‘The Hand that Gives and the Hand that Takes’: The Taming of Zimbabwe Medical Doctors Industrial Job Action

Abstract

The literature on repression and path dependence provides a solid theoretical tradition for understanding how regimes contain and repress protests and strikes. Less well-understood is how and why regimes react in the manner they do in containing industrial job action from critical and essential service sectors such as public doctors. Answering these questions is pertinent not only for advancing scholarly insights on repression literature but also for understanding the state’s power, character and worker resistance in Africa. Utilizing the Zimbabwean case study, the article examines public hospital doctors’ labour protests during 2018 and 2019. The article contends that how repressive regimes respond to collective job action is shaped by path dependence.

Keywords

Doctors protest health strike labour rights repression political economy ZANU-PF Zimbabwe

Introduction

For decades, Zimbabwe has contended with recurrent doctors’ and nurses’ strikes stemming from the health sector’s collapse. Notably, several seismic shifts in the country’s health sector underpin this regularity and frequency of strike action. Nowhere is this more evident than in the growth and decline of the sector during interspersed periods (Mutizwa-Mangiza, 1998). This decline, however, cannot be divorced from the Zimbabwean political economy, which has been under morass at the turn of the millennium. However, this does not suggest that the country’s health sector collapse only started in 2000. It started long back though it might have been accentuated during this period (Kanyenze et al., 2011). This collapse, paired with recurring grievances, has triggered strike action by medical professionals, including doctors and nurses (Mutizwa-Mangiza, 1998; Raftopoulos, 2004). However, Zimbabwe prided on a vibrant health care system before this collapse.

Following independence in 1980, Zimbabwe recorded significant developments in the health sector. This was underpinned by health policies such as the Health for All by 2000 and Equity in Health underpinned by concerted funding support to enhance infrastructural development and health care services (Kanyenze, 2007: 7). Such significant progress was eroded in the early 1990s during the Economic Structural Adjustment Programme (ESAP) era and in later decades. Following ESAP’s inception, public hospitals introduced user fees (Kanyenze et al., 2011). Since then and following the rise of the private sector and budget cuts, access to health shifted from being a public to a commoditized good (Hodgkinson, 2019; Kanyenze, 2007: 7) This and the subsequent years, which saw the collapse of the Zimbabwean economy post-2000, both accentuated the precarious nature of the country’s health sector. Against such a backdrop, the Zimbabwean health sector witnessed several strike actions by nurses and doctors due to deep-seated and unresolved grievances. These recurring actions were to be witnessed in the 2018–2019 crippling strike by the public hospital doctors (Community Working Group on Health (CWGHa; 2018), which is the crux of this article.

The article seeks to put into conversation literature on the nature and practices of repressive regimes (Honari and Muis, 2021; Opp and Roehl, 1990; Thalhammer, 2001), and on state’s handling of industrial job action, in the historical context of strikes by hospital doctors in Zimbabwe under the administration of President Mnangagwa. The article pursues two sets of arguments. The first argument advanced is that repressive regimes’ brutal and coercive actions depend significantly on whether they perceive as a threat those interests who are striking and demanding redress (Honari and Muis, 2021). In the case of Zimbabwe’s striking doctors, it is held that the state did not see the doctors as a severe threat to power and therefore did not engage in strongly repressive measures to constrain and defeat strikers.

Second, by bringing a novel argument, the article contends that the continuities and similarities in the tactics used to contain the doctors’ strike are informed by the path-dependence approach insofar as how regimes continue to inherit, depend and be influenced by past trajectories and experiences (Greener, 2005; Thelen, 1999). The question, however, is what explains the enduring continuities, similarities and variations of policy and action (if any) in treating protesting doctors in Zimbabwe? The article probes, how, why and in what ways did the Mnangagwa regime contain public hospital doctors’ strikes in the post-Mugabe era? In so doing, the article contributes to the academic and policy debates on the public health sector and its conflictual relations with the Zimbabwe government (state-labour relations), explicitly examining worker resistance by public sector employees.

The analysis also endeavours to shed light on how the state has deployed different strategies to regulate associational life in the post-Mugabe era as well as examine why the medical doctors’ strike persisted considering what scholars term ‘unchanged perception of repressive threats from the state’ (Honari and Muis, 2021: 116). Such an analysis helps deepen our theorization of the political economy of health and state–labour regulation in contemporary Zimbabwe. The article is structured as follows: Next, I outline the literature debates and the theoretical lens informing the study before presenting and tracing the political economy of health and the history of public sector labour protests in Zimbabwe. I then present an empirical discussion of the doctors’ strike before concluding the study.

