Contribution by János Kovács, nurse, from Budapest and a friend from Sao Paolo – presented at an international gathering of health workers in Vienna in July 2026. A further contribution on militarism in France can be found here.

HUNGARY

The Hungarian healthcare system occupies a unique, semi-peripheral-peripheral position within the global capital system. In this situation, the system suffers simultaneously from the drain of capital and resources, while at the same time serving as an important market and provider for global capital interests.

1. Exporter of human capital (the “brain drain”),
2. Market for technology and pharmaceuticals
3. The marketization of public services (private capital penetration)
4. Peripheral cost structure

The Hungarian healthcare system is a vulnerable intermediary within the global capitalist system: from below, it supplies cheap (but relatively skilled) labor to the center, while from above, it fuels the profits of global technological and capital interests through procurement and the expansion of the private sector.

In the capitalist system, the primary function of healthcare is the reproduction of the workforce. Hungary’s economic model is based to a significant extent on assembly plants and cheaper industrial labor; the system must produce masses of people in a physical condition capable of withstanding the monotonous strain of multiple shifts.

In a semi-peripheral to peripheral situation (such as Hungary’s), the “rehabilitation facility” function of health care is key.

The system’s focus is on returning individuals to the labor market. In other words, the task is to support people of working age and quickly restore their ability to work, because this provides the economy with its “raw material” – that is, the workforce. Thus, the system’s goal is to maintain the workforce at a functional level. “Well-being” beyond this point, or a dignified old age, is no longer a “business interest,” so these areas remain the arena of political struggles and social solidarity (or the lack thereof). On the other hand, if “treatment” is too costly relative to the expected “return” (the number of years remaining in the workforce), the semi-peripheral healthcare system tends to de facto abandon the patient. This is why, for example, long waiting lists develop (e.g., for hip replacements); those who cannot afford private surgery are excluded from the quality labor market and are often forced into disability retirement or involuntary leave, which, from the perspective of capital, constitutes a “written-off loss.”

Previously, during the Kádár era (1956 – 1988), the healthcare system, though ideologically (ostensibly) opposed to capitalism within the global capitalist system, functioned economically as a “low-cost maintenance zone” for the capitalist world system within the Eastern Bloc. Through the Council for Mutual Economic Assistance (CMEA), but also under the influence of Western loans, it became a sort of agricultural-industrial hinterland. The task of the state healthcare system was to keep the workforce, which produced goods exported to the West (e.g., Ikarus buses, food), operational with minimal capital investment (low wages, state subsidies). And, of course, it had long been dependent on the West in the pharmaceutical industry and in the field of technical equipment.

The so-called socialist state healthcare model (an adaptation of the Soviet Semashko system) was based on the principles of comprehensive free care and state control: a state monopoly, a hospital-centered system, basic care provided as a matter of right rather than by free choice, free care, low wages, corruption (with a capitalist element creeping in through “gratuity payments”), and the reproduction of the workforce.

Until the mid-1970s, the system relatively effectively improved epidemiological and public health indicators, but by the 1980s it had become unsustainable both technologically and financially.

The two decades from the transition to democracy until 2010 were a period of constant reform attempts and structural fragmentation in the healthcare sector. The centralized Kádár model was replaced by a decentralized, mixed-ownership, insurance-based system. The most significant change was the introduction of social security-based financing (the Bismarck model). The state monopoly was phased out, and privatization began. By 2010, the Hungarian healthcare system had reached a hybrid state: primary care and pharmacies were in private hands, hospitals were managed by local governments, and financing was handled by a single state insurer (OEP). Despite technological advances, life expectancy and health status continued to lag significantly behind the EU average. Until 2010, the healthcare system attempted to reform itself according to the rules of a liberal market economy (which, in reality, was already the era of transnational monopoly capital), but political instability and social resistance (e.g., the 2008 referendum) caused the process to stall, leaving the system in an underfunded, chaotic state. The resistance from the working class – the proletariat – was unable to offer an alternative.

