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About the project

The current healthcare situation in Ukraine
About the project
Consortium

The current healthcare situation in Ukraine

In the 19th and  20th centuries the accepted idea was that the more hospitals that were built the better would be the health of the population. This is no longer the case. New technology and research into efficient and effective ambulatory care, with improved PHC-based services, is making inpatient management for many conditions redundant.

Apart from emergency care and serious complex or intensive care, management of clinical conditions in hospitals has traditionally included (a) long stays in hospital beds for stabilising chronic illnesses such as hypertension and diabetes, (b) isolation of patients with communicable diseases in hospital beds, or for special diseases like TB in sanatoria or specialist TB hospitals, (c) non-complex surgical treatments which required long stays in hospital because rehabilitative or community based follow up care was poor or non-existent, (d) most investigations or diagnostic services which were only available at hospitals, (e) admissions for social reasons rather than purely medical or surgical, (f) access to specialist consultant opinion, as they worked inside hospital buildings. Many chronic conditions are nowadays treated and followed up only in PHC or as day cases in polyclinics; many diagnostic tests no longer require people to be admitted to a hospital bed; earlier effective diagnosis of diseases has avoided inpatient care for preventable late complications; new drug therapy regimes for TB mean these patients can be safely treated and monitored in the community; IT technology has enabled specialist consultations at long distance (telemedicine); new surgical techniques mean postoperative recovery is faster and less traumatic, and long bed stays are considered counterproductive because of recognised risks of deep venous thrombosis or bed sores in vulnerable patients.

A positive trend towards reducing redundant hospital beds began in the early 1990’s but halted in 1996, coinciding with the introduction of  Article 49 of the 1996 constitution.
Ukraine is finding itself somewhere in the middle of the transition from the 20th century concept of secondary care as ‘physical buildings’ and ‘beds’ to the 21st century understanding of secondary care as ‘functional service organisation’, ie  effective ‘functionality’ is the key factor for SHC to get right.

Health systems will always need some hospital buildings for inpatient care –but those that become surplus to real needs in the modern age have opportunities to convert to also needed specialised facilities for specific purposes, eg nursing homes, hospices and rehabilitation centres. Flexibility and evolution is intrinsic to nature - those systems that can adapt to changing circumstances will survive and thrive. Governments which can foster this process by strategic guidance on improving quality and building human resources, and develop supportive legislative and normative mechanisms, will reap the benefits in the long term, especially should new mechanisms of funding health care such as health insurance come into play.

According to the WHO (HIT 2004) 64% of total (public) healthcare expenditures are used for hospital inpatient care, 18% for outpatient care and 11.5% for pharmaceuticals. The rest 6.5% is used for capital investments, repairs and renovations.

Constitutional guarantees to free health care (Article 49) have created particular challenges in pursuing structural reform in the health care sector which to this day is managed as a publicly integrated and financed health care services monopoly. Public finance constraints are also evident. On the other hand, private hospitals and clinics are springing up with little evidence of being guided by any strategic global assessment of their relationship to actual need within the umbrella of the national system of health care.

The project will build on the results of previous EU supported projects in proposing approaches to structural reforms to address the consequences of inequities and inefficiencies in the health sector, and in secondary care in particular.

Despite the uncertain political situation in the country, the economy has been growing steadily since the crisis years of the 1990’s: basic economic indicators illustrate a much improved situation in terms of both key indicators and employment although the rate of growth has slowed. Improvements in the economy are also reflected in some key health indicators which have stabilized and slightly improved . There is, however, little room for complacency. Health indicators particularly are extremely weak when compared to those of neighbouring countries in the European Union, and early morbidity and mortality from preventable causes in males remains a serious concern.

The main challenges facing public health care services in Ukraine are well documented and include:

  • A high disease burden compared to neighbouring countries and an ageing population;
  • A highly centralized administration of the health care system with an inflexible, over-burdening bureaucracy and state and municipal medical facilities having extremely limited managerial and decision making power;
  • The quality of services, facilities and skills has eroded through decades of capital under-investment and strict (recurrent) budget control leading to weak institutional capacity and poorly paid and motivated staff;
  • Few incentives or structures to promote the rational and effective use of resources, including poorly developed implementation of evidence-based clinical guidelines;
  • No separation between payer and provider functions;
  • Input-based service reimbursement rather than on other basis, eg meeting criteria or (evidence-based) standards;
  • Growing out-of-pocket payments (official as well as non-official payments) and increasing financial barriers to access to certain services;
  • Low level use of new medical and information technology and communication systems within SHC facilities;
  • Inadequate control over the large-scale advertising of drugs to the public by pharmaceutical companies through the media and through actively encouraging and rewarding medical professionals to promote their products.

