The Struggle for Decent Work in Public Health Care: A CFDT Perspective – PSI


Pascale underlines the significant issues facing care workers and the delivery of accessible, high-quality public care services in France. How will investments in more jobs and decent work for public care workers improve the quality of public care services?

Decent Work Deficits in Public Health Care

The covid 19 health crisis brutally highlighted 10 years of under-investment in the French hospital system. In a recent report, the Cour des Comptes (French Audit Office) noted the increasing obsolescence of buildings and equipment as a result of choices made to avoid excessive debt. While urgent financial measures were taken as part of the Ségur healthcare agreements in 2020, the attractiveness of care professions is still lacking.

Human resources have emerged as a major concern. Despite a 2.7% increase in the number of salaried staff in the public hospital sector between 2018 and 2021, operating difficulties have increased due to recruitment constraints for certain functions, rising absenteeism and the growing reluctance of staff to work night or weekend shifts.

Public hospitals have been forced to resort to expedients, notably temporary staffing and overtime, which have proved problematic and insufficient.

The Alarming State of Public Health Care

The French Hospital Federation (FHF) makes the same alarming assessment: The public hospital and medical-social sector employs almost 1.2 million professionals in France. More than three-quarters are women and only 25% of hospital civil servants have working hours considered “standard”. Among public hospital practitioners, 30% of positions are vacant as are 25,000 paramedical positions.

This persistent lack of attractiveness is a huge challenge at a time when the need for care and support has never been greater: rising chronic illnesses, an ageing population, not to mention exceptional health situations.

The Effects of Understaffing

Understaffing leads to a deterioration in service quality. A survey published very recently in the French business daily “Les Echos” shows that the public services which suffer most from a lack of attractiveness are also those which give rise to a degraded view of their quality. Only 45% of some 2,500 people surveyed last December said they had a good opinion of public health, the lowest level since 2011.

This French observation naturally echoes similar findings in other countries: a female-heavy public health care sector leading to low wages, hardship and professional wear and tear that are insufficiently taken into account. The private healthcare sector is no better off for the same reasons!

The Fight for Decent Work

That’s why unions must fight to finally obtain decent work for care workers! PSI advocates for rebuilding the social organization of care that includes also providing public care systems and regulating all actors of the social organization of care, including the private sector.

In France serious shortcomings persist in the provision of public healthcare services. The feminist strike on March 8 was therefore an opportunity to put forward the CFDT’s demand for quality public services that meet needs, particularly in early childhood: there is a shortfall of over a million jobs in the care and bonding professions, and over 200,000 places in early childhood.

To end on a positive note: France is proud to be the first country to enshrine abortion in its Constitution! The way is open now to fight for this right all over the world!


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