After 2010, the healthcare system became part of the National Capitalist System (NER). Resources are allocated not on a market basis, but on the basis of loyalty and strategy. The goal is to keep the workforce at a minimum level while maintaining political control over the sector and channeling private capital flowing into the private sector toward the appropriate investor circles. Unlike during the Kádár era, the NER has returned to nationalization. There is no Ministry of Health; instead, the sector falls under the Ministry of the Interior. Hospitals were taken away from local governments and placed under a central authority (now OKFŐ). Between 1990 and 2010, workers were public employees with collective bargaining agreements, though their ability to advocate for their interests was limited. Gratuities were part of the system (“invisible income”), which the state tacitly factored into wages. After 2010, the healthcare service employment relationship was introduced. This brought about a more military-style order: collective bargaining agreements were abolished, second jobs were restricted, and workers became subject to assignment. In exchange, doctors’ salaries were drastically increased, and “gratuities” were made punishable by law, which fundamentally changed the patient-doctor relationship.

Major Challenges

• Demographics: An aging society places a growing burden of chronic disease on the system.
• Prevention: The health status of the Hungarian population (life expectancy, preventable deaths) continues to lag behind the EU average, a situation further exacerbated by high rates of smoking and obesity.
• Wage Disparities: Following significant increases in doctors’ salaries, adjustments to skilled workers’ wages have essentially not kept pace. There is a massive shortage of skilled workers.

Number of Skilled Workers:

According to the latest official data, there are currently approximately 104,000 skilled healthcare workers employed in Hungary.

Based on data from the Central Statistical Office (KSH) for 2024 and 2025, the number of skilled workers is as follows:

Workforce Data (2024–2025)

• Number of filled healthcare professional positions: A total of 103,969 (2024 data), representing a slight decrease compared to the 104,103 recorded in 2023.
• For comparison: In 2010, this figure was 96,373; thus, on paper, the workforce has grown by approximately 7,700 people over the course of a decade and a half.

Although the statistics show an increase in workforce numbers, in practice there is a serious labor shortage:

• Part-time work: A significant portion of skilled workers are employed part-time, so the number of individuals is higher than the number of full-time positions.
• Career dropout: According to the Independent Health Care Union (FESZ), the situation had worsened by early 2025, and many are considering resigning for moral or financial reasons.
• Retaining Retirees: Effective January 1, 2026, the government allowed retirees to continue working while receiving their full pension, in an effort to encourage experienced skilled workers to remain in the workforce.

Skilled Worker Wages:

A new, tiered wage system was introduced in March 2024, based on education level and level of responsibility.

• Average gross wage: Currently approx. 650,000 – 850,000 HUF / 1,792.70 Euro – 2,345.15 Euro (average for a high school-educated nurse and a nurse with a college degree).
• Average net salary: Approximately 432,000 – 565,000 HUF / 1,191.89 Euro – 1,558.84.
• Note: The government’s goal is for skilled workers’ wages to reach 37% of the average physician’s salary. Trade unions (FESZ) consider this insufficient and are demanding 50%.

Number of doctors:

According to the latest data, there are currently approximately 43,100 doctors working in Hungary. Experts point out that the figure of 43,000 does not represent that many full-time doctors in the public sector. Many work in dual practices (public and private care) or hold multiple positions simultaneously, so the number of “filled positions” is higher than the actual available workforce. Furthermore, despite the statistical increase, the stability of the system is threatened by the fact that more than 12% of doctors are over 70, and more than one-fifth (22%) have already reached retirement age. There is a drastic shortage of family doctors.

Physician Salaries:

Gross base salary: In the spring of 2026, the base salary of a specialist (with approximately 10–15 years of experience) ranges from 1,800,000 to 2,100,000 HUF / 4,966.20 Euro to 5,793.90 Euro.

Net base salary: Approximately 1,197,000–1,396,000 Ft.

