25th July, 2004  Volume 11, Issue



















Health sector in terminal stage

By Shehan Moses 

With the Health Sector Trade Union Alliance (HSTUA) threatening to go on strike tomorrow (26) following the failure of provincial health authorities to implement the order made by Premier Mahinda Rajapakse to grant salary hikes accordance to the February 2 ad hoc circular, chaos continues to reign within the health system in Sri Lanka.

Last year during the United National Front (UNF) regime, approximately 100 days of work for health services personnel were lost due to unwanted trade union action causing severe inconvenience to the public. Apart from striking on salary issues, HSTUA held a strike last week at Kandy General Hospital because a union member was transferred, which they claim was a deliberate action taken by authorities.

The reason behind this kind of trade union action is basically the salary issues faced by different categories of employees within the health sector. Trade unions representing minor staff -HSTUA, Assistant Medical Officers-Society of Assistant and Registered Medical Officers (SRAMO), and unions representing the government medical officers - Government Medical Officers Association (GMOA) are in competition with each other to strike on salary related issues, thereby paralysing the health system in Sri Lanka.

Various strategies

Governments both past and present have resorted to various strategies to solve this issue. However, their efforts have failed due to the inconsistency within the health system in Sri Lanka. The UNF government during the year 2002 appointed a committee headed by Additional Secretary to the Ministry of Health, Dr. Nihal Jayatilake, to solve the crisis. According to recommendations of this committee a circular was issued.

"According to this circular Assistant Medical Officers (AMO) and Registered Medical Officers (RMO) would receive a higher pay than us," said Spokesman, GMOA, Dr. Annuruddha Pahadeniya. He told The Sunday Leader that this circular would not only generate salary anomalies but also affect promotions within the health sector. Another attempt was made this Februrary by the former UNF regime to solve this problem. An ad hoc circular was issued to increase salaries of all categories of employees within the health sector. This effort however failed to resolve the crisis, since salary hikes were granted only to the central government employees of HSTUA leaving out around 40,000 members of provincial councils. Furthermore, AMOs and RMOs salaries hikes were temporarily halted on February 6, by the Health Ministry.

PM promises

"How can the Ministry cancel our salary hikes when other sectors received their salary hikes, despite this circular being approved by the cabinet," spokesman, SRAMO, Dr. S. Jeewakarathne told The Sunday Leader. Additional Secretary Health Ministry, Dr. Nihal Jayatilake told The Sunday Leader that the Ministry had to suspend the ad hoc circular for SRAMO members due to disparities between the SRAMO and the GMOA. However he declined to comment further, saying that this issue has been forwarded to the Tissa Devendra committee for a solution. Jeewakarathne said that Prime Minster Rajapakse had promised a final solution before September 1. However, he warned that if the PM fails to keep his promise they would resort to trade union action without any prior notice. "We have stated this in the letter we sent to both the Prime Minster and the Health Minister," he emphasised.

Deadline issued

Co-Convenor, HSTUA Saman Ratnapriya, told The Sunday Leader that they have given the government a limited time frame to solve their problem. According to Ratnapriya, the Prime Minister had ordered authorities of provincial councils to provide the necessary pay hikes for the remaining casual and substitute employees of HSTUA. "Why aren't the provincial councils following the orders of the Prime Minister?" queries Ratnapriya. Prior to the recently concluded provincial council election, the HSTUA threatened to take trade union action. It was then that the Prime Minister intervened to postpone the strike, promising solutions before July 15.

Last month around 80,000 workers of HSTUA took sick leave and participated in a one day stoppage throughout the island. On the same day more than 10,000 workers demonstrated in front of the Health Ministry to voice their demands.

Repeat of September 2003?

UNF regime faced a crucial period last September when HSTUA organised an islandwide strike paralysing the entire health services system, which eventually led to the government having to seek the assistance of the armed forces as a substitute for minor staff. Though the HSTUA has waged many protracted campaigns for increased pay, and at one point even accepted various UNF promises, many of these have not been fulfilled, according to sources. The UNF government was finally forced to grant a 40% in installments in Februrary, to avert a health crisis in the country.

HSTUA, an alliance of around 50 public health sector unions comprise about 80,000 members islandwide. This union is considered the largest health sector trade union in Sri Lanka and covers non-medical staff of the public health sector as well, including clerks, midwifes, hospital attendants, substitute workers and a section of nurses. Most of these employees are low paid and have supported a lengthy campaign for decent wages.

