Op-Ed: Health Care Reforms that Have Been Started Must Not End with the Replacement of the Minister

There is a risk that the attempt to fundamentally reform the Ukrainian health care system will be put on hold and, furthermore, that some initial successful steps will be reversed. On April 14, the Parliament approved the new Cabinet of Ministers, without appointing the Minister of Health. 

After more than two decades of mismanagement and endemic corruption in the sector, over the last year, we have finally seen relatively consistent attempts to transform the health care system and address its deeply-rooted problems. Nevertheless, the most fundamental changes are yet to be designed, passed into laws, and implemented and this why the immediate appointment of a Minister and a correct choice of candidate is paramount.

Ukraine has changed 19 ministers of health over the 25 years of independence. Today, the chance for a successful reform is critically sensitive to professionalism, integrity, and consistent work of the minister and their team. Whoever is appointed – this person should be truly devoted to continuing radical reforms that have been started, be willing to use the best international practice, and involve the public as well as international and local experts into the process of reforms.

The recent reforms that have been undertaken and are now at risk of impasse or even reversal include:

• The shift to procurement of medicines, vaccines, and medicinal products through international organizations. In 2015 nearly half of the volume of centralized procurement of drugs and vaccines was organized through international agencies (UNICEF, UNDP and Crown Agents) to avoid the traditional corruption schemes. This mechanism brought tangible results. The cost of some medicines (e.g. cancer treatment drugs) for the state budget was up to 60% lower compared to previous years, though shifting to the new system did cause temporary delays with supply of drugs and vaccines to drug stores and hospitals, raising discontent of the general public. 
• The health financing reform: setting up a new financial model with clear state guarantees, better financial protection for citizens, effective and equitable distribution of public resources. IIn 2015-2016 the intersectoral expert group under the Ministry of Health, with support of the World Health Organisation (WHO), developed a new system of health financing in Ukraine which involves (i) a state-guaranteed package of health services, (ii) a single national purchaser of health services, (iii) a new mechanisms of payment for medical services (the “money follows the patient” principle), (iv) strengthening the role of communities (the new roles of the central government and local authorities). The Respective Concept is ready to be adopted by the Cabinet of ministers. The nearest steps include development of legislation for the new system. The working group is already in place and has started working.
• Providing financial and managerial autonomy to the health care facilities. This was the first fundamental step towards changing the way the health care system is financed and towards reducing its dependence on the state budget. The parliament adopted in the first reading the law on granting managerial and financial autonomy to health facilities. After (and in case of) adoption of the law, the hospitals will get a right to change organizational and legal status of the health facility. The right of the hospital manager to decide on allocation of the facility budget, and to enter into economic relations with the customers are the backbones of efficient use of resources and high quality services.
• Sectoral decentralization in health care. The Ministry of Health and the Ministry of regional development developed an intersectoral roadmap of health care services decentralization. The key elements are: developing a new system of primary care organization at the level of amalgamated communities and establishing hospital districts for secondary care network. If done right, the decentralization of services and transfer of  decision-making and responsibility to local communities can increase efficiency and quality of services, and facilitate development of new leaders in the area of public health. The following steps include developing proper legislation and starting pilot projects in model communities.
• Introduction of a modern national Public Health system focused on prevention rather than treatment. The MoH`s working group prepared a concept of public health system development. The notion of “public health” envisages organized efforts of the society to prevent disease, promote health and prolong life of the citizens. Such efforts, e. g., include health status and risk-factors surveillance and making use of this data in policies development, health security system capable of preventing and responding to emergency, food, water and air safety assurance measures, efforts to guarantee healthy working and housing conditions, policies tackling poverty and discrimination as damaging for health, etc. Public Health “systems” in the developed countries have been uniting these functions into coordinated system with clear leadership, governance and adequate resource supply, which works for the sake of good health of people. The Concept of the MoH foresees building this holistic set of operations on the basis of a new Public Health Center, similar to those which exist in other countries (Centre for Disease Control in the US, Public Health England in the UK). It is planned, that The State sanitary-epidemiological service will be reorganized to serve the needs of the Center, being deposed of its inspection and supervision functions, which have long been the sources of corrupt practices.

Despite the ground-breaking character of the initiated changes, they represent just the first steps on the way to a truly reformed health care system in Ukraine. In order to produce visible results, they need to continue regardless of the political environment. The  reform has been facing and will continue to face fierce resistance of vested interests and the lack of trust of general public.

