How to Get Everyone in the Healthcare System to Stop Hating One Another

Lidziya Tarasenka

January 2023

There are many problems with Belarus’s medical system: underfunding, lack of doctors and equipment, insufficient training…the list goes on and on. But at the centre of the problem is a pervasive animosity that makes it impossible for the healthcare system to achieve any significant improvement.

Lidziya Tarasenka

Lidziya Tarasenka is the Coordinator of the Medical Solidarity Fund of Belarus. Previously, she served as the head of a medical center in Belarus and established the largest endoscopy department in the country. She is a graduate of the Belarusian State Medical University.

There are three main players on the healthcare arena: medical workers, patients, and bureaucrats in charge of administration. Each group has its own vision and tasks:

patients want medical attention, solutions to health problems, clear communicating with doctors, and minimal expenditure of time and money;
doctors want to feel needed, do interesting work, grow professionally, and avoid thinking about the price of the equipment they work with;
healthcare administrators must decide how to allocate a chronically insufficient budget so that the largest possible number of issues connected with prevention, diagnosis, and treatment is covered, while also ensuring that the system is sustainable and predictable.

Given that these groups have different tasks, conflicts are inevitable, and the parties involved should be looking for mutually satisfactory solutions. But in Belarus, mutual animosity is only growing.

There are three main players on the healthcare arena: medical workers, patients, and bureaucrats in charge of administration. Each group has its own vision and tasks:

patients want medical attention, solutions to health problems, clear communicating with doctors, and minimal expenditure of time and money;
doctors want to feel needed, do interesting work, grow professionally, and avoid thinking about the price of the equipment they work with;
healthcare administrators must decide how to allocate a chronically insufficient budget so that the largest possible number of issues connected with prevention, diagnosis, and treatment is covered, while also ensuring that the system is sustainable and predictable.

Given that these groups have different tasks, conflicts are inevitable, and the parties involved should be looking for mutually satisfactory solutions. But in Belarus, mutual animosity is only growing.

There are three main players on the healthcare arena: medical workers, patients, and bureaucrats in charge of administration. Each group has its own vision and tasks:

patients want medical attention, solutions to health problems, clear communicating with doctors, and minimal expenditure of time and money;
doctors want to feel needed, do interesting work, grow professionally, and avoid thinking about the price of the equipment they work with;
healthcare administrators must decide how to allocate a chronically insufficient budget so that the largest possible number of issues connected with prevention, diagnosis, and treatment is covered, while also ensuring that the system is sustainable and predictable.

Given that these groups have different tasks, conflicts are inevitable, and the parties involved should be looking for mutually satisfactory solutions. But in Belarus, mutual animosity is only growing.

The Health Ministry vs public health

Let us start with goals. The World Health Organization has three main ones:

improve public health;
increase the responsiveness of the healthcare system to the needs of the public;
achieve equity in financial contributions, so that the burden of paying for the healthcare system is distributed fairly among households.

When we evaluate Belarusian bureaucrats with these criteria in mind, it becomes clear that health administrators agree with all this in spirit, but when forced to choose between public health and the interests of the regime, they choose the latter. Otherwise, how can we explain events like the raid on a Hrodna hospice, which was funded by external sponsors? Why fire one-of-a-kind specialists from the Center of Paediatric Oncology?

These questions are largely rhetorical, as I don’t know if anyone still has any illusions regarding healthcare in Belarus. But just in case, I’ll offer up a few examples.

We are told that our healthcare is free.

But the real tax burden on wages alone is about 48% in Belarus—even if the number we see in our salary calculations is only 14%. It’s just that the rest is paid by the employer before the funds are disbursed to our bank accounts. Among European countries, only France has higher social welfare payments. At the same time, according to the WHO, in 2019 public health spending per capita was lower in Belarus than in neighbouring EU countries.

