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The recent wave of trade union action by doctors and other medical personnel has once again brought to the forefront the fragile state of labour relations in the health sector. While grievances between healthcare professionals and the government are not new, the latest dispute once again raises significant questions about governance, negotiation mechanisms, and the impact of strikes on the most vulnerable segments of society. The urgent need for a sustainable solution to avoid recurrent disruptions in healthcare services cannot be overstated.  

At the heart of the current stand-off between the government and healthcare workers lies a disagreement over the budget proposals presented by the ruling National People’s Party (NPP) government. According to government officials, the health sector is set to benefit significantly from the new budget, with salary increases expected to take effect from April 2025. The Health Minister Nalinda Jayatissa and other government spokespersons have even provided detailed figures outlining the current remuneration packages of healthcare workers and the expected increments.

However, medical professionals and their representative unions are not convinced. They argue that the proposed salary structures will leave them worse off rather than better. Their concerns about salary revisions and future employment conditions have culminated in the recent industrial action.

Strikes by healthcare professionals have become increasingly frequent, posing a severe challenge to the stability and efficiency of the public healthcare system. Given that public hospitals primarily serve the marginalised and economically disadvantaged sections of society, any disruption in services places an unbearable burden on these individuals. Unlike other sectors where strikes may cause inconvenience but not immediate distress, in healthcare, the consequences can be dire, even fatal.

Television visuals and firsthand accounts of patients struggling to access medical care during strikes highlight the depth of the crisis. The stories of patients leaving home at dawn to attend scheduled clinic appointments, only to be turned away due to sudden strikes, paint a grim picture. Many require urgent medical tests or specialist consultations, and their inability to receive these services can exacerbate their health conditions. This unnecessary suffering of the voiceless poor underscores the need for a structured approach to resolving disputes within the health sector.

A common grievance among patients is that trade union actions in the health sector often occur abruptly, leaving them with no prior warning. This unpredictability means that those in dire need of medical attention make futile trips to hospitals, wasting both time and resources. Proper communication and advance notice could mitigate some of these issues, allowing contingency plans to be implemented.

The need for a dispute resolution mechanism

Given the very real likelihood of future disputes in the health sector, it is imperative for the government to establish a robust dispute resolution mechanism that can effectively address grievances while minimising harm to patients. This mechanism should outline a structured process through which negotiations can take place, ensuring that trade union action remains a last resort rather than the first response to disagreements.

A collaborative approach involving the government, trade unions, civil society organisations, and independent mediators is essential. The Human Rights Commission is well placed to mediate between the Government and the Health Sector professionals in view of its independent nature and could be included in the mechanism that is being worked out. These stakeholders should work together to draft a framework that balances the interests of healthcare professionals with the broader public good. Some key aspects of this mechanism should include:

1. Mandatory mediation and arbitration: Before resorting to strikes, all disputes should first go through a neutral arbitration process, where an independent panel evaluates the demands of healthcare workers and the government’s position.

2. Early warning and notification system: Trade unions should be required to provide sufficient notice before taking industrial action. This would allow hospitals and patients to make necessary arrangements, thereby reducing the extent of the disruption.

3. Minimum services to be maintained: Recognising that healthcare is a critical service, both parties should agree on minimum service provisions during strikes. Emergency units, intensive care units, and essential medical services should remain operational even during periods of industrial action.

4. Transparent communication: A major source of conflict in the current dispute appears to be a lack of clarity regarding the financial benefits of the new budget. Ensuring that both the government and healthcare workers have a clear understanding of salary revisions and other employment benefits is crucial in avoiding misunderstandings.

The recent strike could have been prevented had a proper dispute resolution mechanism been in place. The government had urged medical professionals to wait until their April 2025 salaries were disbursed before assessing the impact of the new budget on their earnings. This request was reasonable, as it would have provided clear evidence of whether the budgetary changes were beneficial or detrimental to health workers. Instead, the premature strike caused unnecessary hardship for patients, many of whom rely exclusively on public healthcare facilities for their medical needs.

If healthcare workers had agreed to assess their April salaries first, the confusion surrounding the proposed salary increments could have been cleared up without resorting to industrial action. Premature strikes, based on assumptions rather than facts, risk not only harming patients but also eroding public trust in the healthcare system.

Strikes in the health sector are always better avoided in view of the direct hardship caused to the poor and marginalised. If strike action is to be taken, it should always be the absolute last resort after all other avenues of negotiation have been exhausted. The government and healthcare professionals must work together to create a sustainable framework that prioritises patient care while addressing the legitimate grievances of medical personnel.

By implementing structured mediation, ensuring transparent communication, and maintaining a balance between labour rights and public welfare, future disputes can be managed more effectively. The most recent crisis could have been avoided, and with the right mechanisms in place, similar situations can be prevented in the future. The primary objective should be to protect the interests of healthcare workers while ensuring that the most vulnerable members of society do not bear the brunt of labour disputes. Only through collective responsibility and proactive problem-solving can the nation’s health sector be safeguarded from recurring disruptions.
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