In the context of the COVID-19 pandemic, health workers carry on their shoulders the greatest social burden, all while taking the maximum risk in the fight against this invisible enemy. To the efforts and sacrifices of health employees at the forefront of the fight against COVID-19, proportional rights must be granted – considering all the social responsibility and the risks taken. Establishing an appropriate appreciation of health workers consists in both respecting all of their legal rights and recognizing and rewarding their dedication by establishing additional solutions/institutions to those already in place.
In order to ensure the ethical treatment of health workers at the forefront of the fight against the COVID-19 pandemic, it is essential to satisfy the following claims, made and substantiated by the Federation for Solidarity in Health (Federația “Solidaritatea Sanitară” din România n.ed.).
1. Adopt all necessary measures to protect the health and safety of health employees (equipment, material and human resources, etc.) in order to lead to a significant reduction in the number of newly infected employees and, in particular, deceased due to COVID-19.
The high number of health workers infected with COVID-19 (visible on the COVID-19 Impact Monitoring Platform on health workers: https://covid.solidaritatea-sanitara.ro/ ) proves that the level of their protection is far from satisfactory.
The very high number of health workers who have died in the line of duty (visible in the Health Heroes Memorial: https://memorial.solidaritatea-sanitara.ro/ ) indicates the extent of the risks taken by health workers and shows the costs they have to bear in the absence of effective protective measures.
In the light of all this evidence, it is clear that there is an urgent need to develop an effective strategy to protect the health and safety of health workers.
In addition to the classic interventions, the strategy must also include:
Developing an appropriate campaign to inform health workers about vaccination.
The effectiveness of an information campaign must be judged on the basis of the results. The share of health workers wishing to vaccinate is the most relevant indicator of the results of the information campaign on vaccination against SARS-CoV-2/COVID-19. This is a low number, due to lacks in information capacity, inability to convey the necessary confidence, incapacity related to indicating the effectiveness of the vaccine, etc. The problem is amplified by the lack of adequate training of a large number of employees over the years, in particular in the category of non-medical and auxiliary health personnel. So far the vaccination campaign has been a personal image opportunity for two to three people rather than an effort to solve a collective problem. The inability to mobilise all relevant health institutions and bodies has also amplified the problem.
Establishing standards for the duration of use of individual protective equipment and ensuring that this equipment is in the appropriate quantity and of the appropriate quality.
In order to properly assess the protection of health workers, we need standards of protection, including the duration of use for the individual protective equipment. In the absence of these standards the only possible assessment is through the number of victims that the COVID-19 pandemic has made among health workers – a high number, and constantly increasing.
Development of a normative number of staff for the treatment of COVID-19 patients.
Ensuring the necessary personnel to carry out the activity under the specific conditions of this pandemic is part of the measures necessary to ensure the quality of medical services, i.e. to adequately protect the health and safety of staff. The lack of staff regulation in the field makes it impossible to assess the possibility of health facilities to provide the necessary services. In the absence of adequate staff regulations we are dealing with sanitary units that are impossible to organise efficiently, with employees overly tired with overloads of work tasks and exhausted by too many hours of work.
Reducing the continuous working time in individual protective equipment to 3 hours.
The absence of this standard of use of personal protective equipment is one of the evidence of a lack of respect for the physical and mental health of health workers, for which the Ministry of Health is primarily responsible. Although the Federation for Solidarity in Health has negotiated and struck a deal with Prime Minister Orban, the indifference of the decision-makers has prevented its implementation.
Limitation of professional liability to the conditions created by the ‘new normality’.
The current legal framework is inadequate to the conditions in which health professionals work.  Non-functioning malpractice insurances, forcing staff to go beyond their professional competence, the impact of material deprivations coupled with the large influx of patients are just a few examples of changes in the situation. These changes lead to an unusual increase in the professional liability of health workers, the most affected being doctors. In this context, it is obvious the necessity and urgency of legal interventions to adapt professional responsibility to the concrete resources and capacities in hand during the COVID-19 pandemic.
