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Statement by the Ombudsman for Equality on the government proposal draft on the regional government reform and the reform on the organisation and provision of healthcare and social welfare services (TAS 353/2016; issued 4 November 2016)

The healthcare, social welfare and regional government reform includes great changes with significant effects on gender equality. In the opinion of the Ombudsman for Equality, it is positive that the background material for the government draft includes an assessment on gender effects. The Ombudsman for Equality is pleased that the Act on Organising Healthcare and Social Welfare Services includes the goal to promote gender equality. It would be important to include this goal in the regional government reform, too.

The healthcare, social welfare and regional government reform will especially bring significant changes to healthcare and social welfare personnel in municipalities and joint municipal authorities, as the major part of the personnel consists of women. In the first stages of the reform, personnel positions are fairly secured, as the transfer-of-business principles will be applied to personnel transfers. However, it is very difficult to estimate long-term effects. This creates insecurity regarding the employees' positions. Employers and workplaces may change, commutes may become longer, and it may become more difficult to reconcile work and family life.

One goal of the reform is to decelerate the rise in healthcare and social welfare costs by approximately EUR 3 billion. As personnel expenses make up about two thirds of the costs of healthcare and social welfare, there is a great danger that the position of employees will deteriorate due to the reform. There may be negative effects on e.g. salaries, pensions, and the stability of employment. It does not seem that women's status in working life will be improved. For some workers, having larger employers due to the reform may be an opportunity to access new assignments and training and subsequently advance in their careers. On the other hand, there will be fewer managerial positions and more competition for these positions.

When the employees of several municipalities and joint municipal authorities are transferred under one employee, i.e. municipality, pay gaps may emerge between employees of different genders performing the same and equal work, and the employer is obligated to correct this gap under the Act on Equality between Women and Men. Systematic work on harmonising pay levels within a reasonable period should be begun as soon as the new employer organisations have been formed. If personnel will be transferring to the employment of private service providers within some time frame, the right to access pay information does not concern these employees.

In the reform, a major part of societal decision-making authority will be transferred from municipalities and joint municipal authorities to counties. The Ombudsman for Equality is concerned about what kind of balance of women and men there will be in the new county councils. In municipal councils, 36% of council members are women. The representation of women and men in the municipal council bodies can be affected by extending the provisions of the Act on Equality between Women and Men to include these bodies.

When planning and providing healthcare and social welfare services, it is important to take into account the health and age differences between women and men and the special needs of genders and gender minorities.

Special measures are needed concerning the health issues of men in poor socio-economical positions and the sufficient provision and availability of the services for this demographic.

Especially in the older population, there are relatively more women than men using health care and social welfare services. Women’s pension poverty prevents them from using additional paid services, which has to be taken into account when planning different services, e.g. services for the elderly.

With the healthcare, social welfare and regional government reform, service production will increasingly be using the services of private enterprises. Counties will also need to incorporate some of their operations related to providing healthcare and social welfare services. The plan is to provide freedom of choice for the users in choosing the provider of the services. Based on the proposal, it is difficult to estimate how the freedom of choice will be realised equally for everyone. It is not clear where the large-scale incorporation of healthcare and social welfare services will lead: whether the development can be controlled by counties and democratic policies and if the results will be in accordance with the objectives of the reform, for example concerning the realisation of equality and gender equality.

According to the Act on Equality between Women and Men, authorities have the obligation to promote gender equality, related to the availability and provision of services, for example. However, the obligation to promote gender equality does not concern enterprises. When arranging competitive tenders for services, it is important to set the realisation of gender equality as one criterion for the choice of service provider.