Perm krai[1] committee of the health workers’ trade union
General information on the organization
The regional organization consists of 254 primary organizations which are incorporated into 46 territorial organizations,[2] 10 primary organizations (which are not part of the territorial organizations, but directly subordinate to the krai committee) and 12 students’ organizations (in 2005 there were 286 primary organizations). The total number of members of the trade union has also declined: on January, 1, 2006 there were 53172 members, of whom 6000 were pensioners, whereas in 2005 the trade union had 57999 members of whom 49268 were working, 3961 students and 4865 pensioners.
The apparatus consists of 2 departments: organizational and legal. The technical inspectorate for labour safety is included in the legal department. There are plans to create a social and economic department, but for now the chairman of the krai committee«covers independently»all questions connected with wages: he negotiates with the Ministry of Health of Perm krai (henceforth PK) and participates in sessions of the Legislative assembly of PK. Over the last ten years number working in the apparatus of thekrai committee has not changed, with ten employees.
Policy of the krai committeeconcerning low wages
The work of the krai committeeconcerning wages and improvement of working conditions and health and safety can be divided into two stages: before the realization of the national projectHealth - in 2004-2005 and during its realization - 2006-2007. Introduction of the national projecthas fundamentally changed the functioning of the regional organization. While in 2004-2005 attempts to carrying out of active actions, down to carrying out of strikes, in 2006-2007 the work of the krai committeeconsists in monitoring the distribution of payments to categories of medical workers within the framework of the national project, in patching up the holes in its realization.
The first stage - 2004-2005.
The activity of the Perm regional committee of the health workers’ unionon the increase of wages in 2004 took up a big proportion of time among other directions of work in 2004-5. The low level of wages of health workers (in the first quarter of 2005 the monthly average salary in the branch across the Russian Federation was 5604 roubles whereas in the Perm oblast it was 4894 roubles) caused the acuteness of the problem.
The activity of the regional committeeto secure decent pay and working conditions was directed:
ﾷAt the mobilization of primary organizations in active actions
ﾷOn lobbying the regional administration
Mobilization of primary organizations on active actions
To involveprimary organisationsin the resolution of questions of payment and working conditions the regional committeeused various forms and methods of work. First, questions of a pay increase were articulated at Plenums and Presidiums of the regional committee, and were reflected in its decisions. The resolutions adopted were based on support for the decisions of the Central Committee of the health workers’ trade union of the Russian Federation and the Council of the Association of trade unions of workers of the non-productive sphere of the Russian Federation.
Second, the regional organization of health workerstook part in the All-Russia protest actions which took place in 2004-2005. On June 10 2004 the first stage of the All-Russia protest action of workers of the non-productive sphere took place in the form of pickets, meetings and processions. The protest was directed against numerous amendments to the laws in force restraining the rights of the working population.
The disintegration of uniform systems of payment, absence of a guarantee of a minimum level of salary, mechanisms of financial support and indexation of salary against the background of low material provision for organizations of the non-productive sphere were the principal causes of the actions. The first protest actions did not bring appreciable results. Owing to this, the Council of the Association of trade unions of workers of the non-productive sphere of the Russian Federation put forward Demands on 28.06.04 addressedto the chairman of the Government of the Russian Federation, the heads of federal ministries and bodies of social partnership. Not having received constructive proposals within the deadline established by legislation, the Council of the Association on the basis of decisions of the presidiums of the Central Committees of trade unions of the non-productive sphere (education, health and culture) adopted decision on 31.08.04 «On the creation of a conciliation commission for consideration of the collective labour dispute on increase of wages». Not having reached agreement, it wasresolved to organize the second stage of collective actions which took place on October, 20, 2004. The Perm regional committeeproposed a system of stepsin preparation for participation in the All-Russia strike. At Presidiums of the regional committee(on August, 8 and on September, 8, 2004) the decision was adopted to carry out meetings and conferences in the primary organizations in support of the demands and to decide on the participation of the collective in the strike. For the primary organizations methodical documents were developed: the organisation of a petition, Appealof the Perm regional committeeof the Health workers’ trade union to members of the trade union, apetition sheet, a draft report of a general meeting about support for a strike. Chairmen of trade union committeeswere recommended to involve all workers, not only members of the trade union,in the decision to strike.
The experience of carrying out a strike revealed barriers in the organization of one-day suspensions of work.
First, there is no legal provision for local strikes. The regional committeesupported the demands which were put forward at the Russian level:
ﾷTo carry out indexation of wages of workers of budgetary establishments of the education system, public health services and culture in the second half-yearof 2004 of not less than 1,5 times;
ﾷIn the preparation of the draft of the Federal law «On the federal budget for 2005» to provide financing to increase wages in budgetary organizations twofold;
ﾷTo preserve supplements to salaries and subsidies for the payment of housing-and-municipal services for specialists of budgetary sphere working inrural districts.