Inclusion of COVID-19 as an occupational disease for health workers.
The negative impact of the COVID-19 pandemic on health workers, significantly greater than on the rest of the citizens/workers (data available on the CoVID-19 Impact Monitoring Platform on health workers: https://covid.solidaritatea-sanitara.ro/ being eloquent evidence) justifies classifying this condition as an occupational disease and adopting appropriate legal measures.
2. Respecting the legal right to the survivor’s pension for the children of colleagues who have died on duty.
Unfortunately, so far (06.01.2021) we have 81 fallen/fallen colleagues. For each of these heroes, the Government continues to refuse to grant the legal right to the survivor’s pension and the rest of the additional rights provided for in Law No. 56/2020. The lack of community consideration for the sacrifice made by some of its members (health workers) in the collective interest hangs quite heavily in the balance of major errors, risking to have particularly serious consequences. Justice must be restored by honouring these rights.
3. Increase in basic wages for all categories of workers from 1 January 2021 to the level provided for by the wage law for 2022. Cancellation of the cut in base salaries provided by the OUG no. 226/2020!
The current Government began its mandate with a theft: at the end of 2020 it stole the right to annual increase in the basic salary for approx. 70,000 public health workers (71% of whom – health support personnel – work on the front line against the COVID-19 pandemic and 29% represent non-medical personnel, who provide the logistical support necessary for the fight). In an attempt to mask this injustice, the Government has presented it as a postponement of the increase in base wages. But a theft cannot be hidden behind words: for the mentioned categories of health workers, the law No. 153/2017 provides the right to an increase in the base salary in 2021. The removal of this right by OUG no. 226/2020 represents a cut in wages. The injustice is all the greater given that the previous Government has promised that on the 1st of January 2021 the base wages of these workers will increase to the level specified by Law 153/2017 for 2022. The commitment was made by the Prime Minister of Romania in July 2020 to the representatives of the Federation for Solidarity in Health and publicly, as a form of recognition and stimulation towards the efforts and sacrifices of health workers. All health workers must be honoured both legal rights and government commitments.
4. Coordinating all increases in wages to the current basic wage and granting all increases at maximum level. The introduction of all categories of health workers in Annex 2 of Law 153/2017.
Given that health workers are the category of citizens who take the maximum risk to defend the interests of all citizens, they need the support of the whole society to successfully complete the fight in which they are committed.
A mandatory minimum form of support is the granting of wage rights as provided for by the wage law, i.e. cancelling all suspensions of wage rights operated by different governments. The right to report all increases to current basic wage should be granted to all health workers, thereby restoring due rule of law.
The working conditions in which public health professionals work are radically different from those before the pandemic, the essential feature being their worsening. It is sufficient to observe the most visible aspect of this change, namely the individual protective equipment, in order to detect its character. In this context, the granting of all increases for working conditions at their maximum level constitutes a natural recognition of the specifics of the current labor of health workers.
In order for the ethical approach to be complete, it is also necessary to include all categories of health workers in Annex 2 of Law No. 153/2017, thus removing the aberration currently existing: workers who work under the same working conditions have rights corresponding to different working conditions.
5. Granting the risk incentive throughout the pandemic to all health workers.
Health professionals now take much greater risks than at the beginning of this pandemic, but with lower rewards. In order to rectify this abnormal situation, it is necessary to grant the risk incentive in all situations where employees assume this specific type of risk and during the entire period of the COVID-19 pandemic.
6. Granting all wage rights provided for by law, i.e. the increase of up to 30%, the increase for combating the epidemic and the payment of overtime, to all workers who have not yet benefited from them.
Political struggle and administrative incapacity have led to aberrant situations in which the governments refuse to comply with the law and prove unable to understand the true nature of current realities.
By the Law No. 56/2020, the Parliament provided for the right of health workers directly involved in the treatment of COVID-19 patients at an increase of up to 30%. The measures for the application of this right have been laid down by Order No 1070/2020, adopted by the previous Government. Although employees who met the necessary conditions had to benefit from this right, the government refused to finance it. The effect of this illegality was that the majority of health professionals were deprived of a wage right. This state of illegality must be stopped by granting all professionals their legal wage rights.
