At 5 am on November 27, Ruth and 50 fellow nurses stepped off a private bus at Teynampet in Chennai, dressed in crisp white uniforms. They had travelled over 600 km from Tirunelveli to join nearly 3,000 nurses from across Tamil Nadu in protest against low wages and long work hours.
The protest at the Directorate of Rural and Medical Services was organised by the Tamil Nadu MRB Nurses Empowerment Association to press their demands for permanent jobs, fixed work hours and higher pay.
Tamil Nadu has employed thousands of nurses under various schemes of the National Health Mission, but only on contracts. While doctors, lab technicians and pharmacists were provided regular employment – and thus the benefits that come with a government job – nurses were offered employment for only as long as the scheme continued. They were paid Rs 7,700 a month, with a fixed annual increment of Rs 550. Additionally, the nurses complained, they were often posted in remote villages far from their homes, yet got hardly 10 days of paid leave a year.
So, Ruth, 44, and the other nurses came to Chennai and sat in protest outside the directorate, refusing to move until their demands were met even when the police asked them to disperse. “I joined this profession to help people and do some good for the society,” said Ruth. “But when I see myself being cheated with such a low salary, I cannot tolerate it.”
The nurses slept on the ground for two nights. “At one point, it began to rain and I thought everyone would leave,” said Ruth. “But they just opened their umbrellas and continued to sit there, in their white uniforms. I never expected such unity and firmness among nurses.”
The protestors alleged that government officials shut the three toilets that the 3,000 of them, including male nurses, were using at the site for a while to force them to disperse.
The officials also tried to convince the association’s leaders to end the protest saying their demands would be considered. K Kolandaisamy, director of public health, admitted that the Rs 7,700 salary was not adequate. “The government knows well that the salary of Rs 8,000 isn’t commensurate with their services and the care they give to people,” he said. “This year we will take it up with the Government of India. We are sure we will revise it to a very reasonable level.”
Kolandaisamy added his department was looking at “how we can regularise their employment, enhance their salaries and provide non-financial benefits like living quarters and better work conditions”.
But G Sudhakar, state general secretary of the nurses association, said since the officials didn’t give them anything in writing, they continued the protest for the third day. By then, media reports started pouring in of health services across the state being affected by the strike. The Madras High Court then ordered the nurses to end the strike, deeming it “illegal”, and the crowd finally dispersed.
“We sent notices to all concerned government offices a month earlier, announcing our decision to strike,” said Sudhakar. “This came after months of trying to negotiate with the government. Now they tell us we did not inform them about it.”
Until 2015, Tamil Nadu only recruited nurses with a diploma in nursing from government hospitals. They were hired on contracts for two to three years before being moved into regular government employment. That year, for the first time, the Tamil Nadu Medical Services Recruitment Board conducted a competitive exam to recruit nurses, and it was open to nurses trained in private colleges and hospitals. Hoping to land government employment, around 40,000 privately-trained nurses took the exam to fill a little over 7,000 posts. “Most of them were BSc or MSc graduates,” said Kolandaisamy. “The government-trained nurses could not compete with them.”
The selected nurses were employed on contracts under the National Health Mission with a consolidated pay of Rs 7,700 per month. They would work as contract workers until a regular vacancy opened up – through retirement or promotion, or the setting up of new Primary Health Centres. Kolandaisamy said this was clearly stated in the advertisement for the jobs as well as in the appointment letter given to the nurses.
But the protesting nurses claimed they did not know they were being offered contractual work under central government schemes. Sudhakar pointed to a 2011 order issued by the Health and Family Welfare Department stating that paramedical staff too must get regular pay from the appointment date. He also referred to a 1962 Tamil Nadu government order which states: “Temporary appointments of MRB Nurses already made should be regularised immediately with effect from the dates of their joining duty in the post with monetary benefit arrears.”
Equal work, equal pay
Kolandaisamy said the practice of nurses recruited under the National Health Mission, launched in 2005, working on contracts for two to three years before being moved into permanent jobs went on smoothly until around 2011. Then, suddenly, a lot more contract workers were hired even though fewer vacancies for regular employment opened up. “Many government-trained nurses were stuck in contract jobs for up to seven years,” Kolandaisamy said.
To solve the problem, the government introduced a new policy in 2014 – for every National Health Mission nurse moved into a permanent job, two would continue to work on contracts. Thus, if a Primary Health Centre had three nurses, the senior-most nurse would get a permanent job with higher salary and benefits while the others would continue to work for Rs 7,700 a month.
But the nurses recruited in 2015 are against this policy, calling it unjust. “There is no difference between the work we do and what the regular staff does,” said Sudhakar. “This goes against the principle of equal pay for equal work.”
In 2015, a Madras High Court judge too observed during a hearing that the Rs 7,700 salary was too meagre, explaining that “nursing students undergo three and half years course and they belong to skilled category”.
Government officials said they are expecting around 1,000 permanent job vacancies this year, to which the senior-most nurses will move into. Already, they added, almost all nurses recruited before 2015 have been moved into permanent jobs.
“There may be a stagnation next year, so we plan to enhance the salary of contract employees,” said Kolandaisamy. “We are also planning to create more posts in old medical colleges. This is an ongoing process.”