Following irregularities that emerged in the implementation in the Single Wage Table (TSU), the Medical Association of Mozambique (AMM) started, on the current December 7, a general strike. According to the statement issued by the association, the strike is expected to end on the 28th of the current month.
This group of health professionals demands, among several aspects, the dignified framing of specialist and general practitioners in the context of the TSU, taking into account the fulfilment of the statute of the doctor in the Public Administration, the revision of overtime, as well as the reassessment of the subsidies for housing rent, location subsidy and exclusivity, by about 40%. The Government, however, argues that the revision of the points in allusion is only in the order of 10%, without exceeding the budget limit.
The doctors’ strike is jeopardizing the adequate care of patients, since many services have been interrupted, forcing patients to resort to the private sector or reschedule appointments for another time. This worsens the health condition of patients who need treatment for their illnesses.
In an analysis around this problem, the Citizen Observatory for Health (OCS) understands that, although the doctors’ claims are legitimate, the strike violates the rights of users of health services, who are deprived of medical care and medication.
“The doctors’ strike is legitimate, because a statute was approved by the parliament and it is not being followed by the Government yet”, said the coordinator of the Public Participation pillar of the OCS, António Mate.
This issue, according to the coordinator, dates back a long time, specifically 2014, when this group of professionals began their claim, the 3rd strike of doctors in the history of Mozambique.
According to Mate, Mozambique has a large deficit of human resources to meet the demand in the National Health System (SNS), worsening currently with the doctors’ strike. For António Mate, this means that besides having this basic problem, there is another one which is caused by the stoppage of activities by doctors.
According to data from the World Health Organization (WHO), on average 2.3 doctors are for 1,000 inhabitants, but in Mozambique has 0.8 (approximately 1) doctor for 10,000 inhabitants. Disaggregating the data, in Maputo City, 2.3 doctors are for 10,000 inhabitants. This means that in order to reach the farthest ratio recommended by the WHO, the capacity of medical personnel must be increased 10 times more in order to reach the margin of 2.3 doctors for 1,000 inhabitants. “With this data, you can see the chaos that is installed, first with these important ratios that the country should reach. So we have poor coverage of doctors at the country level. But we have another aspect that was discussed in the Economic and Social Plan and State Budget (PESOE 2023), which provides for the framework of medical personnel, with an emphasis on more foreign professionals to the detriment of nationals”, Mate explains.
Strike VS Hiring More Foreign Doctors
The PESOE 2023 data foresees the hiring of approximately 741 foreign doctors, which corresponds to a percentage of 87% against the hiring of 158 national human resources, representing approximately 18% of Mozambican doctors that will be hired during the period in question.
This situation, according to the coordinator of the Public Participation Pillar, is inconceivable, since more money is spent on remunerating foreign doctors to the detriment of national doctors, always alleging a lack of budget.
“The basis of the doctors’ demands are the working conditions, not only for doctors, but for all health professionals, as well as the issue of remuneration”, he said.
Mate said that the aspects were agreed upon, which means that there was consensus in general terms, but in specific terms, it’s not being complied with. For example, there is the exclusivity subsidy, which the Medical Association says should remain at 40%.
“But if we bring here the data on the number of doctors, we will realize that the Government is ready to spend, in 2023, more money to hire foreign doctors. The question that arises is: what budget will support the hiring of doctors, in a context where the doctors’ claim is justified by the absence of financial conditions?”
Mate, however, congratulates the Government for the effort it has been making to solve the problems of the Medical Association. The researcher believes that one should not only look at this group, but also accommodate other orders and associations.
“We know that the Government has met with the Order of Nurses and with the Associations of Nurses and Midwives of Mozambique.”
Asked whether or not this is the time to strike, António Mate replied that there is wear and tear on the part of the Medical Association, because this issue is very old, having become acute with the TSU.
“As I said, it is a strike that should have happened quite some time ago, but because of the principle of dialogue, they lowered their sleeves and entered into a negotiation process. What happened is that this process did not achieve the expected results”, he added.
Another aspect that would have contributed to the doctors to go on strike, according to the researcher, has to do with the loss of trust and uncertainty regarding the issues under discussion.
“This may also be a product of the previous discussions that the Medical Association had with the government and which were not resolved”, he said.
“In a scenario like this, where, for example, the second strike of doctors in Mozambique resulted in a lot of administrative violence and the specifications were not resolved either”, said Mate.
He recognizes that this is a sensitive issue for the Government and the Medical Association, but also for all health professionals and, above all, for the user of health services and the population in general.
He also recognizes that the Ministry of Healthy is implementing a contingency plan to remedy the negative impacts of the strike, which is a positive sign and shows that the Government, in contexts of crisis, is able to reinvent itself to deal with the problems that arise. “However, this plan has gaps that does not solve all the problems”, he concluded.
Stoppage of Activities is Harmful to Patients
When the strike by these professionals was first announced, which was scheduled for November 7th, the OCS interviewed the vice president of the Nurses Association, who argued that the paralysation of activities is not beneficial for anyone, since it harms users of the National Health System (SNS).
According to the vice-president, negotiations between the Government and the Doctors’ Association should be guided by a mutual spirit of understanding, through permanent information sharing.
“There must be dialogue and mutual understanding for good communication between the parties, as well as being clear in the presentation of proposals”, Guambe said, stressing that tolerance is crucial for an agreement beneficial to all.
“This is a thoughtful exercise. A debate must be carried out, all interested parties must express openness. Nothing is gained by paralyzing activities because it is the SNS that comes out destroyed”, the source said, adding that “if the strike goes into effect it will compromise the functioning and quality of health institutions.”
Therefore, Grácio Guambe argues that one should continue to defend a universal health system, in which all people are assisted and that opportunities and existing resources are for everyone, without leaving anyone behind.
It is necessary, Guambe argues, that universal access to health care observe the way in which the sector’s servers are treated, respecting the functions, categories, and professional skills of each one “guided by a good salary mechanism within the civil service.”
Asked how the parties should reach consensus, Guambe pointed to mutual trust as the way out, arguing that the media, in turn, should be guided “by impartiality in the way it handles this strike, clarifying misconceptions and eliminating false information. We all have a way to contribute to the smooth running of the system.”
“Striking, as always, is not the best way to enforce rights, one must invest in dialogue and communication between the parties”, he stressed.
Guambe also said that while the Nurses Association is a body responsible for promoting technical-professional dignity and good working conditions, it will never observe the strike as the best way to enforce rights, so “one should invest in dialogue and communication between the parties. The country is too big to accept a problem like this.”