Minister of Health on Impact of Public Sector Strike and Department's Contingency Plans

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24 August 2010
Chairperson: Mr B Goqwana (ANC)
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Meeting Summary

The Minister of Health, Dr Aaron Motsoaledi, briefed the Committee on the impact of the public sector strike on the health sector and the Department of Health’s contingency to deal with this. He noted that not all health workers were on strike. His observation was that "most nurses are not on strike”; however, intimidation and fear kept many away from work. The strike began on 18 August and the Department gathered information twice a day from all the provinces and reported to the Director General and the Minister. Daily teleconferences were held with Heads of Departments to report and provide support where needed.

Members’ questions focused on whether workers in essential health services would be fired for striking, how the Minister would send a clear message to workers that he was serious about firing essential workers, how many people had died as a result of the strike and lack of medical care, and if any murder charges would be laid against health professionals where indications were clear that deaths had occurred because they were on strike. The Committee also wanted to know if charges of intimidation and damage to property were going to be laid against individuals, how many patients had been transferred to private hospitals, how the government would protect nurses that did not want to strike, alternative ways for HIV positive people to receive their antiretroviral treatment, and if contingency plans were in place in case the strike proceeded indefinitely.

Meeting report

Opening Remarks
The Chairperson welcomed the Minister, saying that the Committee thought it imperative to call in the Department of Health to talk about its contingency plans for the strike. The meeting was not being held so that Members could decide if the strike was right or wrong, but to establish the Department had a contingency plan for handling the problems caused by the strike. The Committee was glad that the Minister had come to brief Members at such short notice. The Committee pledged to provide support to anyone in dire need of assistance. 

Minister of Health briefing
Dr Aaron Motsoaledi, Minister for Health, informed the Committee that not all health workers were on strike. The South African Medical Association (SAMA) confirmed that doctors were definitely not on strike. It was less clear if the Democratic Nursing Organisation of South Africa (DENOSA) was actively calling on its members to strike. The Minister’s observation was that “most nurses are not on strike”; however, intimidation and fear kept many away from work. Most of the intimidation at health facilities was reported to be caused by civil servants that were not health workers and therefore not readily identifiable by health management.

The Minister addressed the Department of Health’s management of the strike. The government set up a National Joint Operations Centre (NATJOC) as well as Provincial Joint Operations Centres (PROVJOCs). The NATJOC was operational with senior management of all affected departments meeting daily. All the PROVJOCs were operational; however, there was a concern that the Eastern Cape PROVJOC had only become operational on 24 August 2010. The Department of Health (DoH) gathered information twice a day from these provinces and reported to the Director General and the Minister. Daily teleconferences were held with Heads of Departments (HODs) and the DoH to report and provide support where needed. All provinces had contingency plans in place that were shared with NATJOC and PROVJOC. A national interdict was issued on Friday, 20 August 2010, as well as two provincial interdicts to Gauteng and Kwazulu-Natal. The interdicts,
to stop striking workers from intimidating health workers continuing with their work,  acknowledged that the strike was legal and that the strikers had a right to strike, but also that people in need of medical care had the right to life. At the end of the day, they would not be able to bring back the lives that had been lost. The South African Police Service (SAPS) was in the process of implementing the interdicts in the provinces.

The South African Military Health Service (SAMHS), the South African National Defence Force (SANDF) and volunteers were providing their services in many facilities. Patients had to be referred to private hospitals in the past week due to the instability of public hospitals. The SANDF has deployed more than 2 400 personnel throughout the country. More than 60% of SAPS deployment has been to health facilities.

Strikers planned to move from facility to facility disrupting services. In some instances this plan was temporarily successful. In many provinces, strikers were targeting support services. The SAPS was providing escort services to ensure the delivery of supplies. The impact of the strike varied from province to province, but latest reports indicated that the Western Cape had not been severely affected, incidents in the Northern Cape were sporadic with clinics in the Kimberly area affected, major hospitals were targeted in Gauteng and Kwazulu-Natal with significant disruptions, and there were major disruptions in the Eastern Cape in East London and Port Elizabeth. At least four hospitals were closed in Limpopo as well as in the North West. The Free State experienced significant disruption of services in the Bloemfontein area with major hospitals being targeted. Some facilities in Mpumalanga were closed temporarily. The Minister assured the Committee that there had been signs of
stabilisation over the past week and provinces were working with security forces to secure hospitals and facilities.   

The government’s major concern was to protect lives and ensure that patients received the care that was needed. It was critical for the strike to end immediately, as many lives were being lost. The public health system had to be stabilised immediately. All the necessary stakeholders in the country had to work together under the leadership of the Ministry and the DoH. 