The Health Ministry vs public health

Let us start with goals. The World Health Organization has three main ones:

improve public health;
increase the responsiveness of the healthcare system to the needs of the public;
achieve equity in financial contributions, so that the burden of paying for the healthcare system is distributed fairly among households.

When we evaluate Belarusian bureaucrats with these criteria in mind, it becomes clear that health administrators agree with all this in spirit, but when forced to choose between public health and the interests of the regime, they choose the latter. Otherwise, how can we explain events like the raid on a Hrodna hospice, which was funded by external sponsors? Why fire one-of-a-kind specialists from the Center of Paediatric Oncology?

These questions are largely rhetorical, as I don’t know if anyone still has any illusions regarding healthcare in Belarus. But just in case, I’ll offer up a few examples.

We are told that our healthcare is free.

But the real tax burden on wages alone is about 48% in Belarus—even if the number we see in our salary calculations is only 14%. It’s just that the rest is paid by the employer before the funds are disbursed to our bank accounts. Among European countries, only France has higher social welfare payments. At the same time, according to the WHO, in 2019 public health spending per capita was lower in Belarus than in neighbouring EU countries.

The Health Ministry vs public health

Let us start with goals. The World Health Organization has three main ones:

improve public health;
increase the responsiveness of the healthcare system to the needs of the public;
achieve equity in financial contributions, so that the burden of paying for the healthcare system is distributed fairly among households.

When we evaluate Belarusian bureaucrats with these criteria in mind, it becomes clear that health administrators agree with all this in spirit, but when forced to choose between public health and the interests of the regime, they choose the latter. Otherwise, how can we explain events like the raid on a Hrodna hospice, which was funded by external sponsors? Why fire one-of-a-kind specialists from the Center of Paediatric Oncology?

These questions are largely rhetorical, as I don’t know if anyone still has any illusions regarding healthcare in Belarus. But just in case, I’ll offer up a few examples.

We are told that our healthcare is free.

But the real tax burden on wages alone is about 48% in Belarus—even if the number we see in our salary calculations is only 14%. It’s just that the rest is paid by the employer before the funds are disbursed to our bank accounts. Among European countries, only France has higher social welfare payments. At the same time, according to the WHO, in 2019 public health spending per capita was lower in Belarus than in neighbouring EU countries.

Basically, they’re taking our money and we’re getting ‘free healthcare’ in exchange. Meanwhile, people are increasingly obliged to turn to paid consultations and treatment.

We are told that because the state has given doctors a free education, they should now pay back their debt.

But Germany, for example, has 43 medical universities, almost all of which are state schools. And for German citizens — as well as for most foreign students — the education is free. Does that mean that German doctors have mandatory post-graduation job placements somewhere far from home? No. Young doctors are attracted by good working conditions, and no one is saying that they are obliged to work off some unpaid debt.

We are told that our education is high-quality.

In order to get a medical degree in Belarus, you need six years of university study. Meanwhile, EU countries require 10–14 years, depending on the specialization. What kind of technology are we using that allows us to reduce the training period by half? None at all! Instead, insufficiently trained specialists are assigned to a hospital where they’re made to take on the duties of three doctors at once. This may be great practice, but there’s one problem — their guinea pigs are human. No sane person should be satisfied with such training.

Another problem is the doctor shortage.

There were not enough doctors even before the 2020 protests, and how many qualified specialists has the country lost since? Based on published vacancies, there is a deficit of about 4,000 doctors — this is about 10% of the total number of positions, and not all vacancies are open access.

The worker shortage is kept hidden: if a doctor officially works part time or takes on two jobs, it ruins health clinics’ KPIs — which bureaucrats always ensure are irreproachable. So to avoid spoiling the statistics, the Health Ministry has come up with a ‘smart’ legal resolution, which stipulates that if necessary, doctors may work up to 1,800 hours per year on top of their established working hours. This permits administrators to nearly double the hours of medical workers and simply call it overtime.

