A cursory review of the electronic media late last week revealed most callers heaving a sigh of relief over the announcement that the government had finally overcome its two and a half year tardiness and agreed on a planned framework for administering doctors’ salaries albeit being forced to sign the document under threat of strike action by the doctors.
In its aftermath, it has become a matter of extreme importance to address some recurrent labour issues between doctors and their employers as raised by the general public; mainly whether standard labour practices like concluding a negotiation by signing a memorandum of understanding a copy of which should be deposited with the National Labour Commission ought to take that long to conclude and whether industrial unrest had to be threatened before doing it. In the process, some who perhaps do not sufficiently appreciate the contending issues have been quick to label Ghanaian doctors as a greedy lot who constantly demand an unfair share of the national cake to the disadvantage of other professionals and public sector workers and who perhaps owing to the sensitive nature of their work, have had their demands being met.
Also deserving of some attention is the concern expressed by some non-doctors sympathetic to the cause of doctors that when such labour disputes break, contrary to securing the support, sympathy and understanding of the masses for our cause and against the infractions of government, the doctors do not seem to have sufficiently valued the public relations war to the extent that both supportive and hostile public responses are dished out in equal measure when the support of the public for better conditions of service for doctors should have been something that could be taken for granted normally.
The signing of a memorandum of understanding (MOU) last week however marked the end of a significant phase of the struggle. The leadership of the Ghana Medical Association (GMA) ought also to be commended for keeping their eyes on the ball and especially in the light of the specific tasks set the new leadership by the Takoradi AGM of November 2007. These tasks included securing an MOU with concrete provisions for addressing distorted relativities, wage opener clause (s) and the restoration of fuel allowance (20 gallons/month) illegally and unilaterally abrogated by the government in clear breech of the good faith and unambiguous understanding reached at the Negotiating Table in January 2006.
The GMA leadership has since activated the Wage Opener Clause for the orderly review of doctors’ salaries and in the hope that the government will show similar faith and commitment to implementing all decisions negotiated and agreed upon. If both sides show equal measure of healthy respect, there absolutely should be no problems, at least not from the GMA.
In my mind’s eye however, I see certain features of this new phase that both the leadership and membership of the Ghana Medical Association ought to be critically mindful of.
The first is the need to continue with our policy of playing by the rules while holding the government accountable on all the provisions spelt out in the MOU for addressing outstanding issues. We must continue to be intolerant of acts of bad faith perpetrated by our employers especially in the light of the Labour Commission’s ruling on August 15, 2006 that “now that the Ghana Medical Association has registered as trade union in accordance with Act 651, the employer can no longer take unilateral decisions in issues affecting the GMA, neither can the employer impose its decisions on it. Rather, what both the employer and the employee’s representative should seek to do is always submit proposals for discussion which when approved, would be signed by the parties and would be binding on them as such.” Indeed having followed due process all this while, it is not surprising that both rulings of the NLC have been unambiguously supportive of the position of the GMA.
If other labour Unions prefer not to take on the government for willfully reneging on their word, that is a decision we as doctors must respect but not necessarily emulate.
The GMA leadership is convinced that not only have our demands been fair and just, but that the work load is such that steps ought to be taken to ensure that the good people of Ghana have access to as many qualified health professionals as possible and the least the government can do is to pay those already working their negotiated salaries to enable them to discharge their duties with peace of mind.
When a new crop of doctors was posted to a District Hospital in Volta who spearheaded the NHIS, OPD attendance shot up from an average of 40 to about 207 per day with serious implications for work load and quality of care. While it may be prudent to adopt a policy of free maternity care following the 46 million pounds donated by the UK government, there is also need to ask ourselves whether we have made adequate provision for manpower support in deprived areas seeing that this policy will have clear implications for increased access.
What would it take for example to ensure that the inequitable distribution of health professionals to the disadvantage of the rural Ghana with sometimes up to about 70% of various health professionals being located in Accra, Kumasi and Takoradi, is addressed?
The second consideration is for both leadership and membership of the GMA to engage more proactively and constructively with the public with the avowed aim of smashing false government propaganda published in a certain pro-government newspaper two years ago and repeated by government spokesperson often enough that on the average, the doctors who were making so much noise were earning as much as 40-50 million cedis a month and were still not satisfied.
This propaganda can only be countered if we as doctors overcome our lethargy and both leadership and members resolve to engage on all fronts to counter every lie that is told with two truths. We must engage on the airwaves, in the print media, with text messages, phone call for phone call and on interactive websites where all insults aimed at doctors based on misinformation ought to be countered with a sympathetic ear, decency and the simple truth of the realities on the ground.
This new approach can never successfully be prosecuted by the GMA leadership alone which is why if you see or hear your President on television or on radio respectively, as a doctor-member with a stake in the matter, it is also your responsibility to call in, text in, shout in, laugh in, corroborate his story, encourage him, re-emphasize hidden points and indeed do whatever else you can to support our decision to tell our own story. If we all fail in this and allow the public to hear from us only when we are threatening a strike to the total exclusion of all GMA activities aimed at improving health care, then we shall have no cause to complain when our genuine concerns for welfare and for public health interests is mischievously misrepresented by government spokespersons, propagandists and soothsayers. There shouldn’t be any doubt whatsoever that all doctors have a lot of work to do in this direction.
We must tell our own story, no doubt.
While doing so, we must never deceive ourselves that public opinion is not important. As some in our ranks have pointed out, it is we who have oft displayed an inability to court public favour. We should also never display any lack of sensitivity to the sad realities of various public sector workers who have been having salary reforms for years with no end in sight. While doing so, doctors ought also to empathize with these workers for it is only in so doing that we can better appreciate the extent of the hostility some feel towards us and it is in understanding the hostility that we can better enable ourselves to counter the propaganda that has stirred up the hostility.
