Building Power to Create the Health Sector Africa Needs

Health and social sector affiliates of PSI from East, West and Southern Africa met at Arusha, Tanzania on 30 September and 1 October. They discussed extensively on strategies needed to foster the growth and development of health sector unions in the region.

Considering the worrisome state of public health on the continent, unions must win policy influence, getting governments to improve investment in public health towards ensuring public healthcare for all. Powerful health sector unions, the participants thus agreed, are important for defending the public interest as well as for advancing their memberships’ interest.

Speaking during the opening session, Khamati Mugala, Executive Secretary of the East African Trade Union Confederation (EATUC) welcomed sisters and brothers from outside East African. She noted that across Africa, poor working people face health challenges, which could be curtailed if public healthcare is well funded. Trade unions, she stressed, could make a difference, with campaigns that carry the communities along to demand well-resourced and accessible public health services.

Hery Mkunda, General Secretary of the Tanzanian Union of Government and Health Employees joined Khamati in welcoming participants to Tanzania. He urged everybody to reflect deeply on the task of ensuring a healthier Africa. The health sector trade unions, he added, are best placed to mobilise for improvement in healthcare delivery because in most countries, they have a national spread, and their members are often members of the communities they serve.

Setting the context for discussions on the main items of the agenda, Baba Aye, the PSI Policy Officer for the Health and Social Services Sector pointed out that the region has the worst health indicators in the world.

Key figures

The region of East, West and Southern Africa has the worst health indicators in the world. With the difference in life expectancy being a decade

70 / 75 Male / Female

Average life expectancy

Global

61 / 65 Male / Female

Average life expectancy

Sub-Saharan Africa

And apart from this, the quality of life is largely abysmal for the immense majority of the 1.2bn people living on the continent.

Underfunded public healthcare coupled with poverty, poor sanitation and rising social inequality have contributed to making the lives of hundreds of millions of Africans nasty, short and brutish. This is particularly so for women and child in rural areas and the expanding semi-urban ghettos dotting the landscapes of cities across the continent.

Health and social sector workers have not been found wanting, doing the best they can to try bringing succour to the people, despite the terrible situation under which they have to do this.

Like beacons which refuse to be dimmed by the dark night of challenges, underpaid workers in grossly understaffed public healthcare remain the light of hope for many.

The need to address this worrisome situation by growing the unions and our campaign for the Right to Health was at the heart of deliberations.

Sanya Aggrey, General Secretary of the Ugandan Medical Workers’ Union (UMWU) and Enock Dongo, President of the Zimbabwean Nurses Association (ZINA) shared their experiences and perspectives on fighting privatisation of health as well as organising workers employed by private providers of health.

They showed the relationship between expansion of private for-profit interest in the provision of healthcare on one hand, and the worsening remuneration and working conditions of health workers on the other hand. At the heart of this relationship is the prioritisation of profit over the health of 99% of the people, who cannot afford top-notch private healthcare.

Dr Ivan Ivanov, team leader of the Global Workplace Health Programme at the World Health Organization’s headquarters in Geneva spoke on protecting and promoting the health of health workers at the workplace. Safe and healthy working conditions, he stressed, are fundamental to decent work. Noting that “workplace violence is a major concern within the health sector”, he added that duty of care in healthcare, must encompass both patient safety and worker safety.

Tom Odege, General Secretary of the Union of Kenyan Civil Servants and a member of parliament in Kenya presented the leadoff in discussing how health workers could better influence the policy process by national and regional decision-making bodies. Our message has to be clearly articulated. And we need to build alliances with other social forces, as broadly as possible, including communities, who stand to benefit from our campaign for public healthcare for all.

Dr Ouma Oluga, Secretary General of the Kenyan Medical Practitioners, Pharmacists and Dentists Union (KMPDU) and Godfrey Philemon focal person of the People’s Health Movement in Tanzania spoke more extensively on “building alliances and campaigns to defend public healthcare in the region”.

Dr Oluga, who is also chair of the Health for All Coalition of Wemos, shared the experiences of KMPDU during their 100 days strike for improved remuneration and working conditions in 2017. Almost a year before the strike commenced, KMPDU embarked on sensitization campaign, reaching out to communities, sister trade unions, civil society organisations as well as legislators and decision-makers with evidence-based reasons for the industrial action they eventually took.

A communication strategy which identifies targets and allies for a campaign, he said, is invaluable. At the heart of this must be the campaign message. And this should be transmitted creatively, including with the use of social media.

Godfrey Philemon presented participants with insight on the origins and development of the People’s Health Movement (PHM). Formed at the 1st People’s Health Assembly which brought together almost 1,500 health activists from 92 countries at Dhaka, Bangladesh on 8 December 2000. With “health for all NOW!” as its motto, PHM personifies the spirit of the 1978 Alma-Ata conference and the failure of governments to live up to their stated commitment to providing health for all by the year 2000.

PSI has collaborated closely with PHM over the last few years, including on the World Health Organization Watch programmes organised by PHM for critical civil society during the annual meetings of WHO governance bodies in Geneva. PSI has also collaborated with PHM in some of the sub-regions and countries in Africa in organising campaigns. These include the campaign for a People’s National Health Insurance in South Africa and the campaign against corruption spurred by the privatisation of medical equipment supplies in Kenya.

Genevieve Gencianos, the PSI migration project officer spoke on “international migration and the African health worker in the light of recent global developments”. She drew participants attention once again to the maldistribution of health workers with poorer countries at a disadvantage and these being the main countries where health workers are also migration from.

Of the projected shortfall of 18 million health workers globally by 2030, 4 million will be in Africa (and 7 million in Southeast Asia). There is thus a great need for investment in the health workforce on the continent. She informed participants on steps PSI has been taking to amplify workers’ voice in global policy on migration.

Our objectives in this regard include: winning workers human and trade union rights; achieving decent work, social protection, fair and ethical recruitment for migrating health workers; strengthening the public health sector – fighting privatisation and; building strong PSI unions and health sector networks.

After the rich inputs and plenary discussions, participants worked as three working commissions, towards developing an action plan to guide PSI’s health and social sector work in the region. This will guide implementation of the resolutions that will be reached in November at the PSI African and Arab Countries Regional Conference, in the health sector, over the next four years.