DEVELOPMENT-SRI LANKA: Labour Woes Weaken Health Services

By Feizal Samath Reprint | | Print |

Feizal Samath

COLOMBO, Sep 29 2003 (IPS) - Sri Lanka’s free health service is turmoil, what with at least five strikes crippling services across the island nation so far and forcing the government to mobilise hundreds of soldiers to help out in state hospitals.

Over the past months, newspapers and television have repeatedly shown pictures of soldiers wheeling in patients, manning telephone exchanges, carrying patients into wards and even cooking in hospital kitchens.

The most recent strike took place last week, after more than 80,000 staff, including clerical workers, drivers and labourers, stopped working over complaints over wages.

The health sector trade union alliance agreed to give the Treasury six weeks to forward their recommendations on the workers’ salary demands to the cabinet.

But whether this latest work stoppage has been resolved if far from certain – and last week’s strike already involved a much larger segment of the health service than previous striking unions.

At least four people have died due to lack of medical attention during strikes this year, the latest being a woman who gave birth to a stillborn baby and died this month due to lack of hospital attention in a southern hospital, according to news reports.

Thousands of patients have turned up at government hospitals and clinics over the past few months, travelling long distances early in the morning only to find services unavailable or delayed.

”How can they do this to us?” asked a frustrated 70-year old grandmother, resting on a hospital bench during a recent strike by doctors. ”These people have studied at state expense in local universities. They should work for the benefit of the people.”

The use of the military during a period when emergency rule is not in force has also triggered opposition from some trade unions and politicians, although others believe their use without arms is probably the right thing under the situation.

Opposition leader Mahinda Rajapakse, for instance, said the use of the armed forces was a violation of the constitution and a repression of trade union rights.

”The well-being of the patients is important but the government should act in a manner that is constitutional and fair,” he was quoted as saying in the ‘Daily Mirror’ newspaper during a strike in recent months, when the military was brought in to keep health services going.

However former minister Batty Weerakoon, a leftist politician and trade union leader, said it was difficult to pass judgement on the government’s use of unarmed soldiers particularly when it meant alleviating the suffering of poor patients.

”These are sensitive and vulnerable issues affecting the health of the people,” he said.

The sequence of strikes began this year with registered medical practitioners who treat patients but who are not doctors. Doctors, nurses, paramedics, technicians and support staff followed, mostly over salary issues.

The restiveness traces its roots to 1993, when a certain category of staff got a sharp salary rise, skewed wage scales and triggered complaints among health sector personnel.

”That created anomalies in other categories,” said Dr Channa Perera, spokesman for the powerful Government Medical Officers Association (GMOA). ”They should have accepted the anomaly in all sectors and paid up.”

Perera, whose association went on strike a few months ago and won their demands for their salaries to be rectified, said that going on strike was not the best solution because it is the poor public that suffers. ”But what do we do if the ministry does not listen to our pleas for outstanding issues to be sorted out?

Ironically, the GMOA this month appealed to the striking Health Service Trade Union Association to restart emergency services, which the union has stopped. The GMOA always maintained emergency services while suspending all other routine work during their protest.

”It’s unfortunate that the strikes have come one after the other in recent months all over one issue,’ Perera added.

Unions say the health ministry has been sending mixed messages on the issue, in some cases bowing to the demands, and in other cases citing insufficient money to make the huge payments required to rectify the salary imbalances.

Health ministry officials have quoted the Treasury as saying the government is cash-strapped to raise such huge payments.

Health Minister P Dayaratne said he had been negotiating with the Treasury since July to provide money to rectify the salary issues. He has also been quoted as saying that amending the salary scales of some 290 categories of health sector staff is both labourious and difficult.

Sri Lanka’s health spending over the years has been affected by an expanding defence budget.

Health expenditure rose marginally to 24.4 billion rupees (255.3 million U.S. dollars) last year from 21 billion (219.7 billion dollars) in 2000. But defence spending , a mere 1.7 billion rupees (17.7 million dollars) in 1983 when the ethnic conflict between majority Sinhalese and minority Tamils escalated, soared to 65 billion rupees (680 million dollars) last year.

The government, under pressure from an angry public, sacked 700 temporary, striking workers earlier this month and began recruiting fresh workers, a move that found sympathy with the public.

”Why can’t these workers use other ways of making demands instead of inconveniencing poor patients like us,” a woman was quoted as saying in a television interview, seated on empty rows of hospital benches outside the emergency unit.

”There are many unemployed youth who want jobs. Why can’t we get them to work?” she asked.

Louis Benedict, convenor of the National Movement for the Rights of Patients, reckons this is one of the worst sequences of strikes in the health sector in decades.

”Normally you would find this happening in other sectors like bus services, ports and other sectors, but the health sector is a matter of life and death,” he said.

The Sri Lanka Medical Association, a 5,000-strong body of medical experts and doctors, has recommended the setting up of an arbitration process where the health ministry and trade unions can settle disputes before resorting to strikes.

GMOA’s Dr Perera agreed: ”We need to come to some agreement that this would be an entirely voluntary mechanism. Nevertheless arbitration may be one of the best options available right now.”