Health care system in Belarus
The Belarusian Constitution guarantees the right for all citizens “to healthcare” including free treatment at state health-care establishments”. Medical treatment at medical centres or hospitals is provided free of charge, and conforms to state minimum social standards.
The main owner and manager of the healthcare system in Belarus is the State. The leading role of state medicine in protecting the population’s health is supported by law, and the system itself consists mainly of medical centres and hospitals subordinate to the Ministry of Health and managed by a vertical power structure. In addition, there are also departmental clinics (of the Ministry of Defence, Ministry of Internal Affairs, KGB, etc.). A remnant from the Soviet times, Belarus has retained, and even developed, the system of privileged medical service for state officials. Upon reaching a certain rank, they are granted access to a special clinic and hospital of the Department of Presidential Affairs in Belarus. Ordinary citizens can also receive treatment in this VIP-level clinic, but at full cost.
Primary medical treatment is provided by a large number of day care clinics (separate for children and adults) in cities and ‘Clinics on wheel’ (for both children and adults) in the countryside, as well as first aid offices that employ only middle-level medical staff. Treatment is provided strictly in accordance to a person’s place of residence or location. So if you are reside in Mogilev you can’t get regular treatment in Minsk until you register. Primary emergency aid is provided by the emergency medical services which employ both middle-level staff and doctors.
Funding for the healthcare system is provided by the state budget. In the last five years, about 5% of the GDP was allocated to healthcare, which is slightly under $320 per capita (in 2011 it was $225), which is three times less than in Poland and over 14 times less than in Germany.
In patient treatment (including hi-tech) is an absolute priority, receiving about 60% of the funds. Belarus is No. 1 among the countries of Central and Eastern Europe in the number of inpatient treatment clinics per capita. At the same time, Belarus leads in the number of clinic visits per capita – 13.2 in 2011, which is 2.2 times higher than in EU countries and 1.6 times higher than in other CIS countries.
The private medicine sector in Belarus takes up about 5% of the total amount of medical services and is represented mainly by dentistry. This sector is not developing because of the high standards set by the government for such businesses, as well as regulatory constraints on their income. Meanwhile, the state medicine sector is promoting services which need to be paid for privately (a goal has been set) to increase the volume of provided chargeable services 3.5 times by 2015), meaning that medical treatment may become less affordable to Belarusian citizens, especially regarding complex, lifesaving hi-tech operations.
Belarus is No. 5 in the world in the number of doctors per 1,000 people, but WHO experts note a significant misbalance in the human resource distribution in favour of hospital services with a substantial deficit in the primary treatment system. This deficit is worsened by lots of professionals leaving the country to work abroad due to low income (salaries in healthcare are 30% lower than in the production sector).
While WHO experts acknowledge the achievements of the Belarusian healthcare system in providing accessible medical services to the population, they note a decreased accessibility in the countryside, where there is a lack of medical staff. The decrease in maternal and infant mortality is another achievement observed by the WHO, although it was noted that these results may have been achieved not only through the efforts of the Ministry of Health, but by increased living standards.
The healthcare system remains vulnerable to potential economic reforms which could affect funding levels, asset allocation and management.
State Health Care: Can Belarus Be Proud
On 21 October, Alexander Lukashenka explained to the Regional Office for Europe Director of the World Health Organisation, Zsuzsanna Jakab, how Belarus had succeeded in improving its health service and received many compliments from her for that.
Belarus has achieved much in the fight against certain diseases and has placed modern medical equipment in many hospitals. But a few significant problems remain in the Belarusian public health system, some cities are missing up to 40% of the necessary personnel. On top of this the average medical worker earns only $325.
Moreover, the authorities continue a hypocritical policy of allowing alcohol to be easily accessible to Belarusians and isolating the Belarusian health system from global trends.
WHO Praises Belarus For Good Results
On 21 October, Alexander Lukashenka met with the WHO Regional Director for Europe Zsuzsanna Jakab, who openly praised the Belarusian ruler “for leadership and efforts aimed at improving the health care system that have already brought a clear result.” Jacob arrived in Belarus for a WHO conference “Health 2020”, which brought together several hundred European experts in the field of medicine, including 13 ministers of health.
In fact, public health remains one of the areas where the Belarusian authorities have achieved results. In 2013 the World Health Organisation stated that Belarus had achieved the Millennium Goals. According to the Bloomberg ranking, the Belarusian health care system is almost as efficient as the health service in Belgium. The Belarusian authorities have purchased modern equipment for Belarusian hospitals and built new medical centres. In 2015, the first nursing care hospital for patients with chronic diseases and disabilities was built in Minsk.
Belarus has achieved good results in the immunisation of children, the fight against HIV/AIDS, tuberculosis, child and maternal mortality. The authorities like to underline that no mother died in Belarus during childbirth in 2015.
The health service remains quite affordable for ordinary people, and Alexander Lukashenka has not lost a single opportunity to emphasise this. On 21 October, he stated that “unlike other countries, people in Belarus do not die under a fence if they lack insurance.”
Belarusian health care brings not only international recognition, but also money. Although 95% of medical centres remain state-run, they provide more and more paid services for Belarusians and foreigners. Former chief of Mossad intelligence, Meir Dagan, had a liver transplant in Belarus and Russian neo-fascist, Maxim Martsinkevich, had an eye operation in Minsk.
Russians often use the services of Belarusian clinics as they remain cheaper, better run and more effective than Russian ones. For instance, MRI of the brain in Belarusian top clinic costs around only $60.
Another Story of the Belarusian Health Service
Yet in reality many Belarusians have another vision of the domestic health care system than Alexander Lukashenka. This is due to the lack of specialised doctors and huge queues at clinics.
