Medical Doctors Strike: Ghana’s Opportunity to Reform Labour Statutes

Over the last three weeks, we have heard arguments in defence of and against strike action by the Ghana Medical Association. We have also heard appeals from well meaning Ghanaians, governmental and third sector institutions as well as other trade unions. Decisively, we have heard directives from the national labour commission for our doctors to call off their strike action. Majority of these calls are based on the premise that with the continuous absence of doctors from hospitals and health facilities, there is a greater danger for significant and needless loss of life. However, a proportion of the appeals are based on the argument that the medical profession from its genesis is aimed at restoration of life; therefore it is morally and ethically wrong for medical doctors and other allied health service professionals to withdraw their services under the pretext of industrial laws and collective bargaining. Another school of thought holds that the strike action by the GMA is totally illegal as laid down procedures enshrined in law have not been and are not being adhered to.

Before I proceed with the core subject of this article; I want to add my voice to the 'over grown' calls to our doctors to put aside sentiment as well as their need for greater spending power; and return to their bread and butter duties to help us avoid a catastrophe. Already, Ghana has one of the lowest doctor/patient ratios in the world due in part to the brain drain. Ghana at this very moment needs a healthy workforce to aid its push for greater economic prosperity. Negotiations can, should and will continue whilst they are back to their call of saving and restoring lives. Please GMA, Ghana needs your help, go back to work!

Listening to and reading the sometimes overly passionate, openly hostile and dangerously political debate about the GMA strike that has characterised our print, broadcast and new media over the last few weeks; I couldn't help but draw the conclusion that Ghana has been presented the opportunity to undertake root and stem reform of its industrial and labour statutes. Primarily, industrial and labour market laws as I understand them, are aimed at ensuring that every working person has a minimum condiment of rights in their workplace as well as safeguarding the interest of the employer. These rights are necessary because the relationship between an employee and an employer is inherently inequitable. In the same way as Max Webber characterises human social interaction; the relationship between the employer and the employee operates as a power relationship, with one party seeking to enhance their position in the relationship. Therefore, since the industrial revolutions of centuries past, Kings, Queens and Governments with significant nudging from the masses by way of social and industrial unrest have enacted laws to safeguard the state and employers on one hand whilst increasing the rights of workers on the other.

Today, our nation is faced with industrial action and growing agitation within our labour movements for improved salaries and working conditions. However, no matter how legitimate these demands are, we need to balance them against the nation's ability to afford these or better still meet them. The western world is currently gripped by significant financial uncertainty and undergoing austerity measures because at a point in their history they didn't cut their coat according to the cloth they had available to them. Consequently, on a daily basis we see on the international news channels, massive, chaoto-destructive demonstrations against governments for trying to put in place now, measures they couldn't envisage or thought about during their boom time.

For that reason, we need to learn and we need to learn fast. The government must ride the wave of public sympathy it is enjoying during this difficult doctors strike by overhauling the whole system of engaging workers especially in the public sector, more so our essential public services. My views here are limited to the areas I believe need to be looked into and do not presuppose that other critical areas should not be looked at or the absence of such.

First and foremost, Ghana needs to change the current practice of centralised recruitment in favour of a decentralised system with accompanying decentralisation of financial management. Public sector institutions should be able to recruit and lay off staff at each hierarchical level of their operations. If a particular institution is organised and structured from National to District, then each level of that structure should enjoy autonomy within a decentralised recruitment budget. Management would then have the flexibility and discretion to recruit staff either on a temporary basis, on fixed term contracts or on permanent contracts based on the needs of the organisation and its ability to pay. In the same way, they will have the flexibility and discretion to lay off staff following strict, laid down recruitment procedures based on a chain of evidence that cannot be easily concocted and supported by a strictly applied punitive measures regime to safeguard the process. These safeguards are needed because I believe the average Ghanaian will abuse any system to satisfy their selfish whims.

This change will save the state gazillions of Ghana cedi currently wasted on superfluous, under performing, and unproductive staff who sit around offices reading newspapers, engaging in petty trading in the office and leaving the office to go to church to pray for promotion; without necessarily putting in the man hours and applying themselves effectively as they should, to ensure the organisation delivers its core business and attain its intended objectives.

It is worth noting that to ensure the achievement of the intended benefits of a decentralised recruitment procedure; there is the need for enforced transparency. What do I mean? When management decides that it needs to fill a recruitment gap, they must develop detailed written job descriptions, expectations, responsibilities and benefits of the post holder. This will show the salary scale, the spinal columns and the starting salary points. So you know what you will and will not be getting. This must not be done in isolation. They must necessarily develop a written person specification; this will include qualification, experience, aptitude and all other essential qualities and skill set needed to do the job effectively. They will also detail what potential employees should expect through the process, e.g acknowledgement of applications, testing and interviews, feedback for those who are not successful etc. In effect this will prevent the recruitment of square pegs for round holes and will help eliminate the 'who you know' and not 'what you know and can do' practice which is so inimical to our country's growth and prosperity.

