Latest doctors` strike may be a sign of a bomb waiting to explode

BY HENRY MUHANIKA

18th March 2012

It is only a few days ago that the latest doctors’ strike whose impact to society is still being felt came to an end, after the intervention of our President.
At this time, when members of the public who endured the brunt of that unpleasant experience are feeling deserved relief, a person who dare suggest that what we have seen may be a proverbial calm before the storm is likely to be branded a pessimist, if not a trouble rouser, unless he presents his case convincingly. This is a challenge to be overcome in this column.

By the way, discussion on the subject is still going on in our midst, mainly because the first round of the latest strike was associated with about 200 deaths countrywide and much suffering of innocent patients.

Hence, there are all sorts of comments about the incident, some based on reliable information while others are derived from rumours. You then hear viewpoints which generate more heat than light, as one political analyst put it the other day.

There is a local English daily newspaper which this week came up with an eye-catching front page story with a headline which screamed: “ No more doctors’ strikes”.

A person with a few bucks to spare could not avoid buying this newspaper, as the temptation to find out who has discovered the magic wand to solve a problem of this magnitude is too big to be ignored. The writer was a victim of this newspaper selling antic and bought it straight. He has no regrets as the story gave him a theme for this commentary on silver platter.

In short the story was about President Jakaya Kikwete’s speech while addressing elders of Dar as Salaam during the week, his main theme being the just ended doctors’ strike.

He is quoted to have narrated the history of the strike and, as expected, used the opportunity to try and convince his audience that his government and previous ones have done their best to improve the working conditions of doctors and other health sector workers, only that the efforts are constrained by inadequate financial resources.

In any case, it is true the President said he expected the doctors not to go on strike in future, and this is where the “no more doctors’ strike in future” headline originated.

What is the basis for the President’s expectation that from now onwards a strike by doctors will be history? Analysis of his speech reveals two reasons. The first reason he gave is that professional ethics and the country’s laws do not allow professionals in sensitive areas like the health sector to go on strikes, as doing so may put lives of citizens at risk.

The second reason appears to be that, after all, some of the demands of doctors will be met and costs involved will be incorporated in the 2012/2013 national budget.

Now, the interesting aspect here is that on different occasions when the doctors have opted for going on strike, professional ethics and laws barring them from resorting to such actions have been in place - one may even say doctors are not ignorant of their professional ethics and the Hippocratic oath they take on graduation, even if not all of them may be conversant with the law which prohibit strike in professions of this nature. But experienced colleagues can guide them on this aspect in time of crisis.

From the aforesaid, we note that there are enough precedents to show that when workers’ frustration reach a boiling point, they tend to put aside matters of professional ethics and regulations as they opt to lay down tools at any cost.

Of course, when the most powerful government leader says he does not expect doctors to resort to a strike option again because the laws of the land do not allow them to do so, those who read such statements between the lines should be able to decode the veiled message - which is simply that the government has been lenient enough in the past and won’t hesitate to use the stick in case incidents of this nature recur in future.

But can this approach guarantee that professionals in sensitive areas won’t lay down tools when shortchanged while politicians, parliamentarians, administrators and others engaged in less taxing jobs enjoy better salaries and perks?

As we conclude, we may as well make it clear that those who consider the doctors’ latest strike as calm before the storm do not necessarily wish our country chaos but see signs indicating that workers in other sectors, who find it difficult to make ends meet, are too restless to guarantee industrial harmony.

Henry Muhanika is Media Consultant

Email: hmuhanika@yahoo.com

SOURCE: GUARDIAN ON SUNDAY

Tanga integrates mother, child health insurance fund in development plans

IPP Media: Living at Mikanjuni location, Donge Village in Tanga city, Ashura Omari, 37, has three children, Rama, Kassim and Mwantumu.

Apart from Rama – the first born, Ashura’s other two children were delivered by traditional midwives.

When the young woman, married to Choyo Salimu, a fisherman, felt labour pangs for her first child eight years ago, she requested her husband to take her to hospital.

She packed a pair of kanga and a kitenge in a bag and took with her 2,000/- which was all she had saved from fish sales.

On a bicycle, Choyo pedalled to Makorora Health Centre.

Cycles of powerlessness: How can we improve the health system?

By Dr. Hamisi Kigwangalla


I woke up today reeling from nightmares of what is happening to poor people in Tanzania. I was recently in Tabora conducting research on reproductive health, where I had an opportunity to interview a man who consented to participate in our research. He willingly agreed to share his experiences on the barriers to accessing reproductive health services. His distressing story illustrates the experience of many people across the country.