The regional committeedid not put forward any demands of its own to the Administration of Perm oblast, nor did it make an official statementabout the carrying out of a strike in the territory of Perm oblast. Subsequently this was chargedas an infringement of the legislation, on the basis of which the regional authorities ruled the strike illegal.
Secondly, heads of medical institutions, using the blunders of the regional committee, put strong pressure on workers, threatened them with dismissal or punishment for absenteeism and convinced workers not to participate in the strike.
Thirdly,having limited information, chairmen of trade union committeesdid not show enough initiative and failed to convince workers of the legality of the actions of the trade unions. Insufficient explanatory work among ordinary workers led to a low rate of participation. In total more than 9 thousand public health service workers took part in the strike on October, 20, 2004 in Perm oblast, which is12,5% of those employed in the branch (the average number working in the branch at the time of the strike was 72277), and 18,3 % of working members of the trade union.[3]
Despite the admitted mistakes, the protest action drew the attention of the local authorities to the problems of medical workers. Negotiations were carried out with committees of the oblast Legislative assembly, at which it was decidedto increase the salary of state employees funded by the regional budget not by the proposed 10 %, but by 20 %. But this remained only a promise. With the approach of 2005 the situation did not change. At the Presidium of the regional committeeon July, 12, 2005 it was decided to prepare and carry out the next All-Russia protest action which took place on October, 12, 2005. The basic demand of the trade unions was for an increase in wages in 2005 of 50 % (taking into account the increase of 10 % from January, 2005). Apart from this, thePerm oblast Legislative Assembly was recommended to increase the salary of all state employees and to provide in the budget for 2006 for an increase in salary of 50 % for all categories of employee. Separate attention was drawn to the establishment, uniform for all public health serviceorganizations, irrespective of the level of their financing, of minimal state guarantees of payment for various categories of employees of the branch, the minimum guaranteed compensatory payments, the development of a financial mechanism for the realization of these guarantees in workplaces, taking into account the existing principles of division of powers of management bodies of various levels.
In September, 2005 at the next session of the Presidium, the question of the readiness of the trade-union organization to carry out the All-Russia protest action was discussed. The second stage of the All-Russia protest action was marked by a low activity of workers, in all 1000 people participated.
As an addition to the existing methodical documents on the organization of protestactions, the regional committeedecided to develop Regulations about a strike fund. The regulations about a fund were developed, but it was not possible to realize the idea in practice. The question was considered at the Plenum of the regional committee(on April, 26, 2006), whose participants voted against an additional collection (2 %) from primary organizations for creation of the fund.
Lobbying of the regional administration
Interaction with the authorities was carried out through joint meetings in September - October, 2004 of regional and city trade-union activists and the deputy governor responsible for the social sphere, meetings with heads of medical establishments with theparticipation of chiefs of regional and city public health service administrations at which there was an exchange of views on theissue of the participation of the regional trade-union organization in protest actions.
The main event of 2005 was theadoption of the Law «On the payment of workers of public health serviceestablishments of Perm oblast» (adopted on November, 16, 2005). The regional committeeе created a commission on social and economic questions to analyse the draft law which included organizers of public health services, head physicians, and staff of the apparatusof the regional committee. The trade-union side lobbiedfor the interests through proposing amendments to committees of the oblast Legislative assembly, using deputies loyally inclined to state employees. According to the chairman and the lawyer of the regional committee,two-thirds of the amendments proposed by the trade unions were included in the law. However, important points proposedby the trade unions were excluded from the law. The basic proposalsof the regional committee about mechanisms of increase and indexation of salary were not included in the law, such as:
Dependence of the size of salary directly on increases in the minimum wage and subsistence minimum in the territories of Perm oblast;
On the increase or indexation of wages of workers of the budgetary sphere at the federal level, salaries of workers of state (regional) and municipal public health service establishments of Perm oblast should not be set below salaries (rates) and no later than those established at the federal level;
Increase or indexation of wages should be made simultaneously for all employees of state (regional) and municipal public health service establishments of Perm oblast.
It was not possible for the trade-union side to bring in regulations about the agreement of questions of award of bonuses with the trade-union body. The system of payment has practically not changed, only particular additions, regarding increase in the tariff fund, regarding increase in the extra payment to young specialists in rural districts and regarding the right to use theeconomy fund for awarding bonuses have been introduced.
In 2005 the law was applied only to 40 regional establishments, with an average number of 7003 employees, i.e. only 12% of the medical personnel. Employees of municipal establishments remained outside the action of the new law. Such a division is caused by provisions of law №131 of the Russian Federation, in which differentiation of powers of regional and municipal levels is determined. The law specifies that municipal authorities independently determinethe wage fund of employees in the sphere of public health services. As a result, territories have started to develop their own draft laws on payment. The regional committee has represented itself as the coordinator of work on local draft laws. The lawyer of the regional committeecarried out scheduled consultations with representatives of city committees and district committees. The bi- and tri-partite commissions on the regulation of social - labour relations in Perm oblast became the coordinating body for the preparation and discussion of the draft laws. The final draft was sent as a recommendation both on paper, and in an electronic variant,to the municipal authorities which facilitated the work of local authorities and trade-union bodies. By January 2006 a law on wages in the sphere of healthhad been adopted in all municipal establishments.
