Dr. Hussein Mwinyi, Minister of Health

The ongoing doctors’ strike is an event which can not fail to attract anyone’s reaction. The doctors’ work means a lot to our life because they can shorten it or lengthen it, depending on how you look at it. Tanzanians have mixed feelings about the strike; while some support the doctors’ cause others sympathise with their employer - the government.

However, it would be to everybody’s interest if we treated the strike as a wake-up call and hence delve into a critical analysis of the whole issue. This strike is the second after the first one which culminated in President Jakaya Kikwete addressing Dar es Salaam city elders where he pledged to look into their demands.

Although the current one seems to be petering out, the third one, should it come to pass, might end up being extremely disastrous. Reading in between the lines President Kikwete’s latest end of the month address to the nation, the government has left nothing in store to meet the doctors’ demands. Indeed, it seems to have adopted an I-don’t-care attitude to the issue.  

No wonder the doctors feel that the government is not taking them seriously, which motivates them to tighten the noose around the neck of the government. Both parties in the dispute are trying to win public sympathy which, as has already been pointed out, is divided and none of the two parties has an edge over the other owing to the nature of public health service provision in the country.

Tanzania’s health service provision system is hierarchical and pyramidical in shape. The system includes and starts with an individual, followed by households or families, then a village which is served by a dispensary, then a health centre which usually covers several wards.

Then comes a district or district designated hospital (DDH), regional hospitals, referral hospitals, specialized hospitals, national hospitals and, lastly, alternative medicine. One good thing about Tanzania’s health system is collaborative provision whereby the central government, local government, private individuals, civil society organizations and faith-based organizations team up to provided health services.

 The Tanzania health system is oriented towards prevention rather than curing of diseases. It is also mass-oriented. The prevention of diseases is embedded in the individual and the household. The conduct of individuals can result in a medical condition which, at the end, may force someone to seek medical care provided by the health service provision system.

Individuals are advised, through the public health system which works hand in hand with health care, to eat a balanced diet in order to keep the doctor away. Individuals are also socialized to live risk-free lives and, above all live, in health-supporting environments. However, most of the illnesses which force us to consult the doctors are of our own making and could be avoided.

Pathological environments are responsible for the number-one killer disease - malaria. Bad lifestyles account for diseases such as high blood pressure, while risky behaviour results in sexually-transmitted diseases, including HIV/Aids. All these illness-causing factors can be prevented by individual action. Do we need to be reminded that a fruit a day keeps the doctor away? It is a wake-up call which we better take heed of.

It is naïve to think that we are capable of avoiding falling ill. The health system is structured to deal with simple illnesses which affect many people in their early stages. This means that highly specialized medical personnel have a limited role to play in the provision of health care.

The most important medical personnel for the majority of people are the lower cadre health staff. The structure of the health provision system is what is actually sustaining the situation, otherwise it would have been worse.

However, this otherwise well designed system is being mutated to the disadvantage of the poor majority. The mutation is taking place in the training of medical practitioners in that more effort in being put in the training of highly skilled personnel than the basic ones.

The allocation of resources in the development of human capital has been debated in many quarters where various views have been put forward. One school of thought encourages more expenditure on high education, which produces the medical doctors and specialists. However, the products of high education find themselves out of context as the learning environment does not match with the ultimate working environment.

To say the least, high learning institutions has managed to create a bunch of individuals with high expectations in a difficult environment. Tanzania has spent a fortune on the training and development of medical doctors and specialists with high hopes that we are giving our fellow country men and women knowledge to enable them work for us better. Contrary to our expectation, by training and developing medical doctors and specialists, we have given them power which they have turned against us for their personal benefit.

Medical doctors and specialists have finally shown their true colours. They are doing it now when, as a country, we are no longer training lower cadre medical personnel as we used to do before. They are doing it now because dispensaries, health centres and some district and district designated hospitals and regional hospitals are understaffed, resulting in their refusal to go to work for this or that reason.

They are doing it now after seeing that most health care seekers trust them more than the lower skilled practitioners. They are also doing it now after alternative medicine has been discredited and trashed.

Knowledge is power, which is defined as the ability to exert one’s wish over others. The medical doctors and specialists are indeed exerting their wishes over us despite the fact that we are the ones who gave them the powers in the first place. They have in the process woken us up, hence we should start taking some action to balance the power. We can only do that if we turn to the 1960s and 1980s high education policies as propounded by the World Bank (WB) and International Monetary Fund (IMF).

In that particular time (1960-1980) WB underscored the importance of human resource development as it believed that education made people more productive in improving their living conditions. According to WB economist George Psacharopoulos, the success of education could be analyzed by applying the rate-of-return (ROR) tool.

Through the ROR one would note that, although basic and primary education costs less, it covers a lot of people and has a higher social return. On the other hand, expenditure on high education, which, despite costing poor countries a lot of money, is for minorities and has, not only a lower social return, but it also benefits those who receive it than those who toil to make it available to those few.

According to George Psacharopoulos, ‘‘Poor countries need additional literate people more than they need an extra handful of university graduates. Funding for primary and secondary education versus higher education is decided by a calculus of individual or private return, mostly in terms of increased wages, and not in terms of any larger social or economic benefit such institutions might offer.”

However, other WB officials countered Psacharopoulos’s argument. A Task Force on Higher Education and Society (TFHES) report concluded that ‘‘without more and better higher education, developing countries will find it increasingly difficult to benefit from the global knowledge-based economy.” The TFHES report signified the WB’s change in policies, which was rolled over across the globe.

Of the two arguments, Psacharopoulos’s argument is clearly manifested and fits in our situation better than that advanced by TFHES. The medical doctors and specialist have proven Psacharopoulos right by their demands for personal gain and the fact that we can not provide them with a better working environment.

They are not like football coaches. When Marcio Maximo came to coach Taifa Stars he used the sand beach and hills in place of state-of-the-art gymnasium that he was used to in Brazil.  Our countrymen and women can not do it because they are not highly educated while their medical doctors and specialists are.

It is shocking to note that medical doctors and specialists coming from developed countries who we have witnessed working here can cope with our environment better than native medical doctors and specialists.

The ongoing industrial dispute is giving opposition parties an agenda against the government of the day. The dispute is therefore being viewed by some observers as a political game which has been transferred from the political platforms to hospital corridors.

One needs not to go further than the social networks and activists’ views to observe this. Many views sampled are holding that it is easy to get a new government than to train and develop medical doctors and specialists. But we all should note that, as Mwalimu Nyerere said, once one has tested human flesh they will lust for more. If we give in to the medical doctors’ and specialists’ demands now we shall have set a foundation for similar demands in future.

 That is why the doctors’ strike is a wake-up call. We should now go by Psacharopoulos’s argument. We should spend money on training individuals to live and eat healthily in order to prevent diseases. Money will be more wisely spent if we train people to seek medical care just as illness symptoms are observed.

We must spend money on those who can work in our environment. It is a wake-up call for us to act holistically. And the best way to do this is to be united against the medical doctors’ and specialists’ selfish demands and conditionalities.

The author is a businessman based in Mwanza and a master’s in sociology student at Saint Augustine University of Tanzania.