Health system monitoring

In connection with the epidemiological situation that has arisen since April, the Educational and Social Public Association “Zvyano” has been monitoring the work of the Belarusian health system by a survey of doctors and patients.

Objectives of monitoring: an independent assessment of the measures taken, work with patients and their families, protection and support of medical personnel to provide this data to the Ministry of Health and public.

Interim results of the survey of medics (April 2020):

1. Almost all of the interviewed medical staff reported that in connection with the coronavirus epidemic in February / March, they received additional instructions, additional disinfection measures were introduced, personal protective equipment was issued, visits or admission of planned patients were limited;

2. 95% of medics claim that they have not received orders to hide any information from relatives of patients (patients);

3. 90% of medics note that they have not received an order not to make certain diagnoses to patients, and 70% have not heard of such orders;

4. 90% of physicians report that they did not receive orders to refuse hospitalization or other medical services to patients, except for unreasonable cases (planned operations were fairly limited);

5. Most doctors report that they have not had to work in a sick state;

6. Even before the Presidential Decree “On material incentives for health care workers”, medical staff working with Covid-19 reported getting bonuses for their work;

7. All the respondents note that they did not experience a shortage of medicines. The exceptions are surgeons and anesthetists.

Identified problems and recommendations directed to the Ministry of Health:

1. Provision of PPE.

Despite the fact that the doctors were given additional personal protective equipment, almost all respondents note that there were not enough of them, some also claim a lack of disinfectants (as of April 23, there are statements from regional cities that no additional protective equipment was received). Despite the efforts of the Ministry of Health and the help of public initiatives, doctors of hospitals and clinics, nurses, drivers and paramedics of the ambulance continue to experience an acute shortage of PPE. 70% note that they had to buy PPE at their own expense (while they could not buy PPE with a high degree of protection, since they are not on sale). For a final solution to this problem, we recommend:

– to voice the real needs of the healthcare system in PPE;

-expand cooperation with civil initiatives and businesses to meet these needs;

-simplify the procedures for receiving (and reporting of medical institutions) gratuitous aid, both from Belarusian citizens and organizations, and from foreign citizens and legal entities;

– to exempt from taxes the funds collected for medical institutions by individuals.

An unprecedented step towards efficiently and quickly attracting sponsorship may be the opportunity for legal entities to transfer 5-10% of the amount of income tax directly to the charitable account of the Ministry of Health.

2. Protection of pediatricians.

Special attention should be paid to the protection of pediatricians who report that they are the last to receive PPE, since it is believed that children do not get sick. However, children are carriers of the virus and employees of pediatric departments (where pensioners also work) are asked to provide them with personal protective equipment urgently and in the required amount.

3. Protection of labor rights (payments to medical staff).

Despite the accrual of bonuses and allowances (and now monthly payments in accordance with the Presidential Decree) to doctors who work with Covid-19, the problem of maintaining the salaries of other medical personnel has arisen. For example, surgeons and nurses receive their salaries according to working hours and due to the reduction of planned patients, hospital staff are worried about the loss of earnings. In addition, to the question “if you had to be quarantined in connection with Covid-19, who paid for your temporary incapacity for work,” we received different answers – at our own expense, paid by the employer. From this, we concluded that there is no single position of the Ministry of Health in relation to this issue. There are also reports that some doctors were sent on vacation at their own expense, transferred to 0.5 rates (for example, doctors of dental clinics, employees of sanatoriums). Despite the difficult situation during the epidemic and the economic crisis, all doctors should be protected and leave at their own expense cannot be a fair solution to the issue.

4. Systemic testing of doctors for coronavirus.

Almost 70% of those surveyed have not been tested for coronavirus, while some of those who have been tested say that they did it with difficulty. Some claim that this is only possible if there are symptoms, even if the colleagues in the hospital department were diagnosed with coronavirus. Also, the staff of clinics note that they cannot receive information about confirmed cases of  infected patients who were at the reception. Since doctors are not only the most vulnerable group in terms of morbidity during an epidemic, but can also transmit the virus to patients at the reception, we consider it necessary to systematically approach the issue of testing all doctors.

