Georgia: Health unions fight hospital closures

(June 2011) The health workers union in Georgia is facing up to two main challenges - anti-trade legislation and privatisation.

Since labour law reforms in 2005, employers have been able to dismiss any employee for any reason or no reason at all, at any time. As a result workers are very nervous about protesting, or even joining unions, for fear that they might lose their jobs. The government is also openly hostile to unions.

Meanwhile, the public healthcare system in Georgia has been progressively eroded through privatisation and cutbacks in government spending. The system was changed from one financed through public spending, to a system based on insurance, and services are being privatised.

There is little public finance remaining, except for pregnancy and maternity services. Patients have to to pay even for attending the local clinic to see their doctor. The government wants to continue to privatise health services, and is especially encouraging international investors. As a result of cuts in public spending and private companies' taking profits out of the system, prices for all services and drugs have risen sharply, while health workers' pay has been squeezed.

The government is selling all the major hospitals in Tbilisi to private companies. The government charge rent about $250 per square metre to the healthcare services, which previously occupied the hospitals rent-free. There are no restrictions on how private companies use the building – it can be used as a casino, restaurant etc.. This forces the healthcare services to reduce the scale of their operations, or to relocate to smaller premises in other hospitals: as a result, workers lose their jobs, or are moved to a new workplace.

In 2011 a children's hospital was sold to an anonymous private owner, and staff were told that they had to stop working, and that they would be transferred to a new, unspecified, location. The staff of 10 hospitals which have been sold so far have been relocated into only 2 buildings, with over 2000 jobs lost as a result.

The union (the Health, Pharmaceutical and Social Care Workers’ Independent Trade Union) has been a lone voice speaking out against the cuts and privatisation of healthcare services. It organises press conferences and public demonstrations to criticise the policies and to counter the propaganda issued by the government. This has strengthened the confidence of health workers in the union, and given the it a good reputation with the public and with heath service management.

In March 2011, for example, over 200 union members demonstrated outside parliament protesting against the closure of hospitals and the loss of jobs. This was a remarkable turnout by workers who have no employment protection rights at all, in defiance of government warnings to workers not to attend, and despite heavy rain. The demonstration was also supported by NGOs concerned with healthcare.

The government has tried to undermine public support by denouncing doctors and health workers as corrupt and incompetent, and claiming – wrongly – that no jobs are being cut. It has also promised 100 new hospitals with modern equipment, but construction has not started ona a single new hospital.

Hospital campaign

The role of the union can be clearly seen in the long-running campaign to save the Hospital for Burns and Reconstructive Surgery in the capital, Tbilisi. It is the only unit of its type in Georgia, and the leading one for the whole Caucasus region. It provides emergency treatment of burns, reconstructive plastic surgery and longer-term care. Its services have been crucial for casualties of the wars in Georgia over the last 20 years. Its surgical staff have an international reputation and carry out the most advanced operations, including the treatment of 80% burns, and the nurses and porters are also expert in the special needs of burns patients.

In 2007 the hospital was privatised and sold to PSP, a large Georgian private healthcare group with interests in pharmaceuticals as well as hospitals. PSP installed a commercial business manager as chief executive, and demoted the professor who had run the hospital for many years to the post of clinical director.

By 2009 the payment of salaries was six months in arrears, because the private insurance companies were failing to pay money due to the hospital. In 2010 the staff were told the hospital would shut, and the work would be transferred to become a small unit within another hospital. The company gave no further information, and did not even hold a meeting with the clinical director. The number of staff would be halved, cut from 139 to 60; the space available would also be halved, and the government initially proposed that the number of beds would be cut to 10.

The health workers' union proposed to the medical director that they should launch a joint campaign to save the hospital. Meetings with staff were organised to share as much information as was available, and plan publicity and further action. Press statements were issued, and a number of protest demonstrations were organised at the hospital. This generated a lot of media coverage, including TV and radio interviews with the clinical director of the hospital and the president of the union. The campaign has also won the support of a number of NGOs and opposition political parties, who have themselves issued statements protesting at the planned closure.

The government has already been forced to offer to increase the number of beds from 10 to 20, but this has been rejected as inadequate. The clinical director and unions are not opposed to reorganisation of work to meet the needs of modern technology and clinical practice, but the work has specific needs, including special isolation areas for some patients, and depends on maintaining the skilled workforce for both emergency and plastic surgery work.

Key points

• Actions and demonstrations may be possible on public service issues even in an anti-union environment

• Alliances with managers can be important in defending public services from cuts and closures

Based on interviews and discussions with Joni Janashia, President of the Health, Pharmaceutical and Social Care Workers' Independent Trade Union of Georgia; Natalia Gogava, International Officer, Health, Pharmaceutical and Social Care Workers' Independent Trade Union of Georgia (health_tu@yahoo.com) and Prof Besik Iashvili, Director, Scientific-Practical Centre of Plastic Surgery and Burns (besiko.iashvili@gmail.com)

Further information

Video interview with Joni Janashia (Health, Pharmaceutical and Social Care Workers' Trade Union)

Photographs of healthcare workers in Tbilisi Georgia April 2011