Major disruptions in the public health sector are on the cards if the government does not improve working conditions for doctors within three months.
These will include further strikes, says Dr Rapitse Malatji, representative of the breakaway United Doctors’ Forum, formed last week after many doctors expressed impatience with the slow pace of negotiations between the South African Medical Association (Sama) and the government.
The forum claims it has about 5 000 members — more than 60% of all public sector doctors.
”We may have returned to work on Wednesday after talks with government and Sama, but I want both of them to understand that we will strike again if our needs aren’t met. We’re giving government three months at most to sort out this mess. Our action may be illegal, but our reasons for doing so are very legitimate. We need to address government in the language they understand,” said Malatji.
Doctors are demanding a 50% to 70% salary increase and better working conditions. Currently, state doctors earn a basic salary of between R9 791 and R19 048 a month, depending on their qualifications and experience. Sama and the government have been in talks since last year, but little progress has been made.
”Sama didn’t stick to its promise to organise a national protest action on April 16,” Malatji said. ”And that’s the day we started with ours. We were hungry and broken on the ground.”
Disruption in the sector will also follow if president elect Jacob Zuma’s choice of health minister is ”another Manto [Tshabalala-Msimang]”, said Vuyiseka Dubula, secretary general of the Treatment Action Campaign (TAC).
”If the new government doesn’t take the rights and working conditions of doctors considerably more seriously than in the past and appoint competent people, we’re heading for massive chaos and severe disruptions.
”That could include what some people consider ‘irresponsible action’. We need a Barbara Hogan, or someone of her calibre, to fix Tshabalala-Msimang’s mess.” Dubula said the ”mess” includes the previous health minister’s false promise that the government would pay doctors higher salaries by July 2008.
Sama’s Dr Brian Hadebe acknowledged that there have been ”communication problems” within the organisation.
”We failed to effectively communicate to our members why we had chosen not to embark on protest action,” he said.
”This whole ordeal has taught us we need to drastically change the way in which we liaise with members. Our current strategies, such as mass emails, don’t work.”
By contrast, the United Doctors Forum has explored what it calls ”interactive ways” of communication. Within days of its formation it had set up a Facebook group where members could share their views and frustrations.
On Wednesday night Sama and the forum reached an agreement that Sama would continue for now to represent all doctors when dealing with government. ”We all now have dual membership,” Malatji said. ”Sama will represent us, but we will most certainly not dissolve the doctors forum yet. We’re not convinced at this stage that there will be no future role for it to play.”
Sama negotiated for striking doctors to be reinstated after they were issued with letters of dismissal earlier this week, and the government has agreed to ”backdate adjusted salaries to July 2008”, Malatji said.
The national treasury has also announced that it has set aside R3-billion for salary adjustments over the next three years, with provincial health departments having to submit their individual budgets by the end of the week.
But ”it will take a long time for the broken trust to heal”, Malatji said. ”We’re waiting to see what happens and we will not go unheard again. We need a medical association and a health minister that recognise what we’re worth.”
Tensions within Sama, as well as the strike action, appear to have generated stronger activism than usual among the country’s increasingly disgruntled public sector doctors. ”I think our doctors started to become serious activists during the Aids denialist debate in the early 2000s when the government refused to allow doctors to distribute antiretroviral drugs and they did so in spite of legislation,” said Dubula.
”They’re now building on that and have reached a stage where they will strike, no matter what. We at the TAC don’t necessarily agree with putting patients’ health at risk, but we absolutely understand the reasons for it.”