Several users of the National Health System (SNS), heard by the Citizen Observatory for Health (OCS), in the context of the extension of the Doctors’ strike for further 21 days, consider themselves abandoned by the professionals involved in the strike, as well as consider themselves betrayed by the government, which should have already presented plausible arguments for the resolution of the existing problems.
The extension of the strike, which consists of the paralysis of activities in all health units, started on 01 August, after having lasted for 21 days during the month of July, covering almost all services.
The reaction of users comes days after the Medical Association of Mozambique (AMM) decided to extend the strike because alleged irregularities concerning the Single Wage Table (TSU) still persist.
“The medical profession unanimously decided to extend the strike for another 21 days, meaning the strike will continue until 21 August”, said AMM president, Milton Tatia, at the time of the strike extension on Friday, in Maputo, after a meeting of the association.
The doctors also argue that one of the reasons for the extension of the strike is due to the alleged existence of a document sent to the class reporting on the revision of the regulation of the doctors’ statute that “aims to reduce and eliminate their rights”.
“If the government, through the Ministry of Health, wants to act in good faith, it should provide evidence, send the Association a document explaining the payments so that we can also calm our colleagues”, added Tatia.
Across the country, about 2,000 doctors have joined the strike, due to the fact that no consensus has yet been reached with the government. At the entrance of Maputo Central Hospital (the largest hospital in Mozambique), the OCS approached users who were waiting for the doctor’s assistance. At the scene, some patients reported the exhaustion of the health professionals who were working to guarantee the minimum services.
“We are here, in the largest hospital in the country, but you can see that the professionals are not working at 100 per cent, they seem to be exhausted. We have been abandoned by those who swore to save our lives, it makes no sense for this strike to go on any longer”, said a patient on condition of anonymity to avoid any embarrassment.
An apparently tired and rather sick lady told our team that “the doctors’ strike is a violation of our rights as users and Mozambicans. The government and the doctors’ organization should find solutions as soon as possible, because this is no longer working.”
“I, for example, have been coming to the Central Hospital to solve my health problem, but I have not been successful because the doctors are missing”, the patient added.
“Human lives are being sacrificed”
For Pedro Sambo, a patient in the queue at Mavalave General Hospital, the strike came about to sacrifice the lives of Mozambicans, and it makes no sense that after the first 21 days no consensus has been reached between the parties.
“The government pulls things to its side and the doctors, in turn, pull them to their side. We know that money is involved in negotiations, but no money or status is more important than people’s lives. It is obvious that human lives are being sacrificed.
Sambo claims that the service has been very slow and the queues are long and often a particular doctor is missing to assist patients.
“We have been here for more than two hours, but we don’t know what is going on. No-one turns up to help us, even though we are sick. We die here, looking for medical help, we are being murdered silently”, the patient said.
Another patient, who refused to revealed his name, accused the government of not caring about Mozambicans “because if it did, it would have found immediate solutions to end the strike. What can you expect from a country without doctors in hospitals?”
Exchange of Accusations between the Parties
According to the AMM president, progress has been made on the reduction of the exclusivity allowance from 40 to 5 per cent, the risk allowance from 30 to 5 per cent and the shift allowance from 30 to 5 per cent.
For its part, the Ministry of Health (MISAU) claims to have solved the problem of non-payment of salaries and the TSU framework, although doctors argue that some problems persist.
Since the approval and implementation of the Single Salary Table (TSU) at the end of 2022 – coupled with other factors such as wage shortages, lack of work material and medicines for users – strikes in the health sector have been intermittently common.
However, for a patient at the Malhangalene Health Centre “the exchange of accusations between the parties is no longer funny. We need help, there is no way the country can function properly with the health system damaged and paralyzed.”
Another patient, also in the queue, said the government and doctors should quickly find a solution to end the strike “because this way you sacrifice people’s lives. It may not seem like it, but a lot of people are losing their lives because of this strike.”
Danger behind new doctors’ statute
Despite the uproar over doctors’ pay, the government plans to introduce a new doctor’s statute, which provides for cutting allowances.
The new doctor’s statute also suggests the elimination of risk and exclusivity allowances, as well as a review of the calculation of overtime and the diuturnity allowance.
For the Medical Association, in a statement made public this week, the introduction of the new statute constitutes a violation of the rights of the doctor and removes the incentives for him to perform his duties.
“It is a proposal that has a very high degree of insensitivity on the part of the Government and, more than that, we think it is a great insult, not only to doctors, but also to the history of our country, because the current statute was approved after two major strikes that we had in 2013, and they are trying to annul it before even guaranteeing its full implementation”, said the AMM spokesman, Napoleão Viola.
The doctors, in a statement made public later this week, also threatened to sue the Mozambican government for dishonoring the medical profession.
“Mozambique has made several regional and international commitments regarding the promotion and protection of health with the consequent valorization of doctors and development of the health sector. However, the malicious and negligent way in which the National Health Service is being destroyed and the medical profession marginalized gives AMM the space to call on the relevant institutions in the health sector, at the level of the African Union and the United Nations, including the respective human rights systems, as well as Mozambique’s international partners in the area of health, to intervene in the case”, reads the document.
The document also states that “due to the seriousness of the situation, AMM also intends to carry out an evaluation of successive governments in the health sector, to award the prize to the worst government that has managed this sector and thus give space for due investigations into the reasons that led to such destructive conduct for the appropriate actions of accountability.”
In this order of problems that plague the Mozambican health system and its users, the OCS reiterates its call for good sense between the parties. In this tug-of-war, Mozambicans, especially the most disadvantaged (those living on less than a dollar a day, living in remote and hard-to-reach areas), are the main victims. The government must put the public interest above all other interests on its agenda, bearing in mind that doctors are vital to the appropriate functioning of the state.
In turn, doctors, as well as the entire class of health professionals, must prevent users from being sacrificed. In other words, these professionals must uphold their oath because, above all else, they must save lives.