(Brussels/Belgrade 9 and 10 October 2013)
About 25 participants from Bosnia-Herzegovina (from the Republic of Srpska), the Czech Republic, Kosovo, Montenegro, Serbia and Slovakia participated in the EPSU Regional Health Conference for Central Europe and Western Balkan. The event took place on 9 and 10 October 2013 in Belgrade and was organised by EPSU’s Regional Secretary for the region in close cooperation with the colleagues from the Trade Union of Health and Social Care Workers of Serbia “Nezavisnost”. Colleagues from Croatia could not be present due to a strike action they had called upon, apologies were also sent by the Macedonian colleagues. For those who want to learn more about the industrial action in Croatia read the letter from the Croatian Trade Union of Nurses and Medical Technicians (HSSMS-MT).
- Letter of HSSMS-MT to EPSU (18 September 2013)
Please have a look at photos from the seminar and with the participants showing support to the aims of EPSU’s 1,000 Workplaces Campaign.
(please click to enlarge)
The participants exchanged on the situation in their health care systems “back home” and on recent developments regarding social dialogue, legislative changes, financing, staffing and related employment conditions in the sector of health and social services.
A focus was on Serbia. In 2000 priorities for health care were set out in a National Strategic Plan. It aimed at better access to health care facilities, a system of solidarity-based financing and an improvement of quality of health services. 2005 saw a sacking of health workers that led to staff shortages. In Serbia allocations for the care of elderly at home recently were introduced. For 2014 it is not clear what will happen to thousands of health workers as the Serbian Health Ministry will define a sum setting an upper threshold for the funding far from sufficient to guarantee the wages of those currently working in the health sector. Past, current and future challenges are the low level of pay, the ageing of the health workforce, the privatisation of hospitals and medical centres, waiting lists, the insufficient funding of the health care system with an average amount per capita that can be spent that will not allow to provide health care in the quality and quantity needed. Another challenge is the risk that work-place related medicine is shut down and that measures for health and safety at the workplace are reduced. Trade unions are partially well involved in policy processes, but often also informed last minute which then means a de-facto exclusion from negotiations and decision making process. There are some efforts to replace regulation via government decree by collective agreements. In Serbia the privatisation of special clinics and of spas is expected to happen first. As state-provided health care is limited due to a lack of financing, patients need to pay increasing shares out of their pockets.
A number of similar and additional issues was raised by participants from the other countries represented during the seminar:
a) Bosnia-Herzegovina
- introduction of private management tools into the health sector;
- risk of cancellation of collective agreement and related labour and social rights;
b) Czech Republic
- privatisation of hospitals via changes of legal status, with private insurances becoming owners, too;
- introduction of supplementary payments for patients;
- diversion of money of the health insurance funds that flow into the state budget, but from there not back into the health sector
c) Kosovo
- a new health law was adopted, cooperation with Ministry of Health was possible and improving;
- good news: increased payment for on-call-time actually being paid;
d) Montenegro
- colleagues not taking retirement due to low wages and corresponding low pensions;
e) Slovakia
- under-financing of health care system on the basis of allocations by the State/Health Insurance Fund;
- scarcity of affordable drugs for selected treatments due to policies of pharmaceutical companies;
- discussion on reimbursements for emergency services);
- non-application of minimum staffing requirements;
- with a change of labour law it will become possible to get refunding for trade union activities, in particular for trade union representatives and work council’s members;
- abolishment of local health centres as access points for primary care;
- unilaterally agreed wage increases for doctors and salary changes for nurses voted by the Parliament have an impact on the financial margin of maneuver – clearly restricted – for the other health professions.
Presentations were given by a representative of the Health Ministry of Serbia and of the Health Insurance Fund of Serbia, in both cases about their current policy priorities, main challenges as well as the recent and planned activities of the Serbian government and the Health Insurance Fund. The EPSU Secretariat gave an overview of EPSU’s policy priorities, policy work, projects and publications in the health sector and in the field of personal social services.
- Zoran Ilić, President, Trade Union of Health and Social Care Workers of Serbia “Nezavisnost” (in SRB) - in ppt, due to size of file
- Nebojša Jokić, Health Ministry of Serbia (in SRB)
- Zoran Vlahović, Health Insurance Fund of Serbia (in SRB)
- Mathias Maucher, EPSU (in EN)
A concept paper for the conference that could not be discussed in Belgrade mentions the WHO Ljubljana Charter on Reforming Health Care in Europe (1996) as a reference document to guide legislative and policy reforms. You can have a look at it in EN, FR, DE and RU.
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