Although these are well recognised problems little progress has been achieved in recent years, and successive governments have yet to successfully deal with them. The Health Plan to Year 2010 approved by the Cabinet of Ministers (13 July 2007) is an attempt to set a road map for addressing these problems.

About the project

In 2004-5, the government of Ukraine, through its Ministry of Health, requested assistance from the EU to reform its present secondary health care system, having recognised that it is saddled with overly restrictive and contradictory laws, regulations and rigid norms, and with inefficiencies of practice which could release much-needed funds back into the system if corrected.  The present EU funded project was therefore designed to directly answer the request of the MoH. The project established contact with officials in the MoH in August 2007 upon its commencement, and has begun its technical support to the reform work being undertaken by the Ministry both at centre and in three pilot regions. Experts within the project collaborate with educational institutions to build skills and capacity for health service management, and with other organisations and donors working in the same fields. The project works with regional health departments at practical options for improving health care in their areas, and supports them in master planning and business planning.

The Project  «Support to Secondary Healthcare Reform in Ukraine» has started its work on 6, August, 2007 and will run till December, 2009. The overall objective of the Project is to support the establishment of an effective, cost-efficient and equitable health care system in Ukraine, which will be supported by introducing systematic secondary health care reform.

In the course of the Project’s two-year life cycle, bodies of authority will be receiving assistance in infrastructural and organizational development at the secondary healthcare level in 3 pilot regions – Zhytomyr, Kharkiv and Poltava.

The project tasks are the following:

  • To increase government capacities in relevant Ministries for the preparation and implementation of healthcare sector reform;
  • To promote better hospital care through creating opportunities for Ukraine –EU institutional twinning and exchanges;
  • To increase local government capacities for the management of health care services in selected oblasts;
  • To demonstrate improved financial management models of secondary care aiming at improved coverage, quality and efficiency in three pilot regions: Zhytomyrska, Poltavska and Kharkivska oblasts;
  • To develop improved performance accountability and enhanced equity of access of hospital facilities, validated by health care information and monitoring system;
  • To establish and initiate sustainable hospital infrastructure planning at the oblast level;
  • To develop an institutional framework for training on hospital management and hospital infrastructure planning and offer a training program for health service managers and representatives of relevant medical organization/institutions.

 

The project uses the experience of the three previous EU projects in healthcare: “Preventive and primary activities of health care”, “Health Financing and Management in Ukraine” and “Support to the development of system of medical standard system in Ukraine.”

The project is implemented by EPOS Health Consultants in consortium with ECORYS and NI-CO, a group of European companies which are the leading technical assistance providers in Europe.  The team leader of the project is Oxana Abovskaya.

Consortium

The project is implemented by EPOS Health Consultants in Consortium with ECORYS and NI-CO.

EPOS’ Areas of Competence

  • Health Policy and Financing
  • Primary Health Care, Sexual and Reproductive Health, HIV/AIDS
  • Health Facilities and Services

 Health Facilities and Services

  • Realisation of Needs Assessment and Feasibility Studies
  • Development of Strategic, Master, and Business Plans
  • Planning of Health Infrastructure and Medical Equipment, Procurement Management
  • Management of Health Facilities and Services including Financial, Human Resources, and Physical Asset Management
  • Development and Implementation of Quality Management Systems including Standards, Guidelines, and Performance Monitoring
  • Evaluation of Health Services, Certification, Licensing and Accreditation
  • Design and Implementation of Training Programmes for Clinical, Technical and Managerial Staff
  • Introduction of Health Management and Hospital Information Systems, as well as E-health, and E-learning-Systems

Projects in the Region

  • Health Financing and Management, Ukraine (2003 –2005), European Commission / TACIS Program (partner)
  • Primary Health Care and Prevention, Ukraine (2003-2005) European Commission / TACIS Program (partner)
  • Public Health Reform Project in Moldova (2005 – 2007), European Commission/TACIS Program: The team is working on improvement of the health services planning and financial management procedures at secondary health care level in Orhei pilot rayon hospital
  • Health Promotion and Disease Prevention Project in Moldova  (2002-2005), European Commission/TACIS Program

