Brussels; 30 May 2017
On 16 and 17 May 2017 EPSU affiliates organising health and social care workers from Ukraine (Health Workers' Union of Ukraine), Georgia and Moldova and other Ukrainian trade unions organised a workshop in Kyiv (see the agenda in EN and RU) – with the support of the ILO, ITUC, PERC and EPSU – to exchange information on the health care reforms recently implemented or planned in these three countries, all having signed in recent years an Association Agreement with the EU.
Mathias Maucher, Policy Officer "Health and Social Services", EPSU, was one of the speakers (see his presentation in EN and in RU). He shared information on relevant EU norms and regulations in the context of the Association Agreement Ukraine-European Union - e.g. in the fields of labour law, occupational health and safety or public health - signed in 2014. The exchange afterwards focused on "hooks" for the Ukrainian trade unions to use the reference to healthcare services standards and requirements set at EU level or commonly applied in many EU countries in order to seek an improvement of the pay and working conditions of the healthcare workers, of the individual and collective labour rights, of the health and safety of the workforce in health and social services as well as with regard to staffing levels and access to continuous professional development. Ukrainian committed to approximate national legislation to the existing EU acquis. Colleagues also discussed how the Ukrainian trade unions organising workers in the field of health and social services could be better consulted upon and involved in these processes from the start. The same holds for the challenges to health and social care services stemming to the application of the agreement between the EU and Ukraine on a "Deep and Comprehensive Free Trade Area" (DCFTA). In EPSU's view they are comparable to the ones identified in view to CETA, TTIP or TiSA (for more information see e.g. the article on the SC HSS Resolution “Free trade agreements: Health care and social services are not for trading! of 22 September 2016).
Viktoria Koval, Chairwoman of the Ukrainian Trade Union of Health Workers, gave an overview on the health care reform agenda in Ukraine and explained the related trade union positions, concerns and counter-proposals for a number of health system, health services and health workforce policies (see presentation in RU). Colleagues from Georgia (see presentation by Giorgi Tchanturidze from the Georgian Trade Union Confederation in EN) and from Moldova (see presentation by Mihail Dutca in RU) also made presentations about recent health care reforms in their country and shared the trade union assessment of the key points.
Following the seminar the Ukrainian trade unions agreed on a statement (available in Ukrainian, Russian and English, see below). There and in the joint EPSU-PSI letter (see also below) a number of trade union issues and concerns are elaborated on in relation to ongoing or planned health care reforms in Ukraine:
- the abolition of social benefits and guarantees to top up the low “basic” wages of health workers/professionals
- adding to the functional responsibilities of doctors without commensurate pay increase and fixing the quota a family doctor needs to sign contracts with at 2,000 people which would result in workloads highly detrimental to the quality of care;
- the bypassing of trade unions, without duly consulting them, by the Ministry of Justice when registering the draft order of the Ministry of Health (Amendments to the Order of the Ministry of Health of Ukraine of 28 September 2012 No. 751) on changes to the methodology for developing and implementing healthcare medical standards (standardised clinical protocols) based on evidence-based medicine;
- the application of new clinical protocols without adapting them to the financial, organisational, etc. conditions of the Ukrainian health system while maintaining the professional liability for doctors and other health workers in case of non-compliance;
- the massive dismantling of the State Sanitary and Epidemiological Service of Ukraine that is now heavily understaffed and inadequately equipped on the technical and operational level (also lacking expert knowledge of highly qualified workers that were laid off or left the service), with the consequence that the service for the time being cannot ensure the sanitary and epidemiological well-being of the population; and
- the introduction of a new financing mechanism for health care, with completely insufficient annual budgets (around 10€/8 USD) for the treatment of patients in primary care and for the reimbursement of medical treatment and drugs, both concerning primary health care and hospital care, in contradiction to the basic principles of compulsory social insurance in Ukraine, the Constitution of Ukraine and a number of rulings of the Constitutional Court of Ukraine
For PSI and EPSU, the health system in Ukraine should be build upon the “classical” public services principles “universality”, “accessibility”, “affordability”, “continuity”, “user rights”, “transparency and accountability”. Health services have to be organised to operate in the general interest of all citizens and patients. They have to be funded based on principles of solidarity in the context of tax systems and/or by social contributions paid to equal shares by employers and employees.
In the letter to the Minister of Health and the Prime Minister of Ukraine EPSU and PSI call upon the authorities to comply with a number of judgements of Ukrainian courts won by the Ukrainian Trade Union of Health Workers regarding the reorganisation of the State Sanitary and Epidemiological Service of Ukraine, hospital reorganisation and staffing levels.
EPSU will continue our contacts with the relevant services of the European Commission and the EU-UKRAINE delegation of the European Parliament to monitor the situation and if the dialogue with the trade unions takes place.
Read the statement of the Ukrainian Health Unions from the Health Care Reform in Ukraine Seminar (in EN, UA and RU) and have a look at the article on the seminar on the webpage of the Ukrainian Trade Union Federation (in UA).
Read the joint EPSU-PSI letters to Minister of Health and Prime Minister of Ukraine (in EN). In these letters EPSU and PSI stress a number of points in relation to recently implemented and/or planned reforms in the health care system in Ukraine they are concerned about and they ask the Ukrainian Health Ministry and Government to reconsider and change. These points are based on the discussions at the seminar and on information received from the the Health Workers' Union of Ukraine.