Georgia: Medical Workers Struggle to Make Ends Meet

Lana Kokaia

Georgian journalist based in Tbilisi

Sunday, 23 April, 2023

The link has been copied

Nugzar Nemsitsveridze has worked as an ambulance doctor for the last 14 years, but still struggles to make ends meet on the 1,200 laris (475 US dollars) he earns each month.

The 40-year-old Tbilisi resident is one of hundreds of emergency medical workers in Georgia who have been protesting against stagnating wages and working conditions in an upsurge of labour actions over the past year.

“Our main demand is a pay rise. I have eight 24-hour shifts a month and I could take two more, but after the protests, we were deprived of this opportunity. They’d rather hire new people,” Nemsitsveridze told IWPR.

Salaries for emergency medical workers are determined by the number of 24-hour shifts they work, which are limited to eight per month. A senior doctor receives about 175 laris per shift (70 US dollars), while a junior doctor’s wage is lower. State employees are enrolled in a state-provided health insurance, but workers in private clinics have to pay these fees from their salary.

Alongside low wages in the health care system, workers complain that the state body, the Emergency Situations Coordination and Urgent Assistance Centre (EMSC) is also taking away part of what they claim is due. 

In May 2022, hundreds protested after the government announced its decision to cancel pandemic-related bonuses because all Covid-19 restrictions had been lifted. 

The bonuses, amounting to 50 per cent of salaries, were introduced to compensate for the the emergency during the pandemic. 

The European Public Service Union (EPSU), a Brussels-based organisation representing nearly 300 trade unions, stated it was “unacceptable” to cut bonuses amidst the cost-of-living crisis.

“Georgian emergency service workers undertook the most challenging and hazardous tasks during the pandemic. People clapped for their work, but they were forgotten afterwards,” Artem Tidva, EPSU’s campaigns’ officer said, adding that Georgia’s health care would worsen if working conditions remained the same. 

In December 2022, workers received only 70 per cent of the end-of-year bonus that employees in many countries receive in December. The cut was seen by many as a punishment for the spring strikes. 

But pay is not the only issue. In late October 2022, the EMSC modified the exam that doctors and nurses must take after attending mandatory training.

“I have taken and passed this test with the highest marks in both theory and practice, but I do not think I’ll pass it now. It has turned into a punitive exam,” Nemsitsveridze said. “If 14 doctors in a group of 14 fail the test, there is a problem with the training or the test, rather than with doctors.” 

He sees the change as retribution.

“As soon as we voiced our discontent our qualifications turned out to be questionable,” Nemsitsveridze concluded.

The EMSC, which operates under the ministry of IDPs, labour, health and social protection, rejected workers’ claims stating that conditions for ambulance employees had significantly improved in recent years. 

It stated that in 2022 it introduced overtime pay for emergency employees working on bank holidays: eight laris (3.20 dollars) per hour for senior doctors, six laris (2.40 dollars) for junior doctors and five laris (two dollars) for ambulance drivers. 

The administration added that ambulance workers were also paid bonuses to compensate for overtime and bank holidays and that in 2023, EMSC employees “will have improved health insurance”. 

The call for extra shifts was rejected, even though for those in Nemsitsveridze’s position,  more work means more money to get through the month. 

DIRE SHORTAGE

Nurses like Ia Kheladze, 39, feel disheartened.  

“We went through hard times during the pandemic, there was not enough personnel. It was not right to express discontent [then],” Kheladze, who works in a private clinic, told IWPR. “We went back to the old salaries [just] when prices of everything had grown three-fold. I earn 600 laris a month (238 dollars) for eight 24-hour shifts, with no health insurance. I have to take on other jobs.” 

Revaz Karanadze of the independent trade union Solidarity Network maintains that nurse understaffing was a critical factor in the COVID-19 related death toll in A country where over 17,000 people died from the virus. 

“Georgia needs about four times the number of nurses it has,” he told IWPR. “The World Health OrganiSation (WHO) has included Georgia in the list of alarming countries for nurse shortage.” 

The average ratio of nurses to physicians in WHO’s European region is 2.3, but in Georgia it has not exceeded 0.8 in a decade, meaning that there IS fewer than one nurse per doctor. In rural and mountainous areas, the shortage is even more acute.

It is a vicious circle, noted Tidva: more nurses are needed but the working conditions keep people away from the profession and are also causing an exodus of the workforce. 

“Many colleagues have left or are thinking of leaving, for example to Germany, where nurses are in high demand,” Kheladze said. “I personally had an offer to go and work abroad, on much better conditions, but I am staying because of my family.”

Nonetheless, Some progress has been made. In late 2022, the health ministry approved a minimum hourly salary. From January 1, 2023, doctors receive seven laris (2.80 dollars) per hour, which works out to approximately 1,260 laris (500 dollars) per month, and nurses get 4.4 GEL per hour, or 792 laris (315 dollars) per month on average. The minimum wage will continue to increase gradually through 2025, peaking at nine laris (four dollars) per hour for doctors and 5.6 laris (three dollars) for nurses.

Labour rights’ groups, however, noted that the new regulation only applies to staff in medical facilities providing inpatient care and participating in the state-funded Universal Healthcare Programme. While covering a significant number of employees - up to 9,000 doctors and 8,000 nurses - it still leaves many unprotected.  

It also does not apply to junior doctors, physician assistants, laboratory staff, midwives and those in other support roles.

“The salary of various support staff ranges between 120 and 135 laris (47 to 53 dollars); for example, in Chiatura [in central Georgia] a midwife gets 135 laris while the minimum living wage is 253 laris (100 dollars),” explained Karanadze of Solidarity Network.

“Most nurses have to work in several places to earn a living. I have worked in four hospitals at the same time, for example. As a result, burned-out nurses are unable to provide the assistance each patient needs. With the increase, I get 4.40 laris, but with income tax and pension contribution the wage remains minimal,” Kheladze noted.

Support staff pay is even lower. Ketino Salzutsishvili has been paid at the same rate ever since she began working as a janitor in a clinic in the western Georgian town of Lanchkhuti nine years ago.

“It ranges between 130 and 150 laris (51 to 60 dollars) per month, sometimes it goes up to 160,” the 48-year-old single mother-of-two told IWPR. “We mostly have eight shifts of 24-hours a month, sometimes seven. I get 120 laris a month from another job. We want to work, but we need decent pay. My mother-in-law is disabled and I receive a state social allowance but it is still not enough to make ends meet.”

Labour rights’ campaigners are continuing to advocate for change but with few results, they say.

“The situation is moving towards a health crisis and in this crucial moment, the silence of the health ministry is unacceptable. They are not only avoiding social dialogue, but also applying union-busting tactics,” Tidva told IWPR.

The ministry of health did not respond to IWPR’s requests for comments.