Note: The gross salary for entry-level residents starts at around 700,000 Ft, while that of the most experienced chief physicians exceeds 2.5 million Ft gross.

Number of other healthcare employees:

In the public healthcare system, the number ranges from approximately 35,000 to 40,000 people. But this figure is also misleading, because many functions (e.g., cleaning, food service, laundry) have been outsourced to private companies (close to NER). Thousands more people work in the healthcare sector at these companies, but they are not included in public healthcare statistics.

Wages:

For the most part, these workers are not subject to the healthcare pay scale but rather to the current minimum wage regulations.

• Average gross wage: Typically the guaranteed minimum wage (minimum wage for skilled workers) or a slightly higher level: 330,000 – 420,000 Ft / 910.47 – 1,158.78 Euro
• Average net wage: Approx. 219,000 – 279,000 Ft. / 604.22 Euro – 769.76 Euro
• Note: This category includes cleaners, patient transporters, and kitchen workers. This group faces the most severe livelihood challenges within the sector.

Interest Representation

Doctors

• Hungarian Medical Chamber (MOK): Membership is not mandatory (opposition organization), but the majority of the profession remains affiliated. Primarily a professional and ethical organization, but it is the government’s main negotiating partner and a critical voice.
• Hungarian Doctors’ Trade Union (MOSZ): Engages in traditional union activities (wage negotiations, labor law protection). It is more flexible and combative than the chamber.
• Hungarian Residents’ Association: An organization of young doctors that has played a key role over the past decade in the fight against “gratitude payments” and in enforcing wage adjustments.

Skilled Healthcare Workers (nurses, medical assistants)

• Hungarian Chamber of Skilled Healthcare Workers (MESZK): A public body representing the majority of skilled healthcare workers. It is often accused of being too close to government decision-makers. Membership is mandatory
• Independent Healthcare Union (FESZ): The most militant healthcare professional organization. It gained national prominence during Mária Sándor’s tenure; it organizes the most demonstrations and is currently leading the strike preparations.
• EDDSZ (Democratic Trade Union of Hungarian Healthcare Skilled Workers): A long-standing organization with a large membership that has lost some of its activism in recent years and now focuses more on behind-the-scenes negotiations.

Support Staff and Technical Workers

They do not have their own independent, dedicated organization, which is one of their greatest weaknesses.

• MSZ EDDSZ: They are represented as part of the “umbrella union,” but their voices are often drowned out by the demands of doctors and nurses.
• City/Institutional Unions: At the local level, they are sometimes stronger; for example, support staff at some large county hospitals maintain their own local chapters.

Unregistered Organizations and “Grassroots” Movements

Since the official unions’ room to maneuver is limited, informal networks have emerged:

• Facebook groups: Closed groups for the “cream of the profession” and nursing communities, where strikes, “waves of resignations,” and white/black ribbon campaigns are coordinated.
• Ad-hoc working groups: A collective of workers from a single department who jointly decide to stop working voluntary overtime. This poses the greatest threat to the system because there is no “leader” who can be bribed.
• Professional platforms: Such as 1001 Doctors Without Gratuities, which originally began as an unregistered movement and demanded radical reforms.
• Whistleblower networks: Doctors and nurses who anonymously leak internal information to the press (e.g., about leaky operating rooms or missing medications).

In the Hungarian healthcare system, workplace struggles among skilled workers (nurses, medical assistants, paramedics) and technical and administrative support staff reached a critical stage by the spring of 2026. While doctors’ salaries had previously been significantly adjusted, the pay levels and workloads of skilled workers continue to cause tension.

Wage Disputes and Demands

Trade unions, including the Independent Healthcare Trade Union (FESZ) and the Hungarian Chamber of Healthcare Skilled Workers (MESZK), exerted intense pressure on decision-makers throughout 2025 and into early 2026:

• 20% wage demand: Worker representatives demanded a base wage increase of at least 20% for skilled workers by 2026 to offset inflation and halt the decline in real wages.
• Wage Ratios: Their goal is for the base wage of skilled workers to reach 45–50% of the average medical professional’s wage, thereby reducing wage disparities within the sector.
• Technical and support staff: They were the ones most left out of previous raises; a 15% wage adjustment is considered necessary for them.

