As we enter the 17th month of the COVID-19 pandemic, which has caused more than four million deaths around the world, health workers are exhausted by the pressures they have faced since March 2020. Despite their contribution to the pandemic response, they feel let down in many countries as they face extremely long working hours and precarious working conditions. From February to October 2020, their discontent has led to labor action in 84 countries, from Peru to Iran, and it seems that 2021 is continuing along similar lines.
Junior doctors in Jamaica protest layoffs
At the very beginning of July in Jamaica, for example, junior doctors engaged in industrial action by calling in sick, protesting the fact that around 150 of their colleagues were terminated from service as the country began to scale down pandemic response.
The action lasted for only one day, but it severely affected the functioning of the health system all over the island. In some hospitals, like the Mandeville Regional Hospital in Manchester Parish, over 80% of the junior doctors stayed off the job. Meanwhile, the absence of around 100 junior doctors from Spanish Town Hospital in St. Catherine Parish led to more than 150 reschedulings and transfers among departments. Many of the hospitals admitted their operations were hit by absence of the junior doctors, showing that their presence is key to providing care.
Following the doctors’ action, the government agreed to prolong the contracts of some of them, but there is still little sign of a significant shift when it comes to health workforce planning. Reflecting on this issue, the president of the Jamaica Medical Doctors Association, Mindi Fitz-Henley, said that the governments’ approach to young doctors as temporary resources was contributing to their preference for migrating to other countries, most notably the USA, instead of waiting for jobs that never materialize at home.
Effects of austerity in Nigeria and the UK
Less than a month before the doctors’ action in Jamaica, physicians in the State of Ondo, Nigeria, also announced a strike over unpaid salaries for March, April, and May 2021, and concerns about departures of staff from public health institutions. According to the Nigerian Medical Association, close to 150 doctors left the public health system over the course of the year because they had not been paid for months. Similar to the migration of health workers from low and middle income countries (LMIC) to high income countries, these doctors are just looking for jobs that fulfill the basic workers’ rights.
The health system in Nigeria faces a lack of funding and pressure to cut costs, including the salaries of people who make the system run. This is true for many other low income countries, as highlighted in an analysis by Public Services International (PSI) and ActionAid in 2020. According to the data they analyzed, “of the 57 countries last identified by the WHO as facing critical health worker shortages, 24 received advice from the IMF to cut or freeze public sector wages.” As the countries feared that non-compliance with the IMF recommendation would lead to their non-eligibility for future loans, they followed the advice. According to the WHO, these same countries now face an expected shortage of 700,000 nurses by 2030.
A similar trend can be seen in high income countries as well. For instance, European Union policies are pushing for privatization and commercialization of healthcare, according to research by Sabina Stan and Roland Erne. Through its yearly macroeconomic recommendations for member states, the EU has pushed for an increase in marketization and privatization of healthcare, as well as a reduction of resources for public health services, all of which had an impact on health workers.
Although these policies are relatively newer than in LMIC, they are progressively deteriorating the working conditions of health workers in high income countries too.
In the UK, workers of the National Health Service (NHS) have been warning about the stress and workload they have faced since the beginning of the pandemic. These have been exacerbated by inadequate staff to patient ratios resulting from budget “savings,” as well as a practical freeze on health workers’ income. The UK government has since then acknowledged that the tremendous effort that nurses, doctors, and others put into the pandemic response calls for material recognition – but they have expressed this recognition through the offer of a 1% pay increase. Considering the 15% increase that trade unions and NHS support groups had rallied for long before the pandemic, the official offer becomes comical at best.
As soon as the government went public with the 1% offer, health workers’ organizations told them off, with some of them announcing that they will pass the offer in favor of industrial action. Although their announcements haven’t escalated to a full blown strike yet, Saturday, July 3 saw a series of protests around the UK, which called for fair recognition of health workers’ contributions to the health system and a return to original NHS values.
The world needs more health workers
A global need for more health workers of all profiles was felt long before the COVID-19 pandemic, but the stress experienced by health systems over the past year has brought the role of nurses, laboratory workers, and doctors to the fore. Since early 2020, governments have lauded and applauded health workers, but they haven’t done much more.
Of course, some of these workers face a worse situation than others. Overall, doctors enjoy a better status than nurses do, and during the pandemic, they have faced a smaller risk of infection than nurses. On the other hand, junior doctors usually face significantly more difficult working conditions than their superiors, and this has not changed during the pandemic. As the example of junior doctors in Jamaica illustrates, they are often treated as an expendable part of the workforce, employed on a temporary basis. Temporary employment is not limited to junior doctors. In many LMIC, such as in Colombia, most health workers, whether in small or large facilities, are increasingly employed on informal contracts.
The informalization of work in the health sector has a lot to do with the policies pushed at global and regional level. Austerity-oriented recommendations issued by the IMF and the EU often lead to cuts in jobs and resources available for public health systems. This in turn reduces their ability to respond to situations such as the current pandemic.
In spite of the differences, health workers around the world have a lot in common today. Their persistence in raising issues of informalization of their work and access to basic workers’ rights shows that they are ready to fight for better health systems regardless of where they are. The strength of public health systems is directly correlated to the level up to which working conditions of their health workers are fair. The actions that took place over the last months should be treated as a wake-up call for governments around the world. If working conditions in public health systems don’t begin to reflect the workers’ needs, the period after the pandemic might turn out to be even more difficult than we expect.