TAC and ALP support the public sector wage demands and call for a
public services revival plan!
Set up a Commission of Inquiry into public health workers'
13 September 2004
The Treatment Action Campaign (TAC) and the AIDS Law Project (ALP) call
on government to avert a public sector strike by meeting the wage and
service demands of the public sector unions. We also call on the unions
to engage government on the need for a comprehensive plan to rebuild
the quality of public services.
The TAC and ALP accept that on the face of it, government's offer of a
6% "salary adjustment" for all public servants for 2004 might appear
reasonable as it is above CPIX. So might the 1% pay progression, R500
million for educators to compensate for the lack of increases for 1996
- 2002, a housing allowance, a commitment to a comprehensive medical
aid scheme for all public servants and the payment of a scarce skills
But on close inspection the proposed package is insufficient. In
particular it does not recognise the impact of years of systematic
under-funding of the
public sector. If government imposes this pay deal on the public sector
it will delay improvement and make a mockery of government’s
people-centred public service campaign, Batho Pele. Although most of
what follows in this statement pertains to health-care workers, we are
also concerned about the conditions of service of teachers, police and
other public sector employees.
Bad conditions of employment = bad service!
In the public health sector terrible conditions of employment are
responsible for under-trained and overburdened health care workers who
often seek refuge in resource rich provinces, the private sector or
abroad. Government says it is concerned about the loss of health
workers but the package
it is proposing will not ensure that well-trained health care workers
are attracted to and retained by the public sector. The consequence of
this will be
further health care worker attrition in the public sector. According to
the 2003 South African Health Review, the public sector is extremely
short of a number of categories of health-care workers, such as
pharmacists, and the situation is dire in rural areas. Furthermore, the
proportion of dentists, nurses, medical practitioners, specialists and
researchers to the population using public health facilities has been
declining over a number of years.
The scarce skills allowance, while necessary, is not far-reaching
enough and is only an adhoc solution. Insofar as it applies to nurses,
we note with concern that there are many health care workers who have
the required "scarce skills" and provide the desired services but, as a
result of their lack of formal training, do not benefit from the
A Human Resource plan is urgent!
The Operational Plan for Comprehensive HIV and AIDS care, management
and treatment for South Africa (Operational Plan), released on 19
November 2003, envisages employing an additional 8,000 workers in the
public health-system by March 2005.  However in all provinces
government is failing to recruit health care workers to these posts.
Unless this plan is integrated with a general plan to revive health
worker morale, and public health-care workers are remunerated
competitively with their private sector counterparts, there is no
reasonable possibility that this target will be met; instead the
situation is likely to deteriorate. The price of this will be a failure
to save the lives of people with AIDS.
A human resource plan that identifies reasonable and legal
patient/carer ratios, and career development paths for health-workers
is essential to address these problems. Training opportunities for
nurses have dwindled in recent years because of the closure of nurse
training institutions. This also has to be rectified to achieve the
targets of the Operational Plan.
In view of the more fundamental issues that must be addressed, we
support the call of the public sector unions' for an agreement that
applies only to the current year. This will provide the time and
space for a Commission of Inquiry to make recommendations on standard
conditions of service and employment for all health workers in the
Plan to save lives!
Poor conditions and salaries are not the only causes of loss of health
resources. A 2002 report commissioned by the Department of Health found
an HIV prevalence rate of nearly 16% HIV among health-care workers in
four provinces. The report stated:
"[t]he HIV/AIDS epidemic has an impact on the health system through
loss of staff due to illness, absenteeism, low staff morale, and also
through the increased burden of patient load."
This is why the TAC and ALP believe that the promise of a public sector
medical aid scheme, whilst welcome, is not enough. Its implementation
will take time and nothing is being done in the interim to ensure that
those workers who are currently reliant on the public sector are able
to access health care services that are not yet widely available. For
example, many public servants are not yet able to access antiretroviral
We believe that concrete interim measures are needed to ensure that
workers are able to access comprehensive treatment, care and support,
and to demonstrate that we value their lives.
If money is to be set aside now for the public servant medical scheme,
we see no reason why an interim arrangement cannot be made for those in
need of essential health care services that are not yet publicly
In addition, health-care workers are demoralised because of a paucity
of career advancement and educational opportunities. This is
exacerbated by long hours coupled with insufficient overtime
remuneration and a lack of debriefing and counselling for nurses
working under stressful conditions.
The right to strike!
The TAC and ALP are concerned about government's characterisation of
the proposed strike as damaging "disruptive industrial action".
Constitutional Court explains, the right to strike - entrenched in
section 23(2)(c) of the Constitution - is central to the collective
"collective bargaining is based on the recognition of the fact that
employers enjoy greater social and economic power than individual
therefore need to act in concert to provide them collectively with
sufficient power to bargain effectively with employers. Workers
exercise collective power primarily through the mechanism of strike
The TAC and ALP call for a satisfactory resolution to the current
dispute, and a commitment to a process of fundamental reforms in the
public sector. We regret that government persists in characterising the
call for a better deal as being in conflict with "more critical issues
of transformation", implying that public sector workers have no
interest in "improving the quality of lives of all our people".
In our view, better work conditions for public sector workers form an
integral part of transformation. Without greater investment in
public sector workers, the state will be unable to address the
injustices and inequities caused by apartheid and exacerbated by years
of fiscal restraint.
We appeal to the government to avert strike action and to agree to a
Commission of Inquiry into conditions of service for both teachers and
workers. This means accepting the principal that significant wage
increases might have to follow this process. To build a truly
people-centred public service, workers must have decent conditions of
For comment, contact Nonkosi Khumalo on 072 231 1422 or 011 339 8421,
or Mark Heywood on 083 634 8806.
 South African Health Review 2003/04. Health Systems Trust, 2004
 The Impact of HIV/AIDS on the Health Sector: National Survey of
Health Personnel, Ambulatory and Hospitalised Patients and Health
Compiled by the HSRC, MEDUNSA and the MRC for the South African
Department of Health.
 Operational Plan for Comprehensive HIV and AIDS Care, Management
and Treatment for South Africa. Department Of Health, 19 November 2003.
 Ex Parte Chairperson Of The Constitutional Assembly: In Re
Certification Of The Constitution Of The Republic Of South Africa 1996
(4) Sa 744 (Cc) At