Working Conditions and Staffing Shortages

The “struggle” is not just about money, but also about sheer survival in day-to-day patient care:

• Critical nursing shortage: Estimates indicate that the system is short more than 30,000–40,000 nurses. In some hospitals, this leads to the closure of wards or jeopardizes the provision of safe care.
• Overtime and deployment: New legislation allows for the “emergency” deployment of workers to other institutions, which has sparked resistance due to the resulting lack of predictability in their personal lives.

Monitoring of Side Jobs: Starting in mid-2025, a new electronic platform will monitor whether workers have unauthorized side jobs, further restricting workers’ freedom.

Facial Recognition Systems

In the healthcare sector, the introduction of facial recognition systems is currently one of the most contentious issues, where security interests and worker resistance clash directly. In professional forums, this topic is referred to as “biometric slavery.”

Three key aspects of the situation:

1. The Official Rationale: Security and Attendance

According to arguments put forth by government and hospital administrators, the purpose of these systems (which have already been installed in many places at the entrances to institutions and in central hallways) is:

• Patient safety: To keep unauthorized individuals out of patient wards.
• Time tracking: To replace paper-based attendance sheets. The goal is to prevent workers from “signing in for each other” during shifts or leaving early.

2. Skilled Workers’ Fears: Total Control

The following concerns dominate skilled workers’ forums:

• Penalties for “gray zone” work: Nurses often handle shift changes flexibly due to the brutal workload. The facial recognition system’s second-by-second tracking eliminates this remaining leeway.
• Monitoring of second jobs: They fear that the system’s data will be cross-referenced with that of other hospitals, which could reveal if someone goes to work at another facility immediately after a night shift (which is legally prohibited or requires a permit, but is a necessity for many to make ends meet).
• Surveillance paranoia: Many find it humiliating that while basic supplies (e.g., rubber gloves) are lacking, the hospital can afford expensive surveillance systems.

3. Legal and Ethical Concerns

According to professionals and labor unions (e.g., FESZ):

• GDPR issues: The collection of biometric data falls under a specially protected category. It is questionable whether workers’ consent is truly voluntary in such a vulnerable legal relationship.
• Loss of loyalty: Skilled workers feel that the system does not trust them and treats them as “criminals,” which further accelerates their departure from the profession.

According to reports circulating on online forums, in some places workers are already looking for ways to “circumvent” the system (e.g., by citing mask-wearing requirements) or are simply using the issue as a tool for collective resistance during wage negotiations.

In recent years, healthcare protests have centered on wage disparities (particularly the gap between doctors’ and support staff’s wages), staff shortages, and deteriorating working conditions. While “quieter” discontent was characteristic during the COVID-19 pandemic, street protests have intensified since 2021.

Most Recent Major Demonstrations (2025–2026)

• March 8, 2025 – “Standing Together for Better Healthcare”: This was one of the largest demonstrations in recent years at Kossuth Square in Budapest.
  • Organizers: The Hungarian Medical Chamber (MOK) and the Hungarian Doctors’ Union (MOSZ).
  • Goal: To end the severe underfunding of the healthcare system and to ensure that the profession’s recommendations are taken into account when reforming the system.
  • Participation by healthcare professionals: Although the Independent Healthcare Trade Union (FESZ) joined the protest, the Hungarian Chamber of Healthcare Professionals (MESZK) stayed away as a group, highlighting divisions within the advocacy community.
• March 2026 – “FESZ pressure campaign”: In early 2026, the Independent Healthcare Trade Union urged the government to adopt a wage strategy extending through 2030 by proposing radical wage catch-up measures and organizing local awareness-raising campaigns (e.g., professional days, wearing white ribbons).

