WAHSUN IN PERSPECTIVE Problems and Prospects in Pioneering Sectoral Networking in PSI*

INTRODUCTION

The West African Health Sector Unions’ Network (WAHSUN) occupies a pride of place amongst the five sectoral networks of Public Services International’s affiliates, on the African continent. This is largely because it was the first to be formed. We do feel privileged that the Network has been invited several times by our sister networks and the PSI, to throw some light on the experience of building WAHSUN.

This year’s English Speaking (East & West) Africa Sub-Regional Advisory Committee (SUBRAC) meeting provides yet another veritable platform for us to present perspectives on the origins, growth and development of WAHSUN. We shall equally seize that opportunity of looking at where we are and how we got here, to rub minds on what might be the next steps to take in building on the initiative, drawing on earlier discourse in this direction. This is particularly important as the 2^nd Biennial WAHSUN Conference is scheduled to take place in barely two months’ time.

 We also hasten to state that WAHSUN has equally learnt from the efforts of our sister Networks and hope to learn from them as well, in our efforts to consolidate the building of WAHSUN in defence of health workers and qualitative public delivery of health service for the benefit of working class-people, in our sub-region, in the face of neoliberal attacks against the people.

The subsequent sections of this brief presentation are: origins of WAHSUN; the growth and development of WAHSUN; achievements and challenges of WAHSUN, and; looking forward.

ORIGINS OF WAHSUN

The roots of what is today WAHSUN goes as deep as twelve years back. At the 2004 Sub-regional Evaluation and Planning Workshop which took place at the Mensvic Palace Hotel Accra, Ghana, participants from the Medical and Health Workers’ Union of Nigeria (and the Health Services Workers’ Union of the TUC Ghana) pointed out the need for closer methodical interaction between unions in the health sector, under the broad umbrella of the PSI, to facilitate exchanges of experiences and ideas.

This was partly borne out of the long established relations between both unions, since the 1980s. That relationship was temporarily truncated with the passage of draconian anti-union laws in 1996, by the military junta in Nigeria, which barred international affiliations for trade unions. But it was again through this relationship that Nigeria had returned back to the PSI fold in 2003 when MHWUN reached out to Brother John Akoto of the HSWU who was at the time, the Vice President for the Africa and Arab Countries Region.

A second important leg behind the quest for networking at that time was the then unfolding spate of attacks against public healthcare delivery, which appeared to have the same trajectory, even at that nascent point. In Nigeria, the Bureau of Public Sector Reforms had been established in February 2004, while steps were being taken towards creating the Ghana Ministry of Public Sector Reforms, which was formed in August 2005.

Neoliberal public sector reforms with their kernel of privatisation and cuts in the funding of social services held grave dangers for working class-people as a whole, and for health workers providing a critical social service. There was thus the need to forge a fighting internationalist platform of workers, within the sub-region and beyond.

The proposition was noted by the Sub-Regional Secretariat. The matter then cropped up at the 2005 SUBRAC hosted by the Nigeria NCC, a year later. But at the time, PSI projects were more tilted towards the national framework. Programmes were thus fashioned on inter-sectoral basis for affiliates at the NCC level.

Further discussions on the need for health workers sectoral networking were held at the 2005 Sub-Regional Evaluation and Planning workshop held at Stella Hotel, Tema, Ghana, between: participants from MHWUN, HSWU, National Association of Nigeria Nurses and Midwives (NANNM); and both the then Sub-Regional Secretary, Sister Khadija Mohammed and the PSI Education Coordinator, Sister Jenny Luck.

The hint was dropped that there would most likely be more focus on sectoral work in the next project cycle and assurances were given that PSI would help to engender the much sought for networking between the health sector unions in English-speaking West Africa.

This was the background to the meeting of the leaderships of health sector unions from Nigeria, Ghana and Sierra Leone, summoned by the PSI Sub-Regional Secretariat at the end of December, 2006. The meeting adopted a Memorandum of Understanding, which amongst other things included commitments to:

·        form a sub-regional network of health sector unions;

·        promote exchanges of organisers and researchers between unions from the three different countries;

·        foster women rights and gender mainstreaming in the different unions;

·        encourage the participation of youth in the concerned trade unions.

The 2007 SUBRAC considered this development and endorsed its aims. The preponderance of health sector unions in the SUBRAC, with most NCCs at the time being led by unions from the health sector, helped facilitate this endorsement. After a series of informal discussions, the West African Health Sector Unions’ Network (WAHSUN) was formed on November 9, 2007, at the Ibro Hotel, Abuja, Nigeria.

