The$Greater$Horn$Outlook$0$Issue$#$28 GHEA Outlook

The Greater Horn of East Africa in Perspective

Public Sector Under Siege?

Signs of the times ahead?

Strikes in the health and education sectors

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1. Introduction Issue%Highlights:

It would be an understatement to $ $ $ $ $ $ $ $ Page say that the public sector in East 1.$$ $Introduction$ $ $ $ $ $ 2 Africa has had a tough 2012. In more ways than one, the stresses 2.$$ Global$driver:$moving$from$bed0nets$to$hard$hats$ 3 and limitations of the public sector, 2.1. A%move%towards%‘hard’%investments speci!cally in health and education, 3.$$ Where$are$all$the$doctors?$ $ $ $ 4 in providing essential services to the 3.1. A%Tanzanian%debacle people have caught up. Kenya and 3.2. Three%strikes%and%you’re%out! Tanzania’s public sectors were marred by chronic strikes 4.$ Doctor’s$in$Kenya$Stage$an$E0Strike$$ $ 5 throughout the year in what was 4.1. Doctors%Dig%In seen as a war of attrition between 4.2. #ADifferentWayToStrike the public sector unions and 5.$ No$Books,$No$Desks,$No$Teachers$ $ $ 7 government authorities. Legitimate grievances focusing on the state of 6.$Where$is$the$Government?$$$ $ 8 the public health and education 6.1. It’s%Our%Time%To%Eat…Again sectors in both countries were 6.2. Tanzania:% Promising% more% jobs% and% an% made. However, because neither AIDSNfree%generation side (government and the unions) 7.$Insights$$ $ $ $ $ 9 backs down in time for negotiated 7.1. Insight% #1% –% Are% the% strikes% about% settlements, it is the poor and general% healthcare% or% narrow% labour% vulnerable segments of the union%issues? population that bear the brunt of 7.2. Insight% #2% –%Strikes%R%Us%–%The%Domino% these strikes. Effect Is this burgeoning industrial action a 7.3. Insight%#3%–%Learning%the%wrong%lessons? result of a temporary squeeze on 7.4. Insight% #4% –% New% kind% of% thinking% and% the economies or is there much leadership%needs%to%be%nurtured more to it than meets the eye? For many East Africans, it is hard to explain the rationale of inadequate funds to invest in healthcare when all they see and hear is an apparently endless stream of praise about the East African economies growing at an unprecedented rate by regional and international media outlets and foreign investors. This Greater Horn of East Africa (GHEA) Outlook believes that the public sector is under siege as a result of a continental change in the prioritization from soft issues revolving around human development such as education, health and social welfare to hard

Page$2 The$Greater$Horn$Outlook$0$Issue$#$28 issues like infrastructure, This GHEA Outlook recaps a law and democratic practice may construction and energy. It is clear di#cult year in the public service diminish over the next few that investing in hard issues garner sector in the region and analyzes decades with emerging markets quick wins for those that invest, the broader implications of a (BRIC nations) and private equity and this is not just with the public sector under siege for the !rms not requiring caveats but national governments but poor and vulnerable. It also stable economic conditions. international partners such as the explores and compares the The second GHEA Outlook that Chinese. Its quick to point to responses of the governments in buildings, roads and new airports both Kenya and Tanzania. This pointed towards this trend was on than it is to point to slow success Outlook will also explore if there the ‘East African Budgets: $34 such as eradicating malaria or will be a ‘domino e" e c t ’ Billion For Whom?’ (GHEA Outlook investing in community health throughout the region that will Issue #27) where it was obvious that social services are not seen as workers, a predicament the United occur in 2013. States is realizing. It is no surprise a priority with respect to budget that the word ‘aid’ was only allocation, putting a squeeze on mentioned once and ‘trade’ was 2. Global the poor and vulnerable. mentioned 20 times in President driver: moving Perhaps the best way to capture Obama’s Sub-Saharan Africa this trend and the tell signs of the Strategy. from bed-nets consequences can be captured in Perhaps this shift was inevitable a statement made in November and it is an approach, which to hard hats 2011 by the junior United States primarily relies on a trickle down Senator from Delaware, and member of the Democratic Party, economics approach to 2.1. A m o v e t o w a r d s development. Having highways Chris Coons: ‘hard’ investments and good infrastructure will “America’s extensive public- eventually help and support the Two previous GHEA Outlooks took sector investments in Africa are people in need the most, the notice of the subtle shift in not as visible as those of China. traders and local entrepreneurs. priorities and investment from soft Many Africans point proudly to The trouble is when this shift projects to hard (infrastructure) led the Chinese-built road, along the continuum occurs at the projects. The !rst, ‘The Ascent of building, or hospital in their expense of soft issues, the public Hard Private Financing,” (GHEA capital without realizing that sector goes under a state of duress Outlook Issue #15) saw trends of many of the doctors or nurses because governments have to increased $ows of private money there have been trained by invest their hard earned revenues into the region, driven in part by Americans, medical supplies and donor funding on projects the signi!cant attention given by were provided by the US that demonstrate development, African governments to improve Government, and that many even in the abstract. As a result, the business climate in order to rural health clinics that are you have a doctors strike that attract (mostly foreign) private lowering maternal mortality gripped Tanzania for months and investment. National governments rates, vaccinating children, and Kenyan doctors and public are apparently more concerned at donating mosquito nets across servants going on Twitter to present with their respective ranks Africa are U.S.-funded. We may express their frustrations. Despite in the World Bank Doing Business be winning the war on the legitimate grievances Reports than in the UNDP Human disease, while losing the expressed by those in the public Development Reports. What is battle for hearts and minds sector it is the poor and vulnerable interesting is that the classic in Africa.” (our emphasis).1 that su"er the most because they caveats from Western donors such need and require government as respect for human rights, rule of In a conversation with this services the most. Outlook, Dr. Isaac Maro, a