The second stage - 2006-2007.
In 2006-2007 the regional committeehas worked under the flag of the realization of the national project Health. In this connection, the chairman of the regional committeehas allocated a salary increase as the main direction of work. «From11 directions of the national projectthe trade unions are only involved in those directionswhich result in payment for public health services workers»(from interview withthe chairman of the krai committee), which include:
ﾷadditional payment for local doctors and nurses
ﾷPayment for medical personnel of FAPs (maternity centres) (licensing of FAPs)
ﾷProphylactic medical examination, professional examinationin organizations
ﾷPayment under maternity certificates
ﾷPayment of holiday money, calculation of the "Ural" coefficient
The trade unions have noted significant deficiencies in the realization of the national project. This determines the character of the workof the krai committee,whose activity at the second stage consists in the prevention of infringements and the observance of the norms and the volumes, payable to particular categories of public health serviceworkers.
The first direction of work –additional payments for doctors and nurses in primary care.
In some territories of Perm krai payments were not made to local doctors where the locality was not sufficiently populated (i.e. the population was less than the norm).[4]A critical situation developed in Solikamsk and in the Kungursk district. A brigade of staffof the krai committeewent to the localities,«convinced the head physicians that it is necessary to include in the locality the population of the nearby FAPs».[5] The situation reached an explosive point: the workers declared their decision to take the case to court. The chairman of the krai committeereported the situation at a session of the tripartite commission of Perm oblast, appealed directly to the Ministry of Health of the Russian Federation, and to the Central committee of the health workers’ trade union. After numerous appeals (not only from the Perm regional committee of public health serviceworkers) a new document was issued by the Ministry of Health of the Russian Federation which defined a new kind of locality «the combined territorial locality», i.e., where the population did not meet the norm (2 thousand people per local doctor) they added the maternitysites. In Solikamsk, for example,«they have reformed the sites, in some places SVA were altered intoFAP. People received the maximum and refused to appeal to thecourt».Thus the situation was corrected and the majority of rural doctors received additional payments on lawful bases.
Payments to FAPs(licensing of FAPs)
The second problem which the regional committee had to solve was the organization of payments to medical staff of FAPs. In Perm kraithe realization of the Government Decision № 356 of 09.06.06 «On the order of making grants from the federal budget to budgets of subjects of the Russian Federation in 2006 for monetary payments to medical personnel of FAPs andprimary care doctors, medical assistants and nurses» was complicated by the decision of the Ministry Health of the Russian Federationonly to pay where there are licenses. As of July, 1, 2005 only 30% of FAPs were licensed and in the Komi okrug not oneFAP was licensed. The Krai committee appealed to the governor and to the Minister of Healthof Perm krai, to which they received the answer that payments will be made only where there are licenses. After anotherappeal to the governor, the krai committee received an explanation: in a municipality the administration has the right to make payments to unlicensed FAPsfrom their own resources. Heads of municipal administrations were not in a hurry to part with money. As a result the krai committee resorted to extreme measures –appeals to the Office of the Public Prosecutor. Model applications to court,to the Office of Public Prosecutorand, to the labour disputes commission were preparedfor workers of the branch. As a result of the actions undertaken, the krai committee receivedan instruction from the Office of the Public Prosecutor to the governor of the krai about theillegitimacy of the actions of the local authorities. As a result the regional administration was obliged to allocate heads of territories the means for licensing and the process was set going. All debts for payments were settled:«due to this not less than 500 people received additional wages»(from interview with the lawyer of the krai committee).
Prophylactic medical examination (a method, making it possible to carry out periodic observationof particular groups of the population with the purpose of revealing diseases)
Prophylactic medical examination has a considerable reserve for increasing the salary of medical workers. The organization of professional examinationallows for an increase in wages of narrow specialists of 1,6-1,8 times. At the same time, prophylactic medical examination appeared a complicated question in the realization of the national project, the losses on the payment fund were the biggest. The basic problem consists in getting hold of the allocated money. In 2006 40 million roubles was allocated for prophylactic medical examination in Perm krai, in the opinion of the chairman of the regional committee«the quota was fulfilled 60-70 percent», i.e. the whole sum was not got hold of. The reasons for not getting hold of the money were the bad organization of the population for examination (every examination requires 500 roubles).As a whole across Russia "economy" under the national project of unspent money for professional examination was estimated at hundreds of millions of roubles,«this is billions which simply will not be spent. At a meeting Medvedevspokeabout medical examination, that there are territories where the has only been fulfilled by 6%. That is this money simply will not be used and will return back to the federal level. Therefore at the federal level a big mass of moneywill be saved»(From interview withthe chairman of the krai committee).