Ukraine’s medics are calling for change – but nobody is listening

Workers fighting hospital closures, layoffs and low wages say they've hit a wall in discussions with the government

“To the minister of health of Ukraine, Viktor Liashko, Happy Doctors’ Day! I am asking you to prohibit the uncontrolled reduction of wages for medical workers! Let the money follow not only the patients but also medical workers.”

This was the message of many cards sent to Ukraine’s Ministry of Health by members of the nurses’ movement BeLikeNina ahead of the country’s annual Doctors’ Day on 27 July.

BeLikeNina is demanding the government address the problems facing Ukraine’s nurses and doctors, from primary care workers going unpaid for months due to a lack of funds in hospitals to new laws that facilitate layoffs, as well as low wages and nurses quitting due to work overload.

On Doctors’ Day, a dozen of BeLikeNina's representatives and medical workers went to the Ministry of Health in Kyiv to try and have Liashko listen to their concerns.

But they weren’t allowed to enter the building due to bureaucratic procedures and additional wartime security measures. They instead had to stand outside and discuss their problems among themselves as ministerial workers passed by. The medics left feeling it is impossible to get the government to listen to them – especially during the war.

BeLikeNina was founded in 2019 and its workload has soared in the past two years. Today, it is an umbrella organisation for a number of local trade medic unions and has several thousand members, many of whom were eager to also travel to the ministry to voice their problems but were unable to do so because mass gatherings and protests have been banned since martial law was imposed in Ukraine.

“If there was no war and we had at least some funding, I think we would have brought a lot of doctors to Kyiv [to protest]” —Oksana Slobodiana

“If there was no war and we had at least some funding, I think we would have brought a lot of doctors to Kyiv [to protest],” Oksana Slobodiana, the head of the BeLikeNina movement, told openDemocracy.

“This year we had to turn people down [who wanted to come] because we don’t need it [with war going on].”

openDemocracy approached the Ministry of Health for comment but did not receive a response.

An ignored cry for change

Ukraine's healthcare reform, which began in 2018, aimed to move from financing hospitals to financing the needs of patients, to reduce state expenditure and corruption and make healthcare more accessible for Ukrainians. Under the new system, a patient chooses where they want to be treated and the state, through Ukraine’s National Health Service, then pays the chosen hospital for the services provided to them.

But medics say it has introduced problems ranging from unpaid wages to hospital closures. They say the wartime ban on protests is difficult for them because protests are their tool to make authorities listen.

“In our country, the government only reacts to media publicity. When it could be done at the level of public organisations, at the level of medical associations,” Slobodiana says bitterly.

At the last pre-war protest BelikeNina organised, which took place outside the Ministry of Health in May 2021, then health minister Maksym Stepanov was forced to face those protesting as he left the building. The media coverage reached President Volodymyr Zelenskyi, who issued an order to increase nurses’ salaries to 13,500 hryvnias (around £285) per month.

Last month, the dozen BeLikeNina members who went to the ministry took with them a letter describing the urgent issues facing medics and a gift to the minister – a painting showing how medical workers and the government have been divided into two distinct realities over Ukraine’s ongoing controversial healthcare reform. In one, medics complain that the reform is not working. In the other, ministry officials say they don’t recognise any problems and that the reform is good.

The BeLikeNina Doctors and nurses were stopped at a military checkpoint outside the ministry. The head of security would not let them through because the meeting had not been agreed upon and the ministry does not accept visitors during wartime, although they said a meeting might be considered between medics and the ministry if an application is submitted at least a week in advance.

Slobodiana said the movement had phoned and e-mailed the ministry two weeks before Doctors’ Day, but staff had not answered or answered and said they did not know how to help.

“We thought in a purely human way that considering it was the Doctor’s Day, we should at least have some representatives come out and talk to us, if we can’t go in,” said Nina Kozlovska, the nurse whose Facebook post started the BeLikeNina movement years ago.

So BeLikeNina members gathered nearby to make several speeches, which were live-streamed on Facebook for those across Ukraine who could not participate due to the ban on protests.

Later, Kateryna Balabanova, the director of the Center for Nursing Development, a department within the Ministry of Health, came out and told the BeLikeNina medics that formal procedures must be completed in order to gain the visit in the ministry, saying they may be able to have a meeting in September if their application is approved.

Medics silenced

Despite the failure to win the health minister’s attention on Doctors' Day, BelikeNina members will continue to work to achieve a meeting in the ministry because their problems cannot be solved without the comprehensive participation of the state.

“We need to gather at the same table: someone from the Ministry of Economy, the Ministry of Education, the Ministry of Healthcare, the Ministry of Social Policy, and accordingly, someone from the Cabinet of Ministers. Well, even representatives from the regions, their deputies, would be good, Solobodiana explained. “They will see some problem that can be brought to the Parliament’s session, and the law or resolution can be changed.”

The salaries of healthcare workers remain a key problem, especially for social care nurses in residential homes for the elderly or children, or in kindergartens and schools, who have particularly low wages.

“Our movement achieved an increase in nurses’ salaries. Our next step should have been to make our salaries a fixed wage and not consisting of additional payments” —Oksana Slobodiana

But there are many other urgent problems that harm both medics and patients, too, which medics say have only increased as the Ministry of Health has rolled out new measures as part of its reform. These include excessive workloads and hospital directors intimidating those who speak out about their poor working conditions and salaries.

Olga Turochka, a paediatric surgeon from the city of Shostka, in Ukraine’s north-eastern Sumy Oblast, is one such medic who believes she was punished for standing up to the reforms.

Turochka says doctors at her hospital, which is located in a war zone, were not paid their full salary for three months this year – despite there being a shortage of medics.

Turochka was fired in June, supposedly for ‘neglect of duty’. She believes the real reason is that she missed two hours of work to attend a trade union meeting, where she was asked to head the city’s medical union. She took the hospital to court over her dismissal and won the case, but the hospital appealed and the case is ongoing.

Ukraine’s Ministry of Health has previously told openDemocracy it no longer keeps records of unpaid wages or the number of hospitals threatened with (or in the process of) closure, as it delegated these functions to local authorities under the healthcare reform.

“The hospital director is responsible for the financial situation and payment of wages to health workers,” the ministry said.

Many medics believe that the war has made it harder to fight for medics’ rights.

“Our movement achieved an increase in nurses’ salaries. Our next step should have been to make our salaries a fixed wage and not consisting of additional payments,” Slobodiana said, referring to the fact that in Ukraine nurses’ wages vary depending on factors such as how long they’ve worked and if their role is considered dangerous. “Well, this war did not allow us to do that.”

As BeLikeNina did not manage to hand the letter outlining their problems to Liashko on Doctors’ Day, they now plan to post it to the ministry. So far, Slobodiana said, medics from more than a hundred hospitals have signed it.