Show me the Money
Show me the Money
Available at: http://www.egypttoday.com/article.aspx?ArticleID=8171
Photo Credit: Courtesy of Doctors Without Rights
Photo Credit: Courtesy of Doctors Without Rights
Doctors and teachers, fed up with dismal pay, are speaking up and taking action
By: Ethar El-Katatney
Doctors in my parent’s generation aspired for five ’Ains [words that start with the Arabic letter ’Ain]” laments Dr. Mohammad Abdel-Hameed, who has been working for the past 11 years at Ahmed Maher Hospital. “’Aroosa, ‘Arabeya, ’Eyada, ’Omara, ’Ezba [A bride, a car, a clinic, a building, a farm]. Now we want just one ’Ain: ’Aish [bread].”
Despite the crucial role they play, state-employed doctors and teachers are some of the lowest paid professionals in Egypt. Teachers’ salaries start at around LE 150 and doctors’ at around LE 250 per month. Even after years of practice, salaries rarely go higher than LE 650.
Physicians without private clinics remain financially tied to their parents for years after graduation. Leaving medical school in their late 20s and working long hours, doctors rarely have time for a second job. Slightly ‘luckier,’ teachers have the evening hours to work — giving private lessons where the more experienced can charge up to LE 150 per hour.
In May 2007, the Ministry of State for Administrative Development drafted a new three-stage cadre that banned private lessons in return for a 50 percent raise (an average of LE 70) in salary. That part of the law was scrapped after objections from the People’s Assembly and teachers’ groups (see A Lesson in Futility, September 2007). The raise part remained, although as expected, strings were attached and a year later the Ministry started holding performance evaluation exams. The idea: If you pass, you get the raise. If not, you don’t deserve it.
“‘Because the teacher deserves the best social and professional position’ is the slogan we’ve been hearing everywhere,” says Hoda Abu Zayed, an Arabic school teacher at Dar Al-Saada for Languages who has been teaching for the past 20 years. “And humiliating us with exams was the way to prove this?” She says she is a supporter of the protests and sit-ins teachers staged after the government announced the exams scheme.
Also taking their struggle public, state-employed doctors took a stand early this year. Ateba’a Bela Hokook (Doctors Without Rights), a new lobby group, took to the streets and to the internet, calling for a base salary of LE 1,000. Increases were promised — but again with strings attached.
In September of last year, the first wage increases began trickling down to schools. Teachers more or less got their 50 percent increase. Abu Zayed says her raise, after 20 years of teaching, was LE 102. Her total salary now amounts to LE 575. Education Minister Yousry El-Gamal announced that LE 2.5 billion was allocated for financing the second stage of the pay scale, which would see teachers getting a raise of up to 150 percent in addition to the first 50 percent.
This May, the education administration in Giza suddenly announced that it would begin trials with new examinations to test the professional abilities of school teachers, and consequently whether or not they were eligible for the pay raises — even though the legislation introducing the raises did not stipulate any such conditions.
When teachers found out that their promised salary increases were being pegged to standardized tests, they revolted, rejecting the idea on principle. “Insulting,” “demeaning,” “disrespectful,” “offensive” and “humiliating” were just some of the words hurled by the teachers in local press during the examination period.
With little preparation and expensive crib booklets sold hastily before the exams, testing took place from August 24 to 28, with 900,000 teachers sitting the test according to a Ministry of Education press release.The three-hour multiple-choice test consisted of 100 questions and three sections: Arabic language, teaching and discipline methods, and questions about the teacher’s subject of specialization.
Those who boycotted the exam will not be eligible for the second stage pay increases. Many who took the exams came out of them resentful and angry, vehemently criticizing both the content and type of exam. There were accusations of cheating, leaking of questions, and bad treatment by supervisors, but perhaps most damning of all were allegations that many teachers were tested in topics unrelated to the discipline they teach: Arabic teachers being tested in math, and English teachers being tested in science, for example. Those who did get the right exams claim that the material was extremely difficult and that the exams could not properly assess teaching ability.
Protests were held before, during and after the tests, calling on President Hosni Mubarak to implement the no-strings attached pay scale mentioned in his electoral platform. Protests were also held outside of the capital. Across the country, teachers refused to take the test and staged sit-ins: dozens in Ismailia, 500 in Kafr El-Sheikh, 500 in Aswan and 8,000 in Alexandria.
