Recklessly irresponsible reduction in anti-tuberculosis units in Kharkiv
The Kharkiv Human Rights Protection Group is sounding the alarm over the extraordinary reduction in anti-tuberculosis facilities in the city.
Out of four inpatient units within the city Anti-tuberculosis Clinic No. 1, three are closing, as well as two out of the five outpatient units. The number of inpatient beds has been reduced from 575 to 230, of which only 80 are intended for people first diagnosed with pulmonary tuberculosis in active form and 60 for those with chronic bacterial excretion. Yet how can this number be sufficient for all those suffering from an active form of tuberculosis?
In 2008 719 Kharkiv residents contracted tuberculosis (this being 50 people per 100 thousand head of population, whereas one speaks of epidemic proportions if this figure is more than 40). Of these, 321 were coughing or in other ways expelling bacteria. One should also bear in mind approximately 160 chronically ill patients with an active form of the disease, who need to be in the inpatient unit on a permanent basis. Clearly there are simply not enough places, assuming a cycle of 3 to 4 months.
The Regional Department of Health assures the public that it will provide an additional network of places. However the 600 places in the three anti-tuberculosis units for the region (oblast) located in the city are totally full up. Where will they find the beds and using what funding?
It would surely have been simpler not to remove such a large number of beds, and transfer them to under the regions existing units of Clinic No. 1, not close them. And to not hand three premises over into city ownership.
Order No. 1 envisages outpatient treatment for patients who are not coughing or in other ways expelling the bacteria in three locations. Yet given the social milieu of patients with tuberculosis, can outpatient treatment provide the assurance that these patients will get the medicine they need? Not to mention the fact that the inpatient care meant that they also received meals which for some of them was also a part of their treatment.
An increase in the number of people with tuberculosis can be predicted since the time needed to gain access to a doctor, hospital space and medicine has become longer.
Moreover the Deputy Mayor I.M. Shurma says that this is merely the first phase of the reductions, and that at the second phase, Clinic 1 will stop functioning altogether since the regional budget is not providing money for treating people with tuberculosis. According to Shurma, they have to spend money on such patients which is needed for construction work towards Euro-2012.
What is going on?
In April 2008 the decision was taken by the regional and city councils to transfer Clinic No. 1 from city to regional property. However the regional council passed this decision on condition that it received extra funding from the central budget. This funding has not materialized, and the city authorities are resolving the issue in unilateral manner.
The secrecy with which this is being done is staggering. The relevant Instruction from the Mayor of Kharkiv No. 2778 from 10 December 2008 and Department of Health Order No. 737 from 28 December 2008 are not available on the official website of the City Council and we were unable to obtain access to them. The Regional Department of Health was not even warned about these measures and not shown the documents.
There is another problem. One of the units in the city which from 2004 had been holding people suffering from tuberculosis detained by the police or remand prisoners had 4 wards of 20 beds. The Ministry of Internal Affairs spent a lot of money on reconstruction and annual repairs to the building, yet this building has been closed and transferred to city property. So where are the MIA now to hold detainees suffering from tuberculosis?
The behaviour of the city authorities is a flagrant violation of the Constitution and laws of the country. Article 49 of the Constitution clearly states that the existing network of healthcare institutions may not be reduced. Not to mention Article 3, according to which: “the human being, his or her life and health, honour and dignity, inviolability and security are recognised in Ukraine as the highest social value”
KHPG is convinced that the unlawful Order No. 1 should be revoked. Such a reduction would be a time bomb which in 2010 could lead to an epidemic of tuberculosis in Kharkiv. This need not happen if the city and regional departments of health finally resolve the issue of financing together and abandon all measures on reducing the network of anti-tuberculosis units.