This is a true story on the impact of the protracted doctors’ strike on the poor, based on my personal experience.
The neighbourhood of my rural home in a place called North Karachuonyo, at a location situated at the foot of Huma Hills, in Homa Bay County, is mourning a childless widow only known by the name “Nyar Apanja” who died in Kisumu on Thursday last week.
She had been rushed to Kisumu Referral Hospital but was unable to access treatment due to the ongoing strike.
The sad story of this childless widow, who was known to me at a personal level, left me reflecting on the plight and predicament of the sick poor members of the society who cannot afford the services of private hospitals but are unable to access public hospitals due to the disruptive strike by health sector workers.
Are we really asking the right questions about these perennial and incessant strikes by doctors? The most urgent policy question we should be debating is how to protect innocent third parties from the impact of strikes by doctors and other health workers.
Innocent third parties
Nyar Apanja had to die despite the fact that she was an innocent third party who had absolutely no stake in the dispute between the doctors and their employer. What protection do our labour laws give to such innocent third parties?
Yes, the Constitution protects the right of workers to go on strike. But to avoid incidents of ailing patients being abandoned on hospital beds due to industrial action, the laws and policies on mediation of workplace disputes should provide for alternatives to protracted strikes and work stoppages.
In the aftermath of the famous London Tube strike several years ago, then-London Mayor Ken Livingstone argued that strikes in vital public services should be made much more difficult to call. And I read somewhere that, in Canada, you have to go into compulsory arbitration before you can call a strike in a critical essential services sector.
I have a suggestion. We should tweak the law to make sure that all collective bargaining agreements (CBAs) signed with doctors include provisions for service level agreements stipulating minimum services which must be provided even as strikes or negotiations continue.
This week, President William Ruto declared that the government will not yield to the demands by the striking doctors because it had “no money”. We must start living within our means, he said.
Inequalities and disparities
Granted, the government is grappling with diminishing revenue collections, an unprecedented increase in debt service costs and galloping public sector wages.
Yet the truth of the matter is, the doctor’s strike is more about inequalities and disparities in public sector wages than anything else. The leaders of the doctors’ union do not strike you as those militant ideologues motivated by an exaggerated sense of working class consciousness. Their fight is basically about fairness.
The President’s economic argument is a hard sell to doctors because it is being advanced in the context of high salaries for top public officers—MPs, judges, principal secretaries and members of constitutional commission. How do you preach austerity and belt tightening when your ministers are all over the place flying in choppers and private jets and in a set-up where every PS must be allocated multiple Prados?
Is it not the height of irony that we pay hefty salaries to MPs, regularly adjust salaries of PSs and allowances of other bigwigs yet fully trained nurses and clinical officers out of government-funded medical training schools take years to be absorbed in public hospitals?
Lack of leadership and policy failure is the reason we have too many strikes by doctors. Is it not a public outrage that we have left the fate of sick and suffering patients to the likes of Susan Nakhumicha and Simon Chelugui, who have neither domain knowledge nor experience in union negotiations and tactics?
Special knowledge and skills
Conducting trade union negotiations and bargaining requires special knowledge and skills. In the interest of the suffering patients, let’s bring in independent conciliators. And while at it, let us debate the issue of multiple unions within the health sector. You cannot have sustainable industrial peace where the employer has to deal with a patchwork of grievances by disparate unions representing doctors, nurses, clinical officers and laboratory technicians.
In the past, the law and policy encouraged industry-wide unions as opposed to small craft unions. In the past, industrial peace was easy to achieve because policy and laws made a clear distinction between unionisable employees and management staff. Today, even a consultant and professor in medicine running a profitable clinic in the city is allowed to join a trade union.
The industrial peace we enjoyed in this sector was not an accident; informed policies are what we direly need in health.
