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
Tanzania’s fragile public healthcare system has been severely damaged by the government’s approach to industrial relations, says a group of religious leaders, opposition politicians, and trade unionists. They are calling on the government to reconsider its decision last week to dismiss 300 striking doctors to try to resolve a long running dispute over pay and conditions.
Tanzania has one of the world’s lowest ratios of doctors to population, with only one trained doctor per 30 000 people, the United Nations Development Programme says, so can ill afford to lose so much of its workforce. In the United Kingdom the proportion is one per 440 people, and in South Africa it is one per 1200.
A ninth of Tanzanian children die before their fifth birthday. One in 24 Tanzanian mothers will die during childbirth.
Junior doctors in state hospitals have been involved in a series of strikes since last January. The government has dismissed doctors’ demands that their salaries be tripled—from 950 000 Tanzanian shillings (£390; €490; $620) a month to 3.5 million shillings—and has offered a maximum of 1.2 million shillings, noting that doctors already earn double the average salary of other public sector workers.
The government obtained an injunction against the strike on 22 June, which was largely ignored; and then the situation was greatly inflamed by the mysterious kidnap and beating of the striking doctors’ leader, Stephen Ulimboka.
Ulimboka was found bound, gagged, and badly injured in Pande forest on the outskirts of Dar es Salaam the day after being kidnapped by unknown assailants on 26 June. He is currently in intensive care in hospital in Johannesburg after having been flown out of the country for his safety, said the secretary general of the Medical Association of Tanzania, Edwin Chitage.
The government has denied any involvement, but last week an opposition spokesman used parliamentary privilege to name a policeman from the Criminal Investigation Department whom Ulimboka had claimed was one of his assailants and called for an independent inquiry.
On 7 July a group of religious leaders and activists issued five conditions to the government that they suggested were needed to end the dispute. These included withdrawal of the lawsuit on the strike filed by the government at the High Court, reinstating all sacked doctors, and resumption of negotiations. They also demanded that the government give assurances on the security of doctors and the establishment of an independent commission of inquiry to investigate the kidnapping of Ulimboka.
The local Guardian on Sunday newspaper estimates the average cost of training a doctor in Tanzania at $40 000, which means that the 300 doctors sacked last week cost the taxpayer $12m to train.1
One of the strikers’ supporters told the BMJ: “There are many countries nearby and further afield who would be happy to receive more doctors, especially when they have not paid a penny for their training. If Tanzania wishes to retain their highly educated and skilled native doctors they must surely find a way out of their current impasse. Beating doctors into submission seems an ill advised way of going about this.”
Cite this as: BMJ 2012;345:e4698