There is a danger that without strong leadership the reforms will fade out, having made no real impact on the life of Ukrainians. Therefore, a new minister who will be able to protect and intensify the process has to be appointed as soon as possible. While the new minister has to be able to garner both political and public support for the reforms, it is not his or her political affiliation that matters. The only thing that counts is their desire and ability to push through the reforms that would make the health care system people-oriented, implementation-focused, and outcomes-oriented.

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VoxUkraine Editorial Board
Reanimation Package of Reforms
Ростислав Аверчук, VoxUkraine, співавтор відкритого листа
Ксенія Алеканкіна, VoxUkraine,
Вадим Бізяєв, Київська Школа Економіки
Володимир Шимко,
Андрій Яковенко,Chief Scientist, ФОП
Володимир Шамрай,
Юлія Самородова,
Сергій Шульженко,
С. Ємченко,Студент ДНУ ім. О. Гончара
Максим Ситник, Економіст
Богдан Кріпак, Інженер-програміст CyberVision
Людмила Гордон, лікар-рентгенолог МЦ “НАША РОДИНА”
Наталя Півень, Міністерство Охорони Здоров’я
Павло Ковтонюк,
Сергiй Яковлєв,
Віктор Ляшко, PHSA
Ярослав Юрчишин, Керівник відділу адвокації Реанімаційний Пакет Реформ
Антон Марчук,
Олена Шкарпова, Редактор VoxCheck
Дмитро Остапчук, VoxUkraine
Олександр Сіленко,
Роман Переверзєв, Бухгалтер Корпорація “Укратомприлад”
Володимир Міщук, Асистент кафедри анестезіології та інтенсивної терапії Львівський національнмй медичний університет ім Данила Галицького
Олег Петренко, Deputy CEO, strategic development ISIDA-IVF
Віталій Юрків, юрист
Олександр Жигінас
Наталія Кириченко, Радник заступника Міністра, МОЗ
Руслан Червак, Головний лікар, Інтерсоно Медікавер груп
Павло Замостьян
Іван Юсин, лікар
Володимр Хильчук
Сергій Дацюк, продавець, Львів
Артем Яцунок, Фельдшер, Швидка медична допомога
Максим Скубенко
Володимир Пляцек, Завідувач Центром радіології НДСЛ “ОХМАТДИТ”, Національна дитяча спеціалізована лікарня “ОХМАТДИТ”
Oksana Kachurets, Teacher, University of Kyiv-Mohyla Academy
Ігор Трубич, лікар-кардіолог, комунальна 2 МП м. Львів
Світлана Пиріжок, пенсіонер
Олександр Ябчанка, Менеджер медичної групи, Реанімаційний Пакет Реформ
Julia Dudarenko, Financier, Thor Print Ltd.
Богдан Малиняк, ГО “ЕАГ “Акцент”
Ростислав Камерістов, Лаборант, Львівський національний університет імені Івана Франка
Фрейгофер Марина, лiкар-анестезiолог, КЗ”КОД ДОР’
Олександра Бетлій, Інститут економічних досліджень та політичних консультацій
Валерій Кідонь, Директор з розвитку, Агенція Медичного Маркетингу
Ольга Демешко, Менеджмент проектів, БФ “Пацієнти України”
Сергій Герасименко, Студент, ДДАЕУ
Юлія Собко
Олександр Головкін, юрист, ТОВ “Одеське шляхо-будівельне управління”
Алла Серветник, Заступник головного лікаря, Рівненський обласний перинатальний центр
Костянтин Боровський, Заступник директора, Український центр томотерапії
Олександр Зарицький, заступник директора, ТзОв Сапоніт інвест
Дмитро Кравчук, Аналітик, Nielsen
Виктор Ишков, детский хирург
Olena Ivanova
Василь Михальчук, Зав. ввдділенням, Облтубдиспансер
Андрій Забловський, Керівник Секретаріату, Рада підприємців при КМУ
Ігор Радченко
Ірина Романова, завідувач КДЛ, КУ “Мелітопольський міський пологовий будинок” ММРЗО
Анатолій Велімовський, Голова наглядової ради КМКЛ ШМД
Ірина Коссе, старший науковий співробітник, Інститут економічних досліджень та політичних консультацій
Віктор Думенко, Лікар, КМКЛ12
Yuriy Baiun, Head of center neurosurgery, Kyiv Regional Hospital
Олеся Цикалюк, Міністерство охорони здоров’я

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