Ukrainian Health Ministry officials accuse new management of political pressure

Civil servants within Ukraine’s Health Ministry have addressed an open appeal to Prime Minister Oleksiy Honcharuk in which they say that the new management is jeopardizing the future of healthcare reforms in the country. While the authors of the appeal do not mention any names, it seems likely that the new management is that installed following the removal of the former (acting) Health Minister Ulyana Suprun.

The authors express concern over pressure on the management of directorates, which they call an example of political repression. It’s enough to have your own opinions and the strength to defend the law and reforms for them to push you to leave voluntarily.  The authors assert that they are being directly told that now you need to work according to gang code. 

“Ukrainians are entitled to know that the actions of the management within the ministry are radically different from what comes out in public statements”.  It was claimed at the beginning, they write, that the President, Parliament and the Ministry all considered it a priority to continue healthcare reforms.  The authors, however, are writing to say that these reforms are on the verge of collapse and that the work of the Ministry has been effectively paralyzed for the last three and a half weeks.

This Is resulting in a situation where:

even the documents needed for procurement and supplies of medicine for the gravely ill are not getting signed;

the procurement of ambulances in pilot regions are being blocked, with this meaning that they won’t be bought for the coming years, including in the Donetsk oblast where there is military action;

the process has been suspended whereby the Oncology Institute, the Cardiology Institute; OMXATDIT; the Institute for Paediatric Cardiology gained autonomy. Services in those institutions were supposed to become available for all from 2020 as part of the Program of Medical Guarantees in accordance with the Law on State Financial Guarantees of Medical Services for the Population;

all normative acts needed for the timely start of the next stage of medical reforms at the level of ambulatory and operation-based medical care are being blocked;

all normative documents and decisions for the normal work of the National Health Service are being blocked.  This involves ensuring the normal work and financing of over one thousand medical institutions of primary care and the program ‘Accessible medicine’;

there has been no confirmation of a register of prices for the National List which would make it possible to avoid overpricing of medical supplies which are purchased by medical institutions independently via the Prozorro system. It is thanks to this that institutions can ensure more free medicines for their patients during treatment in hospitals.

“Each of came to the public service to serve the interests of our citizens, not the benefits of a particular political party. We want to fulfil our job responsibilities independently and professionally within limits and in the manner provided by the legislation of Ukraine and the Constitution of Ukraine. We are not afraid to go through any audits as we are confident in the transparency and professionalism of our work.”

The last paragraph above comes from an appeal in English to Ukraine’s partners, also circulated on social media on 24 September.  This spells out in rather more detail the reforms that were underway until recently.

The authors express their readiness for open dialogue in conditions of professionalism and transparency.  They ask the Prime Minister to become the intermediary for such dialogue as soon as possible in order to continue medical reform.

The reforms underway, at least until recently, were initiated by Ulyana Suprun who was appointed Acting Health Minister on 27 July 2016.  There was considerable resistance to her reforms from the government, however she had very wide support from civil society, and her removal after the parliamentary elections was regretted by many.

Suprun’s reforms began with changes in 2018 to the system of primary medical care.  Patients began being treated by a family doctor, a GP or paediatrician whom they (or their parents) chose themselves. The medical institutions in which these doctors worked began reaching an annual fee for serving each patient with whom they had a contract. From 2020 all of the system of medical care was supposed to go over to direct payments from the National Health Service.

These reforms, it appears, are now in danger.