Previous Key Events

• July 31, 2021 – General Assembly of Healthcare Workers: Thousands protested at Heroes’ Square against the new healthcare employment status.
  • Main grievances: Loss of civil servant status, the ability to be reassigned, and wage increases significantly smaller than those for doctors.
• 2024 – Local “flash protests”: Spontaneous demonstrations broke out in smaller city hospitals (e.g., following the closure of certain wards), involving local residents and remaining staff, to ensure the continuity of care.

Key messages of the protests

1. “Wage parity” within the sector: They demand that skilled workers’ base pay reach a fixed percentage (45–50%) of doctors’ salaries.
2. Stopping burnout: Limiting extreme overtime caused by staff shortages.
3. Non-partisanship: The organizers have emphasized on nearly every occasion that they are standing up for patients and colleagues on a professional basis, not a partisan one.

In the healthcare sector, traditional strikes involving a complete work stoppage have been extremely rare in recent years, primarily due to strict legal regulations and the obligation to ensure adequate services. By the spring of 2026, however, the situation had become noticeably more tense.

Current Strike Readiness (April 2026)

According to the latest news, Adrianna Soós, president of the Independent Health Care Union (FESZ), announced in early 2026 that a nationwide strike could begin within months, as wage negotiations with the government had stalled.

• Main reason: Healthcare workers are dissatisfied that neither the 2025 nor the 2026 budget included sector-specific wage increases for them.
• Timing: According to labor advocates, the strike could take place as early as the first half of 2026.

2. Why is it difficult to strike in the healthcare sector?

The Hungarian legal framework significantly restricts healthcare workers’ right to strike:

• Minimum services: The law stipulates that life-saving interventions, emergency care, and continuous patient monitoring must be ensured even during a strike. In practice, this often makes the work stoppage invisible to the outside world.
• Emergency restrictions: In recent years (e.g., during the pandemic), special government decrees have prohibited or restricted the possibility of strikes in the sector.

Alternative “struggle” tactics

Since a traditional strike is difficult to carry out, workers resort to other methods:

• Voluntary refusal to work overtime: This is an “invisible strike” in which doctors and skilled workers en masse refuse to work overtime beyond the legal minimum, causing immediate operational disruptions in hospitals.
• Warning actions: In late March 2026, in coordination with other sectors (e.g., education support staff), they also organized shorter, two-hour warning strikes.
• MOK Statements: In April 2026, the Hungarian Medical Chamber once again issued a strongly worded statement warning of a moral and professional crisis that threatens the safety of patient care.

Acts of Sabotage

In the Hungarian healthcare system, “sabotage” in the classical sense (i.e., the intentional damage of equipment or disruption of processes) is not typical, and workers distance themselves from such actions due to their code of ethics and their sense of responsibility toward patients.

At the same time, there are “hidden forms of resistance” – or, to use the technical term, “passive resistance” – that employees employ in response to systemic shortcomings or excessive workloads:

1. “Work-to-rule”

This is the most common form of protest. Workers adhere strictly to all administrative and safety regulations and do not volunteer to work a single second of overtime. Since the system relies on nurses and doctors performing “gray-zone” (unreported, favor-based) extra work, strict adherence to the rules immediately slows down care, lengthens waiting lists, and causes administrative chaos.

2. Withdrawal of Voluntary Overtime

This is the “legal nuclear weapon” of the Hungarian healthcare system. Workers are withdrawing their declarations of voluntarily undertaking overtime en masse. Result: This is not sabotage, but it effectively paralyzes the on-call system. The operations of numerous departments (e.g., trauma, intensive care) have become unsustainable in recent years due to such coordinated actions, forcing the operator to negotiate.

3. “Paperwork Slowdown”

Resistance to the new, strict digital attendance and performance monitoring systems introduced by the Ministry of the Interior.Phenomenon: Incomplete or minimal data entry, and “overcomplicating” the system during administrative processes, which hinders the compilation of central statistics and the fair application of performance-based pay (the new evaluation system).