The COVID-19 pandemic has two significant effects on health facilities: the increase in the influx of COVID-19 patients and the large number of infected workers. The first effect generates a greater need for staff while the second reduces the available staff. The solution adopted by the sanitary units is to force professionals to perform overtime. As a result, in many cases a large number of workers end up accumulating a lot of overtime hours. Because of the misinterpretation of ambiguous legal provisions, these professionals end up working without being paid (if we add to this the obligation to work then we are clearly in the situation of forced labour). Overtime pay is an essential measure to restore the state of legality.
7. Payment of 18h guard shifts with the hourly rate of the base wage.
The public health system again faces an anomaly: doctors who carry out guard shifts under the current labor contracts, have an hourly rate much lower than that of the basic hourly rate. Although in most cases the work during the guard shifts during the pandemic period becomes even more difficult than that of the regular hours, this distorted approach to legal rights is maintained in all public health units.
Given that this situation was regulated under pressure from the Federation for Solidarity in Health in the summer of 2016, with the Minister of Health being the same as the current one, doctors naturally expect that the current Minister will hasten the cancellation of this inequity, paying doctors on guard shifts with appropriate rates.
8. Repositioning of nurses in the pay scale in the sense of advancing their place in the salary hierarchy, corresponding to their place in the medical team, i.e. their contribution to the treatment and care of patients.
The construction of the wage law is deeply unfair in terms of the position that nurses occupy in the salary hierarchy, both in relation to other professions in health (e.g. the difference from the lower position is extremely small while the difference from the immediately superior position is extremely large) and to the rest of the professions in the public system. The analysis carried out using the level of studies as a comparison criterion gives depth to the proportion of the problem. At the time of the adoption of the wage law, the only compensation obtained, of a temporary nature, was the granting of the entire wage increase, and the problem remained to be settled later on. Therefore, now is the time when this anomaly must be rectified by changing the place that nurses occupy in the pay scale, in the sense of raising it to a higher level than the current one.
9. Negotiating the Annexes to the Collective Labor Contract (CLC).
All the governments are talking about reforms in the organisation of labor in the public health system, but in fact the only reforms they end up making are either to reduce wage rights or to privatise a growing part of the sector.
Currently under the provisions of the CLC at the health sector level, the Ministry of Health is obliged to initiate the negotiation of its special annexes. These regulate essential areas of the work of health professionals, such as the audit of working time, the criteria for the evaluation of workers, the harmonisation of working life with family life, the procedure for organizing shifts, the establishment of new rules on continuous vocational training and its provision free of charge for workers, the information and consultation procedure. All these annexes propose measures to reform the work aimed at modernising labour relations. But the governments constantly refuse to start these negotiations and implement these reform measures, preferring to discuss publicly illusory and unnecessary reforms. The Federation for Solidarity in Health calls for an end to this state of affairs, i.e. the entry into legality and normality by negotiating the annexes to the CLC at the level of the health budget sector.
10. Health workers should benefit from the reduction of the contribution period (retirement age) in proportion to the work carried out that is above the basic norm. A reduction should also be applied to particularly dangerous working conditions.
Although the involvement of health workers at the forefront of this fight against the COVID-19 pandemic would justify the granting of pension rights similar to those of the military, we are in the absurd, illegal and immoral situation in which the politicians in power refuse to recognise an essential right: recognition of additional work at the contribution stage. The additional work (as compared to that corresponding to a single individual contract) by health workers must be recognised as an additional contribution period, creating the possibility of early completion of the maximum contribution period. Health workers in such situations do not require a privilege (such as special pensions), but the recognition of an additional effort made, i.e. the early completion of the contribution period. In addition, these professionals are entitled to a reduction in the age of retirement when working in particularly dangerous conditions (already proven by morbidity and mortality indicators), a right which must also be transposed into the legal provisions on retirement.
See the claims in Romanian, and a call for support signatures here.