Emergency health care workers in the Penza oblast, Russia, several hundred kilometers southeast of Moscow, staged a work-to-rule strike in late May over wages and working conditions. The labor action in the region of 1.3 million people is an expression of the anger mounting across the country over the impact of the government’s ongoing “optimization of health care,” which has led to the shuttering of facilities, pay cuts, and increased burdens on an already overstretched public system.
Medical assistants at Penza’s emergency unit refused to work unless their teams were fully staffed, nurse-anesthetists refused to perform their duties unless accompanied by the appropriate doctor, and drivers refused to operate faulty vehicles. The 138 employees demanded a wage hike and an increase in the number of response teams to the federally mandated minimum such that units can reach the sick within 20 minutes of an emergency call.
Union leaders acted quickly to call off the action, announcing on Friday that they had reached an agreement with local officials to create a joint commission to address the “economic” and “technical” issues raised by the workers. Union representatives said they are “prepared for dialogue.” None of the workers’ demands have been met.
The protest by Penza’s medical workers comes on the heels of similar actions elsewhere. At the end of April, nurses in Kemerovo oblast in Siberia announced a strike over massive cuts to the health care system due to a 1.7 billion ruble (US$26 million) budget shortfall. The governor responded by declaring the action impermissible and a “shame on the honor of the region.”
In early March, health care providers at an emergency unit in Moscow oblast staged a work-to-rule strike over low wages, low staffing, and the burdens created by the closing of medical facilities in neighboring areas. In mid-March, 500 demonstrators protested in Okulovka, a town of 10,000 midway between Moscow and Saint Petersburg, over similar issues.
Throughout the country, public doctors are leaving the profession due to abysmally low salaries and impossible working conditions—facilities lack basic medicines and equipment, such that medical personnel cannot treat patients or are forced to rely on primitive techniques. As is common throughout the world, those with money increasingly turn to private practices for care, creating huge inequalities in the quality of medical services people receive and extraordinary burdens on families desperate for treatment.
The worsening state of Russia’s public health care system is bound up with the Putin government’s “optimization” plan, which has taken advantage of the already deplorable state of medical services to mount further attacks. Particularly in the country’s regions where population is declining, the economy is stagnant, and job opportunities are few, the government has set about consolidating medical facilities, axing staff, eliminating clinics, liquidating specialty departments, and vastly increasing the demands on whatever and whoever remains.
All of this has been done in the name of making a more rational use of resources, which is simply a cover for cutting expenditures by ending access to care for millions of people. Like the changes to the health care system carried out under the Obama administration in the United States, the so-called reforms of the Putin government are overwhelmingly regressive.
In an interview with the press outlet IA Regnum on April 3, Yekaterina Negoda, a medical worker in Kaluga, south and slightly west of Moscow, noted that “optimization” is driving up the death rate. According to her, reforms carried out in Kaluga in 2018 caused mortality in the oblast to exceed the birth rate by 13 percent.
The assault on public health care comes alongside the raising of the retirement age, which is now at such a level that a significant portion of the population will die before it ever sees its pension. Widespread protests against the changes to the pension system unfolded throughout 2018, in yet another sign of the increasing unpopularity of the Putin government.
As occurred with the pension protests, right-wing forces in Russia are attempting to take advantage of the outrage within the population over health care. Alexei Navalny, the US-backed liberal opponent of President Putin, is a key figure behind the recently organized Alliance of Doctors, a supposedly independent trade union aimed at leading the demonstrations against the miserable state of the medical system.
Navalny is an ardent supporter of free-market policies and the total subordination of society to the profit interests of big business. While casting himself as a crusader against a corrupt Kremlin, his opposition to the Putin government is rooted in his support for American imperialism and that section of Russia’s oligarchy that wants to exploit the population as a junior partner of Washington. A Navalny government would continue and intensify all of the attacks against the working class in Russia that have unfolded over decades.
To carry out their struggle in defense of public health care, Russia’s medical workers must reject the effort of Navalny and all other political forces to channel social anger behind one or another form of capitalist right-wing politics. The genuine allies of Russia’s working class in its fight to defend public health are the workers around the world—in the United States, Great Britain, Honduras, Bolivia, New Zealand, Sri Lanka, Ireland, Portugal and every other country—fighting for the same social rights.