Rivalry among Fragmented Health Worker Associations in Ghana, the Bane of Poor Conditions of Service in the Health Sector

It is true that the 1992 Constitution of Ghana provides for freedom of association. Article 21 (1) (e) of the Constitution specifically states, “ all persons shall have the right to freedom of association, which shall include freedom to form or join trade unions or other associations, national or international, for the protection of their interests.” The Constitution does not make that freedom mandatory but formation of associations in the health sector occurs as though the freedom to form association is compulsory. This account for different and numerous employee associations in the health sector. The right to freedom of association cannot be said to be the same as the right to form fragmented associations in one sector, leading to rivalry, cynicism, undermining one another, a domineering approach and poor conditions of service as we witness in the public health sector of Ghana.

As indicated above, the health sector of Ghana has numerous and rival professional associations and each of these associations focuses on the interests of its members, regardless of what happens to members of other associations. One can cite:

1. Ghana Medical Association (GMA)
2. Ghana Registered Nurses and Midwives’ Association (GRNMA)
3. Association of Health Service Administrators, Ghana (AHSAG)
4. Health Accounting Staff Association of Ghana (HASAG)
5. Ghana Association of Certified Registered Anaesthetists (GACRA)
6. Ghana Physician Assistants Association (GPAA)
7. Government Hospital Pharmacists Association (GHOSPA)
8. Ghana Optometric Association (GOA)
9. Health Service Supply Chain and Procurement Practitioners Association of Ghana (HESSCPAG)
10. Mortuary Workers Association of Ghana (MOWAG)
11. Ghana Health Information Management Association (GHIMA)
12. Ghana Society of Radiographers (GSR)
13. Ghana Association of Biomedical Laboratory Scientists (GABMLS)
14. Health Service Drivers Association of Ghana (HeSDAG)

There other health sector associations that have not readily come to mind. As if the foregoing is not enough, some of the associations in the health sector such as GMA and GRNMA have sub-groupings such as Ghana Dental Association (GDA) and General Nurses’ Group (GNG) respectively. Even the Medical Superintendents/Directors have formed a group called Medical Superintendents’ Group (MSG). The MSG members are members of the GMA who are the heads of the public hospitals. This fragmentation of employee groupings in the health sector of Ghana has led to a sustained rivalry among workers who talk about teamwork when it comes to performance of duties but they see one another as enemies when there is a benefit or two to grab form the employer.

I dare say poignantly that the health sector associations are virtually at the throats of one another; hence, they undermine one another at the negotiation table. Each requests for benefits for its members based on what government or the employer had already given to another association.

For example, prior to the introduction of the Single Spine Salary Structure (SSSS), the public sector health workers were paid on the Health Sector Salary Structure (HSSS). There was intense rivalry in the health sector when the SSSS was introduced and various professional associations were negotiating with the Ministry of Health (MOH) and Fair Wages & Salaries Commission (FWSC). At that time, there was a huge split in the health sector; the clinician associations such as GMA and GRMNA classified the health workers as clinical staff and non-clinical staff. Together with the MOH and some clinical staff in leadership positions, the FWSC used job evaluation exercises to price down the value of the support (non-clinical) staff, giving them far lower market premiums than the clinical staff. This has, therefore, placed the support staff on meagre and miserable market premiums with virtually no other condition of service.

There was another conundrum in the GMA. The practising physicians negotiated for a higher market premium for them than what was payable to Medical Superintendents who are the Heads of the District Hospitals. As such, the specialist doctors are paid higher than the Medical Superintendents and the District Directors of Health Services.

Mindful of the ongoing discrimination against the non-clinical staff who also have different professional associations, one would have thought that those support staff in the health sector would come together as one force to contend with the employer at the negotiation table. Unfortunately, that was never the case even though the Health Service Administrators, the Health Accounting Staff and Procurement Officers negotiated in unison but got no handsome package. Methinks the support staff in the health sector even hate one another more than the dislike they get from their clinical counterparts. No unity binds the Procurement Officers, the Health Service Administrators, the Health Accounting Staff, the Human Resource Managers and many other support staff groupings in the health sector. They operate independently and undermine one another even as the clinical staff do not think the support staff also deserve any conditions of service in equal measure. In to what dangers at all do they lead themselves before the employer?

