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Opinions Thu, 13 Aug 2015

Doctors: Strike or Resignation?

In a few days, pending persistence of the apparent stalemate between the Ghana Medical Association (GMA) and the government over the vexed question of doctors’ conditions of service, public sector doctors may carry through their threat to resign en masse.

Even more fundamentally, many question in disbelief the claim that doctors do not have conditions of service. As a newly employed house officer in the Korle Bu Teaching Hospital in 2004, my appointment letter simply listed my new grade and salary and wished me well.

Much later, by word of mouth passed on by senior colleagues, I got to know about number of leave days earned, what the arrangements were for gallons of fuel due and under what circumstances and by what procedure we could qualify for car maintenance allowance.

It was only when I joined the National Catholic Health Service (NCS) in 2005 through my recruitment by St Anthony’s Hospital, Dzodze, that Mr Christian Akoto-Brown, seasoned hospital administrator, taught me that things needed not be so bizarre and haphazard.

I remember the scene so clearly. My wife and I had just gone on a tour of the hospital with a few months left of our Korle Bu house job. We had both committed to relocating to Dzodze. After the tour, we said goodbye to Mr Akoto-Brown, promising to return in weeks. He looked at our naivety in disbelief.

“Aren’t you both interested in discussing your conditions of service?” he asked. We exchanged curious looks and replied, “We have already made up our minds to come to Dzodze, so what you offer or do not offer will not change our minds.”

Mr Akoto-Brown subsequently pulled out a sheet of paper on which he had comprehensively documented diocesan allowances, living arrangements, future training opportunities, arrangements for healthcare in the hospital, and what we could possibly do over the weekend! We were so amused! Today, though no longer specifically with St Anthony’s, we have maintained our close ties with Dzodze, Mr Akoto-Brown and with the National Catholic Health Service.

Absence of codified conditions of service

To my mind, it is this absence of a codified conditions of service for public sector doctors that is at the centre of this current crises and the basis for doctor’s insistence that they do not have conditions of service. The more I think about the current impasse, the more the issue of the failure of some institutions to assert their full mandate comes to the fore.

There is an aspect of the current crisis that is directly attributable to lack of thoroughness by the Fair Wages and Salaries Commission (FWSC) in executing its mandate. What many need to appreciate is that government’s Single Spine Pay Policy (SSPP) had multiple dimensions; a Single Spine Salary Structure rationalising salaries and consolidating certain allowances, to be followed by harmonised public sector conditions of service.

In the specific instance of health workers, the policy made specific provisions for an allowance called an inducement which would be applied to doctors in deprived areas in an attempt to address identified inequities.

From 2010, the Single Spine Salary Structure offered us an excellent opportunity to begin to tie incentives and inducements to critical areas of need.

Today, the SSPP has only been implemented halfway; complaints abound from government of an inordinate proportion of public revenues going into salaries and emoluments and yet the fundamental problem of the mal-distribution status quo remains. Additionally, critical components of the policy, including the inducement and the conditions of service, still remain outstanding.

Fair Wages and Labour Commission

The inability of the FWSC then to proactively follow through with its implementation of critical aspects of the SSPP, including negotiating a deferred implementation pending fiscal latitude is part of the root cause of the current impasse.

Next in line is the National Labour Commission (NLC), a body that through various acts of omission and commission has called its usefulness in the labour discourse into great question. Where has the National Labour Commission been as far back as November 2014 when the Ghana Medical Association first drew attention to the outstanding issue of negotiated conditions of service? Did they call both parties, work out a road map for negotiations, and oversee the negotiation within the fourteen days stipulated by the law?

This for me represents nothing less than a total dereliction of duties. Even more fundamentally, when the NLC has been alive to its responsibilities, examined an issue critically and given a ruling, including ones roundly ignored by the employer, the NLC has displayed neither the appetite nor the ability to enforce its rulings through the traditional courts as a means of securing some respect for itself, truly fulfilling its mandate and sanitising the labour-employer relationship.

The total loss of confidence of the unions in the abilities of the NLC then is also a major component of our unending labour crises. In essence, there is now no arbiter that is seen as independent and fair when formal negotiations collapse between the unions and the employer. This too must change if sanity is to prevail and the time has come for a total overhaul of the NLC.

Critical questions

While commending the GMA for giving sufficient notice in the build-up to this impasse, I also believe there is need at this stage of open ‘warfare,’ to hone the communication with the Ghanaian public with the view to making public engagements regular, proactive, polite and informative. What formed the basis of the doctors’ proposal?

Do doctors have a fallback position? In other words, is it an inflexible position or are doctors willing and able to review their position? In this current impasse, are GMA and government still talking or is there a total breakdown? Are doctors going through with the threat to withdraw emergency services and resign en masse? These are legitimate questions I regularly face as a member of the association and which leadership will do well to improve communication around.

The Deputy General Secretary of the GMA’s assertion that this is a planned mass resignation and not a strike action has stimulated interesting reactions from all quarters. Should government call the so called bluff and goad doctors to individually resign as a government spokesperson indicated on radio last weekend?

Some have argued that a voluntary resignation may give the employer the upper hand and an opportunity to totally renegotiate the employment relationship, including determining who it wants to work with, and in which part of the country the services of such a professional might be needed. While this possibility exists, the alternate could also be true. If all public sector doctors individually actually tender in their resignations, and healthcare services eventually grind to a halt, how does the government plan to cope with the fallout and the public backlash?

Columnist: Sodzi-Tettey, Sodzi