The West African Health Sector Unions’ Network held its 13th Plenary Session on May 19-22, 2015 at the Palais de Congres, Niamey, la Republique du Niger. Present at the Plenary were heath sector trade unions from Burkina Faso, Cote d’Ivoire, Ghana, Liberia, Niger, Nigeria, and Sierra Leone committed to developing public healthcare delivery in the Sub region and defending the interests of the members of health unions. The opening ceremony of the meeting was attended by Dr Idrissa Maiga Mahamadou, Secretary General of the Nigerien Ministry of Public Health and Liaison Officer of the West African Health Organisation (WAHO) Boubacar Bobaoua, Secretary General of the Syndicat Unique de la Santé et de l’Action Sociale (SUSAS) du Niger amongst others.  

 

OBSERVATIONS

 

In the course of extensive deliberation, the network recognised among other things, that:

The rolling back of the menace of Ebola Virus Disease is very much welcome. Slackening of bio-medical and social alertness to ensure a resurgence of the EVD never occurs in the West African sub-region can however be identified in several national health systems. But considering the endemic mature of the hemorrhagic disease, eternal vigilance is of utmost necessity. Further, there is a near absence of necessary psycho-social care and assistance for survivors of the Ebola Virus Disease in Sierra Leone, Guinea and Liberia;

Public healthcare delivery remains grossly underfunded. Despite the fact that the Abuja Declaration of April 2001 by African Heads of States for 15% of national budgetary provisions to be set aside for public health was signed in Nigeria, a country within the sub-region, there appears to be no country in West Africa that has met this commitment, unlike the subsisting situation in some other regions of the continent;

Occupational health and safety for healthcare workers is nothing to write home about. The high proportion of healthcare workers who lost their lives amongst those killed by the spread of the Ebola Virus Disease is a testament to this horrendous reality. Improved safety and health at work is of utmost importance for healthcare workers to adequately deliver the critical services we provide to the public;

The career progression of nurses in Cote d’Ivoire is stunted by the absence of a scheme of service resulting in the dampening of morale as it delimits the opportunities for their career progression;

Nursing in Nigeria is the only core health profession in the country where would-be personnel are not allowed to undergo internship during their under-graduate academic programme. This is despite a court ruling in favour of a unified scheme of services for Nigeria Nurses and midwives;

In 2005 the Niger State decided to make free care for vulnerable populations, as all African leaders have recommended in the declaration of the African Union in Kampala in 2010. In 2006, the country has implemented a policy of free care for pregnant women and children under 5 years of age (who are now 90% to access health services, against 34% previously). Today in Niger, 90% of women receive antenatal care. There are a few years, they were only 38%. Yet despite these dramatic advances, free health care is threatened because the State proves deadbeat from health care services that practice free: it has nearly 22 billion CFA francs (33.5 million euros), according to the Ministry of Public Health of the Republic of Niger.

Burkina, there was a state decision for Universal Care coverage and in practice nothing is done. The unions are appiling on the new government to implement the decision;

The qualitative and quantitative shortage of human resources for health is a major obstacle to the fulfilling the goal of Universal Health Coverage. Understaffed and with personnel not adequately accessing re-training to re-tool them within the context of new and mutating bio-medical challenges, healthcare facilities, which in themselves are equally inadequate, can hardly meet up with the challenge of providing quality health to citizens of the countries in the sub-region. This situation is compounded by the freeze on employment in the health sector in some countries like Ghana. The hitherto insufficient ratio of health professionals to the population has thus plummeted

 

The quest for Universal Health Coverage appears to be a mirage. Apart from staffing norms, dilapidated health infrastructure, the national health insurance schemes of countries in the region still cover only small fractions of the population. The contents of coverage are also not sufficient to achieve universal access to quality health services in the near future;

 

There is increasing economic hardship for working people in the sub-region even in countries that have witnessed relatively impressive GDP growth over the last few years. The adoption of neoliberal policies that have been discredited by the current global economic crisis as the pathway to growth privileges an infinitesimal minority of population in benefiting from the social wealth. The burden on the poor masses is worsened by corruption in high places and economic ineptitude;

