Policy responses for Lithuania - HSRM

Lithuania


Policy responses for Lithuania

2.2 Workforce

The number of physicians in Lithuania is substantially higher (4.3 physicians per 1000 population) than the EU average (3.6) and the number of nurses (7.7) lower than the EU average (8.4). However, as early as 2nd February concerns were raised that there may be a lack of medical capacity in Lithuania if doctors start to be infected and have to isolate themselves.(1) On 13th of March, the first case COVID-19 in person working in health care sector was detected, leading to self-isolation of multiple medical personnel across various hospitals.(2) Since 23 of March, all healthcare professionals can be tested for COVID-19. By 27th of March there were about 30 infected doctors in Lithuania, about half of them in Klaipeda.(3) On 31st of March Lithuania had confirmed 533 cases of coronavirus, of whom 64 were doctors.(4) In order to manage availability of health care staff (because of self-isolation or other issues) medical personal can be reassigned to another health care facility in the same area. Healthcare professionals, medical students, residents  and retired doctors can be pooled if needed.(5) Students who contribute to COVID-19 activities in their work can count this towards their obligatory practical assignment.(20)

 In order to maintain the availability of the health workers, from 13th of March Vilnius Municipality has mandated kindergartens and schools to ensure the education and care of children of medical staff during the national quarantine. Medical staff have the possibility to take their children to kindergartens during the quarantine.(6)

Salaries for physicians, nurses and ambulance staff fighting COVID-19 were increased by 15 percent on 27th of March and 3rd April.(7)(8) On 1st of April, the Parliament failed to make a decision on increasing salaries for health professionals further during the quarantine period.(8) On 2nd of April, however, it was agreed to bring forward (from September to April) the planned salary increase of health care professionals. It is estimated that the wage bill would increase by about 18%.(10) On 7th of April, the Parliament approved a proposal to pay 60 to 100 percent higher salaries to employees of medical institutions who work with patients with particularly dangerous infectious diseases and health care professionals who carry out prevention in the outbreaks of particularly dangerous infectious diseases. They will be paid from the beginning of the month in which the quarantine is announced, e.g. from March until the end of the month of quarantine (18).

On 29th of April the procedure established for the allocation of allowances for health care workers who work with patients with particularly dangerous communicable diseases and for those who carry out prevention in the outbreaks, for the period of the pandemic. For public providers, exact increase in salary (between 60% and 100%) is to be determined by the head of the institution, depending on the type and place of work, and the associated risks of contracted the disease. For private providers, the allowance size is not regulated, however the institutions can get up to 100% of salary reimbursed. The money come from the NHIF for institutions who are contracted by the NHIF, and from the state budget for the institutions without the NHIF contracts.(21) In addition, health care workers engaged in provision of health services in COVID-19 hotspots would receive compensation and a lump sum insurance benefits in the event of incapacity for work due to an infection. In the event of death, the relatives of such workers would be paid an amount equivalent to 93 salaries of the deceased. (22)

Given the risks associated with the spread of the infection in healthcare facilities, from 15th April all doctors are be required to provide data on all their workplaces, both private and public. This measure aims to help heads of facilities to assess the risks and threats of infection more effectively, assist traceability and prevent the cross-contamination. (19)

Vilnius Public Health Bureau and the Crisis Research Center are responsible for providing training for health care professionals to perform testing for COVID-19 safely.(11) The Institute of Hygiene is responsible for issuing guidelines for infection control measures for healthcare facilities, and provision of training for health care specialists on infection control issues.(12) Practical recommendations for treatment and nursing in the Intensive Care Unit were updated by the medical experts.(13) 

A shortage of volunteers to ensure the effectiveness of COVID-19 response was observed.(14) On 19th of March, NCPH issued a call for volunteers.(15)
 Since 25th of March there is also a voluntary psychological assistance initiative for medical professionals.(16) A recommendation on the organization of the work of medical psychologists during quarantine has been adopted on 1st of April, stressing the importance of continuity of work of medical psychologists in primary care settings. (17) In July MOH reported that a large share of medical professionals does not seek psychological help from the public services due to concerns that it may affect their licence to practice. In response, on 28th July the MOH released amendments to current regulation, removing mental disorders from the list of diseases that affect licensing of medical professionals.(25) 
In May, the incidence of COVID-19 among health care professionals in Lithuania remains high and reaches 20% of all persons infected. (23)

From 1st September health care workers who worked during the pandemic will be able to use the state subsidy of up to 200 euros for using certain rest, recreation and cultural services (e.g. SPA centres, village tourism, excursion, guided tours, museum visit), in Lithuania. (24)

In addition, health and social care workers, civil servants and other selected professionals infected with COVID-19 will receive higher sickness benefits if their work involves contact with the infection, i.e. their sickness benefits amount to 100 percent of the net salary (this is not the case for standard sickness benefit which is usually below net salary levels). (24)

As hospitals came under increased pressure from COVID-19 patient flows, some healthcare providers have begun collaborating in terms of workforce. One such example is the Vilnius City Clinical Hospital, which brought in nurses, doctors and nursing assistants from polyclinics under tripartite agreements. Resident  physicians, internal medicine physicians, and physicians in other fields are also invited to assist staff working with COVID-19 patients. Providers contracted with NHIF are classified as civil protection forces, so in the event of a shortage of staff, hospitals may apply to MOH and other medical facilities for reinforcements. By agreement between providers, medical staff may be transferred to another institution, which is required to provide the posted workers with PPE and ensure other safety and working conditions. Employees who are posted to other institutions retain their salaries, plus get daily allowances and other mission expenses (travel expenses, etc.). The Act on the Prevention and Control of Communicable Diseases declares that salaries of healthcare workers who provide services to patients with particularly dangerous communicable diseases or carry out epidemic prevention measures in outbreaks of particularly serious communicable diseases must be adjusted upwards by 60 -100%.(26)

By 21st December, as shortages of staff became critical, the Ministry of Health reiterated that health care specialists, university and college students and medical residents can be temporarily re-deployed to other providers and their functions can be expanded.     

In 2021, the NHIF envisages to designate 45.6  million EUR for for provider reimbursement to compensate for wage increase for health care workers dealing with COVID-19 patients.(27)

By 21st December, as shortages of staff became critical, the Ministry of Health reiterated that health care specialists, university and college students and medical residents can be temporarily re-deployed to other providers and their functions can be expanded. Over December 2020, 17.3 million EUR were allocated for medical salary supplements for COVID-19 related duties (13.7 million EUR were allocated in November 2020) (27) During the first quarantine in March-June 2020, a total of 24.5 million was allocated from the PSDF reserve by orders of the Minister of Health to compensate for the costs of increasing the salaries of medical staff, amounting to monthly average of  EUR 7.6 million. Thus, during the second wave in December 2020 total monthly funds for this purpose have tripled.In 2021, the NHIF envisages to designate 45.6  million EUR for for provider reimbursement to compensate for wage increase for health care workers dealing with COVID-19 patients.(27)