When health workers strike

dscn3778-sm.JPGThere are often opposing views about whether health workers should be able to strike or should be considered essential service staff who must remain on the job and resolve labor issues through other means.  It should be noted that when most people talk about health workers striking, they are talking almost exclusively about health staff in the public sector, which in many malaria endemic is the largest provider of care, especially preventive services.

IRIN News reports today on a health worker strike in Adamawa State, Nigeria that has paralyzed service delivery.  In-patients in government facilities have been discharged, and a very rudimentary out-patient service has been maintained.  The strike is now in its third month, and as IRIN reports

Most of the state’s 7,000 health workers, including nurses, specialists and administrators but not general doctors, began an indefinite strike on 25 June to protest the suspension of an improved salary structure by the state government, according to head of the health workers union.

Although private care is available, “Only a few patients who can afford high medical fees have moved to private clinics, while [most] have resigned to their homes hoping the matter is soon resolved and the strike suspended.” Of special concern is the inability of the state to respond to an impending cholera epidemic.

In Gabon earlier this year a 3-month strike “demanding premiums, pay raises and better work facilities” was reported to have cost many lives. One man told IRIN that, “He is at a loss as to what to do about his three-year-old daughter who he said has had a severe cough for two weeks. ‘I do not have the means to take her to a private hospital. My only recourse is the [public hospital], so I just do not know what to do and this saddens me deeply.'”

In Cote d’Ivoire back in February, “After talks between the medical workers’ union and the government broke down … union leaders called a strike … Unlike past strikes medical workers are maintaining minimum services – emergency care, similar to that normally provided on weekends and holidays, said the union leader.”

The relationship between health workers and government often appears contentious. As one physician told IRIN, “We do not like going on strike. We know that people are in hard times, given the situation of the country. But we have been forced to do so.” Obviously the government cannot ‘force’ people to strike, but what does this say about the overall management and priority of health in a heavily government dependent setting?

These health systems and management issues were cause for reflection by Afrol News. Health workforce problems have “been a recurring matter in most part of Ghana’s 50-year existence, especially as economic conditions worsen. While public health workers deserve good pay, like other professionals, their problems are increasingly being worsened by mounting health problems and population increases. This calls for sober and holistic reflection of the entire Ghanaian healthcare delivery system.”

Part of the problem may increased pressure on existing staff because of workforce shortages. “Sub-Sahara Africa alone needs about 1 million health workers,” reports Afrol News.  This may reflect a vicious cycle of disappointed staff, brain drain, greater staff shortages and even more disgruntled and overworked staff.

A basic principle in human resources management is that self-actualization at the worksite – being able to perform one’s duties with all the necessary resources – is more satisfying and motivating than salary, which can never be seen as enough.  Since malaria control services need to be well integrated into primary care, we need to ask whether donor programs are adequately addressing issues like skill upgrading, quality control, timely and adequate procurement and supply, and other basic health service components that will make it possible for health workers to perform their duties and gain maximum job satisfaction.

We may think we are doing enough in providing billions of dollars of malaria commodities to endemic countries, but unless we address these human resource concerns, strikes may render these malaria control services unavailable just when people need them.

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