Literature debates on public sector workers and industrial job action

The study sits at the intersection of three streams of scholarly literature, namely, that of repression (state power), industrial job action (worker resistance) and path dependence. Noticeably, the existing studies on the industrial job action by medical professionals in Africa and elsewhere tend to focus on the enactment of anti-strike legislation – no-strike laws (Madhuku, 1995; Meltzer, 1963; Ross, 1969) – and more dominantly on the morality and ethics of such activity (Chima, 2013; Ogunbanjo and van Bogaert, 2009). This pertains particularly to whether physicians should engage in industrial job action or not against a repressive state that will not hesitate to curtail these rights (Dhai et al., 2011; Selemogo, 2014). The experiences of medical professionals particularly doctors in various jurisdictions in Africa are somewhat similar insofar as their long-standing grievances have ignited industrial job action. It is noted that in Uganda, Kenya, Sudan, Nigeria, South Africa and Zimbabwe, medical professionals have at different intervals engaged in strike action dissatisfied by the status quo at workplaces including their welfare (Chima, 2020). But there are laws proscribing these industrial job actions with the right to strike not being expressed as an absolute right in most jurisdictions.

Often arguments against physicians’ participation in industrial action are steeped in human rights (rights of the patients), social justice, obligations of the medical professionals, ethics of the profession and their mandate and pledge to save lives (Chima, 2013; Makoni, 2019; Mawere, 2010). However, such analyses often side-step or overlook the role of the an-all-powerful (repressive) state in how it exercises state power in curtailing the rights of public sector employees, especially the right to strike, through overt and covert approaches (Chima, 2013; Madhuku, 1995). Despite such a corpus of literature, there is paucity of evidence on how path dependence conditions the continuities in the state–medical professionals’ labour contestations and regulations. As a foray into this subject and tracing these temporalities and the state of the public services articulated in the extant studies, it is crucial to decipher the endurance of authoritarianism across the Mugabe-Mnangagwa regimes.

Repression and path-dependence literature

The article draws on and is embedded in the theoretical framing of repression (Davenport, 2007; Honari, 2018a; Honari and Muis, 2021; Kurzman, 1996) and state power to examine how repressive regimes utilize different authoritarian forms and tactics to disempower and contain public sector strikes. Repression is defined as ‘the actual or threatened use of physical sanctions against an individual or organization, within the territorial jurisdiction of the state’ (Davenport, 2007: 2). Contemporary scholarship has increasingly been interested in examining how and why repressive governments deploy repressive action in some and not in all protests (Davenport, 2007). It is observed that the ‘decision to repress or not to repress is made on a case-by-case basis’ (Göbel, 2021: 171).

Others have also interrogated how repression undercuts political participation (Honari, 2018a), with others speaking of how it dampens protests momentum and how it can trigger public outrage and condemnation (Hess and Martin, 2006). However, little attention is given to how repression affects collective labour protests by essential workers, particularly those in the health sector. Following Weiss (2013), I contend that repressive regimes adopt a three-tier approach of containing, suppressing and permitting protests, including labour action, depending on their effect on the regime. In this regard, scholars speak of ‘objective’ repression – ‘what states do’ – and ‘subjective’ repression – ‘what individuals perceive’ (Honari and Muis, 2021: 107). Considering state reactions, protesters, including those engaged in collective job actions, also decide whether to become risk takers or risk averse (Ayanian and Tausch, 2016: 704; Honari and Muis, 2021).

The above-calculated decisions are informed by regime reaction and containment strategy to strike action. Such decisions, however, are contingent on the level and intensity of threat, dynamics, actors involved, issues at hand and the organizational capacity of the protesters (Göbel, 2021). Such approaches are designed to have a deterrent effect on participation (Olson, 1965) or what Lorentzen (2017) terms ‘strategic deterrent’. It is further noted in the repression literature that a panoply of considerations shapes regime response to protests. Ranging from size and strength, popular support (appeal effect), demands, nature of the support of the protests and the actors involved (Josua and Edel, 2015). In this regard, Poe et al. (2000: 32) posit that a call for a pay rise poses less threat than other more baleful demands, such as a systematic change in state governance. This is in sync with Cai’s (2010) observations, who also view ‘monetary costs’ as low concessions. This may explain why repressive regimes (Sutcliffe, 2013) may contain such industrial job actions with less force than those that will spark a sustained challenge to state power (Cai, 2010; Göbel, 2021). However, scholars contend that ‘perceived repression may generate moral indignation and social incentives to participate in protests’ (Honari and Muis, 2021: 108). Fear which is viewed as a demobilizing emotion (Jasper, 1998) also plays a role in protest participation.