Page$3 The$Greater$Horn$Outlook$0$Issue$#$28 Tanzanian physician and Director hospitals. The initial demands of Tanzania and President Kikwete. of Clinical Services at the DarDar the doctors were the sacking of The consequences of this second Health study, indicated that “Over high-level o#cials within the strike were stark, with an the years we have witnessed a Ministry of Health and Social estimated 2,700 patients a"ected reduction in !nancial budget Welfare; an increase in transport at the Muhimbili National Hospital allocated to health care services, and on-call allowances, an (the largest public medical facility human resources and the ministry increase in salaries for newly in Tanzania) and over 200 doctors at large. The central Government is employed doctors from 700,000 on strike. There were various keen on improving parts that are TZS ($440) to 3.5 million TZS stories of patients being left rather visible than service ($2,100) per month, medical unattended and consequently provision.” insurance and increased pay for dying as a result.3 other doctors to name a few. After These statements say a lot about “The overall impression a month of stalemates and the current trajectory and do not proclamations, the doctors and created is that the government bode well for vulnerable government came to a mutual is inclined to use more brawn populations. It is true that good understanding. than wit in dealing with serious roads, buildings and hospitals are social matters. This may be easy to point out and admire but It was only a month later in March e!ective in the short run.” 4 what good are these roads and that the doctors were on strike buildings when the people are again. The strikes were a protest Indeed Jason Lakin of the uneducated and unhealthy due to against a perception that the International Budget Partnership a lack of resources and human government was not holding up was right in the quote above, in capital in the health and education its end of the bargain by not !ring that the Tanzanian government was only putting a Band-Aid over a sectors? the Health and Social Welfare minister Dr. Haji Mponda and his deep wound. Matters escalated Deputy, Dr. Lucy Nkya. The strike after the doctors went on yet 3. Where are was “aimed at pushing for the another strike. ouster of the two top sector 3.2. Three strikes and all the ministry o#cials, either voluntarily by resignation or removal by you’re out! doctors? President Kikwete.” 2 On June 11, 2012 a number of health practitioners based in Dar 3.1. A Tanzanian debacle For many this was an extraordinary bold request as it put the es Salaam decided to go on strike once again. Dr. Stephan Ulimboka, The year was kicked o" by a government in a tight corner: no Chairperson of the Medical doctors’ strike in Tanzania, which government or President would Association of Tanzanians made immediately set the tone for 2012 want to be seen to capitulate to this statement “We are suspending by fueling mistrust between the the demands of a strike that was all services to patients to press for government and public sector increasingly been perceived as our rights; we will stop the workers. holding the country hostage. Rightly or wrongly, the doctors felt industrial action once the Doctors in Tanzania stopped going that these two individuals were government solves our problems.” to work and attending to their responsible for the unsatisfactory The demands were similar to the patients in late January and were remunerations and working strike earlier in March and the on strike for three weeks. They conditions. doctors felt that the government reached an agreement with the had yet again failed to keep its Tanzanian government in early The second strike left a bitter taste side of the bargain. February but essential services for amongst the population and Matters escalated signi!cantly a the Tanzanian people came to a resulted into a meeting between week after the third strike was standstill at major referral the Medical Association of

