Unfair Policy? Employees Pay the Electricity Bill at Armenia's Metzamor Medical Center
For some time now, employees at the Metzamor Medical Center in Armenia’s Armavir Province have been allocating a part of their wages to pay the electric bills incurred by the hospital.
It appears that no one at the center has ever filed a complaint.
Every month, nurses and cleaners donate 5%,and doctors,10% of their wages. According to hospital director Mikayel Vanyan, these donations add up to about 1.1 million AMD ($2,280) per month.
The Metzamor Medical Center (MMC) serves around 21,000 residents, of which 11,000 are from surrounding villages.
Armenian Nuclear Power Plant (ANPP), which produces 40% of the electricity used in the country, is in Metzamor. ANPP is the cheapest power generator in Armenia. It provides electricity to High Voltage Electric Networks for 12 drams, while the MMC pays 44.98 drams to the Electric Networks of Armenia.
"We use a huge amount of gas and electricity in the winter, that costs us around five million drams per month. That’s why we have accumulated debts to the Electric Networks of around 23 million drams," says Vanyan.
The MMC, which includes in-patient, outpatient, and one-shift ambulance services, is consolidated in one place, while most of the building is not renovated. The old wooden windows allow cold air in.
Mikayel Vanyan says that the poor condition of the building is also an obstacle to ensuring normal temperatures in winter and cutting costs.
"The in-patient part hasn’t been renovated since the 1980s. The windows are from those days. Except for the resuscitation department, one part of the children's department and the operating room, where some repairs have been made, the rest is in bad condition," Vanyan says.
The polyclinic section was repaired two years ago with World Bank funding. It has also been furnished with modern equipment.
Traces of the 1980s are still to be seen in the corridors of the outpatient part of the hospital, wards and toilets. Walls are wet, covered with big cracks and fallen plaster. Management has found a partial solution. Holes and cracks have been covered with posters.
The director says that all the employees have written letters to the owner of the electric networks, asking to freeze the debt. Mikayel Vanyan says that this year's expenditure will somehow be covered by the funds donated to the medical center, but they cannot repay the entire debt.
"By saving, we’ve drastically reduced electricity, medicine, fuel costs and all our economic expenses over the years. But we still need to have a budget. The salary fund is 254 million drams, and the volume of state orders is 212 million. Of course, we put the main emphasis on paid services, " Vanyan says.
The center’s paid services, through which it tries to alleviate its financial burden, comprise 30% of total services; a serious number.
Vanyan says they are very excited about the new government's policy that will liberalize the budget and pay medical facilities based on performance.
Optimization activities have also had a role in the efforts to save. The staff has been reduced from 237 to 191 in the last three years.
Vanyan says if the budget is liberalized, the Metzamor Medical Center will recover.
According to the government’s decision, every other year, medical centers should be financed by an amount not less than for the current year's work.
Vanyan says that in 2014, without providing any justification, financial support for the services of the infectious and pediatric departments was reduced by 18 million drams. Since then, the amount of funding has decreased every year. That’s when the MMC’s problems started.
The MMC director says that all the ministers have been contacted on this issue, but it hasn’t been solved.
The medical center has other debts, too. For example, it owes 3 million drams for medications and water. Taxes go unpaid. In general, debts total 45 million drams. The center always pays salaries.
Not to accumulate new debt, medicines are now purchased in limited quantities, using the cash they have. This may be enough for one week.
As in other regional hospitals, some of the MMC’s equipment is quite old. For example, the X-ray machine dates to the 1980s. Most of the equipment was produced in those years. Two years ago, a specialist was invited to repair most of the equipment so that it could be used. This is not a solution.
Only the equipment in surgical department, intensive care unit, and polyclinic is new. Paid services’ revenue allows them to update a bit, but at a rate that will take many years.
Mikayel Vanyan says that both conditions in the building and equipment cannot be compared with hospitals in Yerevan, and that's why the provincial patients continue to go to the capital for medical care.
"We have no shortage of patients - we lack finances. Our only problem is that our work is not being paid for, " Vanyan says.
In his opinion, the solution is the following. There are medical clinics in rural communities that have job positions of directors, accountants, operators. According to Vanyan's rough calculations, these staff members annually receive around 120 million drams in the rural communities of Armavir Province.
In his opinion, it would be better if these medical clinics operated under the administration of provincial hospitals and that the 120 million was distributed among those hospitals.
Mikayel Vanyan raised one more issue. There are unused buildings, like the polyclinic building in the city center, that belong to the Metzamor Medical Center. The government proposes to sell the unused buildings and repair the medical center with that amount.