The discussion in this article is also underpinned by the path-dependence canon (Collier and Collier, 1991; Peters et al., 2005). Such a canon is rooted in the rational choice and historical institutionalism theoretical lens (Greener, 2005; Peters et al., 2005). For reasons of brevity, I privilege using a narrower instead of an expansive view of path dependence. Scholars opine that path dependence entails ‘that what happened at an earlier point in time will affect the possible outcomes of a sequence of events occurring at a later point in time’ (Sewell, 1996: 262–263).

The undoubted relevance of the path-dependence theory (Berman, 1998) lies in its utility in facilitating a deeper understanding of institutional arrangements, historical configurations, processes and collective bargaining institutions (Pierson, 2000). This, for instance, entails looking at how the political regime – the Mnangagwa administration through the (courts, police) Ministry of Health and Child Care, Health Service Board (HSB) and the industrial relations unions – has structured and normalized specific patterns and norms in curtailing the rights of medical professionals.

Political economy of the decline of the Zimbabwean health sector

It remains critical to note that the collapse of the country’s health sector is not reducible, nor should it be limited to the impact wrought by ESAP but to the broader developments which characterized the Zimbabwean political economy over successive decades. Here, it is relevant to refer to the claim by Kanyenze (2007: 8), who observed in the wake of ESAP till the turn of the new millennium how the ‘per capita allocations to health declined from a peak of US$23.60 in 1990 to US$14.00 by the end of 2001’.

That the health sector was not spared from the vagaries of a comatose economy is beyond doubt. This is demonstrated in the massive brain drain (Mutizwa-Mangiza, 1998) or outsourcing of health professionals into the region and into Europe, United Kingdom and Australia. However, to the professionals who stayed put, low salaries, poor working conditions, poorly capacitated workplaces, low staffing, depressed morale, victimization and criminalization of strikes has been the order of the day (CWGH, 2018a). Each of these developments underscores the decline of the health care system in successive decades paired with the deepening authoritarian conduct of the state.

History of public sector protests

At the attainment of independence, the newly led ZANU-PF government recorded 178 strikes coupled with work stoppages spanning from March to October 1980, stretching to 1981. This trend affected all major economic sectors (Sachikonye, 1986: 252). Despite the initial government response in promising more than it could deliver insofar as restructuring the collective bargaining and the labour law, the Mugabe-led government quickly resorted to the use of the police to quell labour protests (Dansereau, 2003: 176). This was to become an all-too-familiar trend in years to follow. In 2019, the CWGH (2019a) noted that ‘strikes by health workers in Zimbabwe have become an annual ritual mainly because there are not enough financial resources allocated to the health sector’.

In earlier years, for instance, in 1996, public sector workers, including health workers (nurses) and teachers, engaged in protracted and raucous labour disputes (Raftopoulos, 2000: 268). The intensity of wildcat strikes was also to be felt in the following year in 1997 as evident in the record of 232 strikes (Kanyenze, 2004: 130). Post-2000, the health workers were to continue with industrial job actions, sit in, strikes, picketing and dialogue with the government. The endurance of strike action was only halted during the era of the Inclusive Government in 2009–2013 and resurfaced post the Inclusive Government. Against such a backdrop, I situate the post-2017 Zimbabwe public hospital doctors’ strike.

‘Painting the streets White’: limning the 2018–2019 medical doctor’s strike

The Zimbabwe medical professionals, including junior doctors, downed their tools in March 2018, stretching to December, due to many work-related grievances (Zimbabwe Human Rights NGO Forum, 2018). They were later to be joined by the senior doctors. Commenting on the status quo in the country’s health sector in 2018, one Zimbabwean health organization observed the following:

Infrastructure in hospitals is dilapidated, some is obsolete; medicines and supplies are in short supply; doctors, laboratorians, pharmacists, paramedics and nurses are inadequate and poorly motivated. And this against a background of sustained paltry funding to the sector from national fiscus is of major concern. (CWGH, 2018c)

Against such a backdrop, junior and senior doctors embarked on strike, spurred by grievances congealing around poor remuneration and deteriorating working conditions (Makoni, 2019). Crucial to note is that Zimbabwe public hospital doctors’ engagement in industrial job action is not limited to the post-Mugabe era. Expressing its concern over the frequency and recurrent strikes, the CWGH noted the following:

[t]he perennial pattern at which the strike happens, entailing that the fundamental causes of these yearly strikes are not being tackled adequately, resulting in the unnecessary and avoidable suffering and deaths of innocent patients. (CWGH, 2018a)

However, these grievances have a long tradition predating the 2018 period. As Mutizwa-Mangiza (1998: 8) aptly notes, ‘strikes of 1988, 1989 and 1990 by health workers clearly pointed to underlying frustration and dissatisfaction with working conditions’.

