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Opinions of Friday, 21 October 2011

Columnist: Dondomeso-Soglo, Francis

Porting Of Medical Doctors Salary

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The current Ghanaian public labour front is turbulent and if you are a Minister of State whose sector has not yet been migrated unto the new pay structure then you should be sleeping with one eye open. If the migration of the education sector was bad, then that of the health sector can conservatively be described as a nightmare. Cynics of the Single Spine Salary Structure (SSSS) by now would be hailing themselves as right; after all they have spoken against it right from the onset.

Our medical practitioners about a week ago hanged their coats and a week later added their stethoscopes to demonstrate their dissatisfaction with the implementation of the new pay structure. They have cited a lot of issues including promotion, non-use of the scores of the evaluation exercise, salary relativity as well as not being allowed to port their respective salaries to the position of the District Director of Health Service. In as much as I agree with the doctors on some of the issues raised in the subject under reference, their last concern: porting of professional salary to the District Director’s Grade, is totally reprehensible to say the least. The question to be asked is; is this demand legal, equitable and economical?

The enabling Act of the Ghana Health Service, Act 525 section 25(1) and (2) state that “There shall be appointed for each District a health professional to be known as the District Director of Health Service referred to in this Act as ‘a District Director’. A District Director shall be a person in the health profession who has qualification in public health. ” Section 26(1) continues that “A District Director shall be responsible for the implementation of the policies and decisions of the Council in the district.” In other words, section 25 (1) and (2) stipulate the job title and qualification respectively of the desired professional whilst section 26(1) gives the mandate of a District Director. Article 24 (1) of the 1992 Constitution and section 68 of the Labour Act, Act 651 state almost in unison that “every worker shall receive equal pay for equal work without distinction of any kind.”

Now the doctors in their submission intend to migrate to the District Director’s position with their salary if the salary is higher than what the Single Spine Salary Structure has designated for the District Director or accept what has been designated if the medical officer’s salary is less than that of the District Director’s. I listened to one Dr Serebour on Joy FM who lamented that they, the doctors would be hindered by this to assume the District Director’s position if the Fair Wages Commission’s proposition is sustained. Meanwhile, according to him “they (doctors) have the best brains to carry out the mandate of a District Director”. If people make demands out of ignorance, I think it is noble for them to accept honourably when the odds or flaws are pointed out to them.

This seems not to be the case as the doctors still pursue this demand with enormous zeal. As a matter of fact, it would be a flagrant violation of the provisions of the 1992 Constitution and Act 651 referred to above if the Fair Wages Commission or Government for that matter accedes to this particular request. I would not in this write up attack Dr. Serebour’s second misplaced remark that “they (doctors) have the best brains to be District Directors. “ I believe the framers of Act 525 did know that a health (not necessarily medical) professional with qualifications in public health (now masters) would be adequate to carry out the mandate of a District Director as per section 26 (1) of Act 625. If Dr. Serebour can share with us the scientific study that revealed that doctors are the best managers of districts, this is the moment and we are eagerly waiting for him. It would interest Dr Serebour to know that, anecdotal evidence in the Eastern Region rather portrays the reverse and I would not be surprised if it is so in the other regions.

Granted that the above hurdle (legal) is cleared which I must admit is an onerous one, the next equally important issue to be addressed is whether it is equitable. The Oxford dictionary defines equity as the quality of being fair and reasonable in a way that gives equal treatment to everyone. Would this request be fair, reasonable and gives equal treatment to all District Directors of Health in the Ghana Health Service? Would Dr. Serebour and his colleagues accept if government paid other doctors brought into this country who perform the same duties more than them because they (foreign) doctors were earning more in their respective countries than the average doctor in this country? Would their morale be maintained if Government pays discriminatory remuneration to doctors who perform the same duties? I know the answers to all the above questions would be an emphatic no. So why do it to others? The Bible says do unto others what you would like them do unto you. Also, what is good for the goose is also good for the gander. Indeed, Dr Serebour and his allies should just name one salary structure in the world over where people of the same grade and who perform the same tasks in the same sector are paid differently for us to emulate. In any case, you are not compelled to be a District Director as a doctor. There are other branches of medicine that are probably more financially rewarding for him and his colleagues to pursue than public health. May be, by this intent to make the post of District Director’s unattractive to doctors, government is now waking up to the old age calls for doctors not to desert the consulting rooms and seek administrative posts through this intent. Can you imagine a situation where a district hospital would have only one doctor at post and we have about 210 trained medical doctors running districts as administrators? What a colossal waste! In any case, the very essence of the SSSS is to address among other problems salary rationalisation and equity. So how can the solution that is being sought for a problem seem to create complex and needless ones?

My final concern on this intriguing demand is whether it would also be economical to have the District Director’s position as a preserve of doctors when any health professional with qualifications in public health can carry out the agenda of the Ghana Health Service in the district. Again, the framers of Act 625 knew that the duties and responsibilities of a District Director did not require a degree in medicine. I hope Dr. Serebour has a driver and I wish he makes a proposal for all drivers in the country as well to possess at least a degree in Mechanical Engineering. This country belongs to all of us and our common thinking should be what would be in our best interest as a nation. If you have staff who can perform a function very well with a relatively lower degree why employ others who are more expensive and even scarce in the case of Ghana? Even Cuba, which has the best doctor-population ratio in the world (1:170) does not practise what the doctors are asking for. It would be unthinkable and unfathomable for a country that has a miserable doctor-population ratio of 1:14,286 (as of 2007) to practise such a gargantuan frivolity.

As a media analyst, I have always had concern and sympathy for doctors and their demands but on this matter I seriously disagree with them. I also think the handling of the strike action has not been the best by both the Ghana Medical Association and Government. What is palpably important for the government to note and act as dispassionately as possible is to address the doctors and the health sector’s concerns holistically so as not to be entangled with similar issues by other health workers or public sector workers as they are watching and listening eagerly. In as much as new salary structures come with their concomitant distortions and agitations by Unions, what has happened in the health sector needs much to be desired.


(Bsc. Administration)

Boston State University, MA ,USA.

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