This is nothing more than cooking the books on a large scale: those who run the system are hiding problems to avoid fixing them. And as you can guess, managing a complex system like healthcare when even the responsible officials don’t have accurate data is nigh on impossible.

Basically, they’re taking our money and we’re getting ‘free healthcare’ in exchange. Meanwhile, people are increasingly obliged to turn to paid consultations and treatment.

We are told that because the state has given doctors a free education, they should now pay back their debt.

But Germany, for example, has 43 medical universities, almost all of which are state schools. And for German citizens — as well as for most foreign students — the education is free. Does that mean that German doctors have mandatory post-graduation job placements somewhere far from home? No. Young doctors are attracted by good working conditions, and no one is saying that they are obliged to work off some unpaid debt.

We are told that our education is high-quality.

In order to get a medical degree in Belarus, you need six years of university study. Meanwhile, EU countries require 10–14 years, depending on the specialization. What kind of technology are we using that allows us to reduce the training period by half? None at all! Instead, insufficiently trained specialists are assigned to a hospital where they’re made to take on the duties of three doctors at once. This may be great practice, but there’s one problem—their guinea pigs are human. No sane person should be satisfied with such training.

Another problem is the doctor shortage.

There were not enough doctors even before the 2020 protests, and how many qualified specialists has the country lost since? Based on published vacancies, there is a deficit of about 4,000 doctors—this is about 10% of the total number of positions, and not all vacancies are open access.

The worker shortage is kept hidden: if a doctor officially works part time or takes on two jobs, it ruins health clinics’ KPIs — which bureaucrats always ensure are irreproachable. So to avoid spoiling the statistics, the Health Ministry has come up with a ‘smart’ legal resolution, which stipulates that if necessary, doctors may work up to 1,800 hours per year on top of their established working hours. This permits administrators to nearly double the hours of medical workers and simply call it overtime.

This is nothing more than cooking the books on a large scale: those who run the system are hiding problems to avoid fixing them. And as you can guess, managing a complex system like healthcare when even the responsible officials don’t have accurate data is nigh on impossible.

What can be done?

The problems of healthcare do not end with those described above—the list goes on forever. What is more important is discussing potential solutions.

In the long term, reforming the healthcare system calls for political reforms that will address structural problems. For doctors to stop resenting their managers, they need to be able to engage in dialogue on equal terms. For patients’ attitudes towards doctors to improve, they must feel that the doctors have enough time for open communication. People should not be afraid to look each other in the eyes.

In the short term, it’s best to save strength and focus on yourself. Belarus has a better chance of becoming a decent country to live in if everyone who identifies as Belarusian concentrates on self-development. Trying to keep people inside the country or hoping that doctors will return seems like a less realistic scenario than working to reinvent Belarusian society so that physical boundaries matter less and less.

Many problems in the medical sphere can be solved through technology. For example, there was a sharp decrease in stomach cancer after the invention of the refrigerator, which allowed food to be stored more safely.

Today, technology is reaching a whole new level.

Online consultations with doctors are becoming increasingly common, and scientists are developing gadgets capable of logging vital signs and sending data for analysis to professors as far away as Australia. According to a survey by the STADA group, 64% of Europeans can choose to be diagnosed and treated by a doctor remotely in cases of non-serious illness. Incidentally, okdoc.me, a telemedicine platform developed by Belarusians, is one of the most successful tools of its kind in the world.

Now let’s turn back to our three major players: administrators, doctors, and patients.

What can be done?

The problems of healthcare do not end with those described above—the list goes on forever. What is more important is discussing potential solutions.

In the long term, reforming the healthcare system calls for political reforms that will address structural problems. For doctors to stop resenting their managers, they need to be able to engage in dialogue on equal terms. For patients’ attitudes towards doctors to improve, they must feel that the doctors have enough time for open communication. People should not be afraid to look each other in the eyes.