The whole story starts with this beautiful young lady who got married to this fine young man. The woman got pregnant after some time. She went to the nearby antenatal clinic for care and was advised by the health workers there to go to Kitete general hospital for delivery. But due to lack of finances the family decided not to go to Kitete and rather to go to a traditional birth attendant.

Unfortunately, when the day came the woman didn’t immediately notice that she was in labour. When she finally realized and told her mother-in-law, she was told to just wait and be strong, because she is a woman. So she waited. At night, the pain became aggravating and grew stronger and stronger. She woke her husband, who was fast asleep and drunk, but he assured her everything was alright and that she should wait as his mother had earlier said, because she knows better.

Finally, he noticed his wife groaning and struggling. They quickly awoke the whole family and took her in a cow-pulled cart to the traditional birth attendant, where they were confident that they will receive delivery services. When the traditional birth attendant came and examined the lady in the cart, she quickly noticed that the head of the baby could easily be seen. Upon further examination, she noticed that the woman had twins and that she had lost a lot of blood. Realizing she could not help, the birth attendant told them to rush to the nearby dispensary. It was very late at night and not even a single car passed that way. Suddenly the woman became too tired even to cry. Her movement decreased. The situation was desperate. The husband was sobbing and his cheeks were full of tears. Everyone was quiet, perhaps begging mercy from God. When the midwife was awakened, she quickly jumped off her bed and went to examine the woman. She noticed the woman had twins, had lost a lot of blood and that both the mother and babies were distressed. She opted to call the ambulance from Kitete and at the same time to infuse the patient. She knew she could not be of any further assistance.The poor woman struggled to wait for the ambulance to no avail. The husband sat beside his wife, weeping calmly, his heart full of guilt. As minutes passed, he became aware of the reality that his wife was dying. No sooner than the ambulance arrived, the woman passed away. This is a testimony from the husband.

To this moment, he still cries for his dead wife and twin children. He lost the three most important people in his life in one day. I listened to the story with a chill, as I became aware of the multiple barriers that so many people in this country have to face. These barriers contribute to “cycles of powerlessness.”

The first cycle is within the individual; he or she has to be liberated and enabled to demand for his or her rights. This entails a person who is confident and can make decisions about his or her life and his or her children. Unfortunately many people – especially women – remain trapped in this cycle by a lack of information and autonomy.

Second, a person must overcome barriers imposed by people who have the most direct influence over their lives; i.e. their in-laws and their own families.

Third, there are barriers imposed by the social environment (community) and fourth by the health system. All these barriers create a cycle that is difficult to break – particularly for poor women.

These barriers reflect the obstacles to achieving health equity for women and children in Tanzania. The fact that about 80 percent of Tanzanians live in rural areas, and that more than half of all births occur outside health facilities, compels a strong case towards reforming the health system. We must target improvements in primary health care in order to improve the security of the poor majority living in rural areas. The Government should direct more resources to strengthening primary health care services bringing them closer to the people. Will the budget that is going to be tabled next month in Parliament reflect this?


Dr. Hamisi Kigwangalla is an independent public health consultant and social justice activist. Call 0715636963

PAMJ launches a jobs and announcements portal for announcers

The Pan African Medical Journal
ISSN: 1937-8688 - www.panafrican-medical-journal.com.
Published in collaboration with the African Field Epidemiology Network (AFENET)
Now tracked by DOAJ, AIM, Google Scholar, AJOL, EBSCO, Scopus, Embase, Index Copernicus, HINARI, CABI, PubMed Central, PubMed, Ulrichsweb, etc..
PAMJ launches a jobs and announcements portal for announcers targeting health professionals from Africa and beyond. (Access PAMJ-Jobs here)
Announcers, why you should post your job announcements on PAMJ-Jobs? With a readership of more than 4000 unique visitors per month and a database of more than 3200 (and counting) registered users from more than 79 countries (70% in Africa), PAMJ Jobs is an advertising solution for recruiters targeting doctors, health professionals and public health professionals from Africa. How to post a job announcement? Just contact us at sales-service@panafrican-med-journal.com for guidance or fill our online quick Ad form. Information requested usually includes the start date of the announcement, the expiration date, the detailed content of the position and the contact information of the recruiter. What will happen to your announcement? Your announcement will be posted on PAMJ-Jobs and sent to PAMJ mailing list on a monthly basis. Monthly statistics (number and location of hits) will be provided to the recruiter; allowing him to track the penetration of his announcement. How much will it cost to post job announcements to PAMJ? Recruiters/announcers will be charged a yearly flat rate; this will allow them to post an infinite number of announcements in a year. A fee-per-posting is also available for once-in-a-while announcers. What else can be posted on PAMJ-Jobs? Other announcements like conferences, meetings, seminars, workshops etc... can be posted on PAMJ-Jobs. For more on PAMJ-Jobs, visit: www.panafrican-med-journal.com/pamj_jobs/ For quotation, contact: sales-service@panafrican-med-journal.com For other advertisement opportunities with PAMJ, visit: http://www.panafrican-med-journal.com/ads.php