Page$4 The$Greater$Horn$Outlook$0$Issue$#$28 initiated. Dr. Ulimboka was The fallout from the Ulimboka Kikwete indicated that the doctor’s kidnapped, beaten and tortured event was ugly. This was especially starting salary at 957,000 by persons unknown and so from the outside looking where Tanzanian Shillings (close to $600) abandoned on the outskirts of the up until then many people felt that was double the starting salary of city. He was found severely injured Tanzania didn’t have a ‘dark side.’ other civil servants and the public at Mabwepande forest and many Tanzania’s President went on the sector pay accounts for 48% of the people believed he was left for record to dismiss reports that the government’s total spending.8 dead. The irony here is that Dr. government was responsible for Ulimboka had to be $own to the kidnapping and torture of Dr. The Ulimboka incident capped o" South Africa for treatment due to Ulimboka.5 Nevertheless the a pretty dismal !rst half of the year the severity of his condition. This damage was done as seen in the for the Tanzanian government and was perhaps more to deal with his headlines of The East African: ‘Is the its relationship with the public sector. Not only did the strikes safety but the symbolism was not demon seed about to germinate in lost in that there wasn’t much trust Tanzania too?’ or ‘Dark side of deepen a sense of unease and in the healthcare system that he Tanzanian state emerges from the mistrust between the people and was supposedly undermining, in shadows.’ Charles Obbo of the their government but they also Tanzania. Nation Media Group had this to failed to address the source of the problems and tensions that say: Although investigations on the regular Tanzanians were facing. It matter have been rather “The Ulimboka incident, like was apparent that the high cost of inconclusive there is a feeling past brief episodes of election living and high in$ation in amongst most Tanzanians that the violence in the Zanzibar islands Tanzania fueled and intensi!ed government was involved in the and the recent attack on anti-government sentiment. The Ulimoboka event. A Kenyan man Christian churches there by only problem is that public sector was arrested and supposedly Islamic radicals, suggests that workers were able to mobilize and confessed his involvement but not Tanzania too has the East !nd a voice at the expense of the many people were convinced by African “demon” seed. The more vulnerable population. this turn of events. The traction question is when will it break that conspiracy theories gained fully free and wreak havoc?” 6 said much more about the 4. Doctor’s in mistrust in government than Perhaps to add more suspicions to anything else. The spin by the the situation, the government shut Kenya Stage government was that the doctors’ down the weekly newspaper MwanaHalisi after it ‘revealed’ the strike was a"ecting every facet of an E-Strike Tanzanians and their lives that it names of state security o#cials was no surprise that tensions that were allegedly involved in the 4.1. Doctors Dig In boiled over. abduction and attack. “According to the statement that was issued On September 13, 2012 doctors in Some Tanzanian media outlets by the Ministry of Information, Kenya staged a strike that lasted were very vocal about the MwanaHalisi was suspended three weeks and public hospitals skepticism of the government’s because it published seditious only took on emergency cases. non-involvement. One paper, materials against the Newspaper Just as had happened in Tanzania, MwanaHalisi went as far as Act of 1976.” 7 this had an adverse e"ect on the publishing an article with a Swahili public health sector and put a In the end the government said it heading that translates to “Here’s severe strain on the public. The would raise the salaries of all the man that attacked Ulimboka” strike commenced after the expiry public sector workers by an and blatantly accused a of a 21-day notice that the Kenya estimated 15-20% for the government o#cial for leading the Medical Practitioners and Dentists 2012-2013FY. Even after the whole operation. Union (KMPDU) issued in a bid to Ulimboka incident, President

Page$5 The$Greater$Horn$Outlook$0$Issue$#$28 compel the government to dialogue and address the concerns that the The%#peremendemovement%5%selected%tweets doctors say are plaguing the health @ochiengmd: I've had to scrub out of surgery to go donate blood for sector. The strike ensued despite the patient am operating on. Unacceptable! #peremendemovement government's declaration that the #kot strike was illegal and the Medical Services assistant minister Kazungu @DrJobMogire: VPs posh new residence cost us over 900m; a modern radiotherapy machine worth 63m is una" o r d a b l e ? Kambi appealing to doctors, #peremendemovement pharmacists and dentists to ignore the strike and continue work. He @DrAnkitDave: Today wanted to refer a patient with head injury for a stated that the government had met CT scan. Guess what!? They have no money for transport, bill, scan. all the conditions that the union #peremendemovement wanted ful!lled before ending the @ochiengmd: Unacceptable that in 2012 100 ICU beds for 40 million doctors’ strike in the previous year. Kenyans #peremendemovement