“Every five years the teacher will get a license saying they are ‘fit to teach,’” says Abu Zayed. “And if he fails it ‘expires?’ It’s an insult. Egyptian teachers are more than qualified to teach. It’s not right that after 20 years of having taught generations that I be told I’ve passed my expiry date. Reports on our teaching in class would be a better solution. Or not to give us the raise at all — it was nothing anyway.”
The exam results will be announced in October, with salaries determined accordingly. The Professional Academy for Teachers (PAT), which was set up last year to implement the government’s education plan 2007-2012, will issue licenses to those that pass that test and be in charge of academies that will give training courses to all teachers. According to the government strategy, those who are dissatisfied with their exam results will be trained, and eligible to retake the exam again next year in order to get their pay raise.
The Teachers’ Syndicate, which represents some 60,000 teachers, has been vocal in the past for teachers’ rights. In 2007 it demanded, unsuccessfully, that base salaries be raised to LE 500. However, it has been strangely silent in response to the protests, and its recent press releases showed that it was in favor of the exams. However, deputy syndicate head Yehia El-Kilany told local press that the syndicate had requested that teachers be given their raises first and then take courses at the new academies.
The result of the syndicate’s seeming apathy is that associations that initially aimed to provide social services are now being used to mobilize teachers, including the Association of Teachers of Cairo and the Association for Protecting and Developing Teachers. Dozens of organizations like the Network of Egyptian Teachers (NET) and Teachers Without a Syndicate have sprung up, aiming to unite teachers, make their voices heard, and protect their rights while calling for a new syndicate and across-the-board pay increases not linked to assessment exams.
Another disenchanted group, the Teachers’ Voice, is organizing a “Million Signatures” campaign to strip the Teachers’ Syndicate of its power. In a statement issued during a protest the NET states: “The farce of the assessment exams reaffirms the syndicate’s weakness, its subservience to the executive authority, its participation in the squandering of public funds and its relinquishment of the role assigned to it by law. For these reasons the syndicate should be stripped of confidence.”
Abdel-Nasser Ismail, a founding member of NET, estimates that the examinations cost approximately LE 20 million. Most school teachers, he told local press, do not mind being tested — as long as they receive high-quality training courses first.
El-Gamal gave a statement to the media, claiming that the purpose of the exam was to improve teachers’ knowledge. But many claim it’s not possible, since they were tested before receiving any training.NET believes, similar to many teachers’ organizations’ public statements, that the new academies under PAT should partner or merge with the training colleges, whose role is teaching the teachers.
Sayed El-Badry, founder of the Teachers’ Voice group and head of the Alexandria branch of the Committee for the Defense of Teachers’ Rights alleges that “the aim of the exams was to sieve out a number of teachers because [the Ministry of Education] does not have the financial capacity to raise the salaries of teachers.”
It is not only the teachers that are suffering in the education system: All non-teaching staff in schools are also working to be fairly paid.
Reda Abu Serea, deputy to the Minister of Education, has said in local press that according to Article 70 of Law 155/2007, salary raises will be applied to all who work in the education sector. After wage protests last year a decision to give non-teaching staff working in the education sector a 50 percent raise increase over three years was made, only to be retracted by the Minister of Finance on the basis that non-teaching staff get bonuses equivalent to the pay raise for the performance of exam-related administrative duties.
This see-saw process was repeated a number of times, with, at press time, the final decision being no, they would not be paid. The Committee for the Defense of the Rights of Administrative Staff and Workers was formed in July 2007 to protest the final decision, holding over half a dozen protests this year.Just what the doctor ordered
Teachers’ poorly-paid brothers and sisters, Egypt’s doctors, have a difficult situation of their own. After six years of dedicated study and a year-long residency, new physicians are given a total of LE 250 per month. As late as 2006, resident doctors were paid LE 6 per 24-hour shift. The economic hardship, long working hours, stress of the profession and difficult working conditions means that doctors cannot meet the quality of service desired and can barely be expected to.
“A doctor cannot live on the salary he gets, he just can’t,” exclaims Abdel-Hameed. “24 hours a day he’s in sa’ya [water wheel turned by an endlessly plodding donkey] in order to live [and this is] reflected in his treatment of his patients. The patient isn’t at fault and neither is the doctor. [The Ministry of Health] says I need to smile in the face of my patients. How can I smile when I can’t eat? When I work in inhumane conditions? When I sweat rivers in the [poorly ventilated] hospitals? When I am constantly thinking of how to [make ends meet?]. When I see my kids once a week? When I can’t stand my life? If I was an angel from heaven I still would not [be able to smile].”
