Thank you Mr. Speaker Sir. I would like to thank you particularly because you are affording me this time to deliver this very important statement to the nation, to Parliament, so that we can see the perspective of where we are with regard to the industrial action that is in the health sector.
Mr. Speaker Sir, I will take you through and chronicle to you what has happened
Nurse managers and nurse educators raised concerns in a meeting held in 2017 where they cited their low packages as compared to junior nurses, noting their critical responsibilities. The Health Services Board submitted a request to Treasury for funding of an equalisation allowance for health in order to address the issue of the nurse managers, including management or workers in management.
Treasury did not support this request. When workers were informed about Treasury’s position, they appealed for reconsideration of their case. The Board, working with the Ministry, identified areas where savings could be realised in order to fund the introduction of the equalisation allowance.
On 18th January 2018, the Zimbabwe Nurses Association (ZINA) wrote to me citing concerns over the continued plight of the nurse managers and nurse educators. The Executive Chairman of the Health Services Board acknowledged receipt of the communication and on 5th February, 2018 gave a seven day final ultimatum to have their salary issues addressed, failure of which they would withdraw their services with effect from 13th February.
The Zimbabwe Hospital Doctors Association (ZIDA), in an updated letter addressed to the Executive Director Health Service’s Board, Permanent Secretary for Health and Child Care received on 18th January, raised minimum expectations within 100 days and these are the minimum expectations that the doctors raised,
· That the vehicle duty assisted framework agreed upon with the Health Services Board in 2017 be urgently implemented. No doctor should have to resort to public transport when they rush to respond to medical emergencies and on call duty.
· The current pathetic on-call allowances paid to doctors of $360 per month must be urgently reviewed upwards to $720 per month as per 2014 agreement.
· The third concern they raised was that the blanket fees for recruitment of doctors and other heath workers must be urgently scrapped. Currently, we have one doctor per
250 000 people.
ZIDA requested that the Government delivers on the key demands within 100 days or else they would resort to industrial action for these issues to be resolved. As a Ministry, we believe that the doctors and the nurses have genuine grievances that need to be addressed by this nation. Negotiations for the review of the working conditions is done within the health services bipartite negotiating panel called the BNP which comprises health workers representatives and Government representatives. The issues from both the nurses and doctors were discussed in the BNP meetings and the contact person in all this had been Dr. Munatsi, the then President of the Hospital Doctor’s Association (ZIDA) who tendered his resignation to his association on 28th February, 2018.
Dr. Munatsi’s resignation followed a meeting with Executive Chairman of the Health Services Board held on 27th February, 2018. A new management of doctors took over and proceeded with industrial action. Before a deadlock was reached, 271 junior doctors withdrew their labour with effect from 1st March, 2018. The junior doctors, Mr. Speaker Sir, mostly junior resident medical officers in central hospitals and Government medical officers at Mutare Provincial Hospital were over the course of the past two weeks joined by junior and senior registrars. As at 20th March, 2018 a total of 391 doctors have withdrawn their services or labour and this figure, some of the doctors have withdrawn their labour for 21 days as at 21st March, 2018.
For nurses Mr. Speaker Sir, the nurses withdrew their labour with effect from the 16th March, 2018 and the withdrawal of labour was called off on the 18th March, 2018 just after two days after the signing of the BNP agreement on the 16th March, 2018. The BNP agreement was signed through the ZIDA representatives though the ZIDA representatives walked out, but they noted that there was a quorum. The issues that were discussed at the BNP are as detailed below:
1. Urgent procurement of standard hospital equipment and essential medicines. Mr. Speaker, it should be noted that procurement is dependent on the available resources from both Treasury and the Health Services Fund. Within the harsh economic environment Zimbabwe is facing, commitments have been made by Government to ensure that all public hospitals provide at least all basic services in line with the health care packages delivered or defined for the various levels of care.
Furthermore, Government in December, 2017 disbursed US$22 million from the Health Levy Fund. This has been used primarily to support the procurement of medicines and medical sundries, hospital equipment and the reduction of the cost of blood from an average of $120 to $50 per unit at public institutions. Government continues to accord the health sector priority status in foreign currency allocation for the procurement of medicines, medical sundries and hospital equipment.
2. The other issue that was discussed at the bipartite meeting was the upliftment of the blanket freeze on the recruitment of doctors and other health workers. In 2017, in recognition of the critical role played by doctors in health services provision, Treasury approved the creation of an additional 250 posts for completing their internship. Currently, there are efforts to identify critical posts for unfreezing across the health services. Treasury concurred to the appointment of 162 junior resident medical officers with effect from 1st March, 2018. These positions were communicated to ZIDA leadership through the bipartite negotiating panel.
3. Clearly defined working hours. In terms of the ILO Standards each worker should work a maximum of 40 hours per week. It is then the responsibility of the local management to design duty rosters that are appropriate for their institutions taking into account the available human resource base. This may need further defining.