Imagine my mother, an Assistant Director 1 of the Ghana Education Service who after over 30 years in the service earns a take home pay of less than five million cedis per month. She and other teachers are then told I earn 40 million cedis per month which is more than 8 times her salary and still they hear me asking for more? Never mind that it is the responsibility of her leaders to press their case as long as we as doctors display an awareness that such a serious situation exists and subsequently, mount effective strategies to deal with it especially since the figures being bandied around are simply false.
I will give another example. On a radio programme recently, the Greater Accra Divisional Secretary kept hearing this “doctors are okay philosophy”. Pushed to the wall, the Child Health Specialist asked the presenter what she thought was his net income. “20 million”, she volunteered which was really funny considering that Dr. Owusu-Sekyere’s net income is less than half the figure!
While doing this, it is also important to purge our ranks of the mentality of some of our colleagues who are overly sympathetic to the cause of government to the extent that it blinds them from the naked truth that various acts of omission and commission of this government are largely responsible for courting public disaffection for the medical profession.
This has happened in spite of the fact that on a fair and objective analysis of the issues, it shouldn’t have been difficult to appreciate that doctors have always been fair and straightforward in their dealings with government which has amply demonstrated bad faith a major step of the way. Some of these colleagues have often been quick to attack the leadership of the Ghana Medical Association, sometimes publicly, other times in secret high and low places when their time, energies and resources would have been better spent advising their friends in government to show minimal respect for the provisions of the labour law as regards negotiating and implementing negotiated agreements in good faith.
How come it has taken us over two and a half years to sign a simple Memorandum of Understanding and even then only under threat of strike action when the GMA had always made its input to the draft document available when called to do so? How come government was categorical in its exclusion of fuel allowance from the basic salaries at the negotiating table and yet turned round to unilaterally abolish it without recourse to the GMA as a registered labour union? How come while negotiating the promotion of qualified doctors to the position of Consultants etc, the employer had long issued a written ban on the promotion of doctors without ever finding it necessary to bring this crucial information to the negotiating table contrary to the provisions of Section 97 (2) of the Labour Law? How come over two and a half years after the completion of negotiations, doctors and lecturers in the Teaching Hospitals can still not see their way clear as to their continued exclusion from the new salary scheme? How come the GMA has not succeeded in argueing this case forcefully to the public and win their support in spite of various genuine attempts to use dialogue to solve these problems? In the event, the public has only heard about it and understandably lambasted the doctors after the Association has grown tired of endless fruitless meetings and allowed the groundswell of discontent to take over?
Today, let the people judge whether it is the doctors that are strike-prone or the employer that lacks fundamental respect for the new paradigm of labour-management relations. Today if the GMA had had its way, allegations that some doctors use public facilities for private practice would have been most adequately addressed under the clause on “faculty practice” while by clearly defining hours of work, administrators would have been better placed to bring to book some doctors accused of disappearing from public facilities after a few hours to attend to patients at their private clinic.
Clearly, the attitude of the GMA has never been one of “give me, give me, give me” as the above two examples show clearly the extent to which we are ready to safe-guard the public health interests.
The third thing to watch out for is that on the health front, divide-and-rule tactics have worked too well among various professionals, unfortunately. On this score we must follow the leadership of the GMA President in his attempts to close down our ranks as much and as soon as possible in order to enable us press ahead united on a common front. It is hoped others will reciprocate the gesture.
The last but by no means the least is the need for some members of the media itself to undergo some level of reorientation. Oftentimes when GMA raises critical issues bordering on its unhappiness with the conduct of government, one finds that some media persons seem fixated on “when are you going on strike?” to the total exclusion of the dominant broader underlying issues. As unbelievable as it may sound, I have had an experience when an employee with a television station has told me point blank that if we were not going to declare a strike at a certain scheduled press conference at GMA House, his station would not cover the event! Indeed, the press conference was aimed at announcing the suspension of a series of activities culminating in industrial action and the television station in question simply didn’t show up for the strange reason that it was not a declaration of strike action.
I am by this calling for real support and genuine partnership from the media. The leadership of the GMA does not intend that all its time would be taken up by strikes and salaries etc. GMA is 50 this year and has come out with nationwide health outreaches which happen every month in a chosen Division. Volta Division has only recently organised a medical outreach to Bomigo Island near Keta via a canoe where over 400 inhabitants were screened with free donation of drugs etc. We need media help in telling people about it. We have planned powerful Anniversary Lectures for the month of August aimed at tearing apart the health sector…well, not exactly although our high-profile speakers are expected to deepen the health policy discourse while defining the way forward in the next fifty years and the role of the Ghana Medical Association in this journey. We need some useful partnerships here too.
Furthermore, we have formed a Public Health Advocacy Unit with over fifty volunteer doctors who are constantly engaging various media in dispelling the health misinformation that often saturates the airwaves. Some may also recall the launch of our top-quality 36 page full-color GMA Focus newsmagazine a couple of months ago to deal with the socio-medico-politics of health not just within the GMA but within the larger populace. Interestingly the July-September Edition of the newsmagazine is dedicated to the theme of Heath and Election 2008.
The other day, it was Dr. E. Spio-Garbrah of the CTO who was waxing eloquent on Joy about the need to exploit the benefits of ICT as regards networking for health professionals etc. It might be relevant to point out that the GMA has already established a Google Groups discussion website that is powerfully connecting doctors both home and abroad to engage in amazing creative conversations that are already going a long way to improve medical practice and impact patient care positively.
Clearly, exciting things are happening within the Ghana Medical Association and we shall pursue these philosophical objectives while simultaneously securing the welfare interests of our members.
And so, are Ghanaian doctors a greedy lot? I beg your pardon?! Of course not!