Latvia: Impact of austerity measures on the public health sector

Workers in Latvia’s public healthcare sector have protested about the less favourable working conditions in their sector,  not just low pay, but also the level of shift work, overtime work and work during public holidays.

Financial shortfall in healthcare sector 

There have been discussions on financing the healthcare sector since the beginning of the 1990s, when it became clear that the government did not have the resources to fund it. In 2015, 10.3% of  general government expenditure (€926.1 million) were dedicated to the health sector. The sector contributed to the total value added by 3.4%, the highest level since 2000, when the share was 2.9%.

As a consequence, wages and salaries are low in the public healthcare sector. Men earn 2.7% less than the total average wage, and 12% less than the average wage in the public sector. Women earn, respectively, 1.9% and 7% less. Many medical workers are forced to take several jobs, most often in parallel private institutions. Reforms aimed at optimising infrastructure (closing hospitals and other medical units) have not improved the financial situation in the sector.

Working conditions in the sector are normally less favourable than in other public sectors because of shift work, overtime work and work during public holidays. This, combined with the low pay, have led to increased dissatisfaction among healthcare workers and their migration to countries where pay is better.

The discussion on better financing is being sustained by the Trade Union of Health and Social Care Employees of Latvia (LVSADA). However, employees in the sector have refrained from industrial action.

Changes to overtime pay

During the austerity period, a norm was introduced that overtime in the sector would be paid at the same rate as normal work. The norm was fixed in the Medical Treatment Law (Section 53.1) which states that:

… an extension to the normal working hours of a medical practitioner may be applied, which exceeds the normal working hours specified in the Labour Law but does not exceed 60 hours per week and 240 hours per month. This extension (otherwise understood as overtime work and paid at double rate) is paid as a normal working time.

At the beginning of 2017, when requests to increase finance for the healthcare sector had only been partly met, healthcare workers raised concerns about the fact that they were being treated differently to other workers on overtime work.

In the middle of February, the medical personnel of the Riga Maternity Hospital (RMH) were the first to protest about unpaid overtime, warning that they would shorten their duties or stop working altogether if their pay was not increased. Protesters were supported by LVSADA and medical staff in other hospitals. The situation calmed down when the government promised a small increase in pay for midwives (from €3.05 per hour to €3.50). However, protests resumed at the beginning of April when it appeared that only the RMH midwives would get the pay increases, and that prolonged working time would still not qualify as overtime work.

Medical workers pointed out that pay in the healthcare sector has not returned to pre-crisis levels, while it has in other sectors. Indeed, in 2015, the amount of the general budget was at about the same level as it was in 2008 (just 0.7% less), while expenditure on the healthcare sector was 12.2% less. They also argued that the Supreme Court had ruled that police workers were entitled to be paid for their overtime, backdated for two years. (The Ministry of Internal Affairs had abolished extra pay for overtime in its institutions from 1 January 2007.)

At beginning of 2017, lawyers for paediatric surgeons at the Children’s Clinical University Hospital and for medical personnel at RMH submitted a claim to the Constitutional Court contesting the different approach to overtime for workers in the health sector.

LVSADA regularly warns that it will take industrial action if the requirements of healthcare workers are not met and pay not increased, not only for overtime work but also for normal work. On March 21, the LVSADA Council decided to refuse to work overtime from 1 June 2017 if enhanced pay for overtime was not increased. The union has agreed that overtime pay might be calculated using a multiplier that is gradually increased to a level set by labour law for overtime work.

Health Ministry supports protesters

Minister of Health Anda Čakša supports the workers’ demands and is working with the trade union to solve the problem. She agrees that the main issue in the healthcare sector in general is low pay. Medical workers have decided to address the problem by focusing firstly on overtime work. The Minister identifies three groups of medical workers whose salaries should be raised as a matter of urgency:

  • nurses;
  • doctors who work 24-hour shifts;
  • general practitioners.

The Ministry of Health is seeking a way of abolishing long working hours and of paying overtime work in compliance with the Labour Law. Recently it has tied the issue of increasing healthcare financing to political support for tax reforms.

Conclusion

Tension around overtime work in the health sector should be assessed in a wider context. The financial capacity of a country increases slowly, while needs that were not met due to austerity measures multiply quickly. In the social care sphere, unmet targets have had serious consequences, including poor access to healthcare services, deteriorating public health, emigration, loss of highly educated specialists and a lack of workers. It is unlikely that the demands of the healthcare workers will be fully satisfied. The probability that the healthcare workers will stop working overtime is also low, but if they do, the consequences will be dramatic.

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