The founding unions were:

• ·        Medical and Health Workers’ Union of Nigeria (MHWUN)

• ·   Health Services Workers’ Union of the TUC Ghana (HSWU)

• ·        Sierra Leonean Health Services’ Workers’ Union (SLEHSWU)

• ·        National Union of Private Sector Health Workers of Liberia (NUPSHWL)

The PSI Sub-Regional Secretariat was equally present, as well as two leaders of the Uganda Government and Health Workers’ Union, who participated as observers.

The founding Conference adopted a communique which drew extensively from the 2006 Memorandum of Understanding. It also committed the Network to organising a Campaign for Quality Health for All in West Africa.

GROWTH & DEVELOPMENT OF WAHSUN 

The Network’s trajectory of growth and development over the last nine years has been quite impressive, even though a lot still remains to be done. This has been both quantitative and qualitative as stated herein under:

Expansion of Membership 

While there were only four unions from four countries at the establishment of the Network, it now has nine active member-unions from seven countries. Apart from these, there are five unions from four different countries that have participated in WAHSUN meetings as observers, who have indicated interest in fully joining the Network.

Beyond the numbers, there are two general trends in this expansion which are quite noteworthy. First, WAHSUN is now more inclusive and representative of health workers in the sub-region as a result of bringing on board, unions in French-speaking countries which include: Burkina Faso, Niger and Cote d’Ivoire. Unions from Togo and Guinea are also amongst those that have expressed interests in joining.

Second is the greater involvement of nurses’ unions. NANNM from Nigeria and the Ghana Registered Nurses Union (GRNA) were a bit lacklustre at the beginning. But over the last five to seven years, they have become very active leading lights of the Network as well. The nurses’ union in Sierra Leone has also come into the fold.

Organisational Development 

Beyond growth, WAHSUN has emerged as a body with a systematised sense of collective life. The plank around which this is built is the rotational half-yearly Plenary Sessions which bring the national leaderships, women leaders and educators of the member-unions together to discuss both issues of general concern and particular cases in different countries, for action to be collectively taken on.

Thus far, fourteen Plenary Sessions have been held, across eight countries. The Plenary Sessions have also been quite pivotal in bringing in unions from French-speaking countries.

The Network also organised its 1^st Biennial Conference at the Medical & Health Lodge, Abuja, in March 2014, where a WAHSUN Executive Board was elected for the first time. This was a watershed for organisational development. Before then, the leadership had oscillated between unions from Nigeria and Ghana, which hosted each Plenary Session (even when it was outside those two countries, in terms of shouldering the costs for organising the Plenary Sessions).

The WAHSUN Constitution was first drafted in 2010 and was endorsed by the Plenary Session held at Lome, Togo in 2012. It was widely discussed within the member-unions and was ratified with amendments by the 1^st Biennial Conference. 

ACHIEVEMENTS AND CHALLENGES 

WAHSUN has contributed to significant successes won by its member-unions in defending health workers and the struggle for a people-centred health system in the sub-region. There has however been a plethora of challenges. We look at both sides of the coin of WAHSUN’s history thus far, below:

Achievements

·        The most important achievement of WAHSUN has been its fostering of the primary ethic of the trade union movement i.e. solidarity. This has taken some quite palpable forms, which include: 

•  support for the weaker unions by the stronger ones to attend meetings. The Ghanaian and Nigerian unions have demonstrated comradely solidarity in ensuring that unions from other countries which otherwise might not have been able to attend Plenary Sessions and other activities, could attend these. The PSI Sub-Regional Secretariat has also been very helpful in this regard, with the growing numbers of member-unions which require such assistance;

•  material support has also been made available for unions which needed these to help build their capacities to organise, such as helping to get and furnish offices and acquiring of vehicles to be able to tour their branches, across different terrains;

•  setting up of a Solidarity Fund. This is particularly important because almost all the unions pay into this, monthly. The bigger unions pay $250, while others pay between $25 and $50. The Burkinabe union for example, actually won the hearts of other member-unions during the 1^st Biennial WAHSUN Conference, when it turned down the proposal of being exempted

·      Improvement in wages and working conditions of some member-unions have been won, partly as a result of deputations made by WAHSUN:

• The salaries of Sierra Leone health workers were increased by almost 1,000% following interventions by WAHSUN and support for SLEHSWU in fighting for this;

• A similar situation played itself out in Liberia, albeit not as dramatically. Also, WAHSUN’s intervention influenced significant amendments in the country’s Decent Work bill before it was passed as an Act of parliament last year.

