At the end of last month, Sri Lankan trade union leaders shut down an island-wide strike by 80,000 health workers without achieving any of the initial demands of the campaign. The strikers, mainly non-medical staff including paramedics, clerks, drivers, midwives and attendants, continued their action for 13 days despite concerted government attempts to intimidate them.
The ruling United National Front (UNF) sacked 1,600 substitute and casual workers and illegally dispatched troops to hospitals to carry out the duties of strikers. The Colombo media waged a vicious campaign attempting to blame the striking workers for the suffering of patients caused by the decaying public health system. The strikers were demanding an immediate pay increase, in line with a rise in salaries for doctors granted in April, to compensate for the soaring cost of living.
On September 29, more than 10,000 health workers from around the country marched 4 km from Fort railway station in central Colombo to Hospital Square near the Health Ministry. They were joined by hundreds of workers from factories and offices in the capital and small farmers from Eppawala in North Central Province expressing their solidarity.
The Health Service Trade Union Alliance (HSTUA)—an umbrella group of 54 health unions—used the occasion to call off the strike after reaching a deal with the government to reinstate the sacked substitute and casual workers. The unions dropped their demand for immediate pay parity with doctors and accepted the government’s promises that it would examine the issue in November. All of this was described by HSTUA convenor Ravi Kumudesh as a complete victory.
Many workers were justifiably angry at the decision. A midwife from Anuradhapura, who travelled for hours to take part in the Colombo protest, told the World Socialist Web Site: “The government made similar promises when the minor hospital employees struck last July. But none of our demands were met. The Alliance leaders are responsible for that. If they are betraying us, we will have to find ways to fight against them as well.”
None of the issues facing health workers have been resolved. The government has allowed substitute and casual workers to return to work, but continues to threaten their jobs by refusing to withdraw the official circular announcing their dismissal. The Health Ministry has also rejected demands that it cancel punitive transfers against two union activists, provoking a further two-hour protest strike on October 8.
The government is not about to make any significant concessions to the health workers. Having secured a ceasefire in the longrunning civil war, it is accelerating its agenda of market reforms. In its “Regaining Sri Lanka” plan, the UNF has laid out a comprehensive series of measures aimed at turning the country into a major hub for international capital for the Indian subcontinent. These include the selling off or restructuring of state enterprises and services, and cuts to government spending.
The UNF has explicitly pledged “to continue to encourage the private sector to develop secondary and tertiary care private hospitals.” Already a two-class health system exists, with half of all curative services—including hospitals and dispensaries—in private hands. Those who can afford to pay use private services, while the majority of the population is compelled to use a public hospital system that is increasingly starved of funds.
“Regaining Sri Lanka” claims that the government will reform “health care funding, with the aim of concentrating public support on the poor”. But this is nothing but a cynical exercise in cost-cutting, aimed at limiting the general public’s access to health services. The UNF also wants to introduce a “hospital based management system” which will make individual hospitals responsible for finding extra funds to cover any shortfall in government financing.
The decision by the HSTUA leaders to shut down the strike is a direct product of their refusal to wage a political campaign against the UNF government and its policies. All of the Sri Lankan trade unions are affiliated to one or other of the political parties, which, in turn, all agree with the program of economic reform.
Their attitude was spelled out at the September 29 rally by Mamankadawala Piyaratne, a Buddhist priest and leader of the National Resources and Human Rights Protection Organisation. “We do not want to expel this government. We do not want to bring PA [opposition Peoples Alliance] into power and we are not fighting to bring another type of government into power,” he declared.
At a press conference on the same day, HSTUA leader Kumudesh rationalised the decision to call off the strike by saying: “In the discussion with the cabinet sub-committee on September 25, the ministers pointed to the government’s economical difficulties and the workload of the Treasury.... So we had to come to a certain sort of compromise.”
None of the union leaders from the so-called left parties—the Lanka Sama Samaja Party (LSSP) and the Communist Party (CP)—objected. Both the LSSP and the CP were part of the Peoples Alliance, which held power from 1994 to 2001 and began the process of “reform” in public health. Under the PA government, health spending as a percentage of national expenditure slumped from 6.5 percent in 1989 to 4.7 percent in 1997. As a proportion of GDP, it fell from 2.3 percent to 1.6 percent in the same period.The role of the JVP
Successive PA and UNF governments are responsible for undermining the public health system and for encouraging private profit-making facilities. Health workers and patients alike have suffered as a result. Under these conditions, some workers have turned to the unions of the Janatha Vimukti Peramuna (JVP), which posture as a more militant and even “socialist” alternative to the “old left” leaders.
The JVP was never a socialist party. Formed on the basis of an eclectic mixture of Maoism, Guevarism and Sinhala nationalism, it won a following among disaffected rural youth in the 1960s and 1970s. In the course of the civil war, the JVP leaders veered sharply to the right. They promoted themselves as the true patriots and in the late 1980s waged fascistic attacks on trade unionists who refused to support their chauvinist campaigns.
The bankruptcy of the LSSP, CP and other “left” parties has enabled the JVP to make certain gains, especially within the unions. But the JVP has no program to resolve the social crisis confronting workers and the rural masses. Its 2001 election manifesto promised vast improvements in public health care but provided no explanation as to how they would be brought about. Its main activity over the past two years has been to seek a formal coalition with the PA.
It is not surprising that the JVP leaders raised no objection to the decision to call off the health strike. Sitting alongside other HSTUA leaders at the September 29 press conference, Samantha Koralearachchi, president of the JVP’s All Ceylon Health Service Union, declared with the rest: “This is a considerable victory for the workers.”
A genuine struggle for decent pay and conditions for health workers can only take place as part of a broader campaign for an end to the two-class health system and for the establishment of free, high quality services for all. Such a struggle must be based on a socialist program which insists that the pressing needs of the majority must take priority over the dictates of the market and the profit requirements of the wealthy few.