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Which priorities should the Ministry of Health set for 2021-2022? Opinions of the citizens

Primary health care is the main priority of the Ministry of Health in terms of implementation of health care reform. This was proclaimed by the Deputy Minister of Health of Ukraine for European Integration Ihor Ivashchenko during a public discussion “Priorities of the Ministry of Health of Ukraine for 2021-2022: what do the citizens and the medical community expect?” on March 10.

“Primary health care makes it possible to secure the population with disease prevention measures as much as possible. 60% of the provided medical services should be concentrated in the primary health care, but so far this result has not been achieved yet,” said the Deputy Minister.

However, the Ministry of Health together with the National Health Service of Ukraine is already taking steps in this direction by introducing the indicators of the quality of medical care and expanding the scope of competence of family doctors (mental health, rehabilitation, etc.).

“The position of the Ministry of Health and the National Health Service of Ukraine is that much more needs to be done in respect to the primary health care,” assures Ivashchenko adding that at present the patients can receive some medical services, which should be provided at lower levels, only in highly specialized medical institutions.

In the field of the medical care quality control, the Deputy Minister supports the idea of creating a new specialized agency. And at this point, the eHealth system already allows to monitor provision of medical services to the population.

Changes are also needed in the system of remuneration of medical workers and the deputy minister assures that “We need to reduce the universal rate of pay and increase the payment for each individual case of medical treatment.”

“In the West, 70% of medical services are provided at the primary level. Therefore, Ukraine should focus on the same result,” says co-founder and secretary of the Kharkiv Expert Group for Support of Medical Reform Mykhailo Dovhopol. According to him, the Ministry of Health took measures in the field of primary health care 1.5-2 years ago, and now “the ball is already on the side of medical institutions.”

“We need to change the approach itself: go from the position of “doctor, treat me” to “doctor, let’s monitor my health together,” adds the expert. Another important issue is the openness of medical data to the patients. Dovhopol offered to publish a list of all services provided at the medical institutions.

“One of the priorities of the Ministry of Health should be to preserve the health of schoolchildren and adolescents,” believes the executive director of the International Charitable Foundation “Ukrainian Public Health Foundation”, a member of the Board of the RPR Coalition, Halyna Skipalska.

“Promoting healthcare among adolescents will have a positive impact on public health in general. Investing in adolescent health will reduce the cost of health care in the future,” thinks the expert.

She identified the provision of universal access to medical and preventive healthcare services to adolescents as the key task for the Ministry of Health, as well as the study of factors affecting the health of adolescents and the legislative implementation of their rights to health care (for example, reducing the age at which a person can choose a family doctor).

The main goal and priority for this and the following years is to form an effective, needs-oriented integrated network of health care facilities in the regions in the context of decentralization and change of administrative-territorial structure. This was pointed out by Yevhen Prylypko, Chairman of the “Healthcare Transformation Forum” Expert Public Association and USAID hospital network planning consultant.

Among the main problems in the medical field, he considers the lack of:

According to the expert, the sources and flows of reliable data for analysis and decision-making are being destroyed. He notes that “While analysing the network of institutions, the only primary source is and remains to be the structured statistical data, which is still collected using the same reporting forms that many health professionals and managers would prefer to get rid of.”

Lilia Olefir, executive director of the Advocacy Center “LIFE”, drew attention to the importance of prevention of non-communicable diseases – those caused by lifestyle, genetics, ecology, etc. Those diseases are the leading mortality factors worldwide. “Tobacco kills more than 85,000 Ukrainians every year. That exceeds the statistics of mortality rate from road accidents and AIDS combined. And for the economy – it is UAH 90 billion of losses annually,” noted Olefir.

According to the World Health Organization, 34% of Ukrainian adults are smokers. However, electronic cigarettes and electronic heated tobacco products (HTP) are becoming increasingly popular among the youth.

“There is no safe smoking. Vapes, IQOS and other products contain heavy metals, glycerin, propylene glycol and the like. But at the moment there is no legal ban on the sale of electronic cigarettes and HTP to the minors. Even though the strengthening of anti-tobacco legislation does not require additional budget expenditures. What is more, 87% of Ukrainians support it,” argues the executive director of the Advocacy Center “LIFE”.

The only problem in this issue, in her opinion, is the tobacco lobby in the Parliament. It bears reminding that the Reanimation Package of Reforms Coalition is now organizing a series of online discussions of the Government’s Action Plan for 2021-2022.

“The RPR Coalition has come up with a creative position to include proposals from citizens, doctors and experts into the Government Action Plan. The final stage of this discussion will be the preparation of a comprehensive document with recommendations, which we will send to the Ministry of Health,” emphasized Denys Denysenko, Executive Director of the RPR Coalition.

This public discussion was organized by the Reanimation Package of Reforms Coalition together with the Institute Respublica with the assistance of the National Democratic Institute and with the generous support of the British people through the United Kingdom Good Governance Fund.