The previous collective agreement in the healthcare sector was valid up to March 2008 and was prolonged until the conclusion of new collective agreement. The new agreement is the result of negotiations in the branch council for tripartite cooperation in healthcare, which comprises the representative workers’ organisations of the Confederation of Independent trade Unions in Bulgaria (CITUB) and the Confederation of Labour Podkrepa (CL Podkrepa), employers’ associations and the Ministry of Healthcare (MH). The agreement covers all medical institutions, regardless of their status.
After long and difficult negotiations, a new collective agreement was signed in the healthcare sector at the beginning of June 2008. The agreement was negotiated between the Ministry of Healthcare, trade unions’ medical federations and employers’ association. It provides for a 100% increase in starting wages for medical personnel.
The previous collective agreement in the healthcare sector was valid up to March 2008 and was prolonged until the conclusion of new collective agreement. The new agreement is the result of negotiations in the branch council for tripartite cooperation in healthcare, which comprises the representative workers’ organisations of the Confederation of Independent trade Unions in Bulgaria (CITUB) and the Confederation of Labour Podkrepa (CL Podkrepa), employers’ associations and the Ministry of Healthcare (MH). The agreement covers all medical institutions, regardless of their status.
The parties agreed the minimum starting wage for different categories of personnel and different medical institutions**.** Details are shown in the table below.
Table: Starting salaries of healthcare personnel (EUR 1 = BGN 1.95583)
| Type of medical institution/ type of personnel | Head of department | Doctor with one specialisation | Head nurse | Chief nurse |
| Healthcare and medical institutions financed by the ministry of health budget | . BGN 620 | . BGN 560 | . BGN 500 | . BGN 440 |
| University, national and municipal multiprofile hospitals | . BGN 750 | . BGN 650 | . BGN 550 | . BGN 500 |
| General municipal and private hospitals | . BGN 720 | . BGN 620 | . BGN 520 | . BGN 470 |
| Specialised hospitals and medical institutions for outpatient aid | . BGN 680 | . BGN 610 | . BGN 480 | . BGN 440 |
In addition to the basic monthly pay,the new agreement also regulates minimum additional payments for length of service and professional experience, night shift premia, payments for duty and time when medical workers are at the employer’s disposal, and paymentsfor educational and scientific degrees.
For eight occupations and categories of personnel working in specific conditions and whose work is deemed to entail a risk to health and life, extra annual paid leave may be granted upon application, over and above the minimum leave set out in the Labour code, depending on length of service. This leave varies from six to 18 work days and is greater for medical workers in mental hospitals, workers using apparatuses and medical equipment that radiate electromagnetic and laser rays andfor workers working in emergency conditions.
In the the healthcare sector for the first time, there are provisions in the previous and in the current collective agreements that oblige the employer jointly with the trade unions to undertake measures to prevent all forms of discrimination, violence at work and mental harassment and also to guarantee working conditions that ensure stress prevention, and that prevent physical and mental harm at the workplace.
According to the trade unions, the most important part of the new agreement compared to the previous collective agreement, which dates from 2006, is the 100% increase in starting salaries. In addition, pay will be negotiated before the state budget procedure and thus it is likely that pay rates will increase once more before the budget is adopted. The budget guarantees the budgets of healthcare and medical institutions.
Commentary
This new collective agreement has gained an additional response from the guild organisations of physicians, nurses and pharmaceutical sector workers. They believe that the wage problems of medical staff is important but it should be dealt with in the context of total healthcare reforms, changes in the healthcare insurance model and a new approach to annual contracts between the National Healthcare Fund (NHF) and those who provide healthcare services. This will guarantee on the one hand a decent status for Bulgarian medical workers and on the other hand good quality services, based on fixed standards, for patients, whose access to healthcare services is at present limited due to defects in the healthcare system.
The health strategy developed by the government does not have unanimous agreement and therefore the strategy has not been implemented. The strategy foresees the redesign of the country healthcare map, which, in parallel with a restructuring process, the closing and privatisation of health and medical institutions, should guarantee the territorial coverage of all patients who need health services. However, the problem of healthcare in schools and medical personnel in children’s institutions (kindergartens and crèches) remains unsolved. These institutions are not covered by this collective agreement because their financing is determined according to ministry of finance norms. Payment according to these norms is much lower than for other healthcare institutes and this makes it difficult to appoint school doctors. A month ago, 100 medical nurses in children’s institutions resigned, citing the ‘humiliating low wages’.
Lyuben Tomev, ISTUR
Eurofound recommends citing this publication in the following way.
Eurofound (2008), Social partners agree a 100% pay increase in health sector, article.