To contextualize the overall declining working conditions of the health sector, it is important to also refer to the earlier strike action by nurses in the government hospitals who, in mid-April 2018, protested over poor salaries (CWGHb, 18 April 2018). The obtaining stalemate which followed, just like in earlier years during the Mugabe regime, was faced with a heavy and expected response from the Mnangagwa regime. In a path-dependent trajectory (akin to the previous 1990s and 2000s) strike by the medical professions (Dansereau, 2003; Schiphorst, 2001), Retired Army General Constantino Chiwenga (vice-president) of Zimbabwe, who was also to become the Minister of Health and Child Care, went on to sack more than 16,000 striking nurses (Australian Government, 2019: 35).

Following this sacking, they were all or most re-employed again, even if they were effectively forced back to work by dire material needs. This is essential background relating to the decline in doctors’ working conditions and the extent of the regime’s dependence upon them. Nevertheless, this treatment of nurses is not without precedent. In 1990, the Mugabe regime dismissed striking nurses. However, in this particular year, ‘the demands of the nurses were met in the end, but it took three Ministers and even the President to intervene personally’ (Schiphorst, 2001: 109). However, this is not to suggest that their demands were met in all the striking years.

In the context of 2018–2019, the nurses’ grievances were the same as that of doctors as they pertained to poor remuneration (CWGH, 2019a). They only varied regarding terms and conditions of service, namely, on-call allowances (CWGH, 2018a; ZCTU, 2018). For their part, doctors waged a strike over the failure of their employer (the government), to pay a living wage indexed to the United States dollar, among a range of other issues, including a shortage of drugs and medical sundries in public hospitals (CWGH, 2018d).

Like in earlier episodes of strike action by the doctors, the Mnangagwa administration sacked the doctors to contain the labour stand-off (Dansereau, 2003; Schiphorst, 2001). No sooner than he had resolved the nurses’ debacle, Acting President Dr Constantino Chiwenga vilified the striking public hospital doctors. He labelled and underplayed their importance to the country’s health care system by chastising them as ‘casual labourers’ who do not hold any ‘specific skills’. Instead of cowing the doctors into submission, the slander did the opposite by galvanizing their resolve to continue with the industrial job action.

Continuity in strategies in addressing protesting doctors

Throughout 2018, Zimbabwean doctors intensified their demands for better working and living conditions. At first, to the government, it was unimaginable that the doctors would get the guts to down their stethoscopes and dust coats, let alone storm the streets, considering that the regime had issued threats of dismissals if any medical doctor dared to engage in industrial job action. To this end, numerous references were made to the medical professionals’ mandate, particularly to the doctors; for example, how they should abide and uphold the Hippocratic oath (Limukani Ncube, 25 March 2018). Here, it is pertinent to quote Chiwenga, who noted the following regarding the striking doctors ‘those who withdrew their services chose the wrong profession because if they are doctors, the patient is their priority’ (Newsday, 2018).

This tried and tested regime tactic of appealing to the welfare of the patients whenever public hospital workers strike was employed in this case – to suppress any thoughts, plans and actions of engaging in any form of future industrial job action. The Hippocratic oath compels doctors to act ethically, valuing human life (patients) and binding them from neglecting their duties (Mawere, 2010). Emphasis was stressed that the medical profession is an essential service. This argument has analytical relevance for contextualizing the strike by the medical professionals, including nurses and doctors, categorized under essential services. However, in condemning continuity in the suppression of doctors’ right to strike – one Zimbabwean health organization made the following remark:

[I]t is shocking that the Health Minister Obadiah Moyo dwells on the legality of the job action than solutions as if he is reading from his predecessor’s script. No responsible and accountable Minister or government would turn a blind eye to a crisis of this magnitude or wishes it away. (CWGH, 2018d)

Such a lack of political commitment in addressing the long-standing issues affecting the health sector reinforces the claim that the regime did not feel threatened by the doctor’s strike (CWGH, 2019b). Neither was the regime moved by the public outcry over the fate of patients.

