Ukrainian medics in war zones are announcing salary cuts despite promised raises

According to the Ministry of Defence 15.5 to 18, and junior staff from 8 to 9 thousand hryvnias. Corresponding changes were introduced by the decree of the Cabinet of Ministers № 482 from 12.05.2023.

It concerns health care facilities in communities of Dnipropetrivsk, Donetsk, Zaporizhzhia, Lugansk, Mykolayiv, Sumy, Kharkiv, Kherson and Chernihiv oblasts. A detailed list of territories is updated on the website of the Ministry of Reintegration.

Regularly visiting the front-line areas, I have had the opportunity to see with my own eyes what conditions our medical personnel have to work in. I do not cease to be genuinely surprised by their heroism and dedication. to save people under any conditions: under fire, during missile attacks, during enemy attacks. (...) The salaries of medical workers in active combat zones must be increased. And today we are doing so, Health Minister Viktor Lyashko said in a statement on the adoption of the new decree.

On the other hand, medics from frontline areas themselves have reported pay cuts or being forced to take unpaid leave.

Medics in Chernihiv and Kharkiv oblasts shared their stories with Socportal.

The “watch method” for Kharkiv medics

Elena (name changed by heroine's request), who works in a Kharkiv maternity hospital, has told us about a peculiar way to save money at the expense of medical staff.

She says that the staff is forced to take unpaid leave. It turns out that one month one midwife works and the other "rests", and then vice versa.

We take turns writing a month, once me, once a colleague. And so, almost all of our colleagues, and some will not go to work for the fourth month. And legally it looks like I kind of need this leave. The reasoning is that there are no funds. And I wonder how much longer they will not be, - says Elena.

According to her, there is a trade union in the medical institution, but it is inactive. After all, with this kind of labour organisation, the maternity hospital has one midwife for four floors.

We are not dismissed, but the conditions are such that people run away on their own. There are many of us now, and we are the staunchest ones left, but how long will our strength last? - said the doctor.

At the same time, she says, despite the frontline status of Kharkiv and regular shelling, there are still many pregnant and postpartum women in the city. And they, accordingly, need help.

There are fewer women giving birth, yes. But they still give birth. And women are still giving birth. Thank God, that is good. And they give birth all year round, - says Elena.

Why wounded attendants are getting a pay cut

Lack of adequate pay is also revealed by nurse Anna (name changed by heroine's request) in a hospital in Chernihiv region.

Our hospital receives the wounded. We have a border and there is constant shelling, both of border guards and of neighbouring villages. Aircraft have been shot down recently in the north and it has eased a little," says the nurse.

Since January 2023, she said, staff have been taking pay cuts.

Salary cuts have been taking place since January, and every month the cuts increase. Each time the amount comes out different. The promised 13,500 does not accrue. For example, in April I received 10,500 but only 8,400," Anna says.

There is no detailed explanation from the administration as to why this is happening and whether the staff should expect the promised increase.

There is a trade union, the collective is relying on it, but the answer is the same: "There are no funds," emphasizes Anna.

In addition, the woman has not been paid a health improvement allowance.

I applied for leave. And I also asked to write an application for health-improvement benefits. I was told: "Later. I have not been able to receive these funds for several months now," Anna says.

The nurse notes that a similar situation was with the "covid" payments.

In 2020, we were paid this allowance, but in 2021, we did not receive it," says the nurse.

At that time, the administration also assured that there was a shortage of funds.

According to Anna, despite the constant salary cuts and the evident safety risks, people remain in their jobs, so there is a shortage of staff. However, such insecurity and disregard for rights is frustrating.

Why forced leave and pay cuts are possible

According to Vitaly Dudin, an employment law lawyer and the head of the Social Movement public association, from the legal point of view a distinction should be made between cutting wages and being forced to take unpaid leave. While the employer may, unfortunately, have grounds for the former, the latter is completely unlawful.

This is also noted by Yana Demchuk, an activist of the "Be like Nina" nurses' movement.

Nurses in front-line hospitals, if you are forced to write an application for unpaid leave, do not agree to it! Not for a day, not for a week, not for a month... There is information that in connection with the latest government decree on increasing salaries, the administrations of some PNCs resort to the old manipulative practice - forcing them to write an application for unpaid leave. There is not a single proof of an "order" verbally. No matter how or who persuades you. Holiday is a matter of goodwill, not an order from an economist or the head of the department," says the activist.

