Liberian health workers organize amidst the pandemic

  • November 10, 2021

Care & Community

Liberia’s health workers are waging a dual struggle: battling the COVID-19 pandemic on the one hand, while fighting for their rights and salaries on the other.

Ebola survivor Korlia Bonarwolo leads a training of health workers at a mock Ebola Treatment Unit in Monrovia, Liberia. November 2014. Photo: Morgana Wingard / Sarah Grile

This essay is published in collaboration with Public Services International

On October 26, the Liberian government declared that the country no longer had any active COVID-19 cases. Dixon Korveh heard the news and felt good, “no active case is proof of the hard work we did, despite challenges, we did this” he says.

The challenges Dixon talks about are major. During the pandemic, Dixon worked as a mental health clinician and nurse at Star Base; the primary health center for  COVID-19 cases in Liberia. However, despite the fact that he was working at the epicenter of the pandemic in Liberia, Dixon had to struggle for access to adequate equipment. In addition, his salary was delayed for the first two months.

“I was working for over eight hours a day when  COVID-19 started,” he says. “Sometimes I was in PPE for five hours straight, but they still delayed my pay for the first two months. It just demotivates you.” When Dixon was finally paid, he says it was with dilapidated notes, some of which were rejected by his bank.

For Dixon, working during the COVID-19 pandemic felt like déjà vu to his work in 2015 during Liberia’s Ebola virus epidemic. During the Ebola epidemic, health workers had to grapple with a highly infectious disease, inadequate safety measures and a lack of access to adequate equipment. The Ebola virus went on to kill more than 11,000 people across West Africa, with Liberia losing 8 percent of its doctors, nurses and midwives to the virus.

Dixon’s case is like many other health workers in Liberia. Thus in 2020, amidst the  COVID-19 pandemic the National Health Workers Union of Liberia — a member of Public Services International (PSI), the global union federation of workers in public services — had to implement a stay-at-home action for PPEs, better pay and better working conditions for the benefit of both patients and caregivers.

Unionism in Liberia

Due to its large extractive and agricultural industries, Liberia — Africa’s oldest republic — has always had active unions like the Firestone Workers’ Union and the Agriculture Agro-Processing and Industrial Workers Union of Liberia. Notwithstanding its history of unionism, there is a legal regime that restricts, and in some instances prevents union activity.

An example of these restrictions is the Liberian civil service standing orders which prohibit public-sector employees and employees of state-owned enterprises from organizing into unions and collective bargaining.

Instead, the law provides that grievances may be pleaded through the civil service agency grievance board. In addition, Liberia’s 2015 Decent Work Act bars workers in essential services from striking, however the government is yet to define which services are to be considered “essential.”

Opponents of these laws have argued that the law is in breach of the right to association which is enshrined in the country’s constitution and other international laws that the country has ratified. However, despite the objections, the law remains in place.

With its unitary system of governance, where power is centralized in the president, coupled with the government employing a significant portion of the labor force, the government has used this law to counter unionism in vital sectors like public education and healthcare.

In light of the law, some sectors — like teachers in the public education system — have decided to form associations that are focused on employees’ well-being and internal interactions, as opposed to unions that have bargaining power and can call for strikes and stay home actions. Notwithstanding, workers in some sectors have formed unions, despite the law. The National Health Workers Union  of Liberia is one of them.

Building A Union for Liberian Health Workers

NAHWUL is one of the key unions in the country. Although it was not active in advocacy until the mid-2000s, the union has been pivotal in representing the interests of Liberian health workers with extensive support from PSI.

Health workers occupy an important role in Liberian society as they provided essential services during and after Liberia’s two civil wars that lasted for a total of almost 12 years between 1989-97 and 1999-2003. In spite of the crucial role health workers play in society, they are faced with numerous challenges.

Prime among these challenges is inadequate pay. During the Ebola epidemic, health workers had to strike for better protective equipment and hazard allowance as some were earning as low as US$250.

