Health workers in several provinces of South Africa have engaged in protests and strikes since late March, reacting to missed payments, announced losses of working places, and rearrangements of services that significantly alter access to care. While workers’ grievances differed between provinces, they all pointed towards the discrepancies between the workers’ demands and what is likely to be the government’s path towards post-pandemic recovery: better staffing and working conditions, as opposed to a new round of austerity measures.
At the beginning of March, workers from Orsmond and Empilweni Hospitals, specialized in TB care, rallied in front of Uitenhage Provincial Hospital protesting the intention to shut down the two institutions with a significant overhaul of services provided. During the protest, members of the National Education, Health and Allied Workers’ Union (NEHAWU) said to Ground Up that the provincial Department of Health in Eastern Cape should prove that TB is no longer killing patients before discontinuing services to patients and disrupting workers’ routines.
One of the largest actions took place at Chris Hani Baragwanath Academic Hospital (Bara) in Soweto, Gauteng province. Around the time when protests were taking place in Eastern Cape, workers at Bara Hospital started to warn that without government intervention, more than 800 temporary workers employed to aid pandemic support would be dismissed at the end of the month as their contracts expired. While the workers were demanding that their colleagues be kept on a permanent basis, hospital administration faced budget constraints which caused problems in equipment maintenance and delivery of food, making the outcome of the workers’ actions unclear.
Health authorities in the province echoed the doubt of whether the temporary posts created in Gauteng since the beginning of the pandemic could be maintained in light of the overall lack of funds. Health workers in the Western Cape Province faced the same scenario, and approximately 400 of them lost their jobs around the end of March as funds were not allocated to extending temporary contracts. Earlier this year in Eastern Cape, the threat of losing posts opened during the pandemic extended to more than 2,700 health workers, provoking protests by the workers themselves and solidarity actions by health workers and right to health groups such as the South African Care Workers Forum.
In Bara, workers’ pressure resulted in a renewal of the contracts for 12 more months on March 22, allowing for more time to find a long-term solution to the staff shortage problems that have been experienced all over the country long before COVID-19 as a result of poor governance, mismanagement, and austerity measures. Yet, this is still far from an outcome that could provide concrete improvements for health workers’ rights and access to care for patients.
Pandemic support policies near an end
The possibility of a long-term solution including more healthcare jobs and adequate remuneration doesn’t depend only on the position of the government in South Africa, but also on the funds that are available, especially those coming from international finance institutions. South Africa is, in fact, one of the 90 countries which negotiated funding from the International Monetary Fund (IMF) to boost pandemic response.
According to a 2021 Oxfam report, the overwhelming majority of the IMF pandemic loans include provisions to cut public expenditure, reform subsidies policies, and cut wage bills. In other words, they envisioned that after a brief period of investment in social protection mechanisms and support for people during the early waves of COVID-19, austerity was to return as soon as the pandemic subsided. In the case of about 20 countries whose loans with IMF Oxfam first analyzed, the Fund recommended introducing structural adjustments as early as 2020 and 2021, when the pandemic was still very much under way.
When African countries are concerned, the IMF included structural adjustment measures among the loan conditionalities of all countries that received a loan except for one, said Nadia Daar from Oxfam’s Washington DC office during a panel at the IMF and WB Civil Society Policy Forum. At the same time, in 2021, debt payments cost Africa 8.6 times more than healthcare expenses, casting a doubt over IMF’s claims of still prioritizing support mechanisms for the countries’ population as the pandemic continues.
In fact, Daar noted, there was no sign of the Fund changing direction even as multiple crises were adding to the pandemic burden. According to Oxfam’s predictions, over half a billion more people could be pushed into extreme poverty in 2022 alone because of rising food and energy prices, COVID-19, and war.
Paying for pandemic recovery
Although IMF loans play a key role in ensuring that austerity measures are taken up by governments during pandemic recovery, their implementation is also related to the vision of local policy and budget makers. In South Africa, the 2022/2023 budget already includes a number of cuts to public services and mechanisms of social support. According to a statement by the Assembly of the Unemployed & the Cry of the Xcluded, planned cuts to public expenditure will prove to be particularly harmful for the poor and the unemployed, whose numbers have grown during the pandemic.
Instead of increasing taxes on the rich and using the funds to ensure workers are kept in decent workplaces on a full-time and permanent basis, especially in health, education, and other public services, the plan seems to be offering “inflationary relief” for the rich and transnational corporations, especially in the mining sector, who pay their employees poverty wages and ignore health and safety concerns.
Echoing the health workers’ requests for decent jobs, the Assembly of the Unemployed and the Cry of the Xcluded stated: “We are on a disastrous economic and political trajectory, one that austerity and tokenistic social support cannot rescue us from. We need radical progressive alternatives centered on decent health and education, the right to work, the right to say no, basic income grant, and a large functional public sector focused on the provision of public goods.”
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