A report from the China Labour Bulletin documents the last 10 years of violations and critical problems in the health system. A situation that the Covid pandemic has only fuelled and uncovered, originating from previous and systematic problems. Non-payment of wages, aggression from patients or relatives, overloads and inequalities are some of the unresolved issues.
Beijing () – The panorama that shows the extensive report which was published on September 9th by China Labour Bulletin (CLB) documents the last 10 years (2013-2023) of violations and abuses of the rights of health professionals and the tendency to worsen in recent times. It is a worrying description of the situation of health workers in China, doctors and nurses, men and women – because in this case there are no substantial differences – which worsened, first with the pandemic and, two years later, with the relaxation of the “zero Covid” policy. It presents cases of non-payment of wages, work overload, unequal treatment, lack of security in health centres – with cases of death and homicide of workers – and lack of representation, starting with the union.
Due to difficulties and limitations in data collection, the report on the health situation focuses on the conditions of doctors and nurses working in the country’s hospitals. The main reasons for protests include lack of compensation for work performed (or remuneration much lower than the contract) and issues relating to social security or the Housing Provident Fund (HPF), with 62 incidents recorded, equivalent to 45.9% of the total. Most of the protests took place in private hospitals (almost 60%) and, of these, around 70% in non-categorised or classified establishments.
The conditions of healthcare workers in China have been laid bare by the Covid-19 pandemic, starting with the first “high-profile” death caused by the virus when the health emergency broke out in early 2020: that of ophthalmologist Li Wenliang on 7 February 2020 in Wuhan, the first doctor to raise the alarm about the danger posed by the new “mysterious pneumonia” that was already causing numerous cases and victims. He is considered the example of the sacrifices made by healthcare workers, who in the following years continually faced deadly risks due to the implementation and subsequent (and sudden) abandonment of pandemic prevention measures across the country.
At the end of 2022, when Beijing suddenly cancelled the “zero Covid” policy, more concerned about the devastating effects of the lockdowns on the economy, the demands and pressure on healthcare workers nationwide increased even more. Struggling to maintain regular services, doctors and nurses had to deal with excessive workloads and occupational risks, and at the same time, salary reductions and even non-payment of wages and social security benefits, and sometimes life-threatening situations.
The various protests that have taken place over the past decade, especially in the 2022-23 period, raise one problem above all: doctors and nurses do not have effective representation of their interests, to the point that they have no other option than to assert their demands publicly and seek the help or solidarity of public opinion. Since the official union, the All-China Federation of Trade Unions (ACFTU), is the only authorized one and has not effectively represented health workers, workers are alone in the effort to fight against the problems inherent in the system as a whole, which lead to protests, even harsh ones.
By collecting and analyzing cases of collective actions by health sector workers and their online requests for help, the China Labour Bulletin The report has provided a worrying picture of the sector, especially since, according to experts, the problems are linked to issues inherent to the system and the lack of protection of rights, which encourages attacks or episodes of violence by patients or their relatives. In addition, health workers complain of negligence or lack of attention by hospital managers and government agencies in cases of violence at the hands of patients. Added to this is the lack of support and protection in the area of security; and in cases where protests have taken place, the response has been an iron fist, with repression of demonstrations and arrests of doctors and nurses.
In May 2022, Yu Xiaobao, vice president of the private hospital management sector at the China Hospital Association, revealed that more than 2,000 private hospitals have gone bankrupt and closed their doors after the pandemic. Some of the reasons are the reduced number of patient visits and the increasing workload for Covid prevention and control, the legacy of which continues to affect the country’s healthcare workers. For example, on November 3, 2023, a group of doctors from the Ruzhou Maternity and Child Health Hospital in Henan organized a demonstration to protest over the non-payment of more than a year’s wages. Contributions for pensions and social security had also not been made. The authorities responded that the decline in births, the impact of the pandemic and other factors have caused the center’s activities to collapse, with a consequent drop in income and delayed payments.
However, it would be inaccurate and short-sighted to attribute the problems with the rights of health care workers and related issues solely to SARS-CoV-2. In reality, the pandemic emergency has simply triggered – and uncovered – long-standing problems. That is why specialists have called for a series of measures to be taken to consolidate the system, such as guaranteeing membership in a union, which must be free to negotiate with hospital managers and defend their rights.
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