To make matters worse, in 2018 some health workers were wrongly removed from the government payroll system and a government wage-harmonization exercise saw the reduction of salaries of health workers in 2019.

According to the Assistant General of NAHWUL, Deemi Dearzua, this is where the union comes in to represent the interests of health workers. However, he admits that initially, most health workers did not know of their right to bargain. Therefore, in collaboration with PSI, the union  embarked on a mission to educate workers.

Through the Strengthening Unions for Quality Public Health Systems in Liberia project, PSI conducted capacity-building webinars for unionist and trade unions leaders educating them on laws and international statues in regards to unionism. These lessons from these trainings were also conveyed to other health workers.

“We had seminars and trainings, and we spread the knowledge,” Dearzua says. “Heath workers now know that they have the right to association and bargaining in the constitution and international laws like the ILO convention. Now health workers know that they have a statutory right to demand better.”

The collaboration between NAHWUL and PSI has also helped to increase visibility of the union. “When we started, we were like 600, now we are up to 3.000 and adding more,” explains Dearzua

In a bid to limit union activities, the government has refused to issue the union a certificate of recognition and in some instances, the government has refused to interact with the union.

In light of this, PSI has not only helped extensively with advocacy and lobbying on the international front. Projects like the Strengthening Unions for Quality Public Health Systems in Liberia have also helped the union to develop capacity and policy to help it in lobbying and advocating for the right to unionize and the right to certification.

Helping health workers survive the pandemic

Throughout the COVID-19 pandemic, NAHWUL was instrumental in helping health workers bargain for their rights. When Liberia recorded its first case of COVID-19 in March 2020, the union released a statement calling for health workers’ inclusion in the planning of the COVID-19 response strategy. The union also requested refresher training for front-line workers and an adequate supply of PPEs.

Despite the union’s requests at the beginning and during the pandemic, the government refused to properly cooperate with the union. Consequently, in September 2020, NAHWUL announced an indefinite stay-at-home action. This action was agreed on in response to the government’s failure to listen to their requests.

The requests included: benefits for health workers who died or were infected on the job, increment of health workers’ salaries in fiscal year 2020/2021,the reclassification of health workers and the payment of hazard allowance to all health workers.

Additionally, the union noted the government refusal to honor a 2019 Memorandum of Understanding which was agreed upon after the union went on strike in 2019. The Memorandum of Understanding provided for the union to be issued a certificate of recognition, and a government blueprint on how pensioners can be paid.

In response to the stay-at-home action, the government not only refused to honor the MOU they entered into with the union, but it also maintained an unfriendly, intimidating and threatening posture towards the organized health workers.

Instead, when he met with a delegation from the union, President Geroge Weah threatened to arrest union leaders and workers if they protested. The president also threatened to sack and replace any health worker who went on strike or stayed at home.

Despite the threats, the union proceeded with their stay-at-home action. The government issued a statement in response declaring that; “The Ministry of Health was instructed to solicit applications from qualified health workers of various grades, including nurses, nurse aides, midwives, laboratory technicians, etc. in order to fill the temporary vacancies that have resulted from the strike action.”

The government also assigned volunteers to public health positions in a bid to mitigate the effects of the stay-at-home action. During this period, the lives of union leaders were threatened. “It was a trying time. My life and the lives of other union leaders were threatened; we couldn’t sleep in our houses out of fear” says Deemi Dearzua, NAHWUL’s Assistant General.

While in hiding and maintaining the stay-at-home action, union members and leaders were able to communicate and report virtually. This was largely due to trainings conducted by PSI to build the union’s logistical capacities on how to effectively use virtual meetings and reporting. Union leaders and members were trained on how to effectively use various platforms that are available like Skype, Zoom, MS Teams, Twitter and WhatsApp

Currently, the union holds most of its meetings virtually. This has not only provided more security and reduced costs compared to in-person meetings, it has also helped to expand the reach of meetings. As a result, members and union leaders around Liberia can log on virtually and properly plan union activities under safe and secure conditions.