The neoliberal mantra of free market is selectively upheld. Where the practice of this could lessen the yoke of workers and other common citizens, this is observed only in the breach. The Plenary Session observed that despite the global fall in oil prices, domestic prices have risen in oil producing countries like Ghana and in others like Nigeria there is a crisis of supply with long queues in fuel stations and a thriving black market where petrol is sold at 287% of the official price;

The remuneration of working people in the different countries across the sub-region still remains abysmally low. Considering the increasing cost of living and the worsening hardships that workers and their families face as a consequence of the economic downturn, the present value of salaries and wages cannot sustain quality life for working people. The situation is decidedly horrifying in Liberia where the minimum wage remains exceedingly paltry and the Decent Wage Bill which has been before the Liberian National Assembly since 2009 is yet to be addressed, denying the Liberian working class of work and income security;

The pension regime in the sub-region leaves a lot to be desired. Most of the pension policies and schemes do not place sweet after sweat for workers at the core of their formulation. And where they do, implementation is a far cry from the letters of such policies and legislation making access by pensioners to different portions of their pensions, rather difficult;

 

Incessant violation of trade union rights is very worrisome. Nation-states in the sub-region have a penchant for disregarding Collective Bargaining Agreements, resulting in a spate of industrial conflict. This is very unhealthy in a sector meant to save lives and ensure the good health of the people. The plenary session frowned at this phenomenon;

The non-application of the check off system for trade unions in Burkina Faso and Cote d’Ivoire were considered as being inimical to the social partnership envisaged by tripartism in the world of work. Trade unions need to be strong to be partners in progress and the check off dues system needs to be introduced as is the case in most other countries to ensure the viability of unions;

Attacks on decent work, social protection and access to quality public services has led to increased migration from the Global South to the Global North,   particularly of the much required human resources for health, resulting in alarming brain drain. The Public Services International in conjunction with WAHSUN has commenced a research project on the impact of migration on the health sector in West Africa;

After four years of efforts at initiating relations with the West African Health Organisation (WAHO), WAHSUN leadership met with the top leadership of the WAHO    secretariat. This could be an entry into a mutually beneficial relationship for both organisations, in the interest of the health system and teeming masses of citizens of the member-states of the Economic Community of West African States (ECOWAS).  

 

RESOLUTIONS

In the light of the foregoing, the 1st WAHSUN Quadrennial Sub-regional Conference resolved, thus:

All hands must continue to be on deck to ensure the total eradication of the Ebola Virus Disease from West Africa. WAHSUN in collaboration with the Public Services International (PSI) has thus established an Ebola Coordination Centre for the sub-region and will work together with other state and non-state actors to ensure that the necessary vigilance against EVD be given more steam. WAHSUN also calls for systematic provision of care and support for EVD survivors in countries where the disease became endemic, which shall entail commitments by the governments in these countries and the international community, starting with West African sub-regional solidarity;

WAHSUN unequivocally calls for appropriate funding of the public health systems in West Africa, starting with the implementation of the Abuja Declaration’s commitment of nation-states to dedicate 15% of national budgets to health urging them to draw inspiration from such countries as Rwanda, which has met this commitment, despite a plethora of challenges;

WAHSUN calls for a process-driven institutionalisation of relevant occupational and safety procedures, mechanisms and processes in healthcare facilities across the sub-region. WAHSUN thus resolved to prioritise Occupational Health and Safety (OSH) in its campaigns, including spurring the establishment of bi-partite OSH Committees at all levels of national health systems, from the national policy-formulation point down to healthcare facilities;

WAHSUN frowns at the stunting of the career progression of nurses in Cote d’Ivoire and calls for the prompt issuance of a scheme of service for Ivorian nurses in line with global best practice;

WAHSUN in session condemns the nonchalant attitude of the Federal Ministry of Health in Nigeria towards the release of the unified scheme of services for Nurses and Midwives in the country .We therefore call for the release of same and allow for commencement of internship programme for graduates of Nursing profession in the country, without delay;

