How Ukrainian healthcare workers are fighting for their rights

On 27 and 28 November, Be Like We are organised a conference in Lviv, attended by around 60 healthcare workers and representatives of patient associations.

According to the chair of the union council, Oksana Slobodyana, the Ukrainian healthcare workers union was pleased to welcome participants from different regions of Ukraine and different specialities, who were able to discuss issues in the health sector and share their experiences of fighting for decent working conditions and access to medical care.

"Today, it is clear that the whole of Ukraine is facing major problems in the medical sector. But it is possible to solve them, and it should have been done yesterday. And it must be done in order to preserve our healthcare system. If healthcare is not protected, if human resources are not preserved, no renovation, no innovation, no improvement will be useful. In fact, there will be no state without medicine, without education and without an army. That is why I insist that this is not simply a matter of healthcare workers' whims. It is a cry to say that we must fight for this sector. Because we continue to lose staff, especially nurses. I think we need to radically change the people responsible for nursing, their development, training and remuneration. We need to do this immediately in order to retain the people who have stayed in our country and who are the heroes of Ukraine," emphasised Oksana Slobodyana.

Ruslana Mazurenok, an activist with Be Like We are and head of the independent trade union at her hospital in the Khmelnytsky region, shared her experience of the struggle.

"The system will change if we fight it with the law. And this is currently only possible with the help of trade unions. Because it is the only tool that is truly protected by law and allows us to take action," the activist emphasised.

According to Ruslana, in 2022, their hospital changed directors, and the new director was not interested in development.

"He said that even if there was only one department left in the hospital, he would still remain director and continue to receive his salary. It was a period of repression of employees, pressure, and massive violations of the collective agreement," Ruslana recounts.

The union was dissolved at the hospital, leaving the staff without any protection.

"Several active employees at our hospital started looking for solutions. We found the collective agreement and studied it. But we needed legal support. We started looking for specialists and found Be Like We are, who came to our small town, helped us understand the situation and made recommendations. One of them was to create our own trade union, which would legally defend the interests of the employees. At first, it was very difficult to understand, but we were provided with model documents, explained how to proceed, and in 2023, we created our own trade union," says Ruslana.

According to her, at first the caregivers were afraid to join, but after one of the doctors, with the support of the union and Be Like We are, won his case, the situation changed. This led to the dismissal of the hospital director, as it had been proven that he had violated the rights of the employees. However, at first, the city council refused to do so.

"We filed a complaint with the court to have the city council's inaction recognised. It has been going on for almost a year. At the second hearing, the case was suspended pending the Supreme Court's decision in a similar case. But since July, the Supreme Court hearings have been constantly postponed and our case is somewhat on hold. At the same time, our director's activities have attracted the attention of the regional department, and the city council has been ordered to ask her to write a letter of resignation," the activist notes.

According to her, a new director has arrived who is making a good impression.

"Even if we are fortunate with the new director, we now know that even if someone else arrives tomorrow, we are protected. And even if the director has changed, the trial must go ahead. I have been asked to draft a request to have the case dismissed, as the director is no longer there  and there is no longer any reason to continue with the trial. But I want us to see this case through to the end, to win, to set an example, to show that the union is not just a bonus, but a real mechanism of protection, so that it serves as an example for others. Because that is the only way to change things. Unite. Your cohesion is your armour, it is your weapon," Ruslana emphasised.

In turn, Oleksiy Chupryna, an activist with Be Like We are and the alternative professional union of healthcare workers in the city of Myrhorod, stressed that the level of pay for healthcare workers in Ukraine is unacceptable. However, officials at the Ministry of Health are neglecting this issue, focusing instead on decentralisation and the autonomy of medical institutions. Following the medical reform, the key body responsible for hospital funding, and in particular salaries, is the NSZU [National Health Service]. According to Oleksiy, it has an elected council that can exert some influence on decisions. However, healthcare workers have been passive in electing members to this council.

"It should be noted that there are elections to the Public Control Council within a structure that finances the entire medical sector in Ukraine. But out of approximately 300,000 healthcare professionals, only 11,000 at most participate in the elections. This means that the vast majority of healthcare professionals may not have known that these elections were taking place. Or perhaps they simply considered it a waste of time. And that saddens me greatly. Because one of the essential elements in establishing a dialogue with the structures of power is precisely civic engagement," Oleksiy emphasised.

He also added that the current level of salaries, set in 2021, "undermines the dignity of healthcare professionals".

"The medical sector has been underfunded since 1991. That is why, in my opinion, it would be very good to start by paying healthcare workers what the state owes them. Then we can continue to develop relations between the authorities and healthcare professionals, expand them and continue with medical reform," the doctor stressed.

Olena Poleva, representative of a patient organisation in Kyiv, also spoke at the conference. Together with residents of the Sviatoshynsky district of the capital, she opposes the closure of a medical facility branch. She spoke about the problems encountered by patients and doctors after the reorganisation of medical facilities in the capital.

The activist said that the community had not been informed of the real consequences of the merger of Hospital No. 5 with the Seventh Hospital and the Dermatological Dispensary.

"In fact, the transfer of assets took place without the consent of the medical staff. It was not a reform, it was an abuse of power," Ms Polova emphasised.

According to her, after the merger, the laboratory on the second floor was closed, some of the medical staff were dismissed, and the premises were occupied by administrative services, which are now located 6 km from the main hospital. Patients are offered paid services and asked to make "charitable donations". According to her, in many cases, patients are in fact forced to use paid services. It is almost impossible to make an appointment for a free consultation:

"When you call to make an appointment with a doctor, you are first offered a paid consultation, because free consultations are only available in a month's time," Olena said.

The activist also described the situation with the hospital's special fund:

"The patient has to pay for everything, and doctors have to work like slaves to increase the fund's [hospital] revenue. The director actually considers this fund to be his property."

Poliova pointed out that the community had approached the new head of the Kyiv Health Department and was waiting to meet with her, as people want to know who is responsible for the current state of medicine in the region.

Olga Ivantsyna, a nurse in the palliative care department, also spoke at the conference, pointing out that this is a new area of care, but one that is in high demand.

"We need to invest in it, we need more doctors, nurses and nursing assistants. Care assistants are undoubtedly the backbone of this entire field. These young women work 24 hours a day, each with 50 bedridden patients who need to be changed, washed d and fed. They help the nurses with everything, but their pay is derisory," Olga points out.

According to her, patients face restrictions in their care due to the national list of medicines, not all of which are effective.

"That's why we need to make proposals to help these patients. Palliative care is mainly about relieving pain and making a person's last days easier, simply supporting and helping them, strange as it may seem, to die in peace," said the nurse.

In turn, Tetiana Hnativ recalled the problems encountered by nurses in the school sector. According to her, nurses in nurseries and schools receive the minimum wage. This is despite the fact that they have undergone appropriate training and bear a great responsibility for the lives and health of children. They are not entitled to a salary of UAH 13,500 [€275], like other nurses, because they are employed by the Ministry of Education and Science.

"Last year, at the nursing forum, I personally asked Mr Lyashko [Ukrainian Minister of Health] the following question: 'What about school nurses? Why are you not including them anywhere in the bonuses, reforms, etc.?' Because we work too. For example, on average, our schools have 700 children and our nurseries have 200 to 300 children. What's more, nurses do a lot of work. But we are not heard and we are not seen. This is very unfortunate, because we devote ourselves entirely to children, we look after their health and safety, we accompany them to shelters," explains the nurse.

Conference participants noted that a resolution had been drafted based on the information gathered, and that participants would send it to government representatives.