bmj article-on-tanzania-doctors-strike

Activists call formoremeasured response to Tanzaniandoctors’ strikePeter Moszynski

London

Tanzania’s fragile public healthcare system has been severelydamaged by the government’s approach to industrial relations,says a group of religious leaders, opposition politicians, andtrade unionists. They are calling on the government to reconsiderits decision last week to dismiss 300 striking doctors to try toresolve a long running dispute over pay and conditions.Tanzania has one of the world’s lowest ratios of doctors topopulation, with only one trained doctor per 30 000 people, theUnited Nations Development Programme says, so can ill affordto lose so much of its workforce. In the United Kingdom theproportion is one per 440 people, and in South Africa it is oneper 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 seriesof strikes since last January. The government has dismisseddoctors’ demands that their salaries be tripled—from 950 000Tanzanian shillings (£390; €490; $620) a month to 3.5 millionshillings—and has offered a maximum of 1.2 million shillings,noting that doctors already earn double the average salary ofother public sector workers.The government obtained an injunction against the strike on 22June, which was largely ignored; and then the situation wasgreatly inflamed by the mysterious kidnap and beating of thestriking doctors’ leader, Stephen Ulimboka.Ulimboka was found bound, gagged, and badly injured in Pandeforest on the outskirts of Dar es Salaam the day after beingkidnapped by unknown assailants on 26 June. He is currentlyin intensive care in hospital in Johannesburg after having been

flown out of the country for his safety, said the secretary generalof the Medical Association of Tanzania, Edwin Chitage.The government has denied any involvement, but last week anopposition spokesman used parliamentary privilege to name apoliceman from the Criminal Investigation Department whomUlimboka had claimed was one of his assailants and called foran independent inquiry.On 7 July a group of religious leaders and activists issued fiveconditions to the government that they suggested were neededto end the dispute. These included withdrawal of the lawsuit onthe strike filed by the government at the High Court, reinstatingall sacked doctors, and resumption of negotiations. They alsodemanded that the government give assurances on the securityof doctors and the establishment of an independent commissionof inquiry to investigate the kidnapping of Ulimboka.The localGuardian on Sunday newspaper estimates the averagecost of training a doctor in Tanzania at $40 000, which meansthat the 300 doctors sacked last week cost the taxpayer $12mto train.1

One of the strikers’ supporters told the BMJ: “There are manycountries nearby and further afield who would be happy toreceive more doctors, especially when they have not paid apenny for their training. If Tanzania wishes to retain their highlyeducated and skilled native doctors they must surely find a wayout of their current impasse. Beating doctors into submissionseems an ill advised way of going about this.”

1 Sacking doctors who cost Sh20bn. www.ippmedia.com/frontend/index.php?l=43405.

Cite this as: BMJ 2012;345:e4698© BMJ Publishing Group Ltd 2012

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BMJ 2012;345:e4698 doi: 10.1136/bmj.e4698 (Published 10 July 2012) Page 1 of 1

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