HSTUA demands

While HSTUA and SRAMO are urging the government to increase salaries according to the ad hoc circular issued on February 2, the GMOA wants this circular to be proscribed by the government.  "This circular is extremely unbalanced and will place a huge burden on the government," stressed Pahadeniya. According to Pahadeniya, if the government goes ahead with this circular it would cost the treasury around Rs. 35 billion in additional payments for salaries to staff of health sector alone. He said only 75% of salary anomalies in the February 2 circular have been implemented. Therefore he suggests that the Tissa Devendra Committee should immediately halt the balance 25% being implemented, while the already implemented 75% should be revised or at least temporarily halted.

Countering the view of the GMOA, Ratnapriya emphasised that if the GMOA wants the ad hoc circular issued on February to be cancelled, they should first cancel the circular issued last September that provided the GMOA a salary increase of around 45%.

GMOA opposes

But Pahadeniya points out that the February 2 circular would provide nurses or matrons with a higher salary than medical officers, which he terms extremely unfair. He points out that it is the doctors that take full responsibility for patients. "We can substitute the minor staff quite easily, but how can we substitute a medical practitioner?" he asks. According to Pahadeniya salaries of employees in the health sector should be based on authority and responsibility. "We have to undergo extensive training for more than seven years. Therefore we should receive a better salary than other sectors of the health service," he said.

In a letter sent to the Public Sector Salary Review Committee, the GMOA has recommended that the criteria followed in the salary structure of the judicial service should be adhered to in the health services sector as well.

However, according to Ratnapriya, issues claimed by GMOA regarding salaries and authority are fragmented and aimed at misleading both the public and authorities. But the GMOA has insisted that the Tissa Devendra Committee look in to the salary anomalies of the health sector and come up with a solution. "Experts should handle this matter not medical officers in the Health Ministry. This committee consists of specialists who can approach the problem positively," pointed out Pahadeniya.

However, SRAMO and HSTUA are not keen to have the Tissa Devendra Committee deal with this matter but are simply insisting that the ad hoc circulars issued on February 2 should be implemented.

"Not our problem"

In its election campaign, the UPFA played on widespread public discontent over low living standards, making a series of promises to workers and the rural masses. During this period, the UPFA promised all health employees that they would rectify their salary anomalies and bring about a permanent solution to their grievances. However, recently Health Minister, Nimal Siripala De Silva stated that these problems were created by the previous regime and was not of his own making. According to economists however, the UPFA is under pressure to rectify the necessary anomalies which would cost the government large sums of money, despite the International Monetary Fund (IMF), World Bank and other donor agencies withholding US$4.5 billion in economic aid, pending peace talks with the LTTE and economic reforms being implemented.

Last year the Janatha Vimukthi Peramuna (JVP), one of the UPFA's main coalition partners, led health unions to action. The All Ceylon Health Services Union (ACHSU), which postured as the most militant union within the HSTUA, left the alliance several months ago, while its leaders are doing their best to undermine the joint struggle, according to a member of a health sector trade union.

According to sources, last month, senior members of ACHSU met with Health Minister, Nimal Siripala De Silva and distanced their union from the HSTUA by stating that the Minister had promised to solve their problems.

Meanwhile, the JVP in their trade union newspaper Ratu Lanka, said that certain trade unions were involved in a conspiracy to topple the government. According to them the conspiracy would take place in five stages. The first stage would be a media campaign against the government, the second stage is to identify fields where they possess influence, thirdly to inform workers that salary increases have been scrapped and instigate trade union struggles in those fields and finally to spread discontent about the UPFA government.

Rejecting these allegations, Ratnapriya said that the JVP was no longer fighting for the rights of trade unions and are instead working to safeguard the government. "When they were in opposition they too joined us in trade union action. However, today, they are betraying thousands of the very workers they incited to action," he emphasised.

Strike next week?

Accordingly, all three trade unions have warned of drastic union action if the government fails to implement their demands. "If the government fails to implement the promises by providing a salary increase according to the circular we would resort to trade union action next week," said Ratnapriya. According to Ratnapriya, Castle Street Hospital, De Soyza Hospital, Cancer Hospital and Lady Ridgeway Hospital employees would not participate in the strike.

According to Dr. Pahadeniya, if the government implements further ad hoc circulars to solve this crisis they would in turn take trade union action. "As a responsible union we are trying our best to avoid trade union action. However, if the government tries to give in to the demands of HSTUA employees we would certainly take action," said Pahadeniya.

Despite these trade unions threatening to take trade union action if their demands are not met, the Public Service United Nurses Union (PSUNU) said they would refrain from trade union action. PSUNU said that Prime Minister Mahinda Rajapakse agreed to resolve the salary anomalies faced by their union following successful discussions.

Meanwhile, according to Dr. Jayatilake, all issues have been forwarded to the Tissa Devendra Committee for action. "Presently the Ministry will not make salary anomaly revisions," Jayatilake pointed out.

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