A collective of 126 frontline South African doctors – from more than 40 public and private healthcare institutions countrywide – has lambasted the SA Association Trade Union (Samatu) for failing to represent health professionals’ concerns or to address a deepening crisis, and says it plans to launch a new union where leadership is “recallable”.
The group told Daily Maverick their pleas to Samatu have fallen on deaf ears as junior doctors continue to face mass unemployment, and public-sector clinicians struggle with resource constraints and excessive unpaid overtime hours.
In an open letter last month to Dr Cedric Sihlangu, general secretary of Samatu, calling for “real” action in addressing an exploitative health system, the doctors expressed a growing frustration at what they describe as a lack of action.
“What is happening in Gauteng, Limpopo, Mpumalanga and everywhere else is not a technical oversight. It is the deliberate application of austerity in service of a political class that has no intention of delivering just, functional or universal healthcare. The goal is not to fix the system – it is to break it, hollow it out and contract it to the politically connected,” the letter said.
It also criticised the approach to the National Health Insurance (NHI) Act, saying the NHI was not a path to equity, but a “pipeline for centralised corruption, dressed up in the language of justice”.
The collective questioned the union’s efforts to “build power from below”, calling it a “union of the few speaking on behalf of the many”.
Among the changes it called for at the union were:
- The election of accountable leadership “from below, rooted in struggle not ceremony”;
- The unification of employed and unemployed workers in one movement for workplace democracy;
- Preparation for “real, coordinated action”, rather than symbolic resistance; and
- Acknowledgement that the health system was not “broken”, but functioning to protect capital, contain labour and make politics profitable.
‘Nothing to lose’
Dr Simon Spoor, a spokesperson for the collective, said they had received no response from Samatu and that the network of clinicians had since grown to more than 1 000, represented on a WhatsApp group where they could share their concerns about problems in the sector.
“The movement basically started with people beginning to get fed-up with the lack of response from Samatu, which for years has been largely unaccountable and almost a non-entity when it comes to doctors and doctors’ issues,” he said.
Samatu told Daily Maverick it was aware of the open letter, but that just 15 of the 126 doctors who signed the document were registered union members.
“Samatu deems it frivolous for any doctor to claim the leadership of the union is quiet on matters that affect doctors. More than other unions, and any other organisations that claim to represent … doctors, Samatu has been at the forefront of addressing issues that affect healthcare workers, especially doctors.”
On the NHI Act, Sihlangu said the union had been “vocal” regarding its implementation, but added that there was a need for “system change” in public healthcare.
“We need to allow the overdue systemic revolution in public healthcare, and currently that can only be done by allowing the NHI to take effect,” he said.
Short-staffed and overworked
Spoor said the problems with healthcare delivery in the public sector are often blamed on individual workers or particular facilities.
“The system refuses to acknowledge the …nature of the problems we’re facing, about which the public is also kept in the dark. It’s reached the point where we can’t, in clean conscience, allow it to go on any longer.
“We’re not doing this… just for ourselves. It’s for the patients. No doctor likes to… see your grandmother sitting there for six hours waiting to get treated for a heart attack… and if you do that on a day-to-day basis, it starts to grind you down. At this stage, we’ve got nothing to lose, and we have a moral duty, because if we don’t speak out… then nobody will.”
The open letter to Samatu was released shortly after unilateral policy amendments by the Gauteng Department of Health (GDOH) to reduce commuted overtime contracts for doctors.
Samatu released a statement on 4 April saying in a meeting with the department it had ensured a three-month suspension of the implementation of the proposed changes, pending a consultation process.
However, the letter’s authors said the GDOH’s actions are only a symptom of much deeper problems.
“Doctors have always worked more overtime hours than what they’re paid for, but now they’re … expecting all doctors to work a minimum of 80 hours overtime a month… And in some places… up to 170 hours a month,” Spoor said.
The experiences of doctors in the collective’s network were shared with Daily Maverick on condition of anonymity.
One Eastern Cape doctor said that overtime hours for certain specialities, like ophthalmology and urology, were dropped at their health facility between April and May.
This resulted in general practitioners having to handle specialist cases that came in after hours, as the required clinicians were not present.
“Their wake-up call was when patients started dying like flies… There were also bottlenecks in casualty because most departments would not accept patients over weekends due to lack of cover,” the doctor said.
Another doctor claimed that while they were contracted to work 80 hours’ overtime per month, they consistently worked between 100 and 114 hours.
“I am not compensated for the extra hours. I confronted HR … and was made to feel guilty for questioning why I am doing unpaid extra hours. He said he was disappointed in me,” the doctor said.
Spoor said that in 10 years in the public sector, he had never seen morale among doctors at “such a low point”.
Daily Maverick contacted the National Department of Health for comment but had not received a response at the time of publication.
According to Samatu, “the issue of commuted overtime downgrades started in Limpopo, and there is an ongoing litigation process between Samatu and the Limpopo Department of Health, whereby the High Court ruled in favour of Samatu and interdicted the implementation of a flexi-shift system”.
“It cannot be said that Samatu would be willing to advocate for doctors in Limpopo on this issue and not be willing to do it for those in Gauteng. Just like any organisation, we must strategise on how we tackle issues like this one, for the benefit of members.”
Making a change
Samatu’s election policy states that a person can only be elected as a national office bearer when they have been a member of the union in good standing for eight years or more.
Its constitution states that shop stewards can be elected at places where the organisation has a minimum of 50 members.
Spoor said these requirements exclude many doctors from accessing representation or leadership positions at the union.
“Our view is we need to build something new from the ground up,” he said, adding that the collective had plans to establish a voluntary association to represent doctors, with the aim of expanding into a “fully fledged union”.
“We’re trying to do this democratically… but with a few basic assumptions on which we all agree, which is that every institution should be able to have a representative…
“We want to set up a structure where leadership is recallable at any time and mandates can be made from the rank and file.”
Sihlangu told Daily Maverick that all union members qualify to contest for positions, provided their membership status is in order.
“Just like any other union, Samatu has a constitution to which the organisation must adhere, as well as the Labour Relations Act… clearly stipulating the requirements that must be met by every union to elect representatives.”
See more from MedicalBrief archives:
Intern doctor’s death sparks outcry over public health working conditions
Gauteng Health’s ill-considered cost-cutting risks patient care and training
Overtime non-payment for doctors sparks outrage in Gauteng
Eastern Cape doctors dig in their heels over no overtime pay
Medical union threatens legal action and protests over overtime cuts