4. Payment of all locum hours owed to all doctors. Payment of all outstanding locum claims commenced in February, 2018. Doctors had been owed monies from November, 2017 and from February, they have started paying those locums.
5. Regarding of doctors to their correct salary grades. Treasury in its minute dated and regarding SRMOs, middle level and senior registrars with effect from March, 2018.
6. Cessation of current practice to scrap housing allowance and post-internship housing. Mr. Speaker, what happens is when doctors come as housemen, they are supposed to be staying at their places of work and that is why they are called resident medical officers. So, they deserve either a proper housing at the institution or compensation for that housing if they stay outside. Interns who do not reside in institutional accommodation are given an out of residence allowance of $250 per month in addition to the standard housing allowance of $131 per month to enable them to rent accommodate closer to their work stations, while those that stay in institutional accommodation are given the standard housing allowance only. On completion of internship, the out of residence allowance no longer applies. On deployment as GMOs or HMOs the doctors should now be paid the standard housing allowance.
7. Suspension of contracts for interns. When a doctor finishes housemanship after two years, before they start that internship they are supposed to sign a contract so there was a lot of negotiation around that. Some saying no there should not be, others saying there should be a contract so that we know what is expected of you. So, it was discussed at the bipartite negotiating panel. Everyone is expected to sign a contract of employment on commencement of their internship. This is mandatory and it is standard practice.
8. Implementation of doctors’ vehicle scheme. Doctors and other health professionals have argued and we have argued that doctors do need vehicles and reliable transport. They should not be jumping into kombis when they are going for emergencies. So, a vehicle loan scheme for all health workers has been established as a revolving fund for $10 million and this is immediately available. It will be implemented in terms of the framework designed by the bipartite negotiating panel and approved by the Board. This was communicated to ZIDA in the last BNP meeting.
9. Upward review of all call allowances to a minimum of $1 500. On call allowance was reviewed from 1st April, 2017 in terms of the collective bargaining agreement of the health service bipartite negotiating panel. On call allowances reviewed by 50% with effect from the 1st April, 2018. What has effectively happened is that from 1st April, 2018 whatever call allowances the doctors are getting now will be put up by 20%. This I must say the doctors are clearly not agreeing to this.
10. Post basic allowance. This is mostly for nurses. The Government has reintroduced a post-basic allowance. This is because when a nurse finishes their training becoming a registered general nurse, some go on to do post-graduate training and this was not being recognised. So, the Government has reintroduced a post-basic allowance for nursing staff who are acquire approved additional qualifications up to a maximum of two qualifications. If you have one post basic and acquire another post-basic qualification then you will be given an allowance. This will be in fact from the 1st April, 2018.
11. Nurse managers allowances. Nurse manager allowances have been reintroduced with effect from the 1st April, 2018 for nurse managers in recognition of their added responsibilities. Among the nurses, there are others who are managers who manage other nurses like the provincial nursing officer, principal nursing director and so, they are going to be given because they were now been superseded by nurses who were below them. This is a way of trying to equalize that. This is an outstanding issue which should be tabled and agreed upon.
Thereafter, after this bipartite agreement and negotiations were held quietly, we issued a press statement, the Government then offered what they can offer. The Government made a public offer to the doctors who were on strike. In that offer specifically, this was what was offered by Government that all those who are doing on call allowance; it should be reviewed by 50%. If you are getting a call allowance which is very small, your 50% obviously is small as well. This is a bone of contention for doctors.
Locum payment of all outstanding locum claims, Government says that we have already started paying that from February 2018. Night duty allowance for nurses who do night duty, whatever their allowance was, it was put up by 50%. There are also others on standby or call out, this also was reviewed upwards by 50%.
The Government has reintroduced a post basic allowance for nurses who have acquired a maximum of two qualifications. This has been introduced for nurse managers in recognition of their added clinical responsibility. I have already alluded to the vehicle loan scheme; this is another thing that was offered by Government. This was communicated but the doctors did not accept this because to be fair; they were in the bipartite negotiating panel but they then walked out. Those who remained signed this agreement. If you are at a negotiating panel and you have all the panelists there and you walk out, this is a bone of contention which has made the doctors to stay out.
We believe that there should be continued discussion. The doctor should be given a forum to continue to discuss. I am aware now that we have reached a very critical stage in trying to negotiate. I say it is now a critical state because the negotiations have been elevated to the highest levels and the doctors assisted by senior doctors and consultants, are in consultation with Government in negotiations at a higher level. At this stage, we would like these negotiations to be treated as delicate as they are delicate so that we chart our way forward with the doctors. We generally hope that the impasse can be resolved soon. We want our doctors to come back to work because the real victim is the patient of this country. The real victim is the one we all should strive to assist, that is the real victim that we should all take care of as best as we can.
We need to prioritise the health delivery system of this country as a people. I urge you to try and ring fence the health sector so that it is given the priority that it deserves. If we continue to make it dispersed, then we continue to have these problems. I am however pleased that our principals are now at the center of this in terms of finding a solution and I hope that this can bring some finality to the issue.