KRUK REPORT: Ukraine feverish as giant healthcare reform hangs in the balance

KRUK REPORT: Ukraine feverish as giant healthcare reform hangs in the balance
President Petro Poroshenko visits a hospital in Ukraine's Dnipropetrovsk region in February 2017.
By Kateryna Kruk in Kyiv May 19, 2017

This week the Ukrainian parliament, the Verkhovna Rada, was back at work after an almost month-long break. The past month was a period of intense political negotiations, with the fate of the government on the table.

The replacement of Prime Minister Volodymyr Groysman now looks improbable because there is not a coalition that can produce enough votes to advance a new candidate. But changes among ministers are almost inevitable. Analysts name three to five likely candidates who will soon leave the cabinet.

But while speculation builds about the future composition of the government, it is important to remember that some key reforms are being decided these days. In particular, parliament is considering a bill on reform of the health care system, in probably one of the most comprehensive and boldest reforms Ukraine has ever seen.

Achieving a medical miracle

There are three aspects of the proposed reform that change the status quo. Currently, money from the state budget is spent on maintaining just the basic hospital network, so essentially the state pays to keep the hospital walls standing, not for services received by patients. We inherited this system from the Soviet Union, where the state determined how many hospitals there should be in a republic or region and how many doctors should be in a particular hospital, based, incredibly, on the amount of  floor space of the hospital. So the network of hospitals and number of doctors were not determined by local needs, but according to norms set out on paper in Moscow or Kyiv.

Under the proposed reforms, the state creates a list of services that are guaranteed to every citizen and will be 100% covered from a state budget. If only this change is put in practice it will be little short of a miracle. In Ukraine, it is stipulated everywhere on paper that citizens should have free medical care. In reality, when patients go to see a doctor they must always bring money with them, including to pay for the rubber gloves and antiseptics he or she might use when treating you.

It developed into some kind of obligatory custom that whenever you go see a doctor, you must take them some confectionery, alcohol or hard cash, depending on the severity of your problem. To have a package of services that covers the most basic needs and is absolutely free might sound elementary for some people abroad, but for Ukrainians it will be a ground-breaking move for one simple reason: it will give security that in case of need, you will get the required help no matter how much money there is in your pocket.

Global outlook

Secondly, Ukraine will start using international protocols for treatment. The medical protocol is an instruction of how a doctor is expected to treat a patient. It’s not hard to guess that most of them were inherited from the Soviet Union. Why are good protocols so important? Because currently in the worst case scenario a doctor won’t be charged for a patient’s death if they blindly followed the protocol – even if a protocol is outdated, bad, and caused death in the first place.

As fantastic as it sounds, in Ukraine some diseases are required to be treated the same way they were treated 20, 40 even 60 years ago. Introducing medical protocols that are recognised and used in most Western countries means Ukraine will be using the best practices and world standards in the treatment of patients.

But this is not the only positive outcome. It is also about integrating Ukraine and its doctors into a global network of medical science. It’s about shifting the focus of where you’re looking for the best practices; so far this focus was Russia and the Russian-speaking post-Soviet space, but under the reform plan it can now be Europe and North America.

Surviving to implementation

The goal of the reform presented by Dr Ulana Suprun, the acting head of the Ukrainian Ministry of Health since 2016, and her team, is not to try to cure the ills of the existing system, but to build an entirely new one. This reform is also a definitive goodbye to old Soviet practices and the introduction of Western standards into Ukrainian medicine.

Some aspects of the reform have already been put in motion by government decrees, but in order to institutionalise it, the Rada should pass a law on new financial guarantees for the Ukrainian healthcare sector. But when it comes to the Ukrainian parliament, the main question is will Ukraine’s biggest reform become a hostage in a political game for power?

The only good reform is an implemented reform. Suprun’s ministry is ready to start a full-scale overhaul of the Ukrainian healthcare system. The fear now is that the Rada will become so immersed in the negotiations over possible changes in the government that it will ‘lose’ the health care reform somewhere on the way.

Civil society strongly supports the reform and the team of the health minister, and is busily advocating that the reform is passed. At the same time, opposition to the reform and to the minister’s team is very high. Suprun is not only working on major reform of the healthcare system, but is also fighting corruption in this sphere. She introduced a new system of nominating head doctors via open competition, implemented a big programme called Affordable Drugs, thanks to which pharmaceutical companies reduced prices of drugs, and continues to champion the idea of drug procurement being carried out by international organisations.

Thanks to these actions and many other more, corruption in healthcare has been significantly cut. But the whole process carries a potentially nasty sting in its tail: many of those who benefited from the corruption schemes in the health sector are in parliament now. So there is a very real fear that healthcare reform can be buried by those who profited from the system’s slow decay in years past.

Some are speculating that the acting minister herself can become a victim of political intrigues aimed at avoiding snap elections. Being a political outsider doesn’t help at times like this. On the one hand, Suprun and her team have showed significant results and deserve the strong support from Prime Minister Groysman. Healthcare is one of the government’s priorities and Groysman genuinely seems to support the ambitious reform plans. On the other hand, it is a good moment for any political party to jump in right before the start of the big reform, free-riding on all the effort and input that was done by the ministry during past nine months.

Yet civil society has no doubt: if Suprun and her team have to clear their desks because of a government reshuffle, the question arises whether the reform will ever get off the starting blocks.

The ball is in the parliament’s court. Also on the Rada’s plate are the reform of the energy sector, and the preservation of the independence of the country’s anti-corruption agencies.

Ukrainians are watching parliament very closely and hope that this time MPs won’t lose the chance to achieve something truly revolutionary for their country: to finally give people the universal healthcare that everyone professes to be so committed to providing.

Activist, journalist and co-founder of Global Ukrainians, an international network of Ukrainians worldwide, Kateryna Kruk was awarded the Atlantic Council Freedom Award for her work communicating the Euromaidan revolution to the world. She predicted a frozen conflict in July 2014, which has largely come to pass, and now comments on the progress of crucial reforms in Ukraine.