This reaction was no surprise, considering this has always been the trend, even during the Mugabe regime. This kind of behaviour and conduct bolster the claim that political regimes follow specific behavioural patterns and pathways across time and space (path-dependence trajectory) (Peters et al., 2005; Thelen, 1999). In reinforcing this claim, it is pertinent to refer to the ZCTU (2018), which in 2018 lamented the situation that characterized the state–doctors relations as follows: ‘what is more worrying is that for the past 15 years or so, doctors have been striking almost every year without their issues being addressed’.

Viewed critically and in the latest action in the 2018–2019 era, the state was reluctant to address the doctors’ grievances considering that the strike action was less threatening to the rule and survival of ZANU-PF. This partly explains why the Mnangagwa-led regime could do as it pleases. Such actions echo the repression literature where scholars hold that demand for pay rise possesses less baleful threat than a systematic change in the state’s architecture (Poe et al., 2000: 33).

In the 2018 context, the sacking of the striking doctors was preceded by a series of negotiations between the Zimbabwe Hospital Doctors Association (ZHDA) and the government through the HSB (CWGH, 2018d). Like in earlier years in the Mugabe era, the ZANU-PF-led government also employed dialogue strategies with public sector unions (Mutizwa-Mangiza, 1998). During the later strike in 2018–2019, this seemed to have worked in the interim, as noted in the assertion by one leader of the doctors; ‘our members have begrudgingly resumed work with effect from today as dialogue continues’ (Medical Brief, 2019). Significant to note is that this resumption of duty did not mark the end of the doctors’ strike. It was only but a reprieve.

In months to follow, in acts showing the government’s bad faith, doctors were ordered to re-apply and then be re-admitted into their jobs (Herald, 2019c). The net effect of such a move was to strike fear among the doctors. Strictly speaking, the disciplinary hearings and the firing of the doctors were used as a deterrent to contain any future industrial job action by the medical professionals. This restraint mechanism was presumably inspired by the need to undercut disruption costs. Scholars hold that disruption costs become high, especially when protest events endure and disrupt business or attract a big crowd (Klein and Regan, 2018: 493).

The firing and re-admission of Zimbabwean doctors is not without precedent. Public health workers were forced to return to work in earlier years, but their outstanding grievances could not be adequately addressed. This is even more apparent in how doctors continued to engage in strike action in 1988, 1989, 1994 and 1996, and so were nurses who striked in 1981, 1990, 1996 and in subsequent years (Mutizwa-Mangiza, 1998: 3). The seeming endless trend in the dismissal of public hospital doctors and nurses each time they go on strike and rehiring them were the same tactics adopted by the Mnangagwa regime, underscoring the continuity of repressive response to labour activism. In the 2018–2019 era, the Mnangagwa administration vowed to replace all the striking doctors with Cuban doctors, an antidote that never materialized (Government of Zimbabwe, 2019). While the state has on many times negotiated in bad faith, the Zimbabwean doctors have always enjoyed some power derived from their knowledge and qualification to the extent that they always felt their voice will be heard by the ZANU-PF regime. However, this has not stopped the government from underpaying them, a reason why they engage in persistent industrial job action.

Continuities in addressing strike action in 2019

Undoubtedly, the public sector strikes of the 2010s in Zimbabwe mirror those of the 1990s, with the same issues, actors and generally, the same outcomes. Why do these conflicts keep recurring, and how effective have the government’s actions been in ‘silencing’ public health worker organizations? This is a basis that is relevant in understanding the 2018 strike action by doctors, which took several twists and turns, as evident in how the strike spilt into the following year. The question is, how can we explain the continuities of strike action by the public hospital doctors? The answer lies in the rigidity on the state’s part in addressing the striking doctors’ outstanding grievances. This was also a source of worker dissatisfaction during the strikes of 1988–1989 and 1990 (Mutizwa-Mangiza, 1998: 5). But the reluctance on donor health financing can explain why the Zimbabwean government reneges on improving doctors’ welfare.

For long, the political elite in Zimbabwe has looked to the private sector and donor agencies to finance the country’s health needs rather than worrying about committing sufficient budgetary support to health care (Kanyenze et al., 2011). This stands in stark contrast to the articulations of the Abuja Declaration, which espouse that every state party should provide more than 15% of its budgetary allocation to the health sector (CWGH, n.d.; ZCTU, 2017a). Against such a backdrop, the country’s health sector has been receiving a tiny fraction of the annual budgetary allocation from the state that the 2018–2019 protest by the doctors can be understood.

