By Chris Bryant in Bucharest
Published: October 4 2010
At the Giulesti maternity hospital in Bucharest an eerie calm has displaced the searing agony of little more than a one month ago when a fire engulfed an intensive care unit killing six premature babies and leaving several more with severe burns.
The hospital reopened recently following extensive repairs but a dark shadow still hangs over Romania’s moribund health system, which is creaking under the pressure of budgetary cuts.
Prosecutors in the Giulesti case have focused their attention on a nurse who left her post at the crucial moment when the fire was likely sparked by faulty electrical wiring.
But medical professionals question why only one nurse had to look after so many babies and point out that the hospital could not afford to install a fire protection system.
“This event revealed precisely the weaknesses of the Romanian healthcare system,” Vasile Astarastoae, president of the Romanian College of Physicians, said.
The accident could not have come at a worse moment for the government which is facing a political backlash against its cutbacks.
Following a 7.1 per cent contraction last year, the Romanian economy is set to shrink by a further 1.9 per cent this year, in part owing to budgetary cuts required under Romania’s €20bn credit agreement with the International Monetary Fund.
The government agreed in May to slash public sector wages by 25 per cent and benefits by 15 per cent, and later raised value added tax by 5 percentage points to 24 per cent in order to keep the deficit within this year’s 6.8 per cent target.
In an attempt to revive his administration’s flagging fortunes Emil Boc, prime minister, last month sacked his finance minister and five other ministers. But with only a thin majority in parliament Mr Boc remains vulnerable and is not certain of overcoming a vote of no-confidence due before the end of the month.
Medical personnel were among thousands of public sector workers that have held anti-austerity protests across Romania in recent weeks. Typifying the angry public mood, 100 hospital workers last month tried to storm a clinic in Braila, eastern Romania in a protest over cutbacks in the health system.
Romanian hospitals have for years struggled to provide a decent standard of care, particularly outside the capital where patients must at times buy medicines themselves and bring their own food.
Health funding increased in the years preceding the crisis but social insurance contributions are now shrinking as unemployment rises. Accordingly, Romania will only spend 3.9 per cent of gross domestic product on healthcare this year, less than half the European Union average.
As budgets are squeezed many hospitals have been left badly in debt. The IMF demanded that the government pay 1.9bn lei ($613m) in arrears to companies mainly in the healthcare sector before it released the country’s latest loan tranche last month.
Bucharest allotted new funds to the healthcare budget in August but much of these will be used to cover outstanding debts. Ministers favour the introduction of co-payments, decentralisation and consolidation as a way to make the system more effective but face public resistance to hospital closures and job cuts. “If the system is not reformed, it doesn’t matter how much money you put in, it will go to waste,” said Richard Florescu, senior operations officer in the Bucharest office of the World Bank.
There are fears that a bad situation could worsen with the tide of doctors and nurses leaving Romania for better pay overseas. Since Romanians gained the right to travel freely in the EU in 2007, more than 6,000 of the country’s 41,000 licensed doctors have joined the brain drain. This year, some 2,500 are set to pack their bags, in part due to the 25 per cent wage cut.
Romania has only 1.9 doctors per 1,000 population, half the EU average.
A typical medical resident in Romania will this year earn about €250 ($344) a month, compared with an EU average of €1,400.
Hospital staff frequently supplement their income with informal payments from patients, totalling an estimated €300m, according to a World Bank study from 2005 (the amount is not thought to have decreased since then)