LATIN AMERICA:
Epidemic of Strikes

Raúl Pierri


MONTEVIDEO, (IPS) - Last year public health workers held 37 national work stoppages in 12 countries of Latin America, highlighting the grave crises plaguing health systems that have few prospects of recovery.

Doctors and other health workers in Bolivia, Chile, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Nicaragua, Panama, Peru, the Dominican Republic and Uruguay held strikes last year that lasted from 24 hours to nine months, according to a study by Uruguayan journalist Julio Scavino, a consultant with the Pan-American Health Organisation (PAHO) Observatory on Human Resources in Health.

Motivating the walkouts were demands for larger health budgets, opposition to reforms of health systems undertaken by governments, and demands for the reinstatement of public health employees who had been laid off and recognition of health worker trade union authorities.

The strikes, which entailed a partial or total interruption of medical care, were mainly held in the public health systems, and largely affected the poor.

''I believe that what is needed is an analysis of the limits that these actions should have, due to the risks they pose,'' Scavino told IPS. ''The workers are obviously defending their rights. But perhaps a few aspects should be adjusted, and we should reflect on what the ethical limits should be.''

The reporter recalled, for example, that two babies died in Ecuador last month shortly after they were born in a park near a hospital that turned the expectant mother away because the workers were on strike.

''Is it enough to say that certain workers will attend emergencies? I believe a debate should be promoted on the interplay between the labour rights of workers and the health rights of the public, in a region where labour conflicts are frequent,'' he said.

''The organisations of health professionals and health workers answer to different sets of ethics, and this can generate vacuums in which the health rights of citizens are exposed to risks,'' said Scavino.

The largest number of strikes have been held in Bolivia. Doctors and other health workers staged 12 walkouts of up to 72 hours demanding better salaries and a larger health budget, and Health Ministry workers protested the dismissal of functionaries by going on a hunger strike and holding stoppages of up to 48 hours, says a PAHO report.

''Bolivia still has the lowest health budget of Latin America,'' the president of the Colegio Médico de Bolivia (Bolivian Medical Association), Dr. Miguel Zabaleta, commented to IPS. ''What we want is a better rationalisation of resources, but the government of President Carlos Mesa has admitted to us that it is bankrupt.''

Zabaleta acknowledged that public health strikes hurt the lowest-income sectors, and that doctors and other health workers often hold different views.

''I always try to avoid pressure tactics. It's easy to go on strike, but I don't think it's ethical, it isn't fair, it does not impact everyone equally. However, these actions are decided on by a majority on the Medical Association National Council,'' said Zabaleta.

He pointed out, nonetheless, that emergency health coverage is always maintained, while decisions on surgeries that have already been scheduled are left up to the doctors who programmed them.

''We understand the government's problems, but we need a larger budget to be able to generate more jobs in the sector. Bolivia has just four doctors per 1,000 inhabitants, the lowest ratio in the region,'' he noted.

Health functionaries, meanwhile, argue that going on strike is the only option in the face of the government's ''indifference.''

''We are aware that these measures affect the poor,'' said Galo Yupangui, the president of the Organización Sindical Unica (Sole Trade Union Organisation - OSUNTRAMSA) of Ecuadorian Health Ministry workers.

''But the question here is that the governments must be more willing to work out a peaceful solution,'' he told IPS. ''The governments do not understand what 'dialogue' means. But when we close down the hospitals, then they do sit up and listen.''

The trade unionist said Ecuador's health system is on the verge of collapse.

''In the past, 600 million dollars a year were allocated to the health budget, but for this year the total is just 340 million dollars, which means we are almost 50 percent under-financed. The government is determined to service the foreign debt and is leaving the health system in an irreparable situation,'' said Yupangui.

In the first six months of the government of President Lucio Gutiérrez, who took office in January 2003, Ecuador's doctors went on strike twice, once for 37 days, demanding higher salaries, while OSUNTRAMSA workers walked out for 48 hours in mid-December.

Yupangui, however, said the struggle for a larger budget is led by health workers, without the help of the doctors.

''We are the only ones fighting here,'' he complained. ''Their interests are backed by our struggle, but they don't move a finger.''

In Ecuador, between 25 and 30 percent of the population lacks regular access to health services, according to PAHO.

After Bolivia, the greatest number of health worker stoppages -- six -- were held in Peru, while four took place in the Dominican Republic.

''Doctors have not received a raise in 15 years,'' the dean of the Medical College of Peru, Isaías Peñaloza, said in an interview with IPS. ''A plan to make labour arrangements more flexible, through work contracts, is being implemented, which will reduce the job security of health professionals. And the health budget is not at all in line with reality.''

In Peru, nearly 40 percent of doctors and 50 percent of other public health workers are hired under temporary contracts, and the average monthly salary of physicians stands at 500 dollars.

Peñaloza recognised the adverse effects that strikes by public health sector workers have on the poorest sectors of society, but he held the government responsible.

''These measures obviously affect the normal working of the health system, and can cause damages due to delays in medical attention,'' he said. ''But we doctors also have our rights, especially after seeing our demands put off for 15 years.''