Even though the Health Service Workers’ Union (HSWU) is the trade union with Collective Bargaining Certificate that negotiates for conditions of service on behalf of most of the non-clinical staff associations, HSWU is seemingly interested in the collection of membership dues, leaving some membership interests to the backburners. The support staff in the health sector are worse off due to their fragmentation.

Sadly, most of the employee associations in the health sector negotiate for salaries and other conditions of service with selfish-interests as though it is the entitlement of one association that government may give to members of another association. The clinical staff associations always want to prove that they are better off and their members are pivotal in healthcare delivery. We saw this last year when government decided to incentivise frontline health workers in the fight against Coronavirus. Meanwhile, no professional grouping alone can deliver healthcare to the nation.

The disunity among the health sector employees creates a fertile ground for government to toy with their conditions of service. These are people who work for 24 hours to deliver healthcare to the nation yet they and their children do not have access to free healthcare. Insurance packages for some of them only came to the fore with the outbreak of COVID-19. When it comes to the welfare of the health workers, government (whether NPP or NDC) divides and rules them. Above all, each association wants to prove that its members deserve better and more. This compelled Hon. A.S.K. Bagbin – Health Minister (as he then was) to describe the MOH as “Ministry of Hell.”

The public sector health workers of Ghana seemingly do not see wisdom in the common assertion that in unity lies strength or unity is strength. This is because they prefer to belong to fragmented employee associations that work against one another, saying teamwork on their lips but meaning rivalry and antagonism at heart.

In public policy formulating phraseology, the GMA and GRNMA can be described as forceful policy networks that government listens to. There is the need for these associations to team-up together with the others to fight a common course. Sadly, whenever, the GMA and GRNMA negotiate for a certain condition of service, government approves it and refers its implementation to the hospitals to be funded from Internally Generated Funds (IGF). This leads to implementation failure and forfeiture of the negotiated package because most hospitals cannot cater for that using IGF.

There appears to be some unity in the tertiary education sector, which has only four major employee associations namely University Teachers Association of Ghana (UTAG), Ghana Association of University Administrators (GAUA), Federation of Universities Senior Staff Association of Ghana (FUSSAG) / Senior Staff Association – Universities of Ghana and finally, Teachers and Education Workers Union (TEWU). These associations do not have sub-groupings as it pertains in the health sector and the rivalry among them is minimal compared with what we see in the health sector.

In my considered view, until the entire fragmented health sector employee associations eschew the cynicism, the domineering posture, the undermining agenda and come together as it is in Nigeria and other countries, the employer/government and its agencies will continue to take them for granted. Again, until government also takes a bold step and works on equitable conditions of service for all the health workers, corrupt practices in the health sector will worsen. The other day, I published an article on the fact that some MOH officials are allegedly collecting huge sums of money as bribes from newly qualified health professionals who seek for a review of their postings. Much as the unfortunate bribe-taking act is condemnable, poor conditions of service may be the germane factor behind these greedy acts. However, I am not oblivious of the insatiable human nature that pushes a person to look for more even when he or she has enough at hand.

If individual association strike actions in the health sector will not move government to act favorably towards one association or all health workers, coming together to fight for a collective course will do. Sadly, retired health workers have nothing special to take home and when they are sick on retirement, they go to hospital and pay for the services. Do the leaders of fragmented health worker associations think about this? Dear Public sector health workers of Ghana, either you unite or you perish under the current poor conditions of service. Going solo has not helped any one association, as going together would have done. A health worker who becomes a politician is paid about five times the health worker’s salary aside the ex-gratia paid to the politician every 4 years. The selfish-interest must be collective rather than individualized. Think about all this and fight a collective course. Association leaders who take bribes from the employer during negotiations and stop fighting for the welfare of members should be ashamed of themselves. Bribe today may not help you in retirement. The butterfly must not think himself a bird. Free advice from my hamlet.

~Asante Sana ~

Author: Philip Afeti Korto

Email: [email protected]