·        Exchange of experiences and ideas between member-unions have been very useful for coming up with strategies in different countries towards strengthening health systems and building diseases response capacities:

• The position of the Nigerian member-unions to National Assembly on the National Health bill benefited significantly from insights provided by the Ghanaian unions where a similar law had earlier been passed. These insights were useful for winning positive amendments to the bill before it was passed;

• The sharing of experiences by unions on the Ebola Virus Disease and actions then taken was a major silent element in the sub-regional containment of the haemorrhagic fever. This was also strengthened by the PSI Africa Regional Ebola Response which was formulated and has been implemented in close collaboration with WAHSUN structures.

·        Policy influence has been established at the sub-regional level by PSI, although this is presently rather tenuous:

• The West African Health Organisation (WAHO) has come to recognise WAHSUN as a stakeholder in the sector, albeit grudgingly. Several discussions have been held between both bodies;

• WAHSUN member-unions have been at the fore of putting WAHO in the public domain by organising high profile WAHO Day celebrations on July 9 for the past few years, even when national ministries of health (which host WAHO liaison in the different ECOWAS member-states) do not mark the day, or simply just issue press statements;

·        WAHSUN has produced Information Education and Communication materials such as posters, flyers and pamphlets, as campaign materials. Some of these were widely circulated at the 29^th PSI World Congress in Durban South Africa on November 27-30, 2012, where WAHSUN secured a stall;

·        WAHSUN’s soaring credibility as the pioneer and leading Network in the region has won it international recognition and some extent of support. Materially, SASK supported the Network for a 3-year project aimed at securing observer status for WAHSUN in WAHO, to broaden its policy influence, regionally.

Challenges

·        Despite the leaps and bounds recorded by WAHSUN, most of the aims it set itself at its founding are yet to be met:

• The most important of this, in my humble opinion, is the Campaign for Quality Health for All in West Africa. It must be stated though that, while the campaign itself has not been organised, in spite of the fact that it has been planned for a few times, there have been spinoffs in the form of the IEC materials mentioned above, which have helped to project the core aims the campaign would set itself;

• Exchanges of researchers and organisers are yet to be organised. While there could be some challenges in the details of doing these, there are examples that show it can be done. The most striking of this is that between the textile workers’ unions in Nigeria and South Africa where exchanges of organisers at the turn of the century proved to be very valuable for enriching both unions organising function;

• Integration of youth into WAHSUN structures and processes has not been rigorously pursued. The 13^th Plenary Session at Niamey, Niger did however take some steps at addressing this hiatus;  

·      Organising WAHSUN Plenary Sessions and other activities in different countries have helped to spread knowledge and internationalist working class consciousness with the Network as a plank. The circulation of IEC materials have also helped in this regard, but only to a small extent. There is the need for greater awareness of WAHSUN within the rank and file. This requires regional campaign programmes, such as that for quality health for all in West Africa;

             It has been pretty difficult to win a foothold in WAHO. This is largely because the organisation appears ruffled by the Network’s union essence, being defence of the working class. Without compromising our being representative of workers, the only way to win such foothold is first to win respect in the broader publics, for WAHSUN as a leading force for qualitative development of the health systems in our different countries;

 

·        WAHSUN’s links with the civil society movement in the sub-region is almost non-existent. To effectively build campaigns and adequately lobby where necessary, WAHSUN has to proceed from a sound mapping of the spheres of CSOs (in the health sector) and build different forms of collaboration with the identified different types of CSOs;

·        Coordination has been a challenge in different ways. This was partly addressed with the election of a central leadership by the 1^st Biennial Conference. The Sub-Regional Secretariat has also been very much up and doing in terms of helping to coordinate things. But there might be the need for a more clearly defined central coordination such that tasks set by the Plenary Sessions could all be promptly tackled.

IN LIEU OF A CONCLUSION: LOOKING FORWARD

 We have definitely come a long way. But we have an even longer road ahead of us, for WAHSUN to live up to the inspiration that led to its formation. Some of the tasks at hand and possible strategy in this direction have been somewhat posed in the preceding sections. Essentially, in conjunction with propositions hitherto made, the following are problems and prospects that have to be addressed as WAHSUN’s future unfolds:

·        WAHSUN has to be built now, as a campaigning network:

ð its campaigns will have to creatively build bridges between the general and the specific (e.g. quality health for all on one hand and issues such as crisis preparedness and health insurance on the other) as well as between the development of health systems that can help ensure Universal Health Coverage and union demands in the interest of health workers such as social security, working conditions and respect for trade union rights, for example;