Nevertheless, more than 2,000 @wambuiwaithaka: Per diem for both Minister’s medical trips to the doctors countrywide took part in USA – Ksh 2.95 million. What’s the limit on your medical cover again? the stando" that was called by the #peremendemovement their union. Patience wore thin as @MediaMK: Laughabple…@railaOdinga wants our election to be issue government failed to implement a based. Here is an issue you can tafuna on #peremendemovement return-to-work formula that ended a @kmpdu:@ochiengmd 49yrs post independence Kenya has no similar strike in December 2011. pediatric neurousuregeon & the only one training: me, has been !red? Furthermore Kenya’s striking doctors #peremendemovement went on to call the international labor organizations to intervene and @nyawira_jane: when you lose a diabetic patient because the relatives could not get a chemist open at 3am to buy insulin and a syringe guarantee the rights of workers in #peremendemovement their country. They hoped this would pressure the government to @wambuiwaithaka: the total cost of the parliament severance package meet their demands, after the can build 2 fully equipped national referral hospitals in Kenya. administration threatened to #peremendemovement withhold their salaries if they don’t return to work.

The doctors demanded the Government of Kenya spend more on healthcare, hire more workers, upgrade hospitals and build more health facilities. Some of the complaints the doctors made concerned the conditions in which patients had to undertake; forced to share beds, patients dying on the $oor of corridors without receiving treatment. Standard complaints of a lack of adequate equipment and necessary materials such as gloves or drugs and constant power outages were also made.

Page$6 The$Greater$Horn$Outlook$0$Issue$#$28 Kenyan public doctors demanded left a lasting impression and #peremendemovement and that the government pay a Minister Nyong’o apologized to doctor’s strike there. minimum of 92,000 Kenyan the public for the strike saying Shillings (KES) per month (roughly measures have been put in place Public school teachers in Tanzania $1,000) for registrars who work-in- to avert similar altercations in the went on strike demanding higher training at the Kenyatta National future. He even went as far as salaries due to the high costs of Hospital and Moi Teaching and praising the doctors for exposing living. An estimated 200,000 teachers across the country voted Referral Hospitals. Doctors also the challenges and de!cits that demanded higher pay from their exist in Kenya’s public health in favor of the strike ignoring calls current 80,000 KES monthly sector. The consequences were still from the government, including payment (roughly $948). stark as over 1,000 of the 2,000 President Kikwete, that such a striking doctors were !red even strike was illegal. Teachers demanded an increase in salaries 4.2. #ADi!erentWayToStrike though there is a signi!cant shortfall of quali!ed doctors. by 100% form their current base The doctor’s strike took an Nevertheless it seems as though salaries of 500,000 TZS (about interesting turn when the Kenyan 10 the doctor’s in Kenya were $300). The government indicated Public Health Minister; Anyang mobilized more e"ectively and they would be willing to increase Nyong’o compared the striking by 15% for the 2012-2013 !scal were able to make a more stark doctors to sulking children, and point than their counterparts in year. What was interesting to see asked publicly whether the Tanzanian. For one thing, the unfold during the teachers strike government should use its money doctors did not lose the goodwill was the counter strike by the for development purposes or give and support of the people as the students who demanded it out like peremende (candies in “Tunataka Haki Yetu” translated Tanzanian doctors did. The strike Kiswahili) to sulking children (the in Kenya came to a !rmer they wanting their right to be doctors).9 This triggered a creative conclusion than that of Tanzania, taught. and e"ective response by the most likely due to the Ulimboka doctors as they took to social “What is a fact now, looking incident, which in many ways media, speci!cally Twitter, to at the teachers and the a!ected dampened the mood of the express their grievances. Kenya is pupils is that the most a!ected striking doctors and distracted considered the second highest people by this teachers’ strike them from their end-goal. tweeting African nation, so such a are the have-nots majority of strategy was evidently going to be the population of this country e"ective. whose children attend public 5. No Books, schools or government owned The doctors created a Twitter schools.”11 hashtag #peremendemovement, No Desks, No which went viral and was quite Teachers Tanzania’s public education system e"ective. The doctors used this as has been under immense turmoil. a rally call for Kenyans to bring Former EAC Secretary General, about their attention on the At about the same time as the Ambassador Juma V. Mwapachu negligence of government and doctors were on strike, teachers in admitted as much when he told highlight their lack of prioritization both Kenya and Tanzania also took this Outlook on a previous into the health sector. the streets in protest of what they occasion after reviewing Form felt was a lack of prioritization in Four national examinations in Between October 1 and 31 the the education sector. Teachers in Tanzania where “87% of all #peremendemovement hashtag Tanzania began a strike in July students who took the had over 2.1 million impressions 2012, weeks after the Ulimboka mathematics exam failed.” and 6,113 tweets with an Scandal unfolded. While Kenyan estimated 10 tweets per hour (via teachers were on strike nearly the In Kenya, teachers’ strikes in Symplur Analytics). The movement s a m e t i m e a s t h e September 2012 paralyzed

