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هل تتجه وزارة الصحة نحو إعتماد نظام التعاقد في القطاع؟

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هل تتجه وزارة الصحة نحو إعتماد نظام التعاقد في القطاع؟

تعتزم الحكومة تمرير مشروع قانون جديد يحمل الرقم 39.21، ينص على عدم تطبيق النظام الأساسي العام للوظيفة العمومية على مهنيي الصحة، على غرار رجال القضاء والعسكريين وهيئة المتصرفين بوزارة الداخلية، حيث تقول الحكومة أن مشروع هذا القانون، يأتي لمواكبة التحول الذي تعرفه المنظومة الصحية بالمغرب، وذلك من خلال تأهيل مهنيي الصحة العاملين بالقطاع العام، لكنه مع ذلك، يطرح الكثير من علامات الاستفهام حول مضامينه؟

ويسعى مشروع القانون إلى تحسين العرض الصحي العمومي، وتيسير الولوج إلى الخدمات الصحية، ويهدف إلى إضافة مهنيي الصحة العاملين بالقطاع العام إلى الفئات التي لا تخضع لأحكام الظهير الشريف رقم 1.58.008، وذلك حتى يتسنى إعداد نظام أساسي خاص بهم بموجب نص تشريعي، يحدد على الخصوص، الالتزامات المهنية لهذه الفئات والحقوق التي تستفيد منها.. فهل يحمل المشروع طموحات وانتظارات الأطر الصحية والتمريضية، أم أن المشروع يسعى لفرض نظام التعاقد في القطاع الصحي بأسلوب آخر؟ وكيف ترى الهيئات المهنية هذا المشروع؟

قانون سري

قررت الحكومة اعتماد نظام أساسي خاص بمهنيي الصحة، تزامنا مع مشروع تنزيل ورش الحماية الاجتماعية، حيث أعدت هذا القانون رقم 39.21 لجعل الأطر والعاملين بالصحة لا تطبق عليهم أحكام النظام الأساسي للوظيفة العمومية. لكن عدة فعاليات وهيئات ترى أن هذا القانون يشوبه الغموض ولا يوضح العديد من المعطيات والأشياء المتعلقة بمستقبل الممرضين والتقنيين والمساعدين والإداريين.

فالعديد من الفاعلين يعتبرون أن مشروع القانون الجديد يجب أن يحمي الأطر الصحية ويعطيها ضمانات، ولا يضرب المكتسبات المحققة والحقوق المهنية والحرية النقابية وغيرها، إذ أن هناك مخاوف من تقييد هذا القانون لمختلف المهن الصحية، وتحويل القطاع إلى نظام للتعاقد، الذي فجر أزمة في قطاع التعليم وخلق رفضا شعبيا في صفوف المهنيين، لأنه لا يصب في حماية التعليم العمومي.

في هذا السياق، يؤكد مصطفى جعا، الكاتب العام للنقابة المستقلة للممرضين وتقنيي الصحة، أن مشروع قانون الوظيفة العمومية الصحية لم يقدم لأي نقابة للاطلاع على المعطيات التي يحتوي عليها، إذ يوجد تكتم عليه، وهو مثل نموذج القانون الفرنسي في خطوطه العريضة، مشيرا إلى أن النقابة لم تحصل على تفاصيل المشروع رغم مراسلة وزارة الصحة في هذا الشأن.

وأوضح الكاتب العام للنقابة المستقلة للمرضين، أن القانون الجديد سيقوم بتوزيع فئة الموظفين من الإداريين والأطباء والممرضين والأعوان والتقنيين، على فئات كبيرة ومتنوعة، والموظفين الجهويين الذين سيشتغلون ضمن الوكالات الصحية الجهوية، مبرزا أن هذه الوكالات سيكون لها الحق في التوظيف على طريقة التعاقد، إلى جانب إحداث تغيير في نظام الأجرة المتحرك والذي تعتزم الوزارة تطبيقه، حسب المردودية والعمل، والذي سيمنح زيادة في الرواتب حسب الإنتاجية، ثم تبديل نظام العمل على مستوى الحراسة المتعلق بساعات المداومة (12 ساعة، 36 ساعة).

وأكد جعا على أن المهنيين متخوفين من بنود المشروع القانون الجديد، في ظل غياب التفاصيل والمعلومة حوله، لاسيما في ظل الحديث عن وجود مكتسبات قد يمسها هذا المشروع، مثل العمل النقابي، والحق في ممارسة الإضراب، فضلا عن العديد من الأشياء التي قد تمس مستقبلا، معتبرا أن غياب الشفافية والمعلومة واستمرار التكتم على القانون، يثير مخاوف الموظفين حول كونه يسير نحو خوصصة القطاع.

من جهته، حذر عادل العوين، عضو المكتب الوطني للجامعة الوطنية للصحة، من إعادة استنساخ قانون 33.86 الخاص بالوظيفة العمومية الاستشفائية بفرنسا، والذي يخرج الوزارة الوصية على القطاع الصحي من مسؤولية إحداث مناصب الشغل، في مقابل تفويت هذه المهمة لمؤسسات ترابية جهوية.

وانتقد العوين عدم إشراك وزارة الصحة للمهنيين في إعداد القوانين الخاصة بالقطاع، باستثناء مراسلة النقابات، لأخذ رأيها حول الوظيفة الصحية، محذرا من حرمان الشغيلة من حقها النقابي في القانون الجديد المتعلق بمهنيي الصحة.