NI-CO

  • Dedicated UK international project management company
  • Established by the Department of Enterprise, Trade and Investment in 1992
  • 15 years of experience in management and project delivery –  over 300 projects in 60 countries
  • Specialists in project management with extensive experience of EU technical assistance projects
  • Dedicated project management support team of over 25 specialists
  • Experience in delivering numerous health and social care development projects in Central and Eastern Europe
  • Strong links with UK NHS and health institutions

Selected  NI-CO regional experience

  • 2001-2004 World Bank – Russian Federation: Provision of technical assistance for the National Training Programme in Family Medicine Component of the Health Reform Pilot Project
  • 2001 – 2002 World Bank - Uzbekistan: Evaluation of Primary Healthcare Project – Training of GPs
  • 2002 – 2005 EC – Russian Federation: Establishing a national movement for the introduction of a general practice based Primary Healthcare System
  • 2005 – 2007 EC- CIS: Managers Training Programme IV
  • 2006 – 2008 EC – Russian Federation: Improving the Health Status of the Kaliningrad Region

Selected Ukrainian experience

  • 1999 – 2002 DFID: Enhancing the capacity for the delivery of social assistance benefits in Lviv and Kharkiv Regions
  • 2003 – DFID: Social Insurance Health Scheme – Management Information System
  • 2004 – 2006 EC: Support to the Development of a System of Medical Standards
  • 2005-2007 - Global Opportunities Fund: Building Administrative Capacity for EU Integration
  • 2007-2009- EC: Assisting the Main Control and Revision Office in implementing a new system of Public Internal Financial Control

ECORYS Group

  • Leading international company specialising in research-based advice on economic and social development
  • Working for clients in the public, private and not-for-profit sectors
  • 20 offices in 11 countries (incl. Kyiv)
  • 550 in-house staff
  • € 80m+ turnover

ECORYS – Health Care

  • Health Team consists of highly qualified professionals, including health economists, health management specialists and public health experts
  • ECORYS works within the EU 27, countries in transition and developing countries
  • Major clients include: the European Commission, the European Investment Bank, the World Bank, the DFID,  Patient and Consumer Organizations, the Netherlands Competition Authority, the Dutch Investment Bank for Developing Countries, the Council for Public Health and Healthcare, Ministries of Health, the Council for Health Insurance

ECORYS provides research, advice and TA in the following fields:

  • Health care financing
    • Public expenditure
    • Health insurance
    • Payment mechanisms
  • Health care systems/reform  Health care strategies
    • Priority setting in health care
    • Determining health care benefit packages
  • Health care markets and regulation
    • Organization of health care
    • Regulation
  • Investing in health care Investments in hospitals and medical technology
    • Innovation
    • Education and capacity building
    • Labour market policy in the health care sector
  • Health policy analysis
    • Evaluation of specific interventions/ (research) programs/regulations
    • Health technology assessment

ECORYS Health Care – Projects

Feasibility and appraisal of investments in hospitals and medical equipment (worldwide, multiple clients)

  • Review of methods for projecting hospital cost in the Netherlands, the Dutch Patient Confederation
  • Framework contract LOT 8: Health, EC
  • Multi-country review of Public Expenditure Tracking Surveys (PETS), World Bank
  • Analysis of the Management of the Global Fund 2nd Round in Botswana, EC   
  • Introduction of Sector Wide Approach (SWAP) for health sector in Moldova, EC
  • Evaluation of SIRHASC (Institutional Response to HIV/AIDS/STI in the Caribbean), EC
  • Health Management Training Programme in Serbia, EC
  • Evaluation of Health Investment Fund in Moldova, World Bank
  • Feasibility of Imperial Hospital Ltd., Bangladesh and a Nursing Training Centre, Dutch Bank
  • Philippines: Health Sector Policy Support Programme – Public Finance Component, EC
  • International Comparison of Arrangements for Long Term Care, Netherlands Ministry of Health
  • Due Diligence Hospital Investments in Germany, Austria, Netherlands, France and Romania, EIB
  • Russian Federation, State Budget Reform, EC
  • International Comparison of Entry Barriers for Medical Professionals, Ministry of Economic Affairs (NL)
  • Russian Federation: Sectoral Public Expenditure Reviews (health, education and housing sectors), EC
  EposEcorysNI-CO
This project is funded by European Union This project is implemented by Consortium EPOS Health Consultants with ECORYS and NICO
     

The views in this publication do not necessarily reflect the views of the European Commission.