Some Belarusian cities, according to the Health Minister Vasil Zharko, lack 30-40% of necessary medical staff. Furthermore, a large percentage of the existing staff are either retired, due for retirement or are interns. Often it remains impossible to get an appointment with a doctor, because there is not a qualified doctor in town. Even if a hospital has modern equipment, the waiting time for the use of the equipment can be a few months.
A few doctors even leave the profession or the country because the average salary of health workers, according to official statistics, in September totaled $325. Naturally, doctors earn more, and medical personnel such as nurses earn less. In neighbouring Poland by contrast health workers earn three times more than in Belarus.
To earn this money, health workers usually have to take one and a half full time jobs. Doctors joke, that if they worked only one job, they would have nothing to eat, but if one works two jobs, he has no time to eat.
Isolated Health Service
In the regional context it may seem that Belarus has a similar health service to Poland or Lithuania. All of them have achievements and failures. However, life expectancy in Poland or Lithuania remains higher than in Belarus by five and two years respectively. Moreover, the difference between life expectancy among men and women remains striking in Belarus. Belarusian women live on average 78 years, while men only live to 67.
The state policy of alcoholisation partly explains the issue. It remains difficult to achieve good results in public health, when Belarus ranks first, according to the WHO, in world consumption of alcohol, and the state keeps alcohol prices low. Belarusians also occupy a leading position in Europe in terms of obesity and smoking. State institutions remain reluctant to see health system holistically, so they should not expect that Belarusians will have long healthy lives.
Also Belarusian health care lacks contacts with the outside world or even some basic opportunities to improve qualifications. Usually Belarusian doctors who would like to visit a foreign conference, have to take a vacation at their own expense, ask for permission to participate in the conference and pay all the costs of the conference from their pockets.
Despite the fact that the issue of medical care matters for the majority of Belarusians and opposition now and then try to politicise the issue, public health still has not become a topic of national debate. Even independent media rarely write about Belarusian medicine. However, many people would be grateful to the media and opposition, if they pressed the question of long queues and low salaries. For many, such issues matter more than democracy and human rights.
About Belarus
Belarus officially the Republic of Belarus (Belarusian: Рэспубліка Беларусь; Russian: Республика Беларусь), formerly known by its Russian name Byelorussia or Belorussia (Russian: Белоруссия), is a landlocked country in Eastern Europe bordered by Russia to the northeast, Ukraine to the south, Poland to the west, and Lithuania and Latvia to the northwest. Its capital and most populous city is Minsk. Over 40% of its 207,600 square kilometres (80,200 sq mi) is forested. Its major economic sectors are service industries and manufacturing. Until the 20th century, different states at various times controlled the lands of modern-day Belarus, including the Principality of Polotsk (11th to 14th centuries), the Grand Duchy of Lithuania, the Polish–Lithuanian Commonwealth, and the Russian Empire.
In the aftermath of the 1917 Russian Revolution, Belarus declared independence as the Belarusian People’s Republic, which was conquered by Soviet Russia. The Socialist Soviet Republic of Byelorussia became a founding constituent republic of the Soviet Union in 1922 and was renamed as the Byelorussian Soviet Socialist Republic (Byelorussian SSR). Belarus lost almost half of its territory to Poland after the Polish–Soviet War of 1919–1921. Much of the borders of Belarus took their modern shape in 1939, when some lands of the Second Polish Republic were reintegrated into it after the Soviet invasion of Poland, and were finalized after World War II. During WWII, military operations devastated Belarus, which lost about a third of its population and more than half of its economic resources.The republic was redeveloped in the post-war years. In 1945 the Byelorussian SSR became a founding member of the United Nations, along with the Soviet Union and the Ukrainian SSR.
The parliament of the republic proclaimed the sovereignty of Belarus on 27 July 1990, and during the dissolution of the Soviet Union, Belarus declared independence on 25 August 1991. Alexander Lukashenko has served as the country’s first president since 1994. Belarus has been labeled “Europe’s last dictatorship” by some Western journalists, on account of Lukashenko’s self-described authoritarian style of government Lukashenko continued a number of Soviet-era policies, such as state ownership of large sections of the economy. Elections under Lukashenko’s rule have been widely criticized as unfair; and according to many countries and organizations, political opposition has been violently suppressed. Belarus is also the last country in Europe using the death penalty. Belarus’s Democracy Index rating was the lowest in Europe until 2014 (when it was passed by Russia), the country is labelled as “not free” by Freedom House, as “repressed” in the Index of Economic Freedom, and is rated as by far the worst country for press freedom in Europe in the 2013–14 Press Freedom Index published by Reporters Without Borders, which ranks Belarus 157th out of 180 nations.
In 2000, Belarus and Russia signed a treaty for greater cooperation, forming the Union State. Over 70% of Belarus’s population of 9.49 million resides in urban areas. More than 80% of the population is ethnic Belarusian, with sizable minorities of Russians, Poles and Ukrainians. Since a referendum in 1995, the country has had two official languages: Belarusian and Russian. The Constitution of Belarus does not declare any official religion, although the primary religion in the country is Eastern Orthodox Christianity. The second-most widespread religion, Roman Catholicism, has a much smaller following; nevertheless, Belarus celebrates both Orthodox and Catholic versions of Christmas and Easter as national holidays. Belarus is a member of the United Nations since its founding, the Commonwealth of Independent States, CSTO, EEU, and the Non-Aligned Movement. Belarus has shown no aspirations for joining the European Union but nevertheless maintains a bilateral relationship with the organisation, and likewise participates in two EU projects: the Eastern Partnership and the Baku Initiative.
