Health workers' strikes in low-income countries: the available evidence.

Giuliano Russo,Michelle Mcisaac,Barbara Mcpake,James Campbell,Ibadat Dhillon,Lihui Xu,Marcelle Diane Matsika-Claquin

doi:10.2471/blt.18.225755

Abstract

ObjectiveTo analyse the characteristics, frequency, drivers, outcomes and stakeholders of health workers’ strikes in low-income countries.MethodsWe reviewed the published and grey literature from online sources for the years 2009 to 2018. We used four search strategies: (i) exploration of main health and social sciences databases; (ii) use of specialized websites on human resources for health and development; (iii) customized Google search; and (iv) consultation with experts to validate findings. To analyse individual strike episodes, pre-existing conditions and influencing actors, we developed a conceptual framework from the literature.ResultsWe identified 116 records reporting on 70 unique health workers’ strikes in 23 low-income countries during the period, accounting for 875 days of strike. Year 2018 had the highest number of events (17), corresponding to 170 work days lost. Strikes involving more than one professional category was the frequent strike modality (32 events), followed by strikes by physicians only (22 events). The most commonly reported cause was complaints about remuneration (63 events), followed by protest against the sector’s governance or policies (25 events) and safety of working conditions (10 events). Positive resolution was achieved more often when collective bargaining institutions and higher levels of government were involved in the negotiations.ConclusionIn low-income countries, some common features appear to exist in health sector strikes’ occurrence and actors involved in such events. Future research should focus on both individual events and regional patterns, to form an evidence base for mechanisms to prevent and resolve strikes.

Highlights

Workers’ strikes or industrial action are identified as “...the collective withholding of labour/services by a category of professionals, for the purpose of extracting concessions or benefits, typically for the economic benefits of the strikers.”[1]
To guide the data extraction and the analysis of the individual strike events identified through our search, we developed a framework that summarizes the concepts from the economic, political economy and health system research literature on health sector strikes, and helps to understand the linkages between pre-existing conditions, relevant influencing actors and their interaction (Fig. 1)
Data sources: The World Bank,[19] International Monetary Fund[23] and International Labour Organization.[24] media and press reports, the study provides some unknown level of comprehensiveness

Summary

Introduction

Workers’ strikes or industrial action are identified as “...the collective withholding of labour/services by a category of professionals, for the purpose of extracting concessions or benefits, typically for the economic benefits of the strikers.”[1]. In middle-income countries, some evidence shows that physician strikes can lead to a decrease in clinical activities and increase in mortality.[7,8] Some have argued that such strikes would be justified if directed towards improving workers’ conditions and their ability to care for future patients[9] and that doctors’ strikes may be morally acceptable if proportionate and properly communicated.[10]

Methods

Results

Conclusion