The incentive package the Ministry of Health has proposed for doctors does not even begin to meet their basic demands, writes Hala Sakr The confrontation between Egyptian physicians and the government escalated last Friday when more than 3,000 physicians gathered at their union to protest against a government draft bill which the Ministry of Health insists will create a "special cadre of medical doctors" but which doctors argue is an arbitrary package of incentives that fails to address their demands for an overhaul of wages and conditions. Amid intense security around the syndicate's Qasr Al-Aini Street headquarters in downtown Cairo, the physicians gathered for an emergency general meeting (EGM) chaired by Hamdi El-Sayed, chair of the syndicate and head of the People's Assembly Health Committee. The EGM, attended by members of local syndicate councils across Egypt and members of parliament from the profession, was tasked with formulating a unified stand against that proposed bill. The Doctors' Syndicate was founded in 1940, and after the Bar Association is Egypt's oldest professional union. It boasts a membership of 170,000 with over 70,000 employed by the state. A majority of the current council, who came to power in 1992, are members of the Muslim Brotherhood. Although the law stipulates that the council's term is four years elections have been suspended for the past 15 years. During the EGM the angry gathering requested that the Syndicate Council adopt gradually tougher measures leading, if necessary, to a general strike, in order to force the Ministry of Health into a comprehensive review of basic salaries rather than the current proposals which focus on incentives to be paid mainly to senior administrators. They stressed that improving the working conditions of physicians was essential to any plans seeking to upgrade the quality of healthcare. State-employed physicians working in the government receive basic monthly salaries that start at less than LE300 (approximately $50). These are then supplemented by additional payments that take into account night shifts, postgraduate degrees, administrative responsibilities, performance assessments by the administration etc. This additional compensation, however, remains at the mercy of changing ministerial decrees, available resources and a host of bureaucratic complexities. Mona Mina, a state-employed pediatrician and a member of the Doctors without Rights group, told Al-Ahram Weekly that "there is no alternative to a comprehensive wages cadre." "What the ministry is proposing is nothing but an illusion that aims at keeping physicians hostage to the administration's whims. It is very humiliating." Participants at the meeting were unanimous in their rejection of the Ministry of Health's argument that it has no budget to overhaul basic salary structures and in his address to the EGM El-Sayed rejected limiting any improvement in wages to incentives. He disclosed correspondence between the syndicate and the prime minister and the ministries of health and finance in which the issue of a new wage system had been repeatedly raised. At 3.30pm the doctors attempted to stand on the syndicate's steps to launch a more public, half hour protest, but were prevented from doing so by hundreds of state security officers. As the blockade tightened the lobby began to fill with angry slogans calling for a general strike. "We are no less capable than the real estate tax workers or the workers of Al-Mahalla Al-Kobra spinning and weaving factories... they [the regime] are forcing us to strike and we will do it" ran one slogan. At 4pm sharp they re-convened, and the heated discussions that ensued showed they were even more determined to press their demands. An intense debate began on whether to continue with negotiations on the incentives proposed by the government, with the panel calling for the continuation of the negotiations without giving up the struggle for the wages cadre. "A special wages cadre," emphasised El-Sayed, "means a law and a law means parliament and the government. It is a long process that might even take months, even years. Meanwhile, we can pursue our negotiations on the faster track of incentives to try and alleviate the horrendous situation physicians face." Essam El-Erian, the syndicate's treasurer and prominent member of the Muslim Brotherhood, sees no harm in negotiating to improve benefits for physicians without abandoning the issue of the wages cadre. He told the Weekly that, "this is a battle that needs much patience... Negotiations should continue." The disagreement over whether to continue negotiations on incentives was not reflected in final resolutions of the EGM, which comprised nine articles, one of them mandating the union council to draw a new draft for a special wages cadre with a minimum basic salary of LE1,000. The resolution also called for successive biweekly one hour protests before the People's Assembly beginning on 10 February. On 15 March a limited two-hour strike is planned in all public hospitals, except for emergency and intensive care units, between 9 and 11am. Another general meeting should convene on 21 March at the union's headquarters in Cairo, followed by meetings for local union branches in Beni Sweif on 24 April and in the Nile Delta on 9 May. Following the assembly, Doctors without Rights issued a statement commending physicians for attending the EGM and opposing the Health Ministry's proposals. The statement pointed out that the EGM resolution was the first step on a long journey to achieve physicians' demands. The statement also addressed the general public, stressing that the strike was not directed against patients and arguing that if physicians do not secure their rights then the rights of patients are also compromised. The EGM resolutions, explained the statement, represent an attempt to end deteriorating conditions in Egypt's national health services.