تكريس التعاقد

العديد من الهيئات عبرت عن رفضها لمقاربة الحكومة الأحادية للتعديل المرتقب على النظام الأساسي لمهنيي الصحة بإخراجهم من النظام الأساسي للوظيفة العمومية، حيث أكدت اللجنة الوطنية للأطباء والصيادلة وجراحي الأسنان بالجامعة الوطنية للصحة بدورها على ضرورة إطلاق حوار حقيقي قبل أي تعديل في النظام من أجل صون حقوق الأطر الصحية.

وقالت الجامعة الوطنية للصحة، المنضوية تحت لواء الاتحاد المغربي للشغل، بأن ما روجت له الحكومة حول الوظيفة العمومية الصحية، تم دون حوار حقيقي مع الشركاء الاجتماعيين وكافة الجهات والهيئات والمؤسسات والفاعلين المعنيين، مؤكدة رفضها لـ”محاولة تمريره من جانب واحد في هذه الظرفية الاستثنائية، وفي آخر الولاية التشريعية، تحت غطاء تنزيل ورش تعميم الحماية الاجتماعية، وما يحمله ذلك من غموض يرهن مستقبل الأطباء والصيادلة وجراحي الأسنان”.

وأوضحت الهيئة أن “أي نظام أساسي جديد للأطـر الصحية، يجب أن يصون كل الضمانات الحالية المكفولة للأطباء والصيادلة وجراحي الأسنان، ويعززها بما يتلاءم وخصوصيات وطبيعة المهام التي يضطلعون بها وحجم التحديات والمخاطر التي تواجههم، ويضمن إقرار تعويضات إضافية تضمن العدالة الأجرية، وأن يكفل الأمن الوظيفي والحماية من العطالة ومن الخوف من فقدان الشغل”.

بدورها، رفضت التنسيقية الوطنية لطلبة وخريجي المعاهد العليا للمهن التمريضية وتقنيات الصحة، كل أشكال التوظيف بالتعاقد في قطاع الصحة، محذرة الوزارة الوصية من النظام الوظيفي خارج أسلاك الوظيفة العمومية.

وأكدت التنسيقية رفضها لمخطط التعاقد وتعويض المديريات الجهوية للصحة بالوكالات الجهوية للصحة، متسائلة عن مضامين القانون الذي سيخرج الفئة من النظام الأساسي للوظيفة من خلال استنساخ مخطط التعاقد في قطاع الصحة.

غياب المقاربة التشاركية

إن القانون الأساسي للوظيفة الصحية وما روجت له الوزارة من فوائد وتحفيزات، يظل مبهما بالنسبة للعاملين في القطاع، في ظل غياب الحوار الاجتماعي والقطاعي، حيث دعت بعض الأصوات الوزارة المعنية، إلى التريث في طرح هذا المشروع وإرجاعه إلى ذوي الاختصاص من مهنيين صحيين، وشركاء اجتماعيين وكل المتدخلين، من أجل مناقشته ودراسته للحفاظ على حقوق الجميع.

وأكد المكتب الوطني للمنظمة الديمقراطية للصحة، رفضه للطريقة التي أعد بها مشروع قانون 33.21، الذي يقضي بتغيير وتتميم القانون المتعلق بمزاولة مهنة الطب والذي تم عرضه أمام لجنة القطاعات الاجتماعية بمجلس النواب دون عرضه على الشركاء الاجتماعيين والمهنيين والأطر الصحية.

وانتقد نفس المكتب تغييب المؤسسات التشاركية التي ينص عليها دستور المملكة، وخاصة الهيئات والنقابات المهنية بقطاع الصحة، وكليات الطب والصيدلة ومعاهد تكوين الممرضين وتقنيي الصحة والجماعات الترابية والجهات والسلطات المحلية والمجتمع المدني، باعتبار المشروع يمس في العمق الجهوية المتقدمة في إطار اللامركزية الإدارية.

واعتبر المكتب أن تمرير مشروع قانون إصلاح المنظومة الصحية بهذه الطريقة المتسرعة وفي ظرفية استثنائية بتداعيات الجائحة، فضلا عن قرب نهاية الولاية الحكومية، ودون فتح المجال للشركاء الاجتماعيين والاقتصاديين والمجتمع المدني، لمناقشته وإبداء الرأي في نصوصه، يعيدنا إلى اعتماد نفس الممارسات الترقيعية التي لا تحظى بإجماع الشركاء، وستؤدي إلى فشل الهيكلة الجديدة للمنظومة الصحية وهدر الإمكانيات.

بدورها، استنكرت النقابة المستقلة لأطباء القطاع العام، إخفاء تفاصيل مشروع الوظيفة الصحية العمومية، مشددة على ضرورة اعتماد مقاربة تشاركية في كل مراحل إعداد وصياغة مشروع القانون، تنفيذا لتنصيص الدستور المغربي على تفعيل المقاربة التشاركية في الإعداد والتفعيل والتنفيذ والتقييم للسياسات العمومية.

وحذرت النقابة من أي توجه لصياغة أو تنزيل أحادي للمشروع، مؤكدة على ضرورة تضمين النظام الأساسي للوظيفة الصحية العمومية لكل الحقوق الأساسية والمكتسبات التي يتضمنها النظام الأساسي للوظيفة العمومية الحالي، مطالبة أيضا بحماية المكتسبات الحالية للمنظومة الصحية، وتعزيز العرض الصحي سواء فيما يخص سد الخصاص بأعداد كافية وتوفير المعدات الطبية في كل مؤسسة.

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