Medical reform locally. Zvenyhorodka, Cherkasy Oblast

How doctors evaluate the changes in the healthcare system at different levels and what the reform falls short of

Authors:

Text: Anastasiia Ivantsova, Vitaliy Protsenko

Video: Lena Shulika, Maksym Skubenko, Illya Smyk, Anna Vorobyova

Medical reform began 2 years ago. In many ways, it rested on work at the local level, since the managers of local healthcare facilities now had more powers. However, not everyone can see the results of such changes in their hospitals. What does it depend on? And when can transformation be successful?

VoxCheck, Internews, with the support of the United States Agency for International Development (USAID), and the International Renaissance Foundation, will check in a series of materials on how medical reform is implemented locally, and what problems doctors and their patients face farther away from the capital.

Our first stop is the town of Zvenyhorodka in Cherkasy Oblast. The primary care facilities there have been working with the NHSU (National Health Service of Ukraine) for nearly 2 years, since October 2018. Change does not happen immediately, as it requires a lot of money.

During medical reform, the Primary Health Care Center in Zvenyhorodka received a total of over UAH 36.8 million. Virtually all this funding was received by the institution thanks to the contracts it concluded. Another part of over UAH 250 thousand was received under a valid contract by the Center’s medical teams dealing with COVID-19 cases. Overall, the doctors fighting the coronavirus threat should receive another UAH 350,000 by the winter.

“The funds go to the doctors (with whom declarations were signed – ed.). And if we had to work based only on the funds coming from the NHSU.. the NHSU does not allocate funds to the medical-obstetric stations. And we have 28 such stations, and they serve a large number of people,” says Nataliia Yastremska, head of the Primary Health Care Center, a first-tier facility.

So the Center found another way out. They attract funds from local village councils, because medical-obstetric stations operate on these councils’ territory. The district council also helps financially. This is normal practice. Even receiving funding from the NHSU, the owners of the hospitals, i.e. local councils, still have to invest in their development like before.
In total, about UAH 20 billion is provided for in the local 2020 budgets for financing healthcare facilities on their territory.

Therefore, they were able to make their hospital better during primary care medical reform in Zvenyhorodka.

Understandably, this reform has both supporters and critics. Among the latter in Zvenyhorodka is the town’s Central District Hospital, a secondary care provider offering patients the help of specialized doctors. Not missing the “Semashko system”, they decided to reduce the number of in-patient beds in their institution, as unprofitable. However, they explain that the Ministry of Health failed to take into account Ukrainian infrastructure.

“How can a patient visit a family doctor and then intend to come up here if bus transportation is available on market days only? The market days are Wednesday, Friday, and Sunday. <…> Buses are available till noon, the market closes at noon or 1 p.m… that’s it, no more buses. How can one get to the village?” – says Vardan Ayrapetian, director of Zvenyhorodka Central District Hospital.

The institution is now learning how to operate under the new rules. Since a change in the funding rules, they have already received almost UAH 19 million from the NHSU, with the total annual amount to be received under the contract being UAH 35.5 million. Almost half of this money is spent on in-patient facility maintenance, with another quarter being spent on surgical facilities. Overall, the hospital registered 12 groups of different medical services with the National Service.

By the way, the hospitals have the right to set a list of fee-based services outside the medical guarantees program to earn extra money in this way, in case they need more of it for development. Such institutions are registered as communal non-profit enterprises having the right to conduct business activities.

Nataliia Yastremska, a primary care healthcare worker, thinks that the Central Hospital’s reservations about medical reform must be due to the fact that it is still difficult for them to see the outcomes of all the changes.

“If their work’s results depend – like in our case – on how many declarations we signed, how we serve our people, their satisfaction with our work, then they will see the results of their work,” says Yastremska.

For more information about the changes in the medical system, local failures and successes, watch VoxCheck’s future videos. A series of documentaries on medical reform in Ukraine is made with the support of Internews (with the support of USAID) and the International Renaissance Foundation as part of the “There will be reform” project.

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The authors do not work for, consult to, own shares in or receive funding from any company or organization that would benefit from this article, and have no relevant affiliations