5. Non-interference in private life, respect for personal dignity.

25 % of the surveyed medics reported that they received a ban (warning) on ​​the dissemination of information about the state of health care (this issue did not concern personal data of patients). If such a prohibition exists, it is a violation of the legislation of Belarus, according to which informing citizens about the state of health protection and the epidemiological situation in the country are the obligations of the state and are not subject to restrictions. Pressure on doctors in connection with their public activity during the epidemic, expressing their opinion on the current situation, recommendations on the behavior of the population during the epidemic, criticism of the measures taken (and other actions that do not disclose the personal data of patients) is unacceptable and illegal.

Particular statements concerned forcing doctors to subscribe to periodicals, participate in subbotniks(volunteer unpaid work on weekends), transfer money to public organizations, etc.

6. Transparency of the resource allocation system and the inclusion of medical staff in the management of health facilities.

Almost 70% of the surveyed health workers believe that the measures taken by the Ministry of Health were insufficient. When asked what measures should have been taken, the respondents indicate: the introduction of measures already taken, but earlier, 100% provision of all doctors with PPE, the introduction of quarantine, better organization of patient flows and better re-profiling of hospitals during the epidemic, systemic testing of medical staff for coronavirus.

Based on the answers of the doctors, so far we have concluded that the doctors did not have the opportunity to convey their opinion to the management of the Ministry of Health, since 80% of the medical workers note the absence of real mechanisms to influence the work of the health care system, 60% note the lack of incentives for initiative, almost 50% doctors feel insecure in connection with unfounded accusations (search for scapegoats), 20% are afraid of being fired. If a further survey confirms these indicators, the Ministry of Health should consider establishing horizontal links and reforming the institution management system.

At the same time, in connection with reports about the lack of transparency in the distribution of humanitarian aid (tests, PPE, spending from the charitable account of the Ministry of Health), today the Ministry of Health can demonstrate openness to its employees and society by providing not general, but detailed information on how PPE and other humanitarian aid for healthcare institutions was distributed (or institutions of the Ministry of Internal Affairs, the Ministry of Labor and Social Protection), what exactly and in what amount was purchased from a charitable account and where it was delivered, in what period of time (week, month) this aid is to be used.

Also, some doctors express an opinion about the irrational waste of budget and extra-budgetary funds in the institutions where they work. We propose to consider making public reports of all purchases by each healthcare institution.

Interim results of the patient survey (May-July 2020):

46% of the interviewed patients rate the professionalism of the medical staff who treated them above average, another 28% gave the highest marks on a 10-point scale (9 and 10). When assessing the professionalism of the healthcare system as a whole during the epidemic, 23% of patients gave an above average rating;

96% of the respondents stated that they had never received requests or threats not to disseminate information about the disease, if such requests were received, they came from the leadership of the university or at the place of work;

47% of the respondents answered negatively to the question “did you have to take active steps during your illness in order to resolve the issues of hospitalization, treatment, awareness”, 21% solved this issue by means of the administrative health care system (through the “hotline” or in person), 21 % – through personal acquaintances, 2.5% indicated that they did it due to the encouragement of the medical staff;

30% of those with confirmed infection say that the control over compliance with quarantine was formal and, if desired, it could be violated without consequences, also 14% claim that the quarantine applied only to them, and not to all the people with whom they live, also there was no monitoring of patients with a positive test, which they did on their own;

despite the fact that the interviewed patients responded in different periods of time and the situation with the availability of tests changed, 25% said that they demanded a test for coronavirus, half of them were refused despite the symptoms, 5% did the test on their own and it showed positive result;

35% of respondents report that during the epidemic they faced a shortage of foreign-made medicines (not related to the treatment of coronavirus infection) in pharmacies;

30% of those who were hospitalized say that the medical staff demanded the use of individual masks that were not provided or were provided in insufficient quantities, while some patients were not able to receive deliveries from relatives due to quarantine or hospitalization in a city where relatives are absent;

Many patients drew attention to the inefficiency of the system of “dirty” and “clean” entrances to polyclinics, since after entering the institution, any patient freely moved around the building, and hospitalized patients noted in their responses that when undergoing CT in the hospital they were not isolated although had a positive covid test.