She urges the medics not to deprive themselves of their right to get the money they have earned. Yes, in the case of Elena from Kharkiv, the law is on her side and forcing her to take leave is grounds for going to the police.

The State Labour Service also considers this type of "leave" to be an abuse.

The number of appeals about forcing medical workers to write applications for part-time work has increased. Such actions, if applied by the employer, have the signs of abuse of right, when formally granting unpaid leave to employees according to their applications looks legitimate, although in fact the will of the employees is not present, and the leave is not desirable for the employees. In fact, such actions are aimed at minimising labour costs and result in a significant restriction of employees' rights," the agency pointed out in 2022.

At the same time it is more difficult to oppose the non-payment of health improvement benefits from the legal point of view.

Thus, according to the lawyer, payment of health improvement benefits has been guaranteed to all medics, who worked in budget health care institutions, since 2012. This was stipulated by the Cabinet of Ministers Resolution No. 524 "The issue of remuneration of employees of institutions, establishments and organizations of certain sectors of the public sector".

However, after the 2017 medical reform, health care facilities turned into these communal non-profit enterprises (CNPs) are not recognised as budget-funded institutions. Although, in fact, they continue to be financed from the state budget and perform the same functions, the heads of medical institutions have a narrow understanding of the scope of Resolution No. 524. They claim that the obligation to pay recuperation allowance to the CNP employees arises only if it is stipulated by the collective agreement, - says Vitaliy Dudin.

As for salaries, Sotsportal sent an enquiry to the Ministry of Health asking how medical workers should act if they are not provided with the promised payments.

The agency provided this answer:

Employees have the right to apply to the executive authority for supervision and control of compliance with labour legislation on the basis of the following. In accordance with subparagraph 6 of paragraph 4 of the Regulations on the State Labour Service of Ukraine, approved by Cabinet of Ministers Decision No. 96 of 11 February 2015, the State Labour Service of Ukraine, in accordance with the tasks assigned to it, exercises state control over compliance with labour legislation by legal entities .

At the same time, it was reminded there that "in the 2023 programme of medical guarantees of the health care package 'Ensuring Preservation of Human Resources Potential for Medical Care' (which was in 2022), there is no additional funding for health care institutions to cover wage costs.

That is, there is no additional funding this year to support salary levels. Therefore, on January 13, 2023, the Cabinet of Ministers adopted Resolution No. 28 allowing hospitals to pay the minimum wage "if the cost of wages with accruals for the current month exceeds 85% of the money received in the current month, taking into account accumulated balances".

However, the Ministry of Health reminds that each hospital must decide on the details of wages independently and fix them in the collective agreement. Therefore, health workers should be as interested and active as possible during the conclusion of this agreement.

So which of the medics will get the “front-line extra pay”?

These nuances with salaries and payments for recuperation caused disappointment among medics: the guarantee declared by the current legislative act proved to be inaccessible in practice. When applying the latest regulations on frontline benefits, one should also be aware of certain limitations.

Firstly, the pay rise will not apply to primary or palliative care doctors. Despite promises to extend higher salaries to junior medical staff, in practice not everyone is involved in providing specialised or emergency care. Nurses and nurse practitioners, for example, do not perform such duties. Secondly, implementation of the innovations will depend to some extent on the discretion of managers. The guarantee of a minimum wage applies only to the respective territories defined by the Ministry of Reintegration. In addition, according to sub-paragraph 5 of Paragraph 1 of Resolution No. 28, the hospital must approve the list of workers who will actually provide specialised and emergency care. It is in the interest of health care providers to control the latter, at least on a local level," the lawyer points out.

We should also keep in mind that there are differences in payment in areas of possible or actual military action and that wages may be proportionally reduced in the event of non-fulfillment of working hours (including for valid reasons) or part-time work. It cannot be excluded that in frontline zones employers will resort to suspension of the employment contract justifying the impossibility to provide work by the armed aggression against Ukraine (Article 13 of the Law of Ukraine "On Organisation of Labour Relations under Martial Law"). Fortunately, legislation allows appealing against employer-initiated orders to establish part-time working hours or to suspend the labour contract.

There are concerns that a lot of medics who actually save people in super-complicated conditions will not feel their welfare will be improved. We urge colleagues to monitor the process of approving the lists of those who will receive top pay. We promise to respond in principle to any attempts by directors to set subordinates part-time or encourage them to take unpaid leave," said the head of the Be Like Nina medical movement, Oksana Slobodjana.