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East European Healthcare in Crisis

GENEVA (ILO News) - The grim economic situation in Eastern Europe is taking a heavy toll on state-run health services, creating a severe "crisis in care" for an impoverished population left increasingly vulnerable to chronic illness, worsening epidemics of HIV/AIDS and other diseases and ultimately, reduced life expectancy.

Press release | 10 December 2001

GENEVA (ILO News) - The grim economic situation in Eastern Europe is taking a heavy toll on state-run health services, creating a severe "crisis in care" for an impoverished population left increasingly vulnerable to chronic illness, worsening epidemics of HIV/AIDS and other diseases and ultimately, reduced life expectancy.

According to a new survey by the International Labour Organization (ILO) and Public Services International (PSI) * , the economic and social situation in several East European countries has resulted in the near collapse of some health care systems and afflicted health sector workers with high stress, poor working conditions and salaries at or below minimum wage - if and when they are paid.

"Rapidly increasing rates of sexually-transmitted diseases, HIV/AIDS, tuberculosis and numerous chronic diseases have created a crisis of care made all the more dramatic by diminishing public health structures, lack of training of health care professionals and general de-skilling of the workforce," says Guy Standing, the ILO Director of the Socio-Economic Security Programme and coordinator of the studies. "All of this has surely contributed to the catastrophic fall in life expectancy rates in Russia, Ukraine and some other countries in the region."

The ILO People's Security Surveys (PSS) found 88 per cent of families in Ukraine and 82 per cent in Hungary were unable to afford basic health care. Meanwhile, 78 per cent of healthcare workers surveyed in Ukraine reported that their wages were worse than the average for all workers. In Moldova, the poorest country in Europe, the health service is close to collapse and workers are paid months late, if at all. In the Czech Republic and Lithuania, most healthcare workers said their working conditions and pay had worsened in the past five years. In relatively prosperous Poland, five per cent of hospitals have closed in the last three years.

The crisis stems from governments cutting public funding and decentralizing funding responsibilities, leaving many local authorities without the resources or administrative capacity to meet new obligations. Lack of funds has encouraged doctors and others in direct contact with patients to demand or expect illegal payments. In Russia, for example, such "under the table" arrangements represent an estimated 40 per cent of all expenditures by persons seeking medical care.

Other factors degrading public health include such practices as extensive "administrative leave", in which large proportions of the healthcare workers in such countries as Kyrgyzstan, Armenia and Moldova fail to come to work because hospitals and clinics lack funds to pay them. In other countries, enforced short-time working has become more extensive while some nations are experiencing the growing phenomenon of "presenteeism" - whereby workers who are ill remain on the job for fear of losing their posts or direct payments from patients which constitute a major part of their income.

Health workers face widespread fear over increasing employment insecurity because they do not know what the future will bring in terms of government plans to restructure the health sector. Some workers have been put on contracts of limited duration with no guarantees for the future and temporary contracts have played a particularly increased role in Poland, Latvia and Kyrgyzstan.

Meanwhile, doctors' pay has tended to rise relative to other groups working in healthcare, notably in countries such as Belarus, Croatia and the Czech Republic. In many countries, income from secondary sources account for more than a third of total income while in Poland, the figure is more than 50 per cent.

Poor pay and job insecurity has led to an increase in work-related stress, although this is not recognised as a serious problem by the authorities and little has been done to provide assistance to the suffers.

The results of collective bargaining and negotiation vary enormously in their usefulness across the region, the survey found. In Croatia, unions report that agreed bargaining and consultation procedures do not guarantee the unions a voice. This is the subject of a formal complaint to the ILO. In Lithuania, health unions report consultations with national-level partners to be helpful only 6 per cent of the time.

The overall economic situation in certain counties in Central and Eastern Europe puts them on a par with many developing countries. For example, two out of five Romanians live on less than US$30 per month which is lower than Peru, where the minimum monthly is US$40. Tuberculosis, at 65 per 100,000 of the population, is equivalent to the average found in sub-Saharan Africa.

Trade union membership rates in the healthcare sector have declined in much of the region. For example, in Lithuania health sector union membership has fallen from 100 per cent in 1990 to 20 per cent in 2001. In Poland, membership has halved, to about 20 per cent. In the Czech Republic, unionisation has fallen from about 93 per cent in 1990 to just over 32 per cent with similar trends reported in most of the region.

Health sector workers in Romania, however, report solidarity with their union - which they feel defends their rights. Unions clearly are worried about their ability to bargain and lobby effectively for their members. Privatisation offers them little reason for optimism, since all across the region there is greater resistance to unions in the private sector and one purpose of the ILO conference was to consider how unions might respond to this challenge.

* The ILO Socio-Economic Security Programme organised two surveys - one of healthcare workers in four countries (Czech Republic, Lithuania, Romania and Ukraine) and another among unions representing healthcare workers in all the countries of Central and Eastern Europe. The results were presented at a ILO Conference of trade unionists and specialists in Geneva on Dec. 6-7, attended by representatives from most countries of Central and Eastern Europe.