In June and July this year, governments in Malaysia, Sri Lanka and Zimbabwe took steps to limit the right of health workers to organize and protest. Although government officials argue that the limitations have been imposed for the sake of continuity of care in the context of the pandemic, the changes might be for the long-term. As a result, in the months and years ahead, health workers might be exposed to even more precarious working conditions across different parts of the world.
Contract doctors’ hartal for fair working conditions
The most recent example of a government’s attempt to stop health workers from taking action on the pretext of protecting the people’s right to receive health care was faced by contract doctors in Malaysia. The doctors staged a one day walk-off on 27 July under the banner of Hartal Doktor Kontrak and managed to bring together between 6 and 8 thousand doctors, calling for changes of a grossly unfair model of employment.
Contract doctors, who are employed in public institutions on temporary contracts, represent almost half of all the doctors in the public health system, and are heavily involved in the pandemic response. Although their role is essential for the delivery of healthcare in Malaysia, they work without many rights granted to permanent workers. For example, they do not have the right to go on sick leave for many chronic conditions. This trend precedes the pandemic, which meant that many doctors met the onset of COVID-19 already exhausted.
Under additional pressure from the pandemic, contract doctors decided to take direct action around the time when the country was facing a new increase of COVID-19 cases. They were called out by the minister of health and experienced threats by the police, who announced they would investigate and prosecute doctors who participated in the action in Kuala Lumpur for infringing public health measures. No arrests have been made, but coordinators and participants fear consequences, which lead to self-censorship on social media. In spite of this, in the days following the hartal, Hartal Doktor Kontrak tweeted evidence of many workers quitting their jobs with as little as 24-hour notice because of accumulated problems in the workplace and the rising pressure of an inadequately managed new wave of the pandemic.
It is worth noting that the threats expressed by the police were not unexpected. In fact, under Malayan law, strikes in essential services are more strictly regulated than the ones in other sectors. Although nurses and doctors have a legal right to strike, the possibility remains that they will be penalized by the government.
Re-defining the boundaries of “acceptable” workers’ actions
Sri Lanka and Zimbabwe have also resorted to limiting the possibility of industrial action by health workers by referring to their essential workers status. In Sri Lanka, stricter regulations on industrial action were introduced recently, after many public services employees – nurses in particular – went on strike to protest bad working conditions. Under the new conditions, for taking the same actions, they could face 2-5 years in prison, a financial fine, and losing their professional credentials.
In spite of the newly imposed barriers, nurses have not given up on continuing their struggle for fairer working conditions. At the very beginning of July, they organized a massive sickout after their trade unions and the government failed to reach an agreement on the main requests for improving nurses’ working conditions, including long-postponed promotions.
In Zimbabwe, a new provision of the Health Services Act will define the health workforce as essential, putting them in the same category as the police and military – who do not have the right to strike at all. Nurses and doctors will not have the right to strike more than 3 days in a row; and those found guilty of “inciting industrial action” could face 3 years in prison.
According to Itai Rusike from the People’s Health Movement Zimbabwe, although the recent strikes by health workers slowed down the system, community groups have been sympathetic to the situation of health workers. “They know that health workers’ grievances are not dealt with properly, and that their conditions are steadily declining,” he said.
The Community Working Group on Health (CWGH) has even attempted to mediate between doctors and the Health Services Board (HSB), their employer, but the process has been unsuccessful. Rusike underlines that the HSB itself is seriously underfunded, and that this makes it practically impossible to carry out its mandates. “CWGH has urged the government to allocate enough resources to the HSB and ensure there are enough funds for guaranteeing adequate salaries and working conditions of health workers,” says Rusike.
Strikes for better healthcare systems for all
By limiting the possibilities for health workers to strike and protest, governments are not only curbing some of the most basic workers’ rights, but also limiting healthy criticism of their policies. In practice, industrial action by health workers reflects in a positive way on the quality of care provided to patients. During the pandemic, unionized health facilities reported lower COVID-19 mortality rates, indicating better access to personal protective equipment, higher staffing ratios and a safer environment for patients.
Reflecting on a mass strike held in France a few months before the beginning of the pandemic, PSI’s Health Officer Baba Aye commented that “Ordinary people, health workers and patients alike suffer when governments promote neoliberal policies. The right to quality public healthcare has been hampered by two decades of putting profit before people… Enough is enough.” In the months to come, our governments would be much better off if they took that warning seriously and took it as a guidance for strengthening health systems.