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SOUTH AFRICA: Public Health Strained by Nurses’ Strike

JOHANNESBURG, Aug 26 2010 (IPS) - Striking health workers have continued their work stoppage despite accusations that it endangers patients’ lives. They are part of a nationwide strike by public sector workers that has some observers concerned that rising wage demands could harm South Africa’s economy.

Health workers say their wages disqualify them for social assistance, but are too low to make ends meet. Credit:  Chris Stein/IPS

Health workers say their wages disqualify them for social assistance, but are too low to make ends meet. Credit: Chris Stein/IPS

Beneath the grey monolithic exterior of Charlotte Maxeke Johannesburg Academic Hospital, a throng of red-shirted protesters kept up their vigil, dancing and singing to demand what they feel is a fair wage from the government.

Before negotiations deadlocked and striking began on Aug. 18, the government offered these workers a seven percent raise and $95 housing allowance as part of a three-year contract negotiation. But unions reject the offer, and nurses have since been criticised for neglecting patients and demanding too much.

Protesting outside Charlotte Maxeke, Charlotte Ndamaso and fellow members of the Gauteng provincial chapter of the National Education, Health and Allied Workers’ Union (NEHAWU), vowed to stick by their demands for a 8.6 percent raise and $136 housing allowance.

Ndamaso said the government’s offer would not be enough to alleviate what she characterises as a financially tenuous existence, where nurses are dependent on loans and part-time jobs to make ends meet.

“The government says we are essential when it pleases them,” said Ndamaso a nurse unit manager. “Can you really treat essential personnel like this?”

On average, nurses currently receive approximately $8,160 a year salary and a $68 housing allowance, according to NEHAWU spokesperson Sizwe Pamla, though this can vary based on their experience.

What is a fair wage?

While union members claim that increased wages would lead to better care, union wages have increased beyond inflation over the years, says independent political analyst Daniel Silke.

Silke said the government has focused on adding jobs to the public sector to increase employment, rather than focusing on bringing in foreign investment and creating jobs in the private sector.

Silke, a former provincial politician with the Democratic Alliance, said the situation could become similar to Greece, where the public sector grew to enormous proportions, causing the deficit to balloon and the government to undertake austerity measures.

"The strain on the fiscus is reaching crisis proportion," Silke said. "My concern is that appeasement has to end. The warning lights are flashing about the deficit."

The stoppage has exposed tensions between the ruling African National Congress and ally the Confederation of South Africa Trade Unions (COSATU), to which NEHAWU belongs, and Silke said he predicts the strike will end after intervention by the presidency or some other political apparatus.

"There is a strong political dynamic to this strike," Silke said. "COSATU is staking a claim. There now has to be a political settlement."

Addressing public workers in Johannesburg on Aug. 26, Confederation of South Africa Trade Unions (COSATU) general secretary Zwelinzima Vavi ratcheted up the pressure when he confirmed the federation's plans to expand the strike to other COSATU members if a deal is not reached by Sep. 2.

Though the government was willing to invest money in hosting the Soccer World Cup in June and July, Pamla said it has shown a resistance to pay its own workers.

“When you’ve got a leadership preaching prudence, you can’t be spending [billions of] rand on a soccer tournament,” Pamla said.

According to Ndamaso, nurses’ wages put them in a sort of limbo: salaries are too low to make ends meet, she said, but too high to qualify for subsidized housing or other forms of government assistance.

Ndamaso said unfilled posts in her ward forced her to work up to 60 hours a week. As a result, staff morale in the hospital is low, and Ndamaso said the patients suffer.

“The long hours affect us,” Ndamaso said. “When you’re satisfied, the quality of service improves. You can’t work in a place where you’re not satisfied.”

Work stoppage woes

Though the number of health workers on strike varies from day to day, it has disrupted medical care nationwide.

Many sick people have been forced to travel further and wait longer for care from public hospitals due to the strike, said Fidel Hadebe, spokesperson at the Department of Health.

In Gauteng province, some hospitals have discharged patients; elsewhere, volunteers have been brought in to make up for the staffing shortages, according to Simon Zwane, head of communication for the province’s Department of Health and Social Development. Army medical units have also been deployed to hospitals throughout the country to help.

“We’ve had to transfer patients out of Natalspruit Hospital,” Zwane said. “Those who are stable and recovering have gone home.”

The effect of the strike on those seeking care did not escape protesters at Charlotte Maxeke.

Nobuhle Tshayingca, a clerk and NEHAWU member, said she worried about the health of the patients inside the hospital, but also knew of no other way to fight for a salary.

“The people who are suffering most are the patients,” Tshayingca said. “We are not fighting against people that are sick.”

Deeper causes

Strikes over wages are not uncommon in South Africa, but this one is unusual in its size and scope, according to Lucien van der Walt, a senior lecturer in the Department of Sociology at the University of the Witwatersrand.

“It’s not just nationwide but also industry-wide,” van der Walt said. “This is the biggest in quite a few years.”

In some ways, van der Walt said, the strike was inevitable, due to pay discrepancies between public and private health workers that are large even by African standards. Patient to staff ratios are also three times worse in public hospitals than in private, according to van der Walt.

Van der Walt, who has worked closely with NEHAWU in the past, said the government’s macroeconomic policy was also to blame for its inability to meet the striker’s wages, along with bureaucrats and ministers that failed to use their resource to address systemic problems.

“While the government says it doesn’t have the resources to meet the striker’s demands, its been giving out tax cuts and rebates over the years,” van der Walt said.

According to Hadebe, the government is aware of the vacancies and poor patient-to-doctor ratio within the public health service and is working to address them through pay raises, infrastructure improvement and efforts at career advancement.

“Individual departments are working on these issues, but we can’t solve them overnight,” Hadebe said.

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