It was within such an enduring trend of unresolved grievances that on 30 August 2019, the leadership of the ZHDA issued a notice of strike to the Permanent Secretary for Health and the Minister of Health and Child Care, indicating that its nationwide membership would not turn for duty commencing on 3 September 2019 (Amnesty International, 2019). In the wake of this pronouncement, events fast followed each other. On 3 September 2019, the junior medical doctors in Harare (capital city of Zimbabwe), under the rubric of the ZHDA, again downed their stethoscopes through a work boycott. However, their action was not only limited to boycotting work as they also marched into Harare’s Central Business District (CBD), showing their displeasure against the reduced salary – a paltry US$ 100 per month, which was slowly eroded with inflation.

At least from the doctors’ perspective, their industrial job action was motivated by state reluctance to improve their working conditions, including providing drugs in public hospitals and protective clothing (CWGH, 2018d). Unlike the ZCTU-organized demonstrations that shook the state to react in a more repressive and lethal manner in January 2019 (Australian Government, 2019: 35), the doctors’ strike was primarily perceived as no harm and of less threat to ZANU-PF. This speaks to how the ZANU-PF regime has always perceived and responded to public sector strike action, decisions which are particularly informed by the nature of the character, agency (power) and orientation of the Hospital Doctors Association (HDA) in contradistinction to other collective groups of workers such as teachers (as exemplified in the case of the combative Amalgamated Rural Teachers Union of Zimbabwe (ARTUZ)).

Abductions, propaganda and litigation

Nonetheless, in seeking to force the striking doctors to call off the strike, the Mnangagwa regime also deployed other strategies, including propaganda to sully the striking doctors. Not only that, but it also resorted to abductions of the union leaders (The Guardian, 2019). The abduction of Magombeyi (leader of the ZHDA) was a clear move aimed at containing (in a repressive way) the association’s industrial job action and preventing future job protests. This incident gives credence to an earlier established trend in the literature which posits that under authoritarian regimes, even the politically inactive sections of the population (including doctors) are not spared from some degree of repression (Mason, 1989, own emphasis). This is also reflected in the inter-temporal persistence of this trend (Vogler, 2019) stemming from the Mugabe to Mnangagwa rule. However, for Cai (2010), such repressive actions are only an act of last resort after pursuing concessions.

The ZANU-PF-led regime opined that such an abduction would deflate the association’s energy and potency. However, the rest of the doctors and nurses would not take it lightly. On 16 September 2019, they flooded the streets, demanding the release of the union leader Magombeyi by his abductors. Owing to such and other accompanying ‘repertoire of strategies to respond to repression’ (Honari, 2018b: 8), including public and diplomatic pressure, he was found dumped on 19 September 2019 by the roadside near Nyabira, some 33 km from Harare (Amnesty International, 2019). What can be discerned from this act of repression is that the Mnangagwa regime, rather than improving the doctors’ living and working conditions, seemed intent on silencing them. This claim is undoubtedly not unfounded, judging from the similar tactics deployed to silencing labour during the Mugabe era (Schiphorst, 2001). The regime’s efforts did not end with this strategy.

It engaged in a demonization campaign by painting the doctor’s association as an extension of the political opposition. This was evident in the statement issued by Chiwenga, who made the following remarks:

Government notes with concern the political overtones which the labour issue has now assumed, including attempts by the striking doctors to appeal to constituencies which have nothing to do with health delivery or their employment contracts. (The Chronicle, 2019)

Arguably, by making such claims, the regime realized it could do more damage to the labour protest by discrediting the doctors’ association and besmirching the leadership by putting an opposition tag. This trend resembles the Mugabe era, where, in 1988, he made a veiled threat to labour as noted in the following remark: ‘we do not want to see a situation where the ZCTU becomes an opposition party’ (Sunday Mail, 1988). Predictably, this was to be repeated in years to follow.

After the labour events in 1989, then Labour Minister John Nkomo, in an indirect attack on the ZCTU, retorted, ‘are they trying to form another government’ (Schiphorst, 2001: 103). This followed junior doctors, among other sectors, strike from June to September (Sachikonye, 1990). The Mnangagwa regime emulated the same public sector containment strategies deployed during the Mugabe era. This indicates how repressive regimes treat labour by making sure these do not adopt political undertones.

In complementing the non-legal strategies of containing the doctors’ strike, the regime also used the courts to declare their strike illegal (VOA News, 2019a). The state argued that the doctors were not permitted to strike under the Labour Act under clause 104 subsection 3[a] (i) of essential services (Government of Zimbabwe, 1985) and the Health Services Act (Chapter 15:16). To this end, the Zimbabwean government maintained that the strike was illegal since it violated patients’ right to life (Dzirutwe and Elgood, 2019). However, the ZCTU (2017b) argued otherwise, as noted in the following statement: ‘doctors, like everyone else, have a right to strike when they feel that their rights have been violated’.

