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Signs of the Times Ahead? 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 Page$1 The$Greater$Horn$Outlook$0$Issue$#$28 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.
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