Ukraine health system in danger of collapse as reforms stall
Alessandra Prentice, Reuters, Dec 23 2015
STAIKY, Ukraine – Paint is flaking on the damp walls and cracked ceilings of the small hospital in the village of Staiky, and much of the equipment is over 30 years old. Running hot water is not guaranteed and the hospital, serving about 2,800 people in Staiky and other villages, has not been refurbished since Soviet times. There is also little hope of a change for the better among medical staff who rely on charitable donations to buy even basic medicines and the petrol needed to visit patients in remote areas. A reform drive launched by the government has become mired in bureaucratic inertia, arguments and allegations of corruption. In Staiky, a cluster of dilapidated one-story houses on the River Dnieper, an hour’s drive from the capital Kiev, Dr Nadiya Martynenko said:
I don’t know who is writing and carrying out reforms at the top, or if they have ever been to a village and seen how people live, and with what medical services. State funds cover only the electricity and staff salaries, and over the past decade they’ve cut everything they could, and even what they shouldn’t. It’s very precarious.
Staiky is far from unique. Soviet-era hospitals across the country of 42 million are crumbling, underpayment of medical staff continues to foster a system of bribe-taking, and Ukraine’s poor vaccination rate has placed it on a blacklist alongside countries such as South Sudan. Corruption has plagued Ukraine since the country gained independence from the Soviet Union in 1991, but under Yanukovich it became much worse. Health Minister Alexander Kvitashvili, one of several foreigners Georgians appointed to ministerial positions, hoped to recreate successful reforms carried out in Georgia. But a year after his appointment, the health bill outlining reforms is stuck in the Rada. Kvitashvili told Reuters:
It’s frustrating. There are vested interests. They’re everywhere. Working with the parliament, we differ on what a basic understanding of reform is. Financially, the system will collapse in about a year if not before, because there is no way Ukraine can increase spending to a sustainable level.
The stalled health bill is one of many examples of the slow progress Ukraine is making in reforming its economy, prompting Western backers to question Kiev’s commitment to ending corruption. Squabbles in the Rada have held up other bills. Some of these are required for the disbursement of funds under a $40b international bailout program, and Kiev’s Western backers warn that its attempt to rebuild itself on transparent, democratic lines is under threat. The health ministry’s reforms were finalised in April and brought to the Rada for approval in July, but discussions have dragged on, Kvitashvili said. Part of the plan focuses on separating the procurement and delivery of health services, a system which until now has allowed most contracts to be brokered in back-room deals with little external oversight. According to a report by (an entity of unknown loyalties called) the Anti-Corruption Action Center, only six out of 6,500 authorized pharmaceutical companies took part in the procurement of HIV drugs in Ukraine in 2013, sharing among themselves a market worth $30.9m. The salaries of doctors are too low to eradicate the use of bribes between patient and practitioner, which means many of the health industry’s financial dealings are done in the shadows. Kvitashvili said:
You can see head doctors driving Porsches and having Vertu phones, but the hospitals are in an abysmal condition. (I wonder where in the capitalist universe this is not true! – RB).
The “informal” part of the healthcare economy amounts to about $7b/yr, more than triple the state’s spending, he estimated. Frustration over the lack of progress prompted Kvitashvili to tender his resignation in the summer, rejected by the Rada. Some commentators have said he lacks the know-how to navigate the web of allegiances that continues to bind Ukraine’s ruling class despite avowed attempts to move on from the political cronyism of the past. Doctor and healthcare commentator Evgeny Komarovsky said:
I believe he wants reforms, but he doesn’t totally understand the reality of Ukraine, that if someone promises their support it doesn’t mean they won’t try and trip you up.
Alexandra Ustinova from the Anti-Corruption Action Center also said there was a conflict of interests in some of the appointments at the ministry, such as bringing in a lawyer who used to work for a pharmaceutical company owned by a member from Poroshenko’s party. Giovanna Barberis, the Ukraine representative of UNICEF, said:
The obstacles are huge and sometimes it looks pretty grim because the pace is extremely slow.
The start of an immunization campaign following an outbreak of polio on Sep 1 was delayed by several weeks, prompting Ellyn Ogden, global polio coordinator for USAID, to criticize the “highest levels of government” for an inadequate response. She said:
No other country in the world is in such a dire situation or shows such disregard for protecting children against childhood diseases.
A spox for the Global Polio Eradication Initiative led by the WHO said:
For some time, Ukraine has been a catastrophe waiting to happen.
Ukraine did not buy drugs, medicines or vaccines for most of this year as the health ministry sought to approve a temporary procurement system via international organizations to bypass the compromised system that Kvitashvili hopes to reform. The temporary system was finalised in late October, and Ukraine plans to buy around $100m of vaccines and medicines, but severe shortages remain. For instance, Komarovsky said:
There are no anti-diphtheria vaccines in the country.
Meanwhile the more drastic reform bill is languishing in the Rada, and Kvitashvili says his resignation is still on the table. He said by email:
Well my letter is still there. I didn’t withdraw it. We will see how the Rada will act.
Niqnaq 