NAHWUL also had to ensure that women were properly incorporated in the union structure. During the pandemic, besides dealing with the challenges of the virus, many women health workers  also had to fulfill their roles as primary caregivers for their families who were stuck at home during lockdown.

Having adequate women representation in positions of power helps in addressing the peculiar challenges women face. NAHWUL has risen to this occasion as union structures in every county now include women committees. Women also make up 25 percent of the executive committee and 50 percent in the other decision-making bodies.

PSI has also implemented projects towards issues like sexual harassment that disproportionally affects women. These projects have helped to strengthen the capacities of the unions to help fight, document and report sexual harassment at work. The union was also trained on developing policies and positional statements against sexual harassment.

This is echoed by Edwina Sheriff,  chairperson of the union’s women wing: ”There were women that were harassed and they didn’t know it constituted harassment until we did awareness [training] on sexual harassment. Thanks to the project, we went to major health centers doing [trainings on] awareness and recording cases of sexual harassment.”

In October the health workers called off the strike upon the intervention of the UN resident coordinator and other international partners.

Unionism during and after service.

The fight for pension is an integral part of NAHWUL’s struggle, because retired health workers have to go through significant troubles to access their pension.

At the start of the pandemic in Liberia, the government called out to retired health workers to come out of retirement and help boost the country’s health sector.

Notwithstanding the government’s call, NAHWUL says that the government retired up to a 1,000 health workers during the pandemic. Most of these health workers were retired abruptly regardless of a three months’ notice that is statutorily required. Although the motivations behind this measure remains unclear, it is in line with the IMF-imposed austerity measures that have been in effect since 2019.

Furthermore, the union says that up to 70 percent of the health workers who retired during the pandemic have not gotten access to their pensions. One of them is Lorretta Nyah, a former union member and a health worker who worked for 24 years.

Lorretta started out working as a nurse aid and by 2012 she went and got a nursing degree. Despite getting her degree in 2016 and working as a registered nurse till she was retired in October 2020, Loretta was never re-classified to earn as a registered nurse.

“I still earned the salary of a nurse aide while working as a registered nurse,” she explains. “I was trying for years to be reclassified till they just told me I am retired, no three-month notice, nothing.” So far, Loretta has gotten no benefits or pension.

Some health workers, especially health workers in Liberia’s extremely rural areas, were retired without notice. The union has recorded incidents where health workers continued working for several months after their supposed retirement because they were not notified. Equally important to note is the fact that the procedure to get registered to receive pension is a tedious process for most.

Moving forward

For most unionists, they agree that while some progress was made towards getting hazard pay and the improvement of their virtual meeting skills, they believe that there are many more challenges facing them.

After pressure from the union, the government finally rolled out two million dollars —  or about $142 per person — as a one-time hazard pay for health workers who worked during the pandemic.

Nevertheless, the union says that less than 50 percent of their members have gotten this hazard pay from the government. In addition, families of health workers who died from COVID-19 have not been compensated.

Additionally, due to funding constraints, the union has only been able to carry out sexual harassment awareness and reporting in five out of Liberia’s 15 counties.

Lorretta says the fight of the union is far from over: “I am retired but still don’t have my benefits, we in the union just want what we deserve, we want what we worked for.”

While the government has since refused to interact with the union. NAHWUL is monitoring the payment process for hazard pay while requesting for a faster system. The union has also continued their lobbying for a certificate of recognition, and a faster and clearer pension system for health workers.

In partnership with ROAR, this article has been commissioned by Public Services International (PSI) and supported by Union to Union and Swedish trade union Kommunal under the project “Strengthening unions for quality public health systems in West Africa.”

Dounard Bondo

Dounard Bondo is a writer based in Liberia. His writing usually covers politics, policies, human rights and entertainment in Africa. Dounard has bylines in BBC, Quartz, TRT World and others. He also writes short stories.

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