Opinion: For now there is little hope for real change in the healthcare sector

However, the situation can change if more doctors in Belarus become active, writes Vadzim Smok.

Leading up to New Year's Eve and throughout the first week of 2014, employees of the Minsk municipal ambulance service launched a protest. They are demanding a raise in salaries and improved labour conditions.

The healthcare sector in Belarus remains financed by the state and has one of the lowest average salary rates of any profession. Among its neighbours, Belarus allocates the smallest portion of its GDP towards healthcare, which has resulted in its gradual decline in recent years. This policy has led to a personnel shortage and has put considerable stress on the nation's healthcare services.

Paramedics, who are subject to perhaps one of the most trying work environments, are the first to dare to openly voice their growing problems in public. The authorities in Minsk immediately promised them raises to mitigate the protests, but whether it will cause any systemic change remains, as yet, unclear.

Healthcare among outsiders

In recent years, the Belarusian government has allocated less than 5% of its GDP to healthcare, lagging slightly behind both Russia (who spends over 6%) and Ukraine (with over 7%). In most EU countries such allocations vary from a range between 7 to 11%. Healthcare in Belarus remains mostly state-financed, and private providers healthcare account for only 5% of the sector.

It is true that both in Russia and Ukraine the healthcare system to this day is very similar to Belarus'. However, the percentage of private healthcare providers is significantly higher, and better the higher level of financing provided to employs who work in the healthcare system results in higher wages.

For example, in Russia doctors who work in ambulances have an average monthly salary of $1,200, and paramedic staff makes around $700. In addition to their salaries, it is not uncommon for patients' to pay doctors' additional money out-of-pocket for their work.

State media likes to show footage of new equipment that has been installed in hospitals across the country. This is not to say that this footage is doctored. Indeed there is new equipment being installed all over the country, but with wages for healthcare providers remaining very low, a situation may soon develop where no one will be able to use the new equipment in small towns. 

Although the government tries to introduce more fees for the medical treatment of its citizens, the healthcare sector cannot provide its workers with an adequate salary for their invaluable service to society. As the diagram below shows, healthcare providers have some of the lowest average salaries in the nation, yielding even to agriculture, which itself is a problematic and heavily subsidised sector.

As a result, healthcare providers are experiencing significant hardship in Belarus. Many qualified doctors seek better labour conditions abroad, mostly in Russia, which for the most part is not a serious issue as medical education in Belarus is still considered to rather good. While others simply change careers, still a number of more altruistic individuals remain in the system and continue to do their job.

Since the state runs the trade union system, the Belarusian Trade Union of Healthcare Workers cannot really press for improved labour conditions. Belarusians are very reluctant to organise themselves to fight for the changes they see as necessary in large part due to a fear of their contracts not being renewed for strictly political reasons, an all too common practise in modern day Belarus.

However, recently healthcare providers have dared to organise a public protest, one that received substantial coverage from Belarusian media. The organisers, employees of the Minsk ambulance service, are protesting against very harsh labour conditions and unfair wages.

Low wages and huge workload

Leading up to New Year's Eve they began to gather signatures on a paper petition to submit to the Head of the Minsk Ambulance Service, relevant trade-union and the Ministry of Social Protection. Beyond this, they were going to pass it to the Ministry of Healthcare, the Parliament and the Presidential Administration. In the petition doctors demand the establishment of a legal framework for employees of the ambulance service, social guarantees similar to those of employees of Belarus' security services and a raise in salary.

As the former ambulance worker Viktar Piatuchou shared with the TUT.by web portal, the Minsk ambulance service experiences a high level of staff turnover and is dealing with a constant shortage of workers. Their salaries are low, and those who stick around have to bear the burden of a heavy workload to make sure the service stays up and running. Many employees have to work overtime, though not by choice.

These incomplete ambulance teams who are answering medical emergency calls cannot provide the full medical care that is stipulated by the law. Frequently, the best employees leave the service, leaving young people fresh out of university without any relevant experience, and who are sometimes unable to conduct simple medical procedures, to join the ranks of the ambulance service. Recently, it was rumoured that a foreigner who could not even speak Russian was employed on one of the teams.

As Vital Aheenka, an employee at ambulance station no. 4, said to TUT.by journalists, their station is short by about 40% of the staff it needs to have to function properly.

In these conditions, the administration forces people to work overtime and punishes those who refuse. “If you refuse the additional workload, it means you do not want to help the administration fulfil the norm and become their enemy”, according to Aheenka.

Meanwhile, medical workers from other organisations and towns have begun to contact Vital. They have proclaimed their support and promised to add their signatures to a petition if the protesters will include all healthcare workers in their demands, since similar problems exist throughout the entire system. 

Patients' aggression and ridiculous self-financing

Another problem that paramedics and doctors face is the patients' behaviour. At times they are drunk, and frequently they shout at the ambulance doctors and even beat them. Sometimes, due to a personnel shortage, only a single female doctor may be working in an ambulance, and these kinds of patients can understandably become quite dangerous. Strangely, there is no legal mechanism to defend a doctor from these kinds of hostile patients, while hitting a policemen, for instance, would definitely end in a trial. 

The working environment for ambulance service employees is also rather dreadful. They have to buy all their own cooking appliances for their workplace, be it a microwave or a kettle.  Moreover, they have to pay for all the materials needed for washing their vehicles, and even rubbish bags. After finishing work doctors are required to bathe, but at one of the stations that the journalists visited there was only one shower. 

In this shower, employees have to wash their work cloths and bloodied stretchers. One would be hard pressed to find any soap or toilet paper, as they tend to appear only when inspection commissions come review the stations. Ambulance paramedics and doctors even sometimes have to sew their own uniforms, as there exists no uniform service within the system. 

Minsk authorities respond, regions silent

After various publications covering protests came out and interviews appeared on the Internet, the city's ambulance service administration responded to the claims made. It claimed that the published facts were false or one-sided.

They stated that the salaries for employees of the ambulance service complied with the law, and that employees of the ambulance service also guaranteed protection against violence. Moreover, the administration claimed, many of the workers who appeared in the media had either discipline records or are new to the job.

However, on 8 January representatives from the protesting doctors had a meeting with the Healthcare Department of the Minsk City Executive Council, the city ambulance administration and the Deputy Minister of Healthcare. As a result, a commission was formed which will examine the situation. A similar meeting with authorities also took place in Hrodna.

It should be noted that the protesters launched a petition with their demands on the change.org web site, but it suddenly disappeared after having gathered 7,000 signatures. The initiators made no comment. But it clearly seems to be a compromise with the authorities who have expressed their willingness to cooperate in exchange for keeping the issue from garnering more public attention. “We are not part of the opposition”, the doctors say, “we maintain our political neutrality and want to establish a dialogue with the authorities.”

Soon thereafter, information appeared that the Minsk Municipal Department of Healthcare decided to give employees of the ambulance service a monthly raise of roughly $90 for 2014. However, in most regions, where options for employment are scarce, people fear losing their job, even with low wages and will not risk protesting their labour conditions. 

While most of doctors in Belarus remain passive, there is little hope for real change in the healthcare sector. However, Minsk can become a pioneer for improved labour conditions, something that can spread further - if the government takes the problem serious enough.

Originally published at BelarusDigest