Health Workforce Issues: Lessons from South Africa
The strikes in South Africa that have been making headlines recently seem to be coming to a close. While money has been pointed to as the central issue behind the strikes, most of the media attention in South Africa has centered on the uncharacteristic infighting amongst strikers. For three weeks the strikes dragged on in a stand-off for higher wages; public employees demanded an 8.6% wage increase that was finally countered last week by the South African government with a draft settlement pay increase of 7.5%.
The New York Times reported on August 27th that the strikes included health workers- doctors, nurses, janitors, orderlies, and so on. Hospital wards had to close, leaving expectant mothers unattended, babies in intensive care abandoned and sending infectious TB patients home to their families and communities to spread disease.
The strikes led to violence in some cases, as striking workers attacked those who tried to return to work. Yet in a country where nurses make $8,000 a year - barely enough to get by but not enough to qualify for government assistance - the strikes highlight the workforce challenges that many countries face.
Labor unrest among health workers is not unique to South Africa, of course. In July the Lancet covered Eastern European doctors walking out over pay, and senior Indian doctors went on strike earlier in this year, too. Doctors in Bulgaria went into the streets in 2007 over shortages and low pay; and doctors in Germany struck this year, as they did in 2006 over an increase in hours without an increase in pay. Radiologists in New Zealand struck this year, as senior doctors there did in 2003. Even American health professionals have had clashes with employers over pay and working conditions, although the recent economic crisis certainly has dampened enthusiasm for acting out over workers' rights.
Working conditions in African hospitals are abysmal, as we reported in a paper in Health Affairs last year after surveying hundreds of Ugandan hospital workers. While it's easy to focus on the compensation aspects of labor unrest, the working conditions are probably just as important. Doctors and nurses in hospitals around the world are working without enough help, enough equipment, enough supplies, enough drugs, and in many cases without electricity or running water. This said, nothing makes the violent activities amongst strikers in South Africa acceptable.
Complex problems don't have simple solutions, but these are the sorts of problems emerging as the key challenges in global health today. How do we tackle the issues of working conditions, compensation and appropriate distribution of health workers so that people around the world can receive the best possible care? Health system strengthening is about addressing these issues. The resources required for a functioning health system include cash, of course, but also good management, strong systems, solid infrastructure, a better distribution of health workers away from urban and wealthy population settings, and a sense of equality among workers that keeps morale high and service at its best.
For more information on NGO practices that support a strong public-sector health workforce, learn about the NGO Code of Conduct for Health Systems Strengthening.
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