Approximately 400 non-emergency ambulance drivers and nurses from eight counties in Croatia began an open-ended strike on May 16. The workers protested differences in salary coefficients across regions, which have led to large discrepancies in income. In some regions, non-emergency ambulance drivers are paid up to €200 less than in others in spite of doing the same job, said trade union representatives of Nurses Together and the Trade Union of Emergency Medicine.
The strike, which has been suspended following an agreement, took place in the counties where non-emergency ambulance services are under the authority of health centers and the drivers’ salaries are calculated on the basis of the coefficients used for transport personnel who do not work with patients (0.71). The workers’ action did not expand to counties where the salary of the non-emergency ambulance workers is calculated using a higher coefficient (0.95) and in counties where these services are under the direction of the regional institutes of emergency medicine, where the employees’ ability to strike is extremely restricted by law.
The problems experienced by non-emergency ambulance personnel point towards a wider set of issues stemming from the approach to decentralization of health services chosen by the Ministry of Health in the 1990s. The method pursued by several ministers of health since then has consisted of the Ministry transferring an increasing number of responsibilities to the county level, including those for organizing primary health care and financing significant parts of the health system, without taking into consideration very palpable budgetary differences that exist between them.
Regions with high rates of emigration and deindustrialization such as the counties in the east of the country or the Lika-Senj County, the majority of which engaged in the strike, can count on significantly smaller budgets. Smaller budgets usually lead to an overall lower level of workers’ rights in the county, starting with salaries in those public services that are under the county’s jurisdiction. Still, the work that the workers are expected to do is exactly the same no matter what the place or the institution in charge of the service, making the system completely unsustainable, warned non-emergency ambulance personnel at the beginning of the strike.
The effects of the industrial action have been felt most in rural areas with a high percentage of elderly population where people depend on this service for accessing healthcare services. However, the strike only affected those seeking non-essential procedures and care. Transport for patients in need of dialysis and oncological care was provided without interruption. Approximately 30% of non-emergency ambulance rides took place despite the strike, said the organizers of the strike.
Patients groups expressed their support for the strike, warning that the Ministry of Health should act not only in order to guarantee an adequate standard of workers’ rights, but also to stop the emigration trend that has stripped many health facilities in the country of the health workforce that they need to maintain basic operations.
On the other hand, Minister of Health Vili Beroš said that he had “no understanding for actions that deprive people of healthcare.” His statement has drawn heavy criticism from the workers, who said that it is the Ministry of Health which has been contributing to depletion of healthcare in the country by ignoring their problems and demands for approximately 10 years.
Still, the mounting pressure arising from the strike forced the minister to agree to a meeting with the workers’ representatives on Thursday, May 19. The meeting led to an agreement between the trade union and the ministry, on the basis of which the strike was suspended. According to the agreement, the ministry will implement a decree which will guarantee both non-emergency ambulance drivers and nurses a higher salary coefficient, reducing existing salary differences.
However, if the ministry fails to enact such a decree in the next two months, the strike will resume, said workers’ representatives. This would mean that the health system in Croatia would face a work stoppage in the middle of the tourist season, raising the stakes for the Ministry of Health.
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