Colombia’s skilled health workers have seen the impact on working conditions intensify during the pandemic. Professionals in nursing, medicine, and nursing assistants show steady increases in hours worked per week. Without the possibility of rest, there is a human resource that is not sufficient to cover the large number of patients.
This is the conclusion of a study by the Universidad del Rosario and the Corporation for the Development of Social Security (CODESS), according to which nursing and medical personnel are the main axis for managing the pandemic from the health sector. , which are usually associated with low-income conditions and types of contracting through the provision of services, temporary or related labor cooperatives, the health emergency has caused them to further deepen their inadequate working conditions.
The results of the consultation “Concrete Alternatives for Social Protection and Labor Formalization for Skilled Informal Health Workers in the Face of the Impact of the Covid-19 Pandemic in a Decent Work Perspective” reveal that between 2018 and 2021 there has been a steady increase in hours worked per week, both for nursing and medical staff, said Ivan Daniel Jaramillo Jasir, a researcher at the Labor Observatory of the Universidad del Rosario.
“We can argue that there is an undersupply of staff for the sector (according to information from RIPS and the Rethus database), which is reflected in the average number of patients treated in the same working day: 25 patients per day for every nurse, such as women care for a larger number of patients on average,” Jaramillo emphasized.
On the medical staff, male doctors see more patients each working day with an average of 23 visits per day. A significant difference to what the OECD suggests, which recommends between 12 and 15 meetings per day for health staff in general.
Nursing is a feminized sector
The Large Integrated Household Survey -GEIH- shows that by 2021, 80% of employed medical staff will be women. Similarly, between 2020 and 2021, staffing has increased significantly in response to the pandemic (4.5% nurses and 16.6% medical staff), without yet reaching sufficient levels to meet the requirements. required by Covid-19.
In this regard, Darwin Cortés, a professor in the Faculty of Economics of the Universidad del Rosario, indicated that the study found that the sector has low informality, defined as belonging to social security. By 2021, the rate of informal workers was around 7.4% for medical staff and 5.6% for doctors (GEIH, 2021). Within this population there is a large proportion of self-employed workers (35%), which may be possible evidence of inadequate employment conditions in terms of decent work.
Gender pay gap
Diana Londono, researcher at the Labor Observatory of the Universidad del Rosario, explained that the analysis shows that the average income of those employed in the sector exceeds the minimum required to access the Minimum Level of Social Protection and Periodic Economic Benefits – BEPS. Medical staff earn a monthly per capita income of between $2 and $2.8 million on average, while nursing staff manage to reach and exceed $6 million per month. Men have higher average earnings than women, identifying the gender pay gap in the country.
At the regional level, there are significant differences in the number of employed persons and in the real incomes of these workers. Bogotá has seen a significant decrease in the real salary of medical staff since 2019, while Cartagena is one of the cities that has presented the largest decrease in medical staff wages, Londono commented.
The overall policy that formalizes the profession of health professionals must take into account the problems that are related to the poor matching of the labor market, the shortage of trained health personnel, inadequate types of employment, low mobility that occurs between the population that is trained in nursing schools in big cities and their labor migration to remote areas of the country where there are not enough health personnel.
The research team developed an Occupational Job Insecurity Index that includes information related to decent work. Nursing staff were found to be more likely to be in unsafe conditions than nursing staff. This index takes into account the duration of the employment contract, the terms of termination of the employment contracts and the time of employment, the size of the employing company, the wage levels, the place where the work activities are carried out and the working hours.
Support for trained health personnel
The Universidad del Rosario and CODESS (Corporation for the Development of Social Security) conducted a study that identified the type of support received by trained health personnel: 56% have resources to do their work, 27% have psychological support and only 10% have conditions for break. In terms of economic benefits, 60% receive paid leave, 40% have access to medical insurance, 33% receive transportation assistance, and only 7% receive food.
The consultation offers a series of recommendations aimed at improving working conditions within decent and dignified work, seeking a transition to formalization of the work of all nursing and medical staff; promoting the mobility of nursing staff to territories that require it; have adequate places for rest and time for the nursing staff; establish a pay scheme that recognizes training and experience, seeks gender equality and minimizes exposure to risks for work-related reasons in all areas, among the core.
For John Marulanda, Codess’ expert research advisor, “the study is important in three aspects: first, because it deepens and establishes the real situation of informal work among skilled health workers; secondly, it identifies gaps and inequalities in wages and working conditions by gender and profession of health workers that are unfair and avoidable and, thirdly, because it sets out specific recommendations in favor of decent work in the sector, as well as criteria and basis on the goal of a new health model focused on the most basic level’.
This study will be presented at the workshop “How to improve the employment situation of qualified medical workers in the health sector?: Challenges and proposals on working conditions”, which will be held on 29 July from 9:00 to 11:30