Doctors in Egypt, he says, work according to the Arabic proverb: El-shatra teghzel beregel homar. In rough translation: ‘The skilful spinster can weave even using the leg of a donkey’ (instead of a needle). In other words, they make do with their conditions and scrape by.
Teachers, at least, can work part time. But with the exhausting long hours they work, doctors don’t have the same option. The solution is charging extortionate prices in private clinics, where visits can cost patients over LE 150, or performing unnecessary, expensive procedures and operations.
The rigors of Egypt’s hundreds of thousands of doctors are nothing new. But perhaps what is new is the doctors standing up and taking action.The leader and spokesperson of Doctors Without Rights (DWR), Dr. Mona Mina, has been working for the past 25 years and has heard numerous promises in that quarter-century that have never been fulfilled.
“We hear nice talk, beautiful talk, that is repeated year after year […] and yet wages have been frozen for decades,” says Mina.
DWR was formed as a lobby group in March 2007, composed of doctors aiming to raise awareness of their plight. There are approximately 20 active lobby members and around 400 registered users on its website (atebaabelahokook.blogspot.com), which has had almost 60,000 visitors.
The members meet every week in the garden of the Doctors’ Syndicate — Egypt’s second-oldest professional union, representing over 170,000 members. DWR has four main demands: a minimum wage of LE 1,000 per month for all doctors, an increase in allowances, easier access to continuing education and reduced course fees (which currently cost LE 1,800 — prohibitively expensive for students compared to other state-funded education) for a master’s degree in medicine and finally, for state spending on the health sector to be increased. State spending on heath doesn’t account for more than 4 percent of the budget — the international minimum is 10 percent, according to World Health Organization (WHO) standards.
The 4,000 people at the general meeting of the Doctors’ Syndicate made a unanimous decision for all doctors in all governmental hospitals to go on a symbolic two-hour strike March 15.
The two International Labor Organization (ILO) conventions ratified by Egypt in 1954 and 1957 give all employees except those working in the public sector the right to collective bargaining. However, according to prime ministerial decree no. 1158 of 2003, strikes by workers employed in
“vital and strategic installations” are banned. Public sector employees who violate article 124 of the Penal Code– which bans them striking — risk three to six months in prison. In a much-debated decision, the 12 board members of the syndicate cancelled the strike, after Prime Minister Ahmed Nazif threatened the doctors on state-owned radio, saying they would be penalized if the strike went ahead.
DWR has brought a case to the State Council, aiming to legitimize strike action in the public sector, which, according to the Hisham Mubarak Law Center, is a constitutional right. Khaled Ali, a lawyer at the center, adds that educational staff, teachers and the like do have the right to strike, contrary to popular thought, since the majority of ILO bodies exclude educational sector employees from their lists of public sector employees.
Relations between DWR and the Doctors’ Syndicate have been strained ever since the decision to cancel the strike was made, with syndicate leaders dismissing the lobby group as an “unrepresentative minority.” The decision to keep postponing protests until the People’s Assembly state budget discussions were in process also angered the DWR.
In July a meeting was finally held between government representatives and syndicate head El-Sayyed. Nazif, according to the Doctors’ Syndicate’s website, announced that LE 411 million had been allocated for the first stage and LE 90 million for the second stage of “overhauling doctors’ working and pay conditions and to the syndicate’s demands for improved pay for doctors.”
Ministerial decrees 318-322 were announced during the summer months, pertaining to all health sector employees — part of the government’s new three year plan. The first, ministerial decree 318, was announced in late July, releasing the new pay scales for public doctors (see box).
Implementation was scheduled for between August and October 2008. At press time, many doctors allege that their increases have not materialized, with some filing complaints to the Ministry of Health.
One criticism of the new decree was the discrepancy in raise percentages. Resident doctors, who typically have less than five years worth of experience under their belt, will receive an increase of 300 percent while specialist doctors with decades of experience will receive a 30 percent raise in the first stage. The Ministry of Health’s reasoning is that residents are usually young, needing money to start families and homes, while specialists usually enjoy better financial circumstances by working in private clinics.
In a statement released on their website DWR asks whether this is “an attempt by the Ministry to break the ranks of doctors and weaken their strength.” They point out that there are only 40,000 private clinics in Egypt, compared to the hundreds of thousands of doctors. They add: “We are amazed that the Ministry calculates what a doctor’s entitlements are on the basis of its estimation of the income he receives from his private work […] What if the doctor is not privately employed? Will the Ministry sympathize and accept [if] he puts aside the years of experience he has obtained [to] be demoted to a resident doctor?”