In the short term, it’s best to save strength and focus on yourself. Belarus has a better chance of becoming a decent country to live in if everyone who identifies as Belarusian concentrates on self-development. Trying to keep people inside the country or hoping that doctors will return seems like a less realistic scenario than working to reinvent Belarusian society so that physical boundaries matter less and less.

Many problems in the medical sphere can be solved through technology. For example, there was a sharp decrease in stomach cancer after the invention of the refrigerator, which allowed food to be stored more safely.

Today, technology is reaching a whole new level.

Online consultations with doctors are becoming increasingly common, and scientists are developing gadgets capable of logging vital signs and sending data for analysis to professors as far away as Australia. According to a survey by the STADA group, 64% of Europeans can choose to be diagnosed and treated by a doctor remotely in cases of non-serious illness. Incidentally, okdoc.me, a telemedicine platform developed by Belarusians, is one of the most successful tools of its kind in the world.

Now let’s turn back to our three major players: administrators, doctors, and patients.

What can be done?

The problems of healthcare do not end with those described above—the list goes on forever. What is more important is discussing potential solutions.

In the long term, reforming the healthcare system calls for political reforms that will address structural problems. For doctors to stop resenting their managers, they need to be able to engage in dialogue on equal terms. For patients’ attitudes towards doctors to improve, they must feel that the doctors have enough time for open communication. People should not be afraid to look each other in the eyes.

In the short term, it’s best to save strength and focus on yourself. Belarus has a better chance of becoming a decent country to live in if everyone who identifies as Belarusian concentrates on self-development. Trying to keep people inside the country or hoping that doctors will return seems like a less realistic scenario than working to reinvent Belarusian society so that physical boundaries matter less and less.

Many problems in the medical sphere can be solved through technology. For example, there was a sharp decrease in stomach cancer after the invention of the refrigerator, which allowed food to be stored more safely.

Today, technology is reaching a whole new level.

Online consultations with doctors are becoming increasingly common, and scientists are developing gadgets capable of logging vital signs and sending data for analysis to professors as far away as Australia. According to a survey by the STADA group, 64% of Europeans can choose to be diagnosed and treated by a doctor remotely in cases of non-serious illness. Incidentally, okdoc.me, a telemedicine platform developed by Belarusians, is one of the most successful tools of its kind in the world.

Now let’s turn back to our three major players: administrators, doctors, and patients.

Administrators

The people who currently hold managerial positions in Belarus are not qualified. But where can others be found? Effective administration requires relatively few people, provided they have the right tools at their disposal, like accurate data collection methods and decision support systems. The time between a technology’s invention and implementation has shrunk, and global best practices are accessible around the world. You just need to know where to find the right tools.

As long as the regime is in power, there will not be any improvements, but when a window of opportunity opens, how will we take advantage of it?

Administrators

The people who currently hold managerial positions in Belarus are not qualified. But where can others be found? Effective administration requires relatively few people, provided they have the right tools at their disposal, like accurate data collection methods and decision support systems. The time between a technology’s invention and implementation has shrunk, and global best practices are accessible around the world. You just need to know where to find the right tools.

As long as the regime is in power, there will not be any improvements, but when a window of opportunity opens, how will we take advantage of it?

Administrators

The people who currently hold managerial positions in Belarus are not qualified. But where can others be found? Effective administration requires relatively few people, provided they have the right tools at their disposal, like accurate data collection methods and decision support systems. The time between a technology’s invention and implementation has shrunk, and global best practices are accessible around the world. You just need to know where to find the right tools.

As long as the regime is in power, there will not be any improvements, but when a window of opportunity opens, how will we take advantage of it?

Health workers

Removing physical barriers is complicated for medical practitioners: they can’t operate on a patient in Kostyukovichy from Gantsevichy. Or can they?

Robotic surgery, where surgery is carried out by a machine whose movements are controlled by a surgeon, has been around for a relatively long time. The first real remote surgery was performed in 2001 by a doctor in New York on a 68-year-old patient in Strasbourg (6,230 km away!). Okay, okay, we’re getting carried away. We’re unlikely to see remote surgery in Belarus any time soon—at the very least for financial reasons.

