A report from the Be like Nina trade union[1]
In 1990, there were 670,000 nurses in Ukraine. In 2017, there were almost half that number (360,000). In 2018, the healthcare reform started and the total number of personnel changed. However, if we compare the general data available from the National Statistical Service, it turns out that during this period, the number of all medical staff has decreased by 140,000 - in 2017 there were 848,000 doctors, and in January 2022 there were 709,000. There is no data after the start of the large-scale invasion of Russia. However, it can be assumed that the occupation and refugees have made the reduction in staffing worse.
What the figures say
In the context of the ongoing underfunding of the sector, nurses and junior medical staff were disadvantaged. Those who had the opportunity left. And those who stayed ended up working for two. Health care reform has only made the situation worse, by forcing hospitals to become "profitable". So, in order to save money, it was often those least able to resist who were laid off.
According to Nina Kozlovska, founder of the Be like Nina [nurses' union], the reform did not take into account the interests of junior and middle managers at all. So one of the first actions of the movement was to demand that this aspect be reviewed.
The government seems to have made concessions in some respects, and in January 2022 nurses' salaries were increased to UAH 13,000 (EUR 323). A conditional 'social contract' was created, when those who stayed on after the redundancies could count on a more or less decent salary.
How much do nurses earn?
However, almost immediately there were cases where staff were forced to accept part-time work, thus reducing their wages. And in wartime, it was difficult to resist. In addition, on 13 January 2023, the Cabinet of Ministers adopted Resolution No. 28 on "Certain issues relating to the remuneration of medical, pharmaceutical and rehabilitation staff in public and municipal health care institutions", which allows for a reduction in staff salaries in the event of a deficit in the hospital budget.
If labour costs exceed 85% of the funds received in the current month, taking into account accumulated balances, the minimum wage for medical workers shall be set within the limits of the available payroll fund, but in an amount not less than the minimum wage, in accordance with paragraph 1, subparagraph 4 of Resolution No. 28.
At the same time, the government does not consider such a pay cut as a change in essential working conditions and therefore does not have to announce it in advance. According to the National Statistical Service, in January 2022 the average salary for doctors was UAH 13 000 (EUR 323). However, according to the National Employment Service, in April 2023, the average salary for vacancies in the health sector was already around 12,000 (EUR 297).
Another infringement of nurses' welfare is the refusal to pay health care benefits at the expense of the employer. The refusals are usually motivated by the fact that CMU [social insurance] Resolution No. 524, which establishes the corresponding guarantee, applies to budgetary institutions, while non-profit municipal enterprises are not recognized as such.
Obligation to upgrade at one's own expense
The logic of health care reform means that the most professional staff are given a job. This means that there is a need for constant upgrading and new knowledge. The need to improve qualifications is also enshrined in law.
However, according to Oksana Slobodiana, head of the medical movement Be like Nina, nurses have to do this at their own expense.
"The legislation has lost the phrase that the employer pays for advanced training," she says, referring to the Ministry of Health's order "on improving the system of postgraduate training and continuing professional development for specialists with a higher professional level, entry level (short cycle) and first level (bachelor's degree) of higher medical and pharmaceutical education, as well as a master's degree in nursing.
Nurses in wartime
The Russian invasion has left millions of people without homes. Nurses are among those who have no financial leeway in an emergency.
Moreover, for a long time the status of doctors in wartime remained unclear. According to Oksana Slobodiana, it was only six months after the war started that they managed to get a clear answer from the Ministry of Health that doctors in the occupied territories would not be considered collaborators. It was also not made clear whether female doctors could cross the border and be mobilised. However, at present, only the requirement to be registered is in force.
However, the humanitarian challenges of war, layoffs and salary cuts put nurses in an extremely risky position.
Why nurses need to ask for help
According to Oksana Slobodiana, the biggest fear of doctors is getting seriously ill. After all, they know exactly how much it will cost them.
Nurses are unable to treat a simple fracture, let alone more serious problems, says Oksana, citing the example of a message she regularly receives from doctors:
"It turns out that the day before Easter I twisted my leg, fell and had an open fracture of the lower limb of both shins with displacement and a cracked heel. I am currently in a local hospital, but they don't have a specialist and tools for my operation, so the local trauma surgeon recommended I go to another city. I need a leg operation to install the Elizarov device, which is the best option for me. The prices are of course high, but I can't afford it. I can't even borrow from relatives, because I don't have any, and I don't receive social benefits for children over 5 years old, I only have a salary, which is not enough for me. I thank you and apologise if I asked the wrong question."
Last year, the Be like Nina movement launched a joint project with the German charity Medico International. Previously, the movement had been able to fund complex surgeries for nurses Iryna Cherkasova from Lysychansk and Olga Salimukha from the Rivne region. A number of families of doctors, social workers and others who fled the Russian occupation were given humanitarian aid and temporary shelter. So far, we have managed to house 24 families and pay for their maintenance. More than 100 families have received ad hoc assistance.
However, this charity cannot solve the problems of nurses at a systemic level. This is only possible if they have decent wages and working conditions. This is why the Be Like Nina movement calls on all health care workers to be in solidarity and ready to fight in their workplaces and together at the national level.
"Our way was difficult, but we were able to do it, now the authorities know that there are nurses in Ukraine and in what state they are. And we must not stop, find the strength and leave, for the sake of our soldiers, for the sake of Ukraine," said Oksana Slobodyana.
Translation Patrick Le Tréhondat
Notes
[1] See "We create independent unions in hospitals", Support for Resistant Ukraine, No. 18.