The YDA-government faceoff could’ve/should’ve been avoided
Young Doctors have been on a strike for almost two weeks now and many outpatient wings of public hospitals have not been functional or fully functional. Given the number of people these hospitals treat, this has brought a lot of heartache, heartbreak and in some cases tragedy for patients and their families/friends. Who is legally and morally responsible for this pain? The doctors or the government that has taken not been able to resolve the issue before it went to a strike? We know it has been the patients and their families who have had to pay for this.
If the workers in a factory strike, it is usually not a big public issue. The factory loses output, the workers and the employer suffers and as long as the good is not a basic necessity and that factory does not have a monopoly on the production of a good, say a toothpaste manufacturer as opposed to a monopoly manufacturer of a patented life saving drug, the effects of the strike are limited to those associated with the factory. In such cases, as per the labour laws, the process of negotiation and arbitration can continue for some time and the matter resolved through this process. If it takes a little time to resolve the matter, depending on the urgency that workers or employers feel, it is not that big a deal for the rest of the society. In other words, there are few externalities to the process.
But where essential services are concerned, and there are few alternatives available, like policing, fire brigade, soldiers, doctors, nurses and so on, the impact of a strike is not on the workers and the employers alone, it has large externalities for a larger section of the population too. In many places, recognising the need to continue these essential services in all circumstances, legislations have been made so that those who supply essential services do not have the right to disrupt supply. In other words, the right to strike, for such workers, is taken away. Punjab has similar legislation in place as well. Though, clearly, it is not as effective and not well implemented.
This is not a straightforward solution though. The right to strike is one of the basic rights of labour against possibilities of exploitation. It is needed to level the bargaining power between powerful employers like the state or large companies and weak and fragmented workers. The question to ponder is that if workers in essential services are not allowed to go on strikes, what sort of alternatives are put in place for them to ensure that their legitimate demands are heard by employers and that their bargaining power remains effective even when the right to strike is not there. Has Punjab ensured that such provisions are present?
The Punjab government has been arguing that the demands of the Young Doctors are unreasonable. They are asking for too much and this is not feasible for a cash strapped government to agree to. The Young Doctors are arguing that they are underpaid, overworked and need better working conditions. Which side is correct and to what extent? Inflation has been high in Pakistan over the last many years and salaries in public sector, even though they have been adjusted now and then, have generally lagged behind inflation. Doctors go through a long period of training before they become doctors and young doctors do not have many prospects for private practice too. So they do rely on salaries for their living. The government is saying that young doctors are already being paid more than other civil servants in the same grades. Where this makes it seem like doctors are already getting more, what if the other civil servants have more perks (like those in district administration) or if it just implies that salaries of all civil servants need further adjustments. Before it went to strikes and calls for taking licenses of striking doctors away and their arrests, could we have had a more neutral body assess the validity of the claims of both sides and possibly some arbitration on the issues?
From game theory, we know that threats are of little use if they are not taken to be credible by the other side. So the side threatening has to be genuinely able and willing to carry out the threat they are making. Otherwise the threat will just be discounted as empty talk. If the government threatens to implement the Essential Services Act, which they have done, they should be willing to follow through and use legal means now to break up the strike. Are they in a position to do that? If they are not, they should not have threatened. If they threaten while bluffing and their bluff is called, they will lose a lot of credibility and then next time round it will be harder to take anything they say or do seriously. The Punjab Government has said that if the matter is not resolved quickly they will fire/arrest these doctors and make alternative arrangements to get the hospitals working. This should now be followed through without unreasonable delays if the doctors do not come back to work. Otherwise it is just an invitation for doctors as well as other workers to push the government around.
But moving forward the government has to ensure they have more effective and fairer means and protocols for negotiation in place. In the last few years we have seen teachers, professors, doctors, nurses, and clerks on the streets. We know salaries of many of these groups are definitely not enough to sustain middle class life styles. We know inflation has taken a toll on purchasing power. We also know that most of these professions do not have many official perks, and most of them are not places where money can be made on the side like in civil administration. But these professions are extremely important for us. We should have in place mechanisms that assess the needs of these professionals with empathy and just concern and then ensure that just demands are met. Once the mechanism is in place then Essential Services Act makes more sense. Negotiations can be much better structured than they clearly are. If they are not, the tamasha, for the government and the doctors will continue, and we will have more of such tamashas and it is the people, not a direct party to the dispute, who will pay most of the price.
The writer is an Associate Professor of Economics at LUMS (currently on leave) and a Senior Advisor at Open Society Foundation (OSF). He can be reached at [email protected]