Uganda opens nodding disease clinics to treat children with nodding disease

Uganda has opened new clinics to help the thousands of children suffering from nodding disease, a mysterious syndrome that can be fatal.The disease is said to have affected most children in northern Uganda. The neighbouring countries are also believed to be affected by this disease, Tanzania and sudan in particular. The cure of this disease is still unknown!

Coke, Pepsi change recipe to avoid cancer labels

Coke and Pepsi are altering their drink recipes to avoid a California law requiring them to carry cancer warning labels, the Associated Press reported.The Global post has repoted that the soda giants are reducing the amount of 4-methylimidazole in their caramel coloring – a chemical that's been added to California's list of carcinogens.

Doctors suspend strike after State House meeting

By Florian Kaijage

Medical Doctors in public hospitals have unanimously agreed to call off the strike and go back to work, saying they have taken the decision to give President Kikwete ample time to solve their problems.

The dramatic shift came one day after representatives of the Medical Association of Tanzania (MAT), an umbrella organisation for the profession, met with the Head of State at the State House on Friday.

Announcing the move to end the strike yesterday, the doctors also declared that the Minister for Health and Social Welfare, Dr. Haji Mponda and his deputy, Dr. Lucy Nkya were their biggest enemies.

“This matter was well communicated to the Head of State, that these two heads of the ministry of Health and Social Welfare have failed to deal with matters raised by doctors and they (doctors) have no confidence in them, therefore there is no way we can carry on working together,” MAT Secretary General Rodrick Kabangila underlined.

Kabangula insisted that the doctors’ strike did not aim at making the public experience hardships in accessing medical services but rather it was intended to push the government to improve the health services.

On the demand that the duo (Dr Mponda and Dr Nkya) should be immediately fired so as to pave the way for negotiations, Kabangila said this demand was not a new one as claimed by the government since it was among the eight demands submitted at the beginning of the crisis.

The decisions were announced at the end of a three-hour meeting held at the Don Bosco Hall, Upanga suburb, in Dar es Salaam under chairmanship of MAT President, Dr Namala Mkopi.

Briefing the media, Dr Mkopi said after extensive discussions with the Head of State on Friday during a closed-door meeting, they agreed among other things to call off the strike as well as giving the feedback to their colleagues.

“Doctors have heard the report from our discussion with the President, whom they thanked for showing a good spirit to deal with the current situation especially after he revealed how he was touched by the crisis,” the MAT president told reporters yesterday.

Mkopi affirmed: “Following this decision to end the strike we call upon all doctors to resume work immediately as we pave the way for the President to solve the current crisis.”

But the MAT president was quick to appeal that the move should be well understood among doctors, intoning that there was no show-off aimed at lining up winners and losers.

The main reason for ending the strike is to ensure that while the President works on the current crisis there is a positive atmosphere, which needs that doctors resume work “to rescue the crippled health sector that has suffered major setbacks since early this year.”

Other demands put forward by doctors were an increase of On Call allowance, introduction of risk allowance, reinstatement of housing facility or housing allowance as per Civil Services standing orders of 2004 and 2009, introduction of hardship allowance, transport allowance or loan facility for vehicles, rise of monthly salary, medical insurance, and improvement of medical services to minimise the number of officials who are being treated outside the country.

MAT president Mkopi said President Kikwete assured them during their Friday meeting that he was very aware of the demands from the disgruntled doctors to fire the two ministers but he insisted that he should be given time to act as he may deem fit.

The ending medical doctors’ strike begun on Wednesday March 7 following refusal to fire the Health Minister and his deputy.

As the probable strike loomed, the previous day Prime Minister Mizengo Pinda had addressed a press conference urging the doctors to change their minds as the strike would affect innocent people. He also emphasized that it was impractical for the doctors to compel the President act severely on cabinet ministers.