Page$7 The$Greater$Horn$Outlook$0$Issue$#$28 government primary and and as a result responded timing was not convenient for the secondary schools. The teachers aggressively (Tanzania). One Government of Tanzania: from the nearly 300,000 strong interesting trend that was membership of the Kenya National common between the two “And how could Prime Union of Teachers (KNUT) countries is their lack of explaining Minister Pinda (lead mediator demanded a 300% pay rise while why there hasn’t been enough between the doctors and the Kenya Union of Post-Primary investment into the public sector government during the "rst strike) possibly go from coaxing Teachers, 47,000 members, while simultaneously increasing demanded a 100% increase. The their own government expenses/ doctors to dialogue one day to government responded with the salaries. announcing increased MP same justi!cations saying that it sitting allowances the next? would cost the government over 6.1. It’s Our Time To Eat… This latest tension created by our parliamentarians’ arrogant 400 billion Kenyan Shillings to Again meet the demands, something abuse of their powers is 13 they could not a" o r d . A Among the cynics in both Kenya wearing hard on everybody.” and Tanzania, there seemed to be compromise was made as both The timing was critical, especially no surprise when during the parties agreed to a pay rise of with the doctor’s being on strike height of the strikes in both 5,000 KES for the lowest paid and demanding higher pay. Mr. countries, Members of Parliament teachers to about 19,000 KES Rakesh Rajani, Head of Twaweza a (MPs) decided to increase their ($220) per month. This was a 40% Tanzanian civil society salaries. Perhaps the only increase; whilst higher level organization, addressed this 12 di"erence in this regard is that the positions won a 20% increase. speci!cally “This is purely motion was blocked in Kenya, University lecturers also got disrespect to the society, people while in Tanzania it was involved seeking better pay and are crying of life di#culties, conditions of service. approved…quietly. 6. Where is the Government?

The public sector strikes, in many ways, was also seen as a referendum and assessment on the role of government in implementing duties that by and large should be a priority. The strikes in both the education and health sectors were seen as a testament of failed government policies in delivering services for In January 2012, Tanzania’s doctors demanding better pay, yet the people. It was also a very open Parliament approved an increase you go on to increase your and aggressive challenge to the of sitting allowances for all MPs allowances. The government is government, and in some respects not too long before the doctor’s losing its touch to [sic] priorities.” 14 we saw two di"erent government strike was in full e"ect. The sitting responses, one that was seen as allowances were increased from Jenerali Ulimwengu of The East more accommodating (Kenya) and 70,000 TZS (about $45) per day to African was not impressed either: the other feeling rather threatened 200,000 TZS (about $125). The

Page$8 The$Greater$Horn$Outlook$0$Issue$#$28 “There was also the irritant of the proposed hike in parliamentary allowances, which sat very badly with the refusal to accede to the doctors’ demands. This was another demonstration of the shameless sel"shness of our politicians, to be observed in most African countries, where a political post is a licence to loot the Treasury.” 15

To add insult to injury, this Outlook was told by a Tanzanian Member of Parliament that in July 2012, not too look after the Ulimboka Scandal, MPs were given an increase in their salaries from about 7.5 million TZS ($4,700) per

month to 11 million TZS ($6,900). Source: The Economist This was done quietly for obvious Finance Bill but news broke about would have to work for 61 years to reasons. the addition. Just like the sitting earn the equivalent of a the Matters were not any better in allowances request in Tanzania, proposed MP bonus.17 This was the Kenya. Kenyan MPs are notorious the timing of such a request made second time in a span of six for being known as the highest things even worse. One of the months where MPs requested an paid members of government in main reasons, according to the increase in their salaries. To make the continent. In fact the salaries Government of Kenya, that they matters worse, in August 2012 the of Kenyan MPs and their chronic could not meet the demands of Kenyan National Assembly increases are quite common. In the doctors and teachers is that Speaker, when he called for an July 2010, The Economist ran the there wasn’t enough money to pay increase in MP’s salaries, he said it following chart regarding for them. President Mwai Kibaki was because the monthly salary politicians and their salaries. Kenya rejected the bonus on the was ‘too little’ and that they were tops the list as the ratio of a “grounds that it was ! r s t being paid peanuts.18 political leader’s pay to their unconstitutional, and secondly The following quote is made as a country’s GDP per person: untenable in the prevailing economic circumstances in the reference to Tanzania but could be What’s worse is that every year country.” 16 applied to most of the when parliament is in session, Parliamentarians in the region. there always seems to be a request The fact that it had to get to this “Every once in a while, they for higher pay. In October 2012, and would have passed without assemble in parliament and, on during both the doctors’ and the intervention of the President is behalf of the people they teachers’ strikes, Parliament testament to the severe represent, hike their salaries, requested a one-o" bonus prior to disconnect that exists between the allowances, bonuses, perks and the elections in March 2013 government and public. According freebies. The Treasury obliges. amounting to $105,000…in to the AFP and other news Some countries in our region addition to their estimated agencies, someone earning a house the best-paid politicians $10,000 monthly salary. It was minimum wage in Kenya on earth relative to GDP.”19 done quietly and attached to the (estimated at $1,500 per year)