WAHSUN commends the Nigerien government for its commitment to vaccinating children/the population against meningitis, but which has been hampered by a shortage of vaccines and resources for the purchase of more. WAHSUN appreciates the support for Mali even if this has not been enough to save the situation and calls on all ECOWAS and AU member-states to rise up to the occasion by supporting Niger by making vaccines available;

WAHSUN once again commends the Nigerien government for its commitment to provide free health care for the populace and also URGE them to make financial commitment to meet the needs of pregnant women and children under 5 years of age;

WAHSUN demands concrete steps towards attaining staffing norms in line with standards established by the World Health Organisation with regards to the ratios of different cadres of health professionals to the population. WAHSUN equally calls for methodical training and retraining exercises for health professionals towards qualitatively deepening healthcare delivery;

WAHSUN rued the inadequacy of health insurance schemes in the sub-region to serve as the engine room for Universal Health Coverage which they should be, with the statutes constituting them and the way the function at the moment. WAHSUN thus calls for a strengthening of such schemes in a people-centric manner;

WAHSUN categorically rejected the neoliberal paradigm of growth that has resulted in the underdevelopment of Africa and the worsening of the deplorable plight of the working class and called on the political class in Nigeria to reinvent the democratic developmental state towards a renaissance of social progress and development in the sub-region and across the continent, generally;

WAHSUN observed that the salaries and wages of health professionals and other workers across West Africa fall far below the cost of living in the different countries within the sub-region. Considering the fact that this worsens the economic crisis as a result of declining concrete aggregate demand. WAHSUN therefore calls for urgent wage reviews upwards, in the interest of the working class and the system as a whole;

WAHSUN appreciated the sterling leadership President Eileen Sirleaf-Johnson in combating the Ebola Virus Disease. The Network however finds it discomfiting that the Liberian government is yet to pass the Decent Work Bill after six years of its drafting, despite several appeals of WAHSUN and other well-meaning organisations in the sub-region over this period. Noting that the country is due for elections next year, WAHSUN calls on Sirleaf-Johnson to write her name in gold by doing what is right; ensuring that the Decent Work Act is enacted and a decent minimum wage established for Liberian workers; 

WAHSUN calls for a thoroughgoing review of national pension schemes with a view to removing obstacles that pensioners as senior citizens presently confront in accessing their pensions after spending several years of their lives in meritorious service;

WAHSUN decried the perpetuation of trade union rights violations in several countries within the sub-region.       Social dialogue and collective bargaining remain the veritable means of promoting industrial peace and harmony. WAHSUN thus calls for due respect for Collective Bargaining Agreements freely reached by governments with trade unions, to avoid trade disputes that could be very detrimental to the fragile health systems in the sub-region;

WAHSUN calls on the governments of Cote d’Ivoire and Burkina Faso to introduce the implementation of the check off dues system for the trade membership subscription in line with current standards. The archaic manner subsisting in these countries further the fragmentation of unions and disparate sites of industrial conflicts, undermining what could be an aim of weakening unions to the benefit of the state;

WAHSUN member-unions will participate actively in the research on the impact of migration on the health sector, starting with the pilot cases of Ghana and Nigeria, and in subsequent campaigns that would be informed by the results of the research work;

WAHSUN welcomed the initiation of relations with WAHO and would be committed to working with the Organisation on the basis of mutual respect which places the common woman, men and children in the sub-region at the heart of our activities, noting that both WAHSUN and WAHO and the sub-region as a whole, have a lot to benefit from the deepening of relationship that has now commenced

 

Conclusion

The representatives of member-unions of WAHSUN appreciated the warm hospitality of the members and officers of the Syndicat Unique de la Santé et de l’Action Sociale (SUSAS) du Niger. The 13th Plenary Session, being the first after the 1st Biennial Sub-regional WAHSUN Conference, has been a watershed which it is hoped will inspire greater commitment and struggle towards enhanced public health care delivery in the West African sub-region, by all players in the health sector.