But on the third day of the strike, the effects were increasingly being felt, prompting the Head of State to hastily call a meeting with Dar es Salaam elders at Diamond Jubilee Hall only to be cancelled and substituted by the meeting with doctors at the State House.

The President was forced to intervene as the nation risked a paralyzed health sector as it relatively was for 17 days when public hospitals medical doctors went on strike from 23rd January onwards.

Then the strike was called off after the Prime Minister announced the suspension of Ministry of Health Permanent Secretary Blandina Nyoni and the Chief Medical Officer, Dr Deo Mtasiwa, to permit investigation into allegations facing them.

Early this year President Kikwete stated in an article published in the Global Health and Diplomacy Magazine that: “Maternal and child health are at the top of the list. But we are governments of poor countries. There is a scarcity of medical personnel in Africa. The ratio of doctors to patients in Tanzania is 1:25,000 and the ratio of nurses to patients is 1:23,000. While the ratio in the United States is 1:300.”

He added: “Our government has taken serious measures to address this shortage of health professionals by increasing enrollment in health colleges. In fact, enrollment has increased fourfold over the past three years. In 2007 there were 1,013 students attending health colleges and now there are 6,713. Our goal is to reach 10,000 students by 2015.”

By mid 2011 Tanzania had 4,649 medical doctors and 377 medical specialists but about 80 percent of the specialists were at Muhimbili National Hospital in Dar es Salaam.

As doctors agreed to end their strike the Trade Union Congress of Tanzania (TUCTA) yesterday issued a statement, arguing that if all professional and social groups follow the doctors’ style of calling for their political representatives to resign as a means to settle their demands it is likely the country will be in a shambles.

TUCTA reasons that almost all groups in the country have one or two demands that require the government to address, but demanding a leader, especially a politically responsible cabinet member to resign, is far from being the relevant way to resolve the contentions.

TUCTA sought to make sense of the doctors’ call for the Minister of Health and Social Services Dr Haji Mponda as well as Deputy Minister Dr Lucy Nkya to step down, saying this was an unusual negotiation tactic.

As the major organ for tripartite negotiations between government, employers and employees, TUCTA reiterated their support for the demands of the doctors but faulted their impatience for not allowing the government to work on their claims.

“The fact that the government gave room for discussion with the doctors and formed a committee to closely address their concerns and later went public and promised to handle the demands gave hope that it was willing …the doctors should be patient and give the government time to fulfill their promise,” reads part of the TUCTA statement

TUCTA Secretary General Nicholas Mgaya said that the politicians are not basically the core executives. “These are people who know nothing technical about what the doctors really want. They are just politicians, receiving reports and advice from their subordinates such as the ministry’s Chief Medical Officer. ”

He said when particular leaders like ministers resign, in most cases it doesn’t mean they are directly involved or have anything to do with the misconduct, they are simply practising collective responsibility.

Mgaya cited the example of former President Ali Hassan Mwinyi who resigned as Home Affairs Minister in the First Phase Government after his subordinates made serious mistakes, saying “Mwinyi’s decision was clearly not arising from his own mistakes, thus he later ascended to the presidency.”

Mgaya said he didn’t see any reason for doctors to hold the ministers accountable and advised they should instead put more emphasis on the needs related to their employment and working conditions.

TUCTA warned though that when civil servants are ready for “whatever may come,” it is not a good sign for the nation and the situation sends a message that there are two social groups in the nation, namely the exploiters and the exploited

As the umbrella union appealed to doctors through the media to resume duties at health centres, the doctors were also holding a meeting with the media at the Don Bosco centre following the audience of MAT with President Jakaya Kikwete yesterday.

• Meanwhile, as doctors were meeting to announce their resolution following their meeting with President Kikwete, a handful of them showed up in some hospitals in Dar es Salaam and attended to patients who needed emergence service.

• At Ilala hospital, a few patients who spoke to The Guardian on Sunday admitted to have been treated but said only a few doctors were present compared to the days when there was no strike.

• Dr Christopher Mnzava, head of emergency unit, said: “We are attending to referred patients and doctors continue to come…the situation is not as bad as some media are reporting. If you say the situation is critical, then tell us the number of deaths.

• “But I allow you to go to the mortuary and observe the situation by yourselves.”

• At the mortuary, the medical attendant Yolanda Wana said the number of deaths is much like that of any other day when we receive a maximum of five bodies. He added: “Yesterday there were ten bodies because relatives had not picked them up.”

SOURCE: GUARDIAN ON SUNDAY