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' conditions!

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 allowance.

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.[1]

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 allowance.

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. [3] 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 public sector.

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."[2]

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 treatment.

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 available.

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".  As the
Constitutional Court explains, the right to strike - entrenched in section 23(2)(c) of the Constitution - is central to the collective bargaining process:

"collective bargaining is based on the recognition of the fact that employers enjoy greater social and economic power than individual workers. Workers
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 action."[4]

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 health-care
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 service.

For comment, contact Nonkosi Khumalo on 072 231 1422 or 011 339 8421, or Mark Heywood on 083 634 8806.


[1] South African Health Review 2003/04. Health Systems Trust, 2004
[2] The Impact of HIV/AIDS on the Health Sector: National Survey of Health Personnel, Ambulatory and Hospitalised Patients and Health Facilities, 2002.
Compiled by the HSRC, MEDUNSA and the MRC for the South African Department of Health.
[3] Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa. Department Of Health, 19 November 2003.
[4] 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
Paragraph 66