Page$9 The$Greater$Horn$Outlook$0$Issue$#$28 Once again we are seeing labour union issue. Were the examples of a public sector that is 7. Insights grievances really about bene!ting looking out for their own pockets the public or was it just a matter of and making sure they get their self-interest? time to eat, at the expense of the 7.1. Insight #1 – Are the poor and vulnerable. Who’s strikes about general This Outlook asked a few doctors !ghting for the pockets of the healthcare or narrow labour about their take. A pediatrician based in Dar es Salaam indicated poor? union issues? that “it was a healthcare issue and it is really a testament to the fragile 6.2. Tanzania: Promising An interesting component to the state of public healthcare in more jobs and an AIDS-free doctors’ strikes in both Tanzania Tanzania, it is in a crisis.” The and Kenya is questioning whether generation pediatrician also countered any they were a healthcare issue or a Things get quite interesting when political rhetoric comes into play and when it does not match the realities on the ground.

Recently as the world marked World Aids Day, Tanzanian President Kikwete laid out plans to target zero HIV/AIDS new infections and related deaths by 2015. This was followed on from an agreement between the Tanzanian government and the Global Fund worth $308 million aimed at reducing mother to child transmission from the current rate of 6% to 4% and eventually 0%.20 This is an ambitious target but it is hard to leverage these targets with the public health sector that has been under siege the entire year.

In the GHEA Outlook issue #27, the Tanzanian government promised to create over 71,000 jobs in education, health and agriculture sectors. These promises are well and good but they simply do not match the realities on the ground highlighting a real disconnect between the government and people. How can jobs be created in a sector where the governments say there aren’t enough funds to improve the facilities, salaries and systems?

Page$10 The$Greater$Horn$Outlook$0$Issue$#$28 hints of perhaps a lack of housing allowances. There were no the government needed $250 investment in healthcare by the such empathy-seeking initiatives million to harmonize civil servants’ government, stating that: by the doctors in Tanzania. To salaries.22 In the short-term, the many, the strike was only making minister indicated, such funds “..the Government has been an already bad situation (public would be hard to secure. The most investing in the healthcare healthcare in Tanzania) worse. a"ected would be teachers since sector heavily for many years What compounded the situation they represent a third of the public but with no focus and without was that the doctors didn’t get any service workforce. Expect teachers appropriate prioritization of visible concessions from the to go on strike in 2013. This public major issues: issues that touch government. sector squeeze is a trend we will the end user of the service be seeing in the next couple of rendering all the e!ort and 7.2. Insight #2 – Strikes R years especially if the main lesson i n v e s t m e n t m a d e Us – The Domino E!ect that governments like the United inappropriate and therefore States and donor partners are worthless that translate into Listening to government o#cials seeing, is trade over aid, and poor performance and delivery speak, particularly in Tanzania, a infrastructure over bed nets. More of healthcare services.” sense of resistance against the risk strikes will surely grip the region in of endless demands of public What was interesting in the 2013. sector workers emerges. “Today it’s Tanzania case and one could make the doctors, tomorrow it’s the 7.3. Insight #3 – Learning a strong argument that it was teachers then the garbage purely a union issue was the the wrong lessons? collectors then the police!” claimed demands the doctors made. As a former Member of Parliament. There should be a real concern in soon as the doctors demanded Such sentiments revealed the fear the types of lessons that most that the Minister of Health and of government being held hostage donor partners and governments other senior o#cials be sacked (a by public sector workers. It was are heeding from the shift of focus demand that was loudest during not an unjusti!ed fear. on soft issues towards hard issues. the second round of strikes), the The trouble with this trend is the rationale for collective action Soon after the doctor and teacher perceived certainty that a focus on morphed from concerns about strikes, Kenya’s nurses downed infrastructure, roads, buildings etc. healthcare issue to labour union tools. The nurses were demanding has a more direct, positive impact grievances. both better pay and equipment on the poor and vulnerable. How and improved medical supplies to Public support was lukewarm as can we be so sure and at what all public health centers. The strike Tanzania’s doctors never cost? How much deviation will be forced hospitals to turn away highlighted the healthcare de!cits allowed from soft issues, namely patients leaving doctors to only in same way that Kenya’s the public sector, to hard issues attend to emergency cases. Similar #peremendemovement did. To that are usually coordinated with polarizing statements were made many Tanzanians the strike action public-private partnerships? From like those of the peremende was motivated by doctors pay and the outset it looks like many movement when the Director of livelihood improvement issues. In governments are getting too Medical Services, Francis Kimani, Kenya, the #peremendemovement bogged down in trickle-down stated that nurses and other e"ectively mobilized the public to economics at the expense of the health workers provided poor be pro-strike because they could public sector. Perhaps investing in services because of their poor relate to the stories. They targeted infrastructure and energy alone training.21 the government and their lack of (hard issues) and banking on this resource prioritization. The There were reports of nurses in trickle down is a risky a"air. movement focused more on Burundi going on strike in early The assumption here is that paved healthcare quality and lack of December 2012. Burundi’s Public roads will help people in the rural equipment than on doctors’ Service minister had indicated that

