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16.03.2009 Health

Health workers might strike again if…

By RAS MUBARAK

The job of Ghana's new government is well cut out – jobs to fill, campaign promises to fulfil, contracts to award and a hive of other activities that need taking care of. One of the pressing issues the new administration faces is threat of a nation-wide strike action by Junior Doctors and perhaps others in the Health sector and elsewhere. There are very serious issues to be addressed. Junior doctors are opposed to sections of the Single Spine Salary Structure that was ratified by the John Kuffour led government before it left power. The ratification of the salary structure for workers was just one of the many booby traps the previous government felt it should set for the incoming administration. There were a lot of last minute irrational appointments, approval for better ex-gratia for former president(s) and other interesting announcements, including an approved increase of between 34% and 16% in salaries for different categories of public sector workers. This announcement for wage increases was made on the last day of Kuffour's tenure as president and expected to take from the 1st of January, 2009. Thankfully, the leadership of Organised Labour rejected the increases and said “it was a big surprise to hear that the government has announced that the single spine structure was in operation because we had not completed the process”.

It is very important to deal with the issue of public sector wages dispassionately. This is an issue about bread and butter, the general condition of service for our public sector workers and live hoods. How well or badly we handle it would determine how many 'walk outs' the new government might face and most importantly how workers would be able to keep their families afloat. We must at all cost keep partisan politics out of this issues. Yes, the previous regime railroaded the process, but that should not be the focus of our attention. The crux of the matter is how do we implement a system of paying Ghanaian workers fairly, what should be the yardstick for measuring performance and how much should every category of Ghanaian public service worker earn? As things stand now, the John Atta Mills led government would be confronted with a series of nation-wide industrial action, not only by Doctors and Health Workers, but by other members of Organised Labour if it allowed the John Kufour ratified Single Spine Salary Structure to take effect because there are a lot of anomalies in the report. To quote an anonymous senior health correspondent, “the government will be in serious trouble with Doctors, Nurses and the Allied Health Professions.”

Junior Doctors have expressed their intention to take strike action if the single spine salary structure is implemented because of the apparent inconsistencies in aspects of the proposed salary structure. The Ghana Medical Association has said it will not accept the new structure. The new payroll structure puts at par workers who have different job specifications and that is quite sad. For example, the Director-General of the Ghana Health Service, the Deputy D-G, a Chief Executive (Clinical Professional) a Medical Director in a Teaching Hospital and a Consultant for the GHS are all on a salary grade of 24. A look down the ladder shows a Blood Donor Organiser, Administration Manager, an Auditor and a Biostatistics Officer all graded under the wage structure of 16. A Senior Auditor in the Health Service, Senior Accountant, a Pharmacist, Audiologist and a Nursing Officer are all bundled on a 'health service salary' grade 17.

Different jobs require different academic qualifications, knowledge and skill and person specifications; surely one expects these differences either to show in the groupings of the jobs or reflected in the placing of the job on a salary scale.. One can expect a backlash if this new government fails to undo the anomalies created by the proposed salary structure. It is like saying the Inspector General of Police and the Commander in Chief of the Ghana Armed Forces, (the President) must earn the same salary. Yes times are hard, but you cannot pay the driver and the driver's mate the same salary. The requirements of their jobs are not the same. Even in a time like this any such suggestion must be considered outrageous irrespective of the delicate nature of the issue. It is no wonder that the Junior Doctors at the Korle Bu Teaching hospital have threatened to put down their tools.

Agitations for a strike within the health sector have been raging for about a year now. In May last year, the then minister of health, Courage Quashigah begged the Ghana Medical Association to talk to its members not to go on strike since government could “no longer afford to increase salaries of health workers without concurrent reforms to the way the health workers are managed and remunerated.” However a major flaw in the ensuing action to resolve the matter was caused by the past government's failure to implement the recommendations made in the original report of the Restructuring Additional Duty Allowance (ADHA) project of 2004/2006. At the time the Health Workers discontent did not lie with the main work that had been done to provide an evidenced based framework on which to base a solution to the problem, but lay with the perceived notion that the doctors had been unduly favoured when it came to apportioning remuneration to the jobs. Improving working lives is not concerned only with pay but also with the implementation of mechanisms that guide personal development and progression and improve work health. Underpinning all this is a structured performance appraisal and monitoring system to guide personal and professional development and enhance productivity. The ADHA reports highlighted the complexity of issues that face the health sector and made recommendations to address these concerns. The present government cannot afford to continue to ignore the recommendations made in the ADHA reports of 2004/2006 if they are to begin to try to unravel the concerns of the health sector

As we run commentary and make suggestions, we must endeavour not to downplay the importance and contributions of a category of workers we may deem as subordinates. Each public worker's contribution must be acknowledged. In the business of healthcare it is essentially the team i.e. the multidisciplinary team that works in integration to provide a cohesive quality service. Every responsible public sector worker deserves fair wages. Industrial strife can be avoided if all stakeholders would be realistic and look at the bigger picture; the national interest. We need reforms in our public sector pay structure. Whilst we attempt to reconstitute our pay structure, we must put in place very efficient mechanisms to measure results. The issue must be put in its proper context – in the provision of fair wages the concern for the government must also focus on the type and value of services (product) being purchased. It therefore means that it is in the government's interest to ensure that a basic understanding is reached between itself and health workers of the knowledge and skills required for a job and the value of that particular role in the wider scheme of things, to enable the resolution of the problem to begin.

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RAS MUBARAK

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