But many forms of diagnostics, from blood glucose tests to the identification of early-stage malignant tumours, has already become more personalised: there is a whole range of devices and apps for keeping track of your health. Such tools are becoming vital pieces of medical equipment. For less than $2,000, you can buy an ultrasound machine the size of a power bank; it will hook up to a tablet, and the images it generates can compete with mid-range devices.

Health workers

Removing physical barriers is complicated for medical practitioners: they can’t operate on a patient in Kostyukovichy from Gantsevichy. Or can they?

Robotic surgery, where surgery is carried out by a machine whose movements are controlled by a surgeon, has been around for a relatively long time. The first real remote surgery was performed in 2001 by a doctor in New York on a 68-year-old patient in Strasbourg (6,230 km away!). Okay, okay, we’re getting carried away. We’re unlikely to see remote surgery in Belarus any time soon—at the very least for financial reasons.

But many forms of diagnostics, from blood glucose tests to the identification of early-stage malignant tumours, has already become more personalised: there is a whole range of devices and apps for keeping track of your health. Such tools are becoming vital pieces of medical equipment. For less than $2,000, you can buy an ultrasound machine the size of a power bank; it will hook up to a tablet, and the images it generates can compete with mid-range devices.

Health workers

Removing physical barriers is complicated for medical practitioners: they can’t operate on a patient in Kostyukovichy from Gantsevichy. Or can they?

Robotic surgery, where surgery is carried out by a machine whose movements are controlled by a surgeon, has been around for a relatively long time. The first real remote surgery was performed in 2001 by a doctor in New York on a 68-year-old patient in Strasbourg (6,230 km away!). Okay, okay, we’re getting carried away. We’re unlikely to see remote surgery in Belarus any time soon—at the very least for financial reasons.

But many forms of diagnostics, from blood glucose tests to the identification of early-stage malignant tumours, has already become more personalised: there is a whole range of devices and apps for keeping track of your health. Such tools are becoming vital pieces of medical equipment. For less than $2,000, you can buy an ultrasound machine the size of a power bank; it will hook up to a tablet, and the images it generates can compete with mid-range devices.

Patients

This category comprises all of us, as it’s our taxes that pay for health care expenses: from doctors’ salaries to the development of new medicines. A more transparent taxation system based on block-chain technologies could help make individual transactions transparent, allowing us to choose for ourselves whether to fund riot police uniforms or the treatment of rare diseases, which we currently have to fundraise for via text message.

As long as all levels of society—from the family to the government—are dominated by a culture of violence, these ideas may sound too good to be true. But as soon as a sufficient number of people realizes that the only way forward is to come together and overcome fear and hatred, everything will change—including the healthcare system.

Patients

This category comprises all of us, as it’s our taxes that pay for health care expenses: from doctors’ salaries to the development of new medicines. A more transparent taxation system based on block-chain technologies could help make individual transactions transparent, allowing us to choose for ourselves whether to fund riot police uniforms or the treatment of rare diseases, which we currently have to fundraise for via text message.

As long as all levels of society—from the family to the government—are dominated by a culture of violence, these ideas may sound too good to be true. But as soon as a sufficient number of people realizes that the only way forward is to come together and overcome fear and hatred, everything will change—including the healthcare system.

Patients

This category comprises all of us, as it’s our taxes that pay for health care expenses: from doctors’ salaries to the development of new medicines. A more transparent taxation system based on block-chain technologies could help make individual transactions transparent, allowing us to choose for ourselves whether to fund riot police uniforms or the treatment of rare diseases, which we currently have to fundraise for via text message.

As long as all levels of society—from the family to the government—are dominated by a culture of violence, these ideas may sound too good to be true. But as soon as a sufficient number of people realizes that the only way forward is to come together and overcome fear and hatred, everything will change—including the healthcare system.

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