Another important facet of a decentralised recruitment system is giving the option to staff in essential sectors such health to work as independent self employed consultants or contractors. Offering their labour on flexible terms strictly defined in law which removes the right to strike but also gives the employee the flexibility to terminate their employment as and when they choose to do so and thereby denying the employer the security of a permanent or fixed term contract. This also gives the employee the immunity against prosecution for any losses or mishaps during the performance of their duties, the employer is held accountable instead.

In the same regard, there is the need to do away with the vertical promotion pattern currently practiced in our public services, in favour of an inbuilt transparent career grade with associated salary packages, spinal columns points with specific guidelines on annual increments once an employee reaches the end of their particular career grade before their retirement age and or have not moved on to another career grade pathway or moved to the private sector. Consequentially, management and the rise to management or senior positions of various Teams and services within any hierarchical level of government operation will not be based on promotion and for that matter seniority. Management or the rise to senior positions will therefore be based on a combination of factors among them, experience, academic qualification and aptitude, leadership skill set and the willingness to put oneself through the interview and testing process. This will ensure that promotion patterns do not become a constant bone of contention between unions and employers and will increase competition; the absence of which has contributed to the laid back culture and consequently under development we have become accustomed to in Ghana. This will also facilitate the administration of salaries and the internal management of employees.

Similarly, Ghana needs a change in the current system of 'ready jobs' immediately after University or college for majority of its public sector workers such as those in the health and education sectors. The state spends enormous amounts of money subsidising the training of until recently all the workforce, including those who then go on to work in the private sector. Our nation started on a premise of the state being provider and dispenser of all things. So that for starters you went to school to receive formal education, which equips you with a level of literacy and consequently the aptitude to function within the apparatus of the state to bring about development to march what pertains in the Whiteman's land. However, the world has moved on, majority of nations have had to change, in the interest of being able to meet the development and wellbeing of their peoples. Therefore, to be able to compete and ensure our best brains remain within our nation to oversee its development, we need to change our ways. How can you be competitive when you cannot pay your doctors and other essential staff a decent wage to prevent them from falling prays to the lure of the developed nations. One way, is to cut the waste and inculcate a competitive streak in the DNA and culture of your people.

Consequently, you eliminate 'ready jobs' and put in place a platform which requires every qualified doctor, nurse or teacher after national service to apply for a job and compete with their peers for the best locations, the best starting salaries and benefits, etc. This will also offer the employer the opportunity to include clauses in the employee's contract of employment, which bars them from withdrawal of essential services such as health care. Competition in this area becomes a dualism, as employers compete among themselves for the best talent and the potential employees compete for the best packages available. This mechanism will only work in a properly regulated manner with qualified HR managers and officers in place. Subsequently, there will be jobs for the many HR graduates who come out of university and cannot find employment or reduced to working in banks as teller and customer service officers. In addition, we need to establishes a broadly applied and actively deployed national minimum wage for the entire workforce of the nation, including specific declarations on overtime pay, a broadly agreed market premium and basis of annual salary increments once an employee reaches the upper limit of the spinal column point of their salary scale, and specific instruments establishing standards to guard against child labour.

Further, Ghana needs to streamline its provisions on the formation and workings of unions. This will include membership patterns, union rights and responsibilities, withdrawal of services and its implications for the delivery of services especially essential services such as health care and education as well as implications on the continuous enjoyment of the full benefits package of employment. The need to examine the liability of unions and union leaders for any losses necessitated by their strike actions and how employers should manage individual employees should not be overlooked. Crucially, our labour statutes should expressly make provisions which stipulate that employees will have no rights to conditions of service benefits when they are on strike. However, procedures will need to be adopted which make it clear whether an employee is taking part in strike action or is on sick leave, holiday or other legitimate absence.

There is the need to ensure union leaders are devoid of political influence hence, card bearing members of political parties must declare such information before contesting union elections. Also, any personal, private or professional associations with leaders of political parties must be declared before assuming office. More importantly, union members should be formally balloted before strike action can be called and unions must attain a minimum threshold of up to 70% plus one of all union members voting in favour of a strike before a strike can be called. In addition, balloting should be transparent and all members who are legally registered and of current standing should be balloted, in the absence of which strike action cannot be called. This requirement inherently presupposes and enjoins unions to keep proper membership records which can be verified by third parties.

Further, there is the need to categorise employee and employer disputes into two major strands; namely mandatory and permissive. Mandatory disputes will include those in relation to wages, working hours, and working conditions, and should be the items for which employers and employees or their representatives will be required to bargain. Permissive disputes will then be all other disputes not related to the mandatory strand. A typical example of this was the case of the doctors at the cardiothoracic centre going on strike because of the removal of Prof. Frimpong Boateng as honorary Director. This dichotomy is essential as only strike action based on disputes under the mandatory strand and not the permissive will be allowed by law.

In my view Ghana as a nation, will never really get another opportunity such as this to begin the dialogue which will lead to the promulgation of laws to safeguard Ghanaians against strikes by essential service providers such as doctors and allied health professionals.