Parliamentary efforts to negotiate a solution notwithstanding, it was evident at the end of the first week of January that only one solution was available.
It is to sack all striking and go-slow doctors, put up new terms of service including payment for seeing the doctor and the latter pays a third of the fee to the hospital for assurance of infrastructure and other bills like paying incentives to employees, while salary scales remain the same.
Those who would wish for such a situation would apply, not negotiate over demands for 300 percent hike in salaries and tripling of allowances for out of work consultations, trying to be paid like MPs, which is useless.
This way of doing things was already apparent as the Ministry of Health and Social Welfare was saying that the demand for salary hikes and other amenities would take nearly a quarter of the country’s total budget, as it comes to above three trillion shillings per year compared to Sh13trillion budget.
The demands are thus totally grotesque and they have a Boko Haram mentality, that ‘either you pay us or people will die,’ and indeed they are recouping plenty of the cash they are demanding by doubling charges in private hospitals where they work either in daylight or by moonlight, in which case they have nothing to lose – the doctors and their families. It is a sharp blow to what used to be known as social solidarity, but it’s a different issue.
In what may already be the most crippling or effective strike that has ever been put up by doctors in the country, despite that such instances have occurred in the past, two issues occupied the public mind at the beginning of the weak. The first was whether the government was capable of ending the issue ‘manu militari’ as it had chosen to do, and the second was what chances exist that other cadres would go on strike as well. There was a worry that teachers would soon join, and they are a much wider cadre than doctors, having less harm to the public in comparison with doctors and nurses, but are definitely more effective in mobilization.
The government knows that there aren’t many cadres that can imitate doctors in relation to going all out against the government, as doctors have greater opportunities of being hired within and outside the country.
Evidently it is a risky undertaking, to put everything on the table and start combating the government with one’s eligibility for employment as the sole effective weapon at hand, but depending on circumstances it could be reached, as it occurred this time. As usual one cites a series of misunderstandings, between doctors and the Permanent Secretary, Ms Blandina Nyoni, the bête noire of Medical Association of Tanzania (MAT) membership.
While there have been frequent misunderstandings between the hospital administration and internship doctors, this time the divide was more intense, and soon encompassed to include doctors employed in government hospitals.
How far the government could go about enforcing a return to work operation was unclear, or what that meant for the quality of medical care that would be rendered thereafter – in like manner as uncertainty clouded stop gap services being provided by medical personnel from the armed forces.
In a way the government felt there was little else it could so as it could not just implement the diktat of the doctors and open doors for massive demands from other cadres, so it had to start counting the bodies, and the dismissed.
What is not being said too loudly in the discussion concerning the matter is its provenance, that there is without doubt a series of demands by medical doctors that have been lying ministerial desks for ten years, like improving allowances when called out of duty time.
But there are circumstances which helped to radicalise those demands and especially start paying much less attention to procrastination in the sense of pleading that budgets are tight in the Ministry of Health and Social Welfare, not just for allowances but working conditions.
It was being said that often a doctor would be assigned to theatre and then materials would be missing, though it is unclear if doctors have often assisted patients by having an own stock of gloves or methylated spirit if it comes to that, though it is a bit excessive to task doctors with that kind of gesture, routinely.
Listening to what was being picked from doctors from time to time, including placards in one or other gathering, one element was that it is MPs’ allowances hike which pushed them to the brink, seeing that they are being cheated. If the government can afford raising allowances by about Sh.130,000 for each MP on a daily basis on top of what they are already obtaining, it means there is plenty of cash somewhere that is ready to be used for the purpose of raising salaries and allowances.
Obviously it is a logical fallacy to say that if a person has Sh.1,000 to give to a beggar, than such a person has plenty of such money to give to all beggars at least along that street, for it sufficient for any of them to hear of the ‘donation’ and say, me too. But while for the beggars it would be a bit of illusion, in the doctors’ case it is one of anger, learning a secret.
The point hence is that the doctors’ strike nationwide has been caused not by existing grievances of doctors (in the past we used to be told that is an objective condition) but were galvanized by the huge revision of daily allowances for MPs (a subjective condition).
In other words if left with objective conditions alone, the usual modes of civic contentions continue, for instance who has auxiliary practice at a well paying private hospital, or how far extortion of patients in wards or specialized treatment, directing them to private clinics can help doctors augment earnings, etc.
But when such an event as a gargantuan allowances hike surfaces, it provides the glue necessary to tie them together – and also to defy the government in the face of public opinion as despite everything, there was still greater sympathy for the doctors than the government, privately.
In that case the government brought the issues to a hilt when it permitted those allowances and still claims that it has no money to pay doctors and place the necessary equipment in hospital wards and theatres.
In part this reflects long term structural problems in public payments problems, despite plenty of World Bank projects and even ‘satisfactory’ reviews of public finance management reform, in the May 2010 report for the Country Assistance Strategy. It is a situation where various professional cadres could lay down tools and ask MPs to go and pick them, as they are paid so well they should be patriotic to do whatever task is at hand.
Examining it by a different angle, one finds that the governmen wasn’t unaware of possible repercussions of the MPs allowances massive hike, but there was little it could do. MPs have been demanding hikes by comparing their pay with those of our neighbours in the EAC and it is uncertain if their pay comes anywhere near packages for MPs in Kenya.
The latter have tended to have inflated pay packages and an allergy about paying taxes (they add extra allowances to cover the tax liability vis a vis an agreed figure), while in Uganda a few newspapers were astonished to see a demand for a tenfold salary hike by the Chief Justice, to move from what seems to be the equivalent of Sh3.5m at present to Sh35m, probably comparing with the Kenyan pay package.
When the government is weak, it can’t resist pressures of MPs, for they can become radicalized. There is a bit of that element in the decision to hike allowances of MPs, noting especially the fact that the move came a few weeks after a much hyped direct intervention by ex-premier Edward Lowassa in the ruling party’s policy making National Executive Committee (NEC).
He said there was nothing he did which the president did not know aforehand, and there were measures he wanted to take but the president stopped him because he had obtained different advice from (a committee of) permanent secretaries. In other words Lowassa ‘shedded’ the Richmond contract burden and placed it squarely on the head of state, implying that he had resigned only as act of goodwill and respecting the office of the president, but if his gesture is ignored, he could spill the beans.
That is where the president stands, and if MPs for some reason become radicalized and go back to the Richmond file, apart from Kagoda Agriculture Ltd, EPA cases etc, the going could become a bit rougher for JK.
It is thus a sort of blackmail politics by MPs, that they get allowances and leave the president in peace, or if they are frustrated, they are also sure to wreck the political system, the horse trading the president opted to skip.