this has been delayed because the Ministry of Finance has not provided the necessary funds. The Health Minister, Christine Ondoa, told the Social Service Parliamentary Committee on Monday 7 May 2012 that her department could not even afford to increase the salaries by 50% at this stage. The committee insisted that the wages must be increased, at least by 15%, in order to ensure a motivated and effective workforce.
See New Vision “No money for health workers’ salary rise – minister” 8 May 2012 http://www.newvision.co.ug/news/630886-No-money-for-health-workers--salary-rise-minister.html
The South African Municipal Workers’ Union (SAMWU), together with the Independent Municipal and Allied Trade Union (IMATU), are starting wage negotiations in May with the employer body, the South African Local Government Association (SALGA). SAMWU and IMATU are demanding an across the board increase of 15% or R 2000, whichever is the greater; a minimum wage of R 6000; the filling of all vacant posts on all Municipal Council approved organograms on a permanent and full-time basis; and a one-year agreement only. A detailed statement from SAMWU in support of their demands can be found on the PSI website at http://www.world-psi.org/en/samwu-preparing-huge-battle .
Meanwhile, in Zimbabwe, Bulawayo Council workers went on strike for a week in April demanding that their salaries, which hadn’t been paid since January 2012, be paid. The strike ended without an agreement being reached, and the issue will now to for arbitration to the Ministry of Labour. The Council claims it cannot pay the salaries as it has no money – it has a huge debt of over $3 million, and is owed about $1.5 million by ratepayers in the City.
In Zambia, council workers are unhappy about the disparities in salaries across the country. The union submitted a document to the government in December 2011 on the harmonisation of the salaries and conditions of service across the country. According to Noel Kalangu, the General Secretary of the Zambia United Local Authorities Workers’ Union (ZULAWU), the harmonisation process should bring up the wages of the lowest paid workers, some of whom were receiving wages as low as K250, 000.00. Wages for most council workers had remained stagnant since 1996. The union is waiting on the government to study the document so that they can begin negotiations.
See: Times of Zambia “ZULAWU urges calm among members” April 16 2012 http://www.times.co.zm/?p=5081