Strike cripples health services in South Africa

BMJ 2007; 334 doi: (Published 14 June 2007) Cite this as: BMJ 2007;334:1240
  1. Pat Sidley
  1. Johannesburg

    Some 600 nurses have been fired from South Africa's public hospitals for taking part in a large civil service strike that has crippled many hospitals, schools, and other government services. The strike, which is largely about pay and conditions but also signals civil servants' opposition to the government's economic policy, has led to many health services effectively shutting down, while others are taking only the most critically ill patients.

    The dismissal of the nurses has added new impetus to the strike, which has been running for two weeks and shows no signs of ending.

    Nurses, the government maintains, are emergency workers and are not allowed to strike. However, this has not stopped tens of thousands of them, together with other hospital staff across the country, from striking, many of them chanting and dancing angrily outside their hospitals.

    Media reports have claimed that patients have died because of the lack of ambulances or because hospitals are providing only limited services. Patients with HIV or AIDS and tuberculosis are also being denied their regular treatment because of clinic closures, they say.

    The Chris Hani Baragwanath Hospital, one of the largest hospitals in the southern hemisphere, has been forced to fly premature and sick babies in incubators by helicopters to private facilities. Hundreds of critically ill patients have also been transferred from public to private hospitals, for which the state will have to pay.

    The government has sent army personnel into several hospitals to perform cleaning duties and provide nursing care where they have the skills, as well as to fly helicopters. Police have been stationed outside hospitals to try to control violence and intimidation aimed at hospital workers who show up for work, although some police officers have also been accused of brutality.

    The strike is technically about wages but has a large political undertone. The Congress of South African Trade Unions, although allied to the government, is implacably opposed to President Mbeki's economic policy, which the congress says provides tax benefits to rich people while neglecting social services. Unusually, this strike has united several different unions and union federations, illustrating the deep anger and frustration among government employees at government policy, pay, and working conditions. Staff at private health facilities have also threatened to strike in support of their public sector colleagues.

    Although doctors are paid through the same system, few are on strike. Those doctors and nurses still working, however, are not dressed in white coats or uniforms, for fear of violence and intimidation.

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