Page$11 The$Greater$Horn$Outlook$0$Issue$#$28 areas and improve the livelihoods lost some extremely expensive Unless the leadership cadre (both of the poor and vulnerable. Hadeel sta!, the public has lost out on public and private) acquires and Ibrahim, Director of Strategy and health professionals, and actively uses the necessary skills External Relations of the Mo Tanzanian doctors have and knowledge to confront and Ibrahim Foundation, an skipped out on their public address the various and organization that deals with service.” 24 multiplying challenges that they promoting good governance and are bound to face, it is not likely leadership in Africa spoke to this in 7.4. Insight #4 – New kind that there will be much traction a conversation with SID.23 She of thinking and leadership gained in winning over public indicated, that “maybe there has needs to be nurtured sector workers to their side. The been too much faith placed in context in which both government trickle-down economics but I In view of the new reality in which and the private sector must would also question whether we donor (and national) investments operate is increasingly driven by have had enough investment in are focused on infrastructure complex dynamics and infrastructure.” However, she spoke development at the expense of interlinkages, which require to this issue of trickle down and ‘soft’ issues of human specialized knowledge. We can unregulated private sector is not development, there needs to be safely surmise that the era of the only solution and “we have to nurtured a new leadership know-it-all politicians and be very clear about what markets commitment to ensure that the managers is over and that populist can deliver and what governments latter is not sacri!ced at the altar pronouncements and postures will need to deliver and the of the former. It is increasingly not necessarily converge with the relationship between the two.” clear that in the lack of evidence of reality of markets, investment or trickle down gains, the even the challenges of attaining a It is true and commendable that honeymoon period in which all vision. We can also safely assume the Greater Horn of East Africa citizens were enthralled by their that more strikes will occur, and (GHEA) should be treated as an growing economies has come to the demands will be even bolder equal partner in terms of trade and an end. As inequality gaps grow, than previous industrial actions, as economic development. There is a paradoxically, it will be a result government and other tendency to deliver quick wins and professionals – who are better public institutions should plan and garner the respect and ‘win hearts placed to understand the extent to anticipate them and invest in and minds’ amongst the which the wool is being pulled social spaces. Strong arming the constituents by building the paved over the public’s eye – who will unions or using brute force to roads, high-rises etc. in hopes to lead the charge against those in scare public sector workers into get the appreciation. In the long the citadels of power. There is a submission will not work forever. run though, this comes at a cost risk that myopic and intransigent Having better negotiating and and the cost is a slow and painful positions adopted by the communication skills will also squeeze on the poor and governments might contribute to help. Dr. Maro spoke to this when vulnerable populations, the ones deepening social con$icts, which – he explained the strikes in that are so dependent on the as always – will count the bulk of Tanzania resulted from poor public sector that deal primarily their victims amongst the poor communication between the with the soft issues. As Elsie and vulnerable. As such there doctors and the ministry. Eyakuze summarizes the entire needs to be developed within Institutions did not take things doctor’s strike in Tanzania, in the government, but also within trade seriously “It seems like responsible end it is a three-way loss, with the unions and civil society bodies did not see any ill e"ects poor being the biggest losers: organizations capacity for dealing that would result from this minor “In the bigger scheme of with sticky problems, complex !nancial problem.” negotiations as well as foresight. things, this feels like a three- Clearly the problems of the future way loss: The government has can no longer be faced with the

