The authorities follow the path of introducing serfdom in healthcare

“Salidarnasc” continues its round of publications devoted to a research conducted by a group of Belarusian physicians, members of the Independent Healthcare Workers’ Union, which has become a sort of response to an article published in one of the State-run mass media outlets.

Stanislau Salavei

The article with a pathos-heavy title “Belarusian Healthcare Secures Its Human Resources, Strengthens Its Infrastructural and Technological foundation, Expands Imports, and Goes Digital” asserts, among other things, the “the system now receives an ever-increasing number of young specialists, secures its human resources, and strengthens its infrastructural and technological foundation” and that “the postgraduate work assignment of young specialists has contributed to bringing staffing levels of healthcare institutions in terms of available physicians to 96.1%, while bringing down the share of those who hold more than one position to an optimal coefficient of 1.25”.

The research group has found out what the strengthening of the infrastructural and technological foundation actually meant; and a member of the research group, himself a physician and one of the Independent Healthcare Workers’ Union leaders, Stanislau Salavei, shared their outlook on the real situation in today’s healthcare system in Belarus with the Eagle-Owl.

“In 2025, they increased the admission of students to public medical universities and expanded “targeted” training programmes. All this can be described by the broad phrase of “securing human resources”.

“Yet, if we look at the wage statistics, it becomes clear why the authorities, rather than attracting people with good working conditions and wages, choose to follow the path of introducing “serfdom” in the national healthcare system. Like, do you really need to pay decent wages to those who can be simply “bonded to till the land”?

“For comparison: in Germany, physicians’ wages are 5-6 times bigger than in Belarus; in Poland, they are 3-4 times bigger; in the Baltic countries 2-3 times.

“The pay gap contributes to the migration of healthcare specialists – particularly, anesthesiologists/emergency physicians and primary care physicians – from Belarus to the EU countries, leading to specialist staff shortages (particularly, anesthesiologists/ emergency physicians and primary care physicians) and, consequently, to increased work load for those who remain (a higher patient-to-physician ratio, less time for each patient).

“There is an equally significant pay gap for medical nurses in Belarus and in the EU countries: in Germany nurses are paid 4-5 times more, in Poland 3 times more, in the Baltic countries 2-2.5 times more.

“Apart from wages, we must mention another important indicator – the “nurse-to-physician ratio”. In developed healthcare systems it is between 2 and 4 nurses per 1 physician. In Belarus, the figure is smaller, which increases the work load while bringing down the quality of care. As a result, Belarus faces an even greater shortage of medical nurses than that of physicians.

“Currently, the healthcare system in Belarus is regulated exclusively by the State. Even in the private healthcare sector there is not that much of a competition and few incentives exist to pay people more, that is why the range of services it provides is rather limited. The rationale is simple: why pay more if the State is the monopolist.

“Dental care is probably the only exception – wages there are higher than in other parts of the healthcare sector. And, by the way, the introduction of market mechanisms has ensured that this sphere still remains accessible to people and currently experiences no staff shortages.

“The share of those in Belarus who leave the profession for one reason or another amounts to approximately 30-40% of the overall number of healthcare workers. The State does not see that as an issue: it steps up the so-called “targeted” admission of medical students and increases the duration of the mandatory work term they are obliged to serve upon graduation – the problem is solved. Or, rather, they believe it is.

“In other countries it is done differently. I can give you an example of a colleague of mine. Currently, he works in the northern part of Poland where they have an acute shortage of physicians who are not particularly willing to go and work there; he draws a monthly wage of about EUR 7,000. But should he choose to go and work in, say, Krakow, he will earn less.

“So, the State uses a financial incentive to deal with a staff shortage issue where there is one. True, working there is hard, but, for instance, young physicians who plan get a mortgage loan for their house or buy a car, will opt for it. Willingly, too, no coercion there.

