Authorities Create the Conditions for Corruption Themselves

A group of Belarusian physicians from the independent healthcare workers’ union has conducted a study of the state of the country’s healthcare system.

The analytical report was prepared as a response to an article published by one of the state media outlets under the pompous headline: “Belarusian Healthcare Strengthens Its Workforce and Material Base, Expands Exports, and Goes Digital.”

Stanislau Salavei

Among other things, the article claimed that “the steady performance of the sector is ensured by infrastructure modernisation and stable funding.” Propagandists also asserted that “while many EU countries face staff shortages, overloaded hospitals, and the threat of funding gaps, Belarus is focusing on stability and development.”

The research group set out to examine what exactly was meant by “stable funding,” “stability,” and “development,” as well as the smug comparisons with supposedly “troubled” European healthcare systems.

Stanislau Salavei, a member of the research group, a physician, and one of the leaders of the independent healthcare workers’ union, described the real situation in Belarusian healthcare.

“First, a few figures about our ‘stability’ and their ‘problems’. The share of Belarus’s state budget spent on healthcare is 11.7–12.3% for 2022–2023. Public healthcare spending amounts to 4.4–4.7% of GDP. Total healthcare expenditure, including private spending, is 6.6% of GDP. In other words, Belarus spends about one-eighth of its budget on healthcare — a moderate level by European standards.

“Meanwhile, Germany and France, for example, spend around 11–12% of GDP on healthcare, while the Nordic countries spend 10–11%. So Belarus allocates less to healthcare than developed European countries do, with a gap of between 2 and 5 percentage points.

“If we look at annual healthcare expenditure per capita, the real gap is much larger than the budget percentages suggest. In Latvia and Lithuania, spending per person is about twice as high as in Belarus; in Poland, three times as high; and in Germany, five to six times as high.

“And this is critically important, because a healthcare system runs on absolute resources. That means more staff, higher wages, better technologies and medicines, and access to innovation.”

Another participant in the research group, physician Aleh Paulau, spoke about the problem of centralisation and unequal access to medical care across the country.

“Yes, Minsk has some very impressive medical centres, particularly in transplantology and oncology. But as soon as you go beyond the capital, the picture changes. I won’t even start talking about district hospitals.

“Take heart attacks, for example. The cost of treating a patient in Navalukoml and in Minsk differs by roughly a factor of ten — and the same applies to mortality outcomes.

“Most EU countries do not have this level of centralisation. A teacher once explained to me the difference between an operating theatre in Lyon and one in Paris: in one case the door opens with a foot button on the right, in the other with a foot button on the left.

“But the kind of gap we see in Belarus, where a medical centre in Minsk is a hundred times better equipped than a hospital in Navalukoml, does not exist in the European Union.”

According to Paulau, the authorities also manipulate medical statistics.

“Let me explain. If a heart attack is not treated at all, mortality will be around 50% — that is, half the people will survive on their own. If it is treated in the old-fashioned way, say with IV drips, mortality is around 16%. If modern methods are used, it is about 5%, and with the newest techniques it can be reduced to 1.5%.

“The authorities report mortality at 5%, but in reality it is closer to 16% if the person is treated outside Minsk, because on at least a third of the country’s territory there is simply no capacity to use modern methods. The reason is straightforward: there is no money for modern equipment outside the capital.”

He added that even when district hospitals do receive new equipment, they often cannot properly use it.

“Yes, district hospitals may buy something modern — a CT scanner, an MRI machine, or other equipment — but then all of it requires servicing and consumables, and those cost money that simply is not there. These consumables and maintenance are paid for in dollars and euros, in absolute terms, not relative to local prices. That is why absolute healthcare spending matters so much.”

According to the researchers, ordinary doctors are now also expected to help raise money for their hospitals.

“Even the smallest hospital has what is rather absurdly called a ‘growth plan for paid services’. In other words, whatever the hospital earned this year, next year it is expected to increase that figure by 130%.

“And what can a small hospital that receives no real investment offer? Perhaps a separate room with a fridge and a TV. But somehow it has to make money, because funding is insufficient.”

Another recent development is the expansion of paid medical services on weekends.

“If you do not want to wait in line, come on a weekend, and doctors will, of course ‘voluntarily’, see you, perform an ultrasound, or even carry out an operation.

“So a person pays taxes and is supposed to receive a set of medical services free of charge. But in reality they cannot access them in normal time, so they go to the same state hospital or clinic and pay again.”

The researchers compared this with Lithuania:

“In Lithuania, cataract surgery can be performed either in a private medical centre or in a state hospital. But in both cases, the state pays for it.”

They also pointed to the dependence of Belarusian healthcare on foreign purchases.

“Almost all high-tech equipment, many medicines, and pharmaceutical substances are bought abroad in euros. And often cheaper drugs are purchased. Yes, they may have more serious side effects, but the authorities act as if there is no other option. It is the old logic: ‘There is no money, but you carry on.’

“Belarus has decent treatment protocols for oncology patients, but very often the necessary medicines are replaced by cheaper alternatives because of underfunding. Or, for example, a CT scan may be done without contrast. And if we are not talking about a major medical centre in Minsk, that has become the norm.”

One example illustrates the gap between the capital and the regions.

“Not long ago, I read two remarkable news items on the same day. One said that a new medical centre had been opened in Minsk. The other said that a ramp had been installed at a district polyclinic. That says it all.”

Another serious problem is the lack of proper emergency air transport.

“We do not have a proper medical aviation system that can quickly transfer a person in a critical condition from a small town or village to Minsk or another specialised centre — for example, by helicopter. In Germany and other EU countries, such services exist. In Belarus, there is no money for this. So people wait for help and sometimes do not survive long enough to receive it.”

Paulau stressed that the difference in spending on treatment inevitably affects both outcomes and statistics.

“This is true not only for heart attacks, but also for strokes and many other diseases.

“That is exactly why medical statistics in Belarus are closed. They are ‘administered’ — a polite way of saying manipulated — when healthcare managers demand specific figures and punish those who fail to produce them.”

Stanislau Salavei highlighted two additional key issues.

“There are two fundamental problems with healthcare funding in Belarus. The first is simply that there is too little money. If we compare a hospital in Poland and one in Belarus, the only real difference should be staff wages, because in theory everything else should cost roughly the same. Equipment and medicines cost about the same. And if medicines in Belarus are supposedly much cheaper, then there is a catch — the same drug cannot cost dramatically less if it is genuinely of the same quality.

“The second issue is how resources are used. In Belarus there is a plan for the number of patients who must be treated in hospital, and it has to be fulfilled even when a patient could be treated on an outpatient basis. Or vaccines are poured away if the vaccination plan is not met. On paper, all vaccines were used properly, because nobody wants to face problems or lose a bonus for failing to fulfil the target.”

Finally, he addressed paid services in public hospitals.

“When it comes to paid services in state hospitals, the authorities are essentially creating the conditions for corruption — and then the basis for subsequent inspections.

“What would stop them from accusing, for example, the head of a department or a surgeon of deliberately creating a waiting list for operations in order to perform them on weekends and make money from it? The law can be interpreted exactly that way. And yet hospitals are required to provide paid services, because the state needs the money.”

Read in rus