Responding to the court action, the doctors would not take the verdict from the Labour Court lying down, as demonstrated in how they continued with their industrial job action (Herald, 2019c). They reasoned that their grievances had little to do with legal recourse as it was purely a labour dispute demanding a non-legal remedy in collective bargaining and consensus. Expectedly, the initial move by the state to approach the Labour Court is not surprising (Herald, 2019b). This is judged by the precedent of how repressive regimes combine the courts and lethal force against labour protesters.

The multiple waves of ESAP-era strikes in the 1990s, including both the public and private sectors, and many instances of doctors and nurses strikes, were often handled by precisely the same tactics used by the Mnangagwa government against doctors after 2017. They ranged from legal threats, harassment of leaders, forming alternative protégé unions, dismissals and rehirings, and extended negotiations amid government threats. In circumstances where government definitely did see strikers as a threat to its power (and justifiably, given the concurrent gestation of the Movement for Democratic Change - MDC), the Mugabe regime deployed heavy force to quell labour protests (Raftopoulos, 2000; Schiphorst, 2001). Such acts of violent restraint on labour through coercive tactics, including arrests (Raftopoulos, 2000: 262–263) were witnessed in the protesting rural teachers’ union led by the ARTUZ during the Mnangagwa era. This was the same time when the doctors were striking.

The question is why, then, is it that in response to the striking members of ARTUZ, the state acted in a heavy-handed fashion exemplified through harassment, arrests, torture and trials (Zimbabwe Lawyers for Human Rights (ZLHR), 2019). Why were teachers an easy target for repression, and why were these actors treated differently? The answer lies in the nature, demands and threat level (Cai, 2010; Honari, 2017) of the two industrial job actions. ARTUZ members have always been viewed suspiciously by the state as articulating political demands. The ARTUZ case study further underscore the similarities, which seem more substantial than the differences in how Mugabe and Mnangagwa treated public sector strikes, especially when holding reasonable suspicion that the industrial job action will turn into a challenge for the incumbent rule.

Judging from the state response, it could also be that the doctors’ strike did not warrant a crackdown because theirs was orderly and peaceful. Indeed, their concession costs were low. As scholars note, concession costs become high when protesters’ demands articulate, for instance, ‘high-level resignations or changes in political representation’ (Klein and Regan, 2018: 492) or resort to the ‘use of violence’ (Göbel, 2021: 171). This was not the case with the striking Zimbabwe medical doctors.

Again the striking doctors self-censored their chants, songs and slogans. This gave an assurance to the government that the aggrieved doctors’ disaffection was genuine and that they were well-meaning (CWGH, 2019b). In framing the repertoires of contention, they made sure not to sing songs that would infuriate the police or flare anti-establishment sentiments. Consequently, their strike action remained apolitical and non-riotous. Here it is relevant to quote Tilly (1978: 106), who holds that ‘governments respond selectively to different sorts of groups, and different sorts of actions’.

Threat level and state response

Notably, the Zimbabwean medical professionals were able to demonstrate in the streets, assemble at Occupy Africa Unity Square (OAUS) and petition parliament while holding placards and insignia reflecting their grievances with no amount of significant force used against them (VOA News, 2019b). The deployment of fewer forms of overt coercion or harassment by the riot police underscores that the regime felt less threatened by the doctors’ industrial job action. This finding replicates the established claims in the literature on repression (Davenport, 2007; Göbel, 2021). In this regard, scholars perceive

repression as a function of cost/benefit calculations by [. . . ] officials, and the ‘forcefulness’ of a protest: repression will be used when it is more beneficial for them than making concessions, or when a protest lacks forcefulness. (Göbel, 2021: 169–170)

Scholars further conceive forcefulness (Cai, 2010) through ‘factors such as protest size, protester violence, repression and media coverage and is thus similar to the concept of protest ‘intensity’ (Göbel, 2021: 170).

As scholars enunciate, a regime’s level of force to quell and quash protests in whatever form is contingent on the ‘threat level’ to the elite (Josua and Edel, 2015). This also includes considerations of ‘backfire’ (Hess and Martin, 2006). Repressive governments, in some and not all cases, are less brutal against a small collection of essential workers if they are not perceived as a threat, with brutality by riot police being the critical litmus test of what a threat response is.

