Update on critical situation with anti-tuberculosis units in the Kharkiv region
As reported already, the Kharkiv authorities have taken the extraordinary decision to significantly reduce the network of anti-tuberculosis units in the city. According to Order No.1, issued on 3 January, three out of the four present four inpatient units are being closed, as well as two of the five for outpatient care.
This is already a reduction from 575 to 230 beds however the Deputy Mayor Ihor Shurma predicts that these beds will also go in 2009. He claims that the upkeep of these units is to be funded from the regional budget and the city has not received any money for this purpose. He says that the city has been spending 15 million UAH per year and that at the moment this money is needed for construction aimed at Euro-2012. The Deputy Head of the Regional Administration disagrees and maintains that treatment of city residents in regional clinics cost considerably more – 43 million UAH and that the city authorities are not returning this money.
The assurances from the Regional Department of Health that an additional network of places will be provided beg the issue of why the places were removed at all when the 600 places in the three anti-tuberculosis units for the region (oblast) located in the city are totally full up.
If the inpatient facilities of City Clinic No. 1 are reduced, then the funding for the regional units will have to cover patients from the city. At present the regions anti-tuberculosis units have 1070 inpatient places and 380 places in sanatoriums this being clearly not sufficient. One will need to forget about hosting Euro-2012 in the city due to the likely tuberculosis epidemic.
As mentioned, last year 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)
As of 1 January this year, there were 4,728 people with an active form of tuberculosis in the Kharkiv region. Of these around 1500 are coughing etc the bacillus and need inpatient treatment. Of this number 613 (298 in the region and 315 in Kharkiv itself) have a drug-resistant form and need to be in a clinic on a permanent basis.
Each person in this situation could infect 20 others in a year. Nor is there any guarantee that all patients will agree to be transferred from the city to sanatoriums in the region.
Order No. 1 envisages outpatient treatment for patients coughing or otherwise expelling bacteria in three locations, with only one after the total closure of Clinic No. 1. The creation of a single outpatient centre fails to take into account the condition of the patients, their ability to visit the centre each day, using public transport, with the likelihood that they will be infecting others. 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.
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.