Activists call for more measured response to Tanzanian doctors’ strikeBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e4698 (Published 10 July 2012) Cite this as: BMJ 2012;345:e4698
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The Tanzanian Doctors Strike: A Public Health Crisis
The Doctors strike in Tanzania is no less than a public health crisis.
First and foremost, almost one month of skeletal service has already shown its effects on the chronically ill. As an example, one hospital reports a recent admission and fatality of a diabetic patient who had run out of medication normally dispensed from outpatient clinic. Cases such as these are likely to be the tip of the iceberg.
Secondly, the Governments recent action of dismissing over 360 interns, before their full registration is granted, has robbed the country of a much-needed group of medical doctors. Whether these trainees will wait, hopeful of being reinstated, or choose to take their expensive and high level of education into another field, perhaps in another country, will wait to be seen.
Thirdly, the unity of the medical profession lies in tatters. From a unified group after the attack on Dr Ulimboka they have successfully been divided and ruled upon. The recent intern dismissals have drawn only a weak response from their colleagues, while an increasing number have chosen to up and leave the country completely. The Southern African Development Community Embassies’ in Dar es Salam report 50 medical personnel who have chosen to seek work outside of the country since the strike started, a significant increase on usual numbers.
Fourthly and finally, although the Tanzanian health system is no stranger to strikes, general opinion is that this has been the worst in its history. Relations between the Government, Doctors and the Public are at an all time low. The Public do not trust either the Government or Doctors to be stewards of their Health. Those people that can afford will seek care privately or out of the country, and those that can’t will seek their own traditional healers before presenting late to seek medical care. Doctors are feeling bruised after heavy-handed punishment from the overly-pleased Government; neither will be keen to get back to the joint task of building their nations health systems. As it stands, aside from those Doctors that aren’t already looking to leave the country, others are looking to disassociate themselves from the Government either by working for private health care or setting up their own clinics.
The lasting damage that has been caused in the past month cannot be understated. In many ways, the original aims of the strike have been largely forgotten and are minor in comparison to its after effects. The challenge now is to rebuild a health system which is trusted by the people, and helmed by a cohesive and trusting partnership between Government and Doctors.
Competing interests: No competing interests
The current doctor's strike is only the latest in a series of strikes that have taken place in Tanzania over the past few years. There has been plenty of time to pre-empt the latest action. It is vital for all parties involved to resolve expeditiously and amicably the issues which have led to recurrent strikes by the doctors. It should be possible to put in place a framework for immediate and future negotiations regarding terms and conditions of service and renumeration.
Caught in the midst of this dispute are the patients who are not receiving the care they expect whether scheduled or as emergencies and it is possible lives may have been lost although figures are hard to come by. A country that had less than ten doctors at independence in 1961 has done well to have, fifty years later, 300 interns to sack and yet still have a viable health service. It is possible some of these interns may decide to stay home and wait for tempers to cool down on both sides, others may decide to join NGOs who offer more lucrative work, yet others may leave medicine to go into administrative work within or outwith the health service. Another option might be to leave Tanzania altogether and join the migrant health workers who are much sought after by those countries who cannot produce doctors fast enough to care for their populations. One hopes the current situation has not accelerated the potential brain drain from that country and exacerbated the status of Tanzania as one of the ten most 'under doctored' nations in the world.
Competing interests: No competing interests