4. Staff Turnover as a “Vote with Your Feet”

Many experts view mass resignations or migration to the private healthcare sector as the ultimate form of resistance. This fragments work communities, and although it is not intended to cause harm, the result is a structural weakening of public healthcare.

5. Informal Disclosure 

Some workers—often anonymously—leak internal photos and documents to the press or professional organizations exposing untenable conditions (e.g., leaking operating rooms, shortages of supplies). Although management often characterizes this as “discrediting” or “sabotage,” workers say it is the only way to force change.

 

BRAZIL

Brazil has the largest public health system in the world, the SUS ( Sistema Unico de Saude -Unified Health System), which, despite its name, is not the only one, as it coexists with a private system, both through private care and health insurance plans. 

The focus of this text will be the SUS, its functioning and challenges. 

A brief historical summary 

The SUS was born in Brazil with the promulgation of the 1988 Constitution, which came about after the fall of the right-wing military dictatorship that lasted 21 years in Brazil (1964–1985). The historical context — of popular struggle against a right-wing military dictatorship — is fundamental to understanding the creation of the SUS, a universal health system that requires no insurance affiliation or payments, covers any type of health condition without restrictions, and is also responsible for the country’s sanitary oversight. In the constitution following the military dictatorship, health was guaranteed as “a right of all and a duty of the state.” 

Regarding its structure, there is federal and state coordination, but municipalities are the main ones responsible for the local organization of the system. Given the size of the country, with more than 5,000 municipalities, there is great heterogeneity in how the SUS functions across different parts of the country. Another important point is that the SUS’s organization is highly decentralized and territorialized, with Basic Health Units (UBS) — primary care facilities maintained by the state — staffed by doctors (GPs and sometimes pediatricians, gynecologists, and psychiatrists), as well as nurses, community health agents, and other professional categories working together within this reasonably sized structure. In the SUS, worker organization tends to be stronger in UBS settings than in hospitals, given the way the system was structured. 

Situation in Sao Paolo

We will now focus mainly on the difficulties of the SUS in São Paulo, the largest and richest municipality in the country (approximately 12 million inhabitants), which is where our movement, VivaSus, is based. Over the past 20 years, São Paulo has undergone an expansion of private contracts within public health, where private companies are hired through public bidding processes. These companies today dominate more than 80% of public health jobs. As a result, there has been a shift in workers’ organizational power as a class, since there are numerous such companies scattered throughout the city, making it difficult to unite workers from different companies around a common struggle. 

In addition, there has also been the implementation of performance targets stemming from the introduction of electronic health records and service digitization, with an increase in individualized monitoring and growing worker overload. While technology can, on one hand, increase work efficiency and consolidate data and information for better care, the implementation of these technologies through private companies has been distorting work processes, with metrics that hold only workers accountable — there are no metrics related to, for example, reductions in health conditions among the population (number of people vaccinated, prenatal visits completed, infectious diseases reported, etc.). Instead, only procedures and appointment numbers are used to calculate “efficiency” targets, following a neoliberal logic of “efficiency” that fails to account for fundamental activities such as family meetings, time spent explaining health actions, patient reception and support, and community-oriented actions. 

The implementation of electronic health records and performance targets, under this neoliberal and individualizing approach to health, combined with the bidding out of health facilities to private companies, also brings another problem: health policies are no longer developed through public discussion involving workers and civil society, but are instead determined by a small number of politicians and business owners who hold de facto — not legitimate — power over the increasing determination of public policy. One example of this type of political decision can be seen in the installation of facial recognition security cameras in health units, already underway in the city of São Paulo, which has already led to the arrest of health service users — something that directly violates the confidentiality of care. Where might this type of policy lead, becoming ever more distant from public scrutiny and increasingly determined by a small number of health oligarchs? In summary, the privatization of health care in São Paulo is leading to an ever-increasing implementation of neoliberal control over health practice, combined with a loss of organizational capacity among both the working class and the civilian population.