“While in Belarus there are no other methods but coercion. So, we look at the statistics for, say, the Mahilyow Region and see that the share of healthcare workers who choose to stay and work on after their mandatory placement term expires is only 20%. And if you take into account, say, women who are on a maternity leave while still being officially employed, this percentage can be even lower.

“Local authorities have no reason whatsoever to motivate young healthcare workers to stay on, neither with wages, nor with helping them get an apartment or a house of their own. Once these people arrive, they are not going anywhere. And when the mandatory term expires and they leave, it is not a problem either: new “serfs” will be sent down to replace them.

“So, what can possibly motivate a physician in a situation like this? It is understood that this kind of attitude towards young healthcare workers is not universal, but the system built by the State does create all the preconditions for it.

“I would like to give you a quote from an article published in the State-run mass media: “Unlike many CIS countries, Belarus has preserved the practice of pre-graduate residency training and internship for senior students, which has served to improve the quality of young physicians’ training: future specialists acquire real clinical experience and enter the system being better prepared for work”.

“So, do they mean to say that one year of internship makes a Belarusian physician, a medical university graduate, better prepared for practicing his profession than his Polish colleague who has 5 years of residency training under his belt? That becoming fully employed after one year of internship, a young surgeon who has been exiled to a central hospital in a remote district under the mandatory post-graduate placement scheme and allowed to perform operations independently, without assistance from more experienced senior colleagues, will make less mistakes? Will have a better post-operation complications record? How can this be?”

Another participant of the research group, Aleh Paulau, also a physician, says that he cannot understand why it is impossible to pay higher wages to healthcare workers in Belarus:

“Now, if you want specialists, then you pay more. Yet this is not in the books. The authorities grudge spending money on people.

“There is a shortage of healthcare workers in the whole world, the issue is not unique to Belarus. The healthcare workers shortage is there because people increasingly need more of them. The population is ageing, the system now can treat diseases that could not be treated in the past. Despite the growing technology level of healthcare, the number of patients undergoing treatment processes is also on the rise.

“Belarus neighbours countries where healthcare workers earn more, and considerably more, too. This is why physicians have been leaving the country. Initially, in the early 2000s, to Russia, mostly to Moscow or Saint-Petersburg; my department saw a virtual exodus of specialists then. I mean, the difference in wages was so big that people were ready to start a new life elsewhere.

“But after this process became massive they began creating obstacles to migrating healthcare workers. For example, they started introducing changes in the medical university curricula to make them at least slightly different from the Russian ones, so that people had to go through re-training courses after the move. This did not cost the migrants much, but still…

“I mean, even then the government officials’ train of thought was unidirectional: how to bond people, how to make sure they do not leave. They did not bother to somehow motivate them, providing financial incentives, among other things; they just wanted to create problems and male things difficult for them.

“After 2020, healthcare workers would migrate mainly to Europe. And despite all the difficulties they have to go through to have their diplomas recognized, they are still rushing there, particularly, the younger specialists. While the big gap in wages and working conditions is there, migration will continue.

“When our group began comparing nurses’ wages, we realized that the gap was of catastrophic proportions. And that in a situation of a huge nursing staff shortage in Belarus. About one third of all medical nurses leave the profession. They take a look at the working conditions, the attitude towards them, the wages, and they just leave.

“While in civilized countries this is a much respected occupation. I mean, a nurse is not seen as a physician who has not got proper training, it is a profession of its own standing. On top of that, the daily work of physicians and nurses involves a lot of things that have nothing to do with their professional duties.

“My colleagues and I discussed the issue of staff shortage, like, can it be “drowned” in money? And we concluded that money, while being a necessary prerequisite, is totally insufficient by itself.

“Because, after 2020, only a small percentage of healthcare workers have left the country for economic reasons. We have surveyed 500 Belarusian physicians who now work abroad. 48% of them would not respond to the survey and only 16% of those who did indicated that they had emigrated for financial reasons, while around 24% quoted political repressions as their main reason.”

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