A better alternative, Mina says, would be allocating salaries according to working hours, instead of on “a false assumption.” El-Sayyed answers this criticism, saying that in the second stage of the plan, the specialists’ pay will go up by 200 percent.
The second criticism of the decree was that the increases were called “doctors’ incentive payments” and not raises, which some say alludes that they may be subject to evaluation, similar to the teachers’ situation. Minister of Health Hatem El-Gabali had previously verbally promised that 70 percent of the salary would be fixed and only 30 percent subject to evaluation, though this was not in the decree.
Doctors’ salaries are composed of a base salary and additional allowances and incentive payments, which take into account postgraduate qualifications, the number of night shifts they work, performance assessments and any additional duties they perform. However, these incentive payments are very subjective, and at the mercy of administrators– who often work hand in hand with the Ministry.
The Doctors’ Syndicate’s website states: ‘Performance-linking must not be used as a means of stripping financial reform of its meaning, as was the case with the master’s degrees and doctorate raises: The syndicate has proposed that rather than being deprived of incentive payments, doctors should be subjected to a disciplinary investigation [in cases of malpractice].”
The mention of master’s degrees and doctorate raises refers to a recent incident when an announcement was made that those who received a grade of “excellent” in their master’s degrees would get an allowance of LE 100 per month. That year, almost no doctor received an excellent grade compared to previous years, provoking accusations that the government, as Abdel-Hameed says, “tells us what we want to hear and then turns around with indirect orders to [the administration] so we don’t get our money.”
Article three of the decree says “the payment of these incentive payments is linked to the availability of finances.” Also, the decree is a ministerial one, subject to change if the minister wants it, not a law approved by the People’s Assembly and fixed in legislation. According to El-Sayyed, the government refused to draft a doctor’s law that would guarantee doctors a stable raise in their salaries because of financial reasons.
In a nutshell, say the critics, if your boss says you’re not good enough you don’t get the money. If he says you’re good but the Ministry doesn’t have the money, you don’t get the money. And if you get the money, the next Minister might change his mind about giving it again.
However, El-Sayyed believes the raises are still a step forward, and credits the syndicate with negotiating with the Ministry of Health for the last two years to bring them about.
“In the year and a half [since DWR] began things changed, movement happened,” says Mina. “True, the decrees are not what we want. But even with all our objections it’s a step. There is hope.” DWR is currently collecting signatures on a petition calling for a 300 percent across-the-board increase and the scrapping of the decree’s article three.
At press time, no official decisions had been made about the second and third stages of the plan with regards to projected raise amounts or an implementation time frame. Parliament is also currently debating a draft law, which calls for doctors to be assessed every five years by the National Committee for Professional Upgrading. It is unclear what impact this might have on the pay increase issue.
There’s no doubt that the landscape of Egypt is changing. No longer content to be silenced, disappointed, disenchanted groups are speaking out. The problem of the crumbling public education and health systems in Egypt starts with pitiful salaries, but definitely doesn’t end there.
The government has more or less tied the much-deserved public sector pay increases to stringent conditions, and unearthed a buried decree that forbids protests by those who were promised the raises, according to DWR.
The President promised raises for public sector employees in his speech on Labor Day, and taxes were reportedly increased to gather funds for the raises. Giving with the right hand and taking back with the left is what has happened, and wage increases in the forms of allowance and incentive payments are not sufficient — change in the base salary is needed, as was written on teachers’ protest placards.
And even if the promised increases are finally delivered to every doctor and teacher, it’s not enough. It’s not enough to increase teachers’ wages. The teaching and examination curriculum needs to be overhauled so we don’t have students committing suicide like they did this year. Free training for the teachers would be a good idea, and even better if they get an incentive for joining the profession, says El-Badry, of the Teachers’ Voice.
It is also not enough to increase doctors’ wages. In order to perform well they have to be part of an organized health system — a sentiment echoed by doctors across the board. Syndicates have to work hand in hand with any new organizations that might help their cause. The government has to realize that caring about its citizens means caring about those that serve them. Promises are good, but as has been demonstrated by all protesting sectors, the people want the government to put its money where its mouth is.
“Kitchen workers make LE 250-270 at the hospital I work at,” Abdel-Hameed says. “How do you think a doctor with an LE 250 salary feels?” et