Page$12 The$Greater$Horn$Outlook$0$Issue$#$28 same kind of thinking that has 9.Kimani, S. (2012) ‘Kenya’s striking 23. Development Journal, “African resulted in the hobbled doctors turn to Twitter’, http://bit.ly/ Strategies for Transformation” Vol. development approaches that we Ww7yHs 55.4, December 2012 are currently navigating. But more 10.Reuters (2012) ‘Tanzanian teachers 24.Eyakuze, E. (2012) ‘Beatings, importantly, a new kind of in strike over pay’, http://reut.rs/ sackings don’t you just love thinking is needed to revisit the Y0wpnN democracy?’ The East African, http:// bit.ly/YpyFcl social contract that binds citizens 11.Kuhenga M.W. (2012) ‘Teachers’ and state together. Such a process strike and plight of our pupils’, http:// will necessarily revisit rights and bit.ly/WoB7tD The$Greater$Horn$Outlook$is$ published$by$the$Society$for$ responsibilities of each party. 12.BBC News (2012) ‘Kenyan schools There should also be a focus not reopen after teacher-strike deal’, International$Development$as$ only on how to weave functional http://www.bbc.co.uk/news/world- part$of$the$Searchlight$and$ safety nets for the weaker africa-19713784 Trend$Monitoring$Project$of$ segments of society but come up 13.Eyakuze, E. (2012) ‘Doctors’ strike: the$Rockefeller$Foundation. with creative ways of ensuring Pinda loses the healing touch’ The East their sustainability over time and African, http://bit.ly/Y0wxDG Disclaimer:$The$views$ not leave them at the whim of the 14.Ernest, S. (2012) ‘Now Ikulu expressed$in$this$publication$ changing winds of donor and distances JK from Bunge Allowances’ do$not$necessarily$reflect$the$ investor tastes. The Citizen, http://bit.ly/XyY5gS views$and$opinions$of$the$ 15.Ulimwengu, J. (2012) ‘Bitter Pill: Govt. caves into doctors after Rockefeller$Foundation$nor$of$ Endnotes unnecessary posturing and the$Society$for$International$ stonewalling’ The East African, http:// Development. 1.Statement by Senator Chris Coons bit.ly/WoBhkw (November 2011), http://1.usa.gov/ 16.BBC News (2012) ‘Kenya President Photo%credit:%Cover%page%N% W2lk7k Mwai Kibaki rejects MPs’ bonus Kenyan%doctors%on%strike%in% 2.Ibid attempt’ , http://www.bbc.co.uk/ Nakuru.%Copyright%©,%Alex% news/world-africa-19892524 KimKim 3.Balile, D. (2012) ‘Doctors’ strike in 17.Ibid Tanzania impacted thousands of ©$Copyright,$2013$O$Society$for$ patients Sabahi, http://bit.ly/148AquN 18.Leftie, P. (2012) ‘Speaker says MPs International$Development$ deserve an increase in their salaries’, 4.Lakin, J. (2012). ‘Doctors’ strike: When (unless$specified$otherwise). govts. cut o" $ow of information, they http://bit.ly/YpysFS get gangrene. The East African, http:// 19.Ulimwengu, J. (2012) ‘Are you a Permission$should$be$sought$ bit.ly/VljiAI quali!ed teacher or doctor? Better run from$SID$prior$to$reproducing$ for MP then, instead of going on 5.BBC News (2012) ‘Tanzania’s Jakaya portions$of$this$work$in$any$ Kikwete denies Steven Ulimboka strike’ The East African, http://bit.ly/ torture’, http://www.bbc.co.uk/news/ WWtIAW form$or$by$any$means.$ world-africa-18671315 20.Daily News (2012) ‘Kikwete targets Permission$will$normally$be$ 6.Obbo, C. (2012) ‘Is the demon seed zero HIV infections by 2015’ The Daily granted$on$condition$that$the$ News, http://bit.ly/WoBuEl about to germinate in Tanzania too?’, source$is$acknowledged. http://bit.ly/11Tt4LW 21.Daily Nation (2012) ‘Wards Society(for(International( 7.Heilman B. and John, W. (2012) deserted as nurses dig in’ The Daily ‘Countries at the Crossroads 2012: Nation, http://bit.ly/W0WhAt Development Tanzania. Freedom House Report, 22.Kanuni, P. (2012) ‘Burundi under via$Ardeatina$802 http://bit.ly/10TUHpc pressure over public service pay’ The $Rome,$00178,Italy Africa Review, http://bit.ly/WWtQk1 8.Ng’wanakilala, F. (2012) ‘Tanzania www.sidint.net president denies doctors’ leader torture’, http://reut.rs/14cSVNP twitter:$@SidEastAfrica

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