Verdade (Maputo)

22 February 2013

Mozambique: Why the Doctors Went On Strike

Maputo — At the beginning of this year, Mozambican doctors went on strike for an entire work week. The strike by doctors affiliated with the Mozambican Medical Association (AMM) was preceded by the demands of those concerned being downplayed. It was motivated by the doctors' dissatisfaction with deteriorating working conditions combined with the Government's alleged indifference to making improvements.

Health workers have been dissatisfied for a long time. In 2008, for example, this was aggravated by doctors being removed from government housing in the provinces. They repeatedly appealed to the provincial governments to cancel this move. No-one listened to them.

As a result, on the 26th of October, 2012, the Order of Physicians and the Mozambican Medical Association wrote a letter to Minister of Health Alexandre Manguele appealing for the Government to retract the decision in question, and were unsuccessful.

Given this situation, on November 24th last year, in a meeting which brought together around 200 doctors at the Eduardo Mondlane University Faculty of Medicine in Maputo, the doctors decided that a strike was their last resort to demand improvements to the precarious conditions that Mozambican doctors are subjected to, while foreign doctors enjoy privileges.

It should be noted that at this point the doctors' main concerns were for a fair salary, housing and a Medical Statute that dignified the profession. Medical professionals have been fighting for a statute to this effect for 17 years. But socioeconomic and political issues related to the state of the country have always been cited as the reason for rejection.

The AMM believes that the Medical Statute approved by the Council of Ministers, and submitted to the National Assembly in July 2012, for consideration and approval, does not reflect the wishes of its members.

At the end of the meeting, minutes were prepared which summarised the different points debated. In relation to the statute, the doctors decided that they should be reasonable and wait until March 31, 2013. However, regarding salaries, approval should be immediate, "for January 2013; with a decree-law being made to this effect, as there is budgetary approval and they are two different documents". It is in this context that the doctors are currently fighting to see their salaries immediately improved.

The First Talks

The AMM has pressured the Government several times to resolve these problems. In an attempt to "sweep it under the rug", it promised, for example, that the Medical Statute would be approved in the last session of the National Assembly, which did not happen. In September 2012, the association drew up a letter requesting that the National Assembly discuss the document so that it could be implemented in the first months of 2013.  Once again, there was no reply.

Even so, the AMM knew that the Medical Statue was not included among the various items on the agenda for the last session. On November 19th, the Ministry of Health (MISAU) met with the Order of Physicians and the AMM and gave them the final version of the Medical Statute and salary proposal. The next day, the AMM met with its General Board. The MISAU's explanation was that the Medical Statute could not be approved without those from other professional areas being approved at the same time. It was feared that nurses would strike.

Letter to the Prime Minister

Outraged at their working conditions, at the end of November 2012, the doctors addressed a letter to Prime Minister Alberto Vaquina, which also did not receive a reply, stating that their worth was deteriorating each day. "We have seen deep and general dissatisfaction from doctors due to these issues (lack of a statute and decent salary), combined with the fact that doctors have precarious housing conditions and are being removed from government housing in the provincial capitals."

"With the current living situation, doctors have become obliged to take on other types of extra work in the private sector, with these professionals being referred to as 'turbo' doctors, calling into question the quality of the service being provided to the National Public Health Service. Others, to improve their living conditions, request registered and/or unlimited licenses to leave the state system and work in the private sector. We cannot ignore this real situation", the letter states.

The same letter, signed by the Director of the Mozambican Medical Association, Jorge Arroz, mentions that the success of the recently-launched programme on humanising healthcare depends on improving the working conditions (material, human and financial resources) and motivation of professionals in the sector, including doctors.

"Social factors profoundly influence the lives of doctors and other health professionals, and not just those in the communities. We believe that, after a long waiting period, we need to take care of those who care." The Prime Minister took no notice.

At the end of the Doctors' meeting in November, a report was produced stating that, "doctors have always been the only highly educated professionals in extremely remote places and districts, including during the pre-independence period, post-independence period, and even during the civil war".

However, gradually, and with a certain negligence by those concerned, "a deterioration in the dignity of provincial doctors has been observed".

Realising that they were not being heard, in December the doctors threatened to go on a national strike if their problems were not addressed.

The notice issued by the office of AMM President Jorge Arroz to the members was provided to all interested institutions, including the Ministry of Health.

Meeting between the AMM and Government

Consequently, on the 14th of December the Government decided to enter into dialogue with the AMM and the parties agreed that the decision related to housing would be suspended. The doctors went back to living in government houses, with the occupancy expenses being borne by the Government, in this particular case, by the Ministry of Health. This measure had immediate effects and the professionals made it clear that they would not accept co-habitation.

n entire work week. The strike by doctors affiliated with the Mozambican Medical Association (AMM) was preceded by the demands of those concerned being downplayed. It was motivated by the doctors' dissatisfaction with deteriorating working conditions combined with the Government's alleged indifference to making improvements.

Health workers have been dissatisfied for a long time. In 2008, for example, this was aggravated by doctors being removed from government housing in the provinces. They repeatedly appealed to the provincial governments to cancel this move. No-one listened to them.

As a result, on the 26th of October, 2012, the Order of Physicians and the Mozambican Medical Association wrote a letter to Minister of Health Alexandre Manguele appealing for the Government to retract the decision in question, and were unsuccessful.

With regard to the statute, a technical committee was created to review it and bring it into line by January 30th this year.

Disagreement over Salaries

Regarding salaries, at the same meeting it was decided that a technical committee would also be created between the doctors and Administration to discuss salaries and present a mutually-agreed proposal by January 5th, 2013. However, the doctors report that, days before this date, the Government presented a salary proposal of 600 USD, in contrast to the 660 USD they had initially put forward.

It should be noted that during negotiations the association rejected another monthly salary proposal from 1650 USD to 3550 USD. Their argument claimed that after deducting Personal Income Tax (IRPS) amongst others, the salary would be between 1300 USD and 2600 USD, including rent allowance.

According to the doctors' calculations, the above values would mean the following: with rent allowance of 450 USD per month, the salary would go down to 850 USD and 2100 USD. For a newly-graduated doctor, the subsidy would be only 130 USD.

Meanwhile, the base salary was between 660 USD and 1250 USD, meaning an increase of only 160 USD for new graduates, and an insufficient increase for "colossal" doctors, that is, those well-established in the area.

Lack of Consensus Lead to the Strike

On January 7th 2013, what had been a threat became reality. The doctors affiliated with the AMM went on strike, taking interns and residents along with them. This involved not going to work across all sectors, except for emergency services in central and provincial hospitals.

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