Health Workforce Migration from Bulgaria and Romania - challenges and trade union actions

Dr. Steve Shelley, Mathias Maucher, Marina Irimie, Dr. Odile Frank
Brussels / Bucharest, 14 March 2013

EPSU organised a conference on workforce migration in the health care sector for the health trade unions in Bulgaria and Romania. The conference was held on 20 and 21 February 2013 in Bucharest and was attended by 32 participants from the 4 health unions from the 2 South-Eastern European countries. Important contributions were made by representatives of these affiliates, including Claudia Petcu, Secretary General, SANITAS, and Zlata Zlatanova, Vice-President of the Federation of Trade Unions in Health Services - CITUB, as well as by
- Marina Irimie, EPSU Officer South-Eastern Europe
- Dr. Steve Shelley, University of Hertfordshire, UK
- Dr. Odile Frank, PSI Health Officer and
- Mathias Maucher, EPSU Policy Officer "Health and Social Services".

The main objective of the conference was to provide a more in-depth analysis of the situation in the 2 South-Eastern European countries with regard to the health workers migration and the opportunities and challenges provided to it and the impact of the workforce mobility on the quality of and access to health services and also on the working conditions of the health care workers.

Dr. Steve Shelley, from Hertfordshire University, UK, presented a report on “Health Worker Mobility and Employment Relations Responses in Romania”, following a research project developed in 2011-2012. Dr. Odile Frank, PSI Health Officer, presented the PSI Strategy for the Health Care Sector, and Mathias Maucher, the EPSU Policy Officer "Health and Social Services" introduced the work of EPSU in the health and social services area and the institutional framework and structures for social dialogue at European level.

In the presentations from and the discussions with and amongst the colleagues from Bulgaria and Romania the following topics were dealt with:

a) Romania
- Need and main objective of re-bargaining a collective agreement at the sectoral level to counter the current policy to only keep collective agreements at local level
- Need to adapt health care law that had been changed without previous discussions or agreement with trade unions
- Fighting rules that make it more difficult for trade unions to achieve representativity, e.g. by mixing different sectors and keeping thresholds difficult to attain
- Often unclear who is the counterpart at employer’s level, in addition to a total silence as to social dialogue in 2010 and 2011
- Challenges related to the transfer of health workers to regional and local institutions and of social care workers to local authorities which deprives them of acquired rights
- Need to organise a specific budget for the wages of the health workers, outside the general state budget
- Need to reduce the number of fixed-term employment contracts that have become the rule
- Need to fight against increase of test phase from 3 to 6 months, not least as this also pushes workers into the black economy

b) Bulgaria
- Building on successful conclusion of collective agreements in 2012 in view of the negotiation of working and pay conditions for 2013
- Achievement of a branch-level agreement on minimum wages
- Renegotiation of staffing issues given important staff shortages
- Arriving at a guarantee about the payment of disability pensions
- Need of modernisation of equipment in health care facilities
- Need to have earmarked and separate funds for the investment into the health care infrastructure and for the improvement of working and pay conditions, not least to diminish incentives or pressures to migrate abroad
- Addressing the risks and challenges related to the high share of health workers aged 50 and older or 60 and older
- Problems of access to health services in rural areas, given the concentration of health services, in particular specialist services, in some bigger cities
- Increasing of coverage of collective agreements in the private health care sector
- (Need of and reality of) coordination of positions and viewpoints with professional organisations of nurses and doctors

In the last part of the conference, the participants from Bulgaria and Romania exchanged ideas and experience about trade union strategies with regard to health workers migration and identified the best ways to integrate their work at national and regional work into the EPSU/PSI policy for the health care sector at European and world level.

In terms of future action, the following proposals were formulated by the particpants:
- setting up/arranging the possibility of a transfer of union membership to other countries and the use of electronic membership cards
- increased role of PSI/EPSU in facilitating bilateral agreements between trade unions, with examples of cooperation agreements to be made available to the unions on the website
- EPSU to develop a web page and set up a forum of discussions on migration, including legal counselling from the destination countries;
- need of better trade union leaders’ education on migration
- inclusion of migration on the agenda of the regular training activities for health professionals
- need to lobby on politicians to change legislation on health so people can stay and perform in decent conditions in their own country
- need for a unitary policy and better coordination in the EU on the issue of professional qualifications
- setting up information desks and materials for professionals who want to emigrate that would also provide updates on legislative changes

Please read the detailed report (17 pages) on the seminar (in EN) - being translated into RO.

Please have a look at the "summary version" (10 pages) of the seminar (in EN).


- Marina Irimie

a) RO

b) EN

- Slava Zlatanova

a) BG

b) EN

- Dr. Steve Shelly

a) Presentation (EN)

b) Article (RO)

- Dr. Odile Frank (EN)

- Mathias Maucher (EN)

Material / Background Information

- EPSU/Uni Hertfordshire Report on migration of health & elderly care workers and related trade union initiatives: Report + Executive Summary and Recommendations

a) BG (Executive Summary and Recommendations)

b) RO (Executive Summary and Recommendations)

- EPSU-HOSPEEM Code of Conduct on Ethical Cross-Border Recruitment and Retention

a) BG

b) RO

- EPSU Contribution to EC Consultation on Revision of Directive 2005/36/EC on the recognition of professional qualifications (15 March 2011)

a) BG

b) RO

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