Radom Strike Raises Questions about Tactics

The strike in Radom ended in a rather unfavourable deal for nurses and midwives who remain underpaid and face constant claims that hospitals have no money to pay for their raises. This particular strike was also attacked by the Minister of Health who claimed that the employment level was too high in the hospital.

In strike after strike, nurses are told that their demands are "impossible" and that they are lucky to have jobs at all since their hospitals are "in debt" and should be restructured or shut down. In such circumstances, unions face an uphill battle.

Anna Trzaszczka, head of the Nurses' and Midwives' Union in the Radom Hospital, complained about the role of the media in their struggle in an article published on the Health Market website:

"Information in the media about the possibility of some wards being shut down took its toll. We were aware of the odium which would fall on us if this were to happen. We wouldn't want our action to lead to stories about the nurses who "destroyed their own hospital"."

Indeed the media portrayal of such strikes tend to come from the position of the governments' economic logic. Nurses unfortunately have still not found a way to combat the eternal myths about there being no money for health care.

Health Care Funding a Political Problem

The problem has an economic and political basis. The budget of the National Health Fund was raised dramatically last year and there was over one billion zloties surplus in addition to the over 2.7 billion zloties already held in reserve. However, they are predicting that in the next two years there will be a deficit due to a drop in payments made through the social security fund (ZUS) and the farmers' insurance fund (KRUS), which provide funding for the National Health Fund.

Reform of the KRUS system will be introduced into 2010, which could lead to more money in the system. However, recently introduced reforms allow the self-employed to pay much lower ZUS for a two-year period. Poles working abroad also do not pay health insurance in Poland. Furthermore, some people simply try to avoid paying money into ZUS or KRUS since they are higly dissatisfied with the poor services one may receive.

So we hear a lot in the press about how the National Health Fund will start to run a deficit, even though it now has a surplus. However there is little heard about efforts to put more money in the system. Even in the situation with KRUS, it is unknown whether the amount of money put in will actually increase; payments by farmers are expected to increase, but this does not mean total payments will increase since KRUS is state-subsidized. What may happen is that the burden merely be shifted and the state cut their amount of subsidies.

Little is heard about efforts to increase the health care budget because of the state's ideological slant towards the private sector. Many would like to undermine the public sector and boost the private, which means it is not in their interest to improve financing, either through contributions or state subsidies.

It is not surprising then that Poland spends only a minute fraction of its GDP on health care; this percentage has been falling steadily in recent years and is the lowest in the European Union.

A direct correlation therefore has to be made between the supposed lack of money in the health care system and the gross underfunding of the sector by the government.

Combatting a Bad Reputation

Despite the fact that government policy is largely to blame for the poor state of public health care, the general public is more likely to blame bureaucrats or health care professionals themselves for the problem. This is not only because of the usual tendency to vent anger at the person one comes in contact with rather than the creator of policy; waste and corruption is well-known to exist in the administrative level. But it has been corruption amongst doctors which has stayed in the public consciousness. Individuals who know they pay lots of money into the system but receive little in return and often not too sympathetic to calls for increased health care funding. At times the workers bear the brunt of general dissatisfaction.

Striking nurses have had to also deal with media indignation over their "leaving the patients bedsides". Common reactions to health care strikes involve the automatic explanation that "there is no money" and that the nurses are "putting patients at risk".

Although there is much evidence that people have (at least in the past) supported nurses demands, there is no evidence of this support in the public consciousness and the nurses have not managed to successfully counter the media offensive against them.

A Question of Strategy

Poland has seen large numbers of health care strikes over the last few years, but there hasn't been a national general strike of nurses yet. The government has benefitted from this as it passes responsibility for budgets onto each separate Voivodship or hospital, each which should be its own cost center and be responsible for its own profitability. In such a way, nurses do not benefit from large-scale collective action.

The nurses action in Warsaw a few years ago showed that nurses could garner widespread support for their struggle, yet since that time, little has been done to mobilize the general public. Any effective action on the part of the nurses must include a resolute strike action plus a public mobilization with concrete political demands.

Too much time has already been wasted. The percentage of nurses employed on employment contracts is dwindling. We also see that the government is preparing for new austerity measures, under the pretext of the upcoming budget deficit. Very shortly, the nurses will be in an even weaker position to advance their demands. If the nurses do not act quickly to take more concerted, large-scale action, most of them will continue to be underpaid for years to come.