ð we must never forget that the debilitating state of healthcare delivery in the sub-region is a direct result of a systemic anti-poor people agenda of the 1% represented not only by international financial institutions and transnational corporations, but as well by the rich and African states that practice and promote policies which foster inequality and poverty. Our campaign for better health for all thus must be considered and pursued as part of a broader struggle for a better world. Another world is possible….but we must fight to win it;

ð along with the need for a more robust central coordination in the broadest sense to ensure seamless follow up on set tasks at all times, there is the need as already suggested by the Ebola Response Coordinator for the speedy establishment of a WAHSUN Communication Team, as a follow up to the October 2015 WAHSUN IT Training at Tema;

ð Stronger ties have to be forged between the work of WAHSUN and the national and sub-national organs of member-unions. This will involve and evolve from such bridging of the general and specific mentioned above, taking into consideration common issues and particularities in different countries and regions/states within these countries;

·        WAHSUN’s campaigning essence must be buoyed by activism rooted in rank and file awareness. But it equally has to be knowledge-driven (actually, these two sides of the coin could be mutually reinforcing if strategically pursued):

ð A major resolution of WAHSUN, which was reaffirmed at the 13^th Plenary Session, last year, is the need for WAHSUN to commence publication of a periodical, a West African Health Review or by whatever name so called, which would advance worker’s perspectives, with scientific methodology on policy, practice and politics as regards health, in and across the sub-region;

ð WAHSUN should equally issue occasional publications, that are profound but written in simple and clear language on key health issues of the day, of concern within the region. These should also etch out the relations between questions of health and the socio-economic realities of inequality and poverty which make it impossible for quality health to be available, accessible and affordable for the immense majority of our populations. Posters and flyers should also be issued more regularly;

ð Related to the foregoing is the need for us to continually expose neoliberal policies in general and in the health sector in particular for what they are anti-people and utopian. We have to turn the argument around. Time and again, the proponents of neoliberalism claim that such basics as health for all are utopian. But what the current global economic crisis has shown, more than any other thing is that neoliberalism and capitalism as a whole, is what is actually unworkable and unsustainable, dragging the earth and humankind to the precipice of catastrophe;

ð WAHSUN and member-unions should forge closer relations with the schools that train would-be health personnel, where such has not been done, as well as trainees in these schools. For the latter, one of the ways of doing this is to institute an annual West Africa-wide essay competition (this could be built into the annual WAHO day programmes of WAHSUN or as a standalone programme). Amongst other things, it would help inspire an internationalist spirit as well as WAHSUN awareness amongst the youth.

·         In the discussions leading to the establishment of WAHSUN, the possibility of constituting the then emergent Network, as a continent-wide one, was considered. But, it was eventually resolved that, while that should be envisioned, we needed to start building on a foundation and not from the “decking”. We thus:

ð Resolved to inspire the formation of similar sub-regional Networks in East Africa, Southern Africa, Central Africa and North Africa. In this regards, Uganda, Democratic Republic and (particularly) Rwanda participated several times as observers in WAHSUN Plenary Sessions, one of which was held in Kigali for which unions from Uganda, Kenya and Tanzania were invited. Discussions were also held with the South African NEHAWU which promised to attend one of the Plenary Sessions, but couldn’t eventually;

ð The aim is that, a Pan-African Amalgamated Health Sector Unions Network (PAHSUN) or by whatever name so-called would then be constituted. The beauty of this envisioned trajectory was that while the sub-regional networks could engage with sub-regional concerns, the Pan-African Network would engage with continental institutions and issues, and would be stronger on the basis of the foundations built at the sub-regional level;

ð I do believe that the time is now, for similar Networks as WAHSUN to be established in other sub-regions, for us to grow together into the envisioned Pan-African Amalgamated Health Sector Unions’ Network

The future is in the making. We have a lot to learn from, and will continue learning. But we have to seize the time, learning from our practice and enriching our practice with the learning. The working class and public health systems are already facing heavy barrages of attacks, with the worsening state of the global economic crisis and its dire impact on Africa which has been sucked into the crisis from an earlier state of perennial crisis.

We can turn the tide around only by organising, and building strong internationalist bonds of struggle of health workers’ unions that stand up for membership and health systems were poor working class-people are the loci.

Thank you all for listening

* Being a presentation by Baba Aye, Deputy Secretary General, Medical & Health Workers’ Union of Nigeria, to the Public Services International English-Speaking (East & West) Africa Sub-Regional Advisory Committee (SUBRAC) meeting, on February 16-17, 2016, at The Mirror Hotel, Kigali, Rwanda.