Mr M Waters (DA) stated that it had been mentioned that workers in essential services such as nurses would be fired if they participated in the strike. He agreed with this, but given the shortage of nurses in the public sector, how would this be possible? He asked if the Minister had a contingency plan to fill the gap that would be left in the health sector. He did not know if it was legal, but wondered if the Minister could make an example of one hospital to show that he was serious about firing health workers that were striking. This would send a clear message to other essential workers that were striking. What process would the Minister follow to show he was serious about firing essential workers? In the 2007 strike, nurses received an Occupation Specific Dispensation (OSD) with no consequences for striking. The lack of consequences had led to the current strike becoming violent. He asked how many people had died as a result of the strike and lack of medical care at hospitals. Would murder charges be laid against health professionals where there were clear indications that deaths occurred because they were on strike? There were also health workers that had charged into hospitals, intimidated people and destroyed property. Were charges of intimidation and damage to property going to be laid against these individuals? How many patients had been transferred to the private sector during the strike?

The Chairperson interrupted the discussion session to caution Members that the Committee had said that it wanted to hear what the DoH’s contingency plans were for the strike. The strike was still in progress and certain questions that Members wanted to ask the Minister could only be answered at the end of the strike.

The Minister replied that he could not talk about some of the strategies and legalities of the strike at the meeting. There was a question of whether people could be fired; however, these health workers were putting themselves in a position to be fired. If a health worker was barging into hospitals and intimidating other working health workers, then the Minister would not hesitate to fire such a person. If the health worker were identified, s/he would be fired. 

On the question of how many people had died due to the strikes, he said it was a difficult question to answer and he did not want to cause any mass hysteria. Since most of the hospitals had been stabilised and were working, the DoH no longer needed to transfer patients to private hospitals. There were transfers from Natalspruit Hospital to Netcare when the babies had been abandoned. Transfers only happened when hospitals were under tremendous pressure. Lives had to be secured at all costs. Unfortunately, not all patients were transferable.

Ms M Mafolo (ANC) said that the Committee appreciated everything that the Minister and the Department were doing. She asked what would happen to nurses that were being intimidated at their own homes. How would the government protect nurses that did not want to strike?

The Chairperson answered that there were other ministers that had also been tasked to look into this security matter. The Minister of Health had only been called in to tell the Committee what the DoH’s contingency plan was.

The Minister answered that he was not able to explain the security details to the Committee. There were nurses that had been intimidated right in front of him. People were threatening the nurses’ children. He had sent security forces and intelligence forces to resolve the matter. However, he could not give the details of these security operations.

Ms E More (DA) worried that people infected with HIV were not getting their antiretroviral (ARV) treatment. She knew of a pregnant woman in Roodepoort that could not access her clinic for treatment. She asked if there were alternative ways that these people could still receive medical treatment. Were there further contingency plans in place in case the strike was prolonged?

The Chairperson asked Members to focus on the contingency plans that the DoH and the Minister were currently implementing. The question on ARVs was very important, as people built up a resistance to to the
ARV treatment if they stopped taking the treatment.

Ms M Segale-Diswai (ANC) agreed, saying that disruptions in ARV and tuberculosis (TB) treatments could lead to worse consequences. She appreciated that Minister’s briefing and said that he was doing a really good job.

The Minister replied that if people did not receive their ARV treatment, it would have far-reaching consequences on an individual’s resistance. This could be costly to individual’s finances and health. Dr Yogan Pillay, Acting Director General (DoH), had had a teleconference with all the health managers to discuss strategies for the treatment of HIV/AIDS, Sexually Transmitted Infections (STIs) and TB. The best strategy was being used in Kwazulu-Natal where mobile units were placed at certain areas where people could go for treatment. Mpumalanga had also announced to the public where there were places that people could go for treatment. He had instructed Dr Pillay to inform all the provinces to adopt the strategy used by Kwazulu-Natal. 

Ms A Luthuli (ANC) stated that the Committee had heard that the strike would continue indefinitely. People warned that it would become even more intense. If this were to happen, would the DoH be able to keep the SANDF and SAPS engaged all this time?

The Minister replied that there was no such thing as an indefinite strike. In one way or another all strikes came to an end. However, when this strike came to an end, they would have to count the number of lives that had been lost. SANDF and SAPS would continue with their duties until they were not needed. The SANDF was not being deployed anywhere else in the world, so they would be able to help with the strike for as long as was needed.

Mr D Kganare (COPE) wondered if it was too late to negotiate a Service Level Agreement (SLA) with unions and to discuss the issue of intimidation and the rules of picketing.

The Chairperson repeated that the Minister had been called in to brief the Committee on the contingency plans that the DoH had to address the strike. They did not want to go into detail about how the strike should be handled and whether it was wrong or right.

The Minister replied that everybody had a right to strike, but SLAs stated rules under which a worker could strike. The rules of the strike were to decide how many doctors and nurses would remain in the hospitals. The problem was that workers in South Africa had not accepted this. SLAs could only be renegotiated after the strike. He did not think this venture could be taken on now while emotions were still very high.

The Chairperson thanked the Minister for the briefing and discussion. The Committee had gone beyond the time allocated to interact with the Minister so there was no time for any follow-up questions.

The meeting was adjourned.




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