It is posited that repressive regimes use repression depending on the nature of the actors, for instance, how exigent they are (Davenport and Inman, 2012; Hess and Martin, 2006; Honari and Muis, 2021). In this regard, medical professionals’ potency of organized labour can determine whether the regime can contain, constrain, proscribe or permit it to flourish. The other factor is that regimes consider whether protests or strikes will subside or persist (and in the case of the latter) under what circumstances and with the application of what amount of force. ZANU-PF employed a calculated strategy to contain the 2018–2019 Zimbabwe medical doctors’ industrial job action. This is, however, not without precedent. Following the 1989 strike and after being detained, ‘doctors were released after one night and were promised higher incomes and better conditions’ (Schiphorst, 2001: 103).

In explaining the decision and acts of the medical professionals and public sector workers in Zimbabwe, one can also correctly argue that issues around social structure, declining political economy and class consciousness have triggered industrial job actions over the past decades. For instance, whereas the ZHDA is ordinarily expected to be more inclined towards professionalism than embracing unionism, it embraced the militant image of trade unionism in the period under investigation owing to the above-mentioned radicalizing factors.

The ruse of a ‘new dispensation’

In further interrogating why the regime used less ruthless strategies in quelling doctors’ industrial job action, this was done to create the façade that the ‘new’ Mnangagwa regime was amenable to industrial job action and protests. This strategy resonates with case studies elsewhere. History being the best guide, we are reminded of the context of Indonesia during the famed days of Suharto, where students were somehow allowed to access the rural areas to mobilize protests on localized issues on the account that they did not establish structures that would enable the entrenchment of an enduring organization (Boudreau, 2009).

Some would claim that the other reason why the Mnangagwa administration left the doctors to strike without much repression might also be strategic. Following his ascent to power, he wanted to distinguish himself from his predecessor and rebrand as a changed person (Tendi, 2020). This is buttressed in the claim that ‘his administration prioritized health and the well-being of all Zimbabwean citizens’ (CWGH, 2018d). However, scholars caution that in several contexts, political change does not go hand in hand with structural changes (Honari, 2017: 3). In Zimbabwe, we can see in making strategic choices to repress the striking medical professions in less handedness that Mnangagwa wanted to paint a picture of a society where citizens and professionals are free to picket, sit in and protest whenever they feel aggrieved. Contrarily, Mnangagwa’s efforts to distinguish himself fell short of the intended goal as the public could see through this ruse, which was the continuation, if not rendition, of past strategies.

Breaking the deadlock: reaching a settlement

Suffice to say, it does seem the government did manage to win the struggle, as exemplified in how the doctors returned to work but with their grievances not satisfactorily addressed just like in earlier years (Mutizwa-Mangiza, 1998). Several explanations may be proffered as to why they agreed to return to work. Some non-state actors got involved in the negotiations to persuade doctors to return to work, including the Zimbabwe Catholic Bishops Conference. However, one persuasive argument lies in the intervention of the private sector.

In ending the stalemate between the government and the striking doctors, businessman Strive Masiyiwa mentioned that a negotiated settlement pledged to cater to the doctors’ salaries and allowances for 4 months through his wife’s Higher Life Foundation (HLF) (BBC News, 2020). Nevertheless, this could be seen as an interim and unsustainable ad hoc measure to diffuse the labour stalemate (ZSHDA, 2020). It was against such pledges that the government committed to fulfilling and addressing the striking doctors’ outstanding grievances. However, this could have been a ploy to arm-twist the striking doctors to resume their duties or a ruse of buying time.

Conclusion

The main conclusions are that how political institutions (successive regimes) are conditioned considerably affects how they structure behaviour and patterns, including how they react to collective bargaining. This relates to how successive political regimes regulate industrial job action through a path-dependence pattern taking a cue from the previous regime. The article also established the pattern of limited behaviour change in how repressive regimes regulate labour relations. The argument pursued in this article is that there is a change here and continuity there. This is amply demonstrated in how the Mnangagwa regime treated striking doctors the same way the Mugabe-led administration treated public health industrial job action. Such findings offer firm empirical claims to theorize state-worker resistance within the historical institutionalism (path dependence) analytical lens. Furthermore, how repressive regimes react to labour protests is mainly contingent on a measured analysis of whether these will threaten incumbent rule or not. This explains the variation in the methods deployed by the Zimbabwean state in containing labour protests.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

ORCID iD

Gift Mwonzora

Author biography

Gift Mwonzora is Post-Doctoral Research Fellow, Unit for Institutional Change and Social Justice, University of Free State, South Africa. His areas of research interests include democracy and democratization, human rights and social justice, elections, reconciliation and transitional justice, political parties, social movements, and protest participation.

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