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Shopsteward Volume 27: Special Bulletin

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Media Centre  |  COSATU Speeches

Address by COSATU General Secretary, Zwelinzima Vavi at the SAMA Strategies for the Survival of Doctors

21 September, 2003, East London

Dear friends and comrades,
This is an historic occasion for us – our first input to a SAMA event, and the first where SAMA is in the process of becoming an affiliate to COSATU. We want to welcome all of you warmly into COSATU, the home of all working people. We are sure this is the start of a working relationship that will benefit all of us, both in terms of improving conditions for healthcare workers, and in ensuring all South Africans have access to decent healthcare.

We must also thank SAMA for taking part, however limited, in our historic Eighth Congress last week. We regret that because our relationship is so new, you could not participate fully. We are sure that you will make a bigger mark on our Ninth Congress in 2006.

Our relationship is still in its infancy. To use a more precise metaphor, we have just gotten engaged. Like a marriage or any long-term relationship, this new affiliation will require work, patience and understanding from all of us. Affiliation is a two-way process, where we must each adjust to some extent. But our experience with new affiliates shows that the effort is worth it, as we both gain immensely from greater unity.
Our experience shows that the process is particularly challenging – and therefore also particularly rewarding - for professional associations. Our biggest professional affiliates, as you know, are the teachers’ union SADTU, and more recently DENOSA for nurses.

As we see it, the challenge arises mostly from the difference in culture between industrial unions and professional groupings. Industrial unions, and COSATU, have essentially three key principles as their foundation – worker control, solidarity and an overall working class perspective in all our work. In contrast, professional associations generally see their members as unique, different from other workers; and they often have a different understanding of democratic leadership and the roles and responsibilities of members.

We have to ask what the principles of worker control, solidarity and working-class perspective mean for SAMA. How do your members fit into the broader struggle for transformation by the majority of our people? How can we adapt the organisational requirements of the COSATU Constitution to your needs?
In the end, our experience shows that both sides gain from this type of interaction. But we all have to be prepared to be flexible and constructive in finding a common way forward.

Our recent Congress shows the importance of unity and co-operation between workers in different sectors and different occupations - from healthcare to mining, from banking to education to clothing production, from agriculture to policing.
COSATU’s Eighth Congress focused on developing an in-depth analysis of our current situation and finding a strategic way forward. We have included our main strategies in our 2015 Programme, which you can get off our website. The critical elements are strategies to build our organisation and to support policies that can ensure social and economic development.

To build the organisation, our 2015 programme emphasises first, a stronger recruitment campaign, to organise all unorganised workers under the COSATU banner. Second, it calls for a campaign to improve service to members, ensuring that our shopstewards, in particular, can meet new challenges. Finally, we need to improve our educational work. As a union federation, we focus education, not on professional competencies, but on ensuring a common understanding and discussion about workers’ needs and ways to meet them.

In policy terms, the 2015 programme prioritises the central policy issues for COSATU – that is, the strategies need to drive development to benefit the majority of our people. Above all, that means we must overcome the extraordinary high level of unemployment – over 40% according to the latest Census.
Our main proposals for stronger development strategies are, first, to overcome the poverty and dualism left by apartheid. That requires that we do more to ensure that the poor and historically disadvantaged have greater access to skills, assets, infrastructure and business institutions such as the financial sector and marketing. Second, it requires restructuring of the formal sector toward relatively labour-intensive sectors that can create jobs.

The health sector has two key roles in this type of strategy. On the one hand, it forms an important component of the overall system of social protection. A society that cannot provide decent healthcare for all its people cannot retain broad support or sustainable economic growth. On the other hand, the health sector itself is an important employer, with well over half a million employees in total. As a value chain, including its linkages to the pharmaceutical, equipment, clothing and other industries, it supports even more workers.

In light of the importance of the health system, a central challenge for COSATU is to bring together all our health affiliates to address the huge challenges it faces. You know those challenges better than I do, from your experiences on the job. But every worker knows two main obstacles to quality health care: soaring medical aid costs in the private sector, and drastic underfunding of the public health system. As a result, the public health system in particular has seen falling working conditions, increasing overwork, and rising vacancies.

COSATU has long argued that the only possible long-term response is a national health insurance system. In effective, this system would nationalise the funding for healthcare, while continuing to support a network of public and private providers. It would permit greater equity and more efficient allocation, as well as cutting down on administrative costs and support rationalisation of high-level facilities.

The rumour is that you have been told that the national health insurance system would ban all private practice. That is an attempt to undermine our proposals. But it is true that as we envision it, the national health insurance would be the only source of funding for covered conditions. What conditions those would be, and how others would be paid for, remains a matter for more work.

In effect, this system would mean that private medical aids would become essentially an optional add on. That contrasts with current government efforts to make them both mandatory and comprehensive – an effort that has already led to soaring costs, and that, as currently proposed, would make healthcare simply unaffordable for many workers.
Clearly, national health insurance is a long-term vision, which is not going to be installed overnight. We need to engage more with your members during the induction process.

In the short run, COSATU argues that the public sector needs more funding, and that greater regulation must prevent inefficient duplication of private and public sector facilities. In addition, the public sector in particular must do more to improve working conditions for both doctors and nurses, in particular by reducing work loads, improving faculties and establishing well-defined professional career paths and in-service training. Overall, the system must do more to ensure accessible, quality healthcare in poor communities and in rural areas.

We are now about to embark on the process of deepening ties and sharing views as part of the affiliation process. We see this process as having two key components. First, we need to set up an induction process over the coming months, where we can share views and discuss how to align our structures. In this process, we hope to gain a better sense of what SAMA members expect from COSATU. Second, SAMA must form part of the broader effort to ensure that all our healthcare affiliates work together to refine a common vision of how to solve the problems facing the health sector.