National strategy for building a new health care system
This document was created by the Strategic Advisory Group on Health Care Reform in Ukraine (Health Care Advisory Group), which was established by Order of the Ministry of Health No. 522 dated 07/24/2014. The creation of the SDG was the result of a joint initiative of civil society, the Government of Ukraine, and the International Renaissance Foundation. The common goal of the initiative was to attract highly qualified national and international experts to provide advisory assistance to the Government on the strategy of reforming the industry, optimal use of international aid, consolidation of donor efforts to support reforms in Ukraine and solving urgent problems.
After a series of meetings and the study of many documents, this Strategy summarizes the proposals proposed by national and international experts and reflects the legitimate aspirations of Ukrainian society regarding the future health care system.
Undoubtedly, the Strategy is a framework document that should be presented to the Cabinet of Ministers for consideration in the coming months. The group emphasizes the need to conduct a process of broad discussion of the document. After all, we do not have answers to all questions, taking into account the fact that other interested parties may see things differently, so suggestions and participation in the discussion and further implementation are only welcome.
This document contains a situational analysis and explanation explaining “what” and “how” should be done in accordance with the proposed strategy (paragraphs 1, 2 and 3 below), as well as a preliminary action plan (paragraph 4) explaining “what is necessary perform” in the short term—in the next two years—and over the next decade. From a technical point of view, the structure of the document is as follows:
1. The health of the population and the state of the health care system; main policy issues
2. Stakeholders, values, goals and objectives of the healthcare system of Ukraine
3. Structure of the health care system; strategic opportunities for Ukraine
4. Construction of a new health care system, development of the concept and action plan of the SDG on health care consists of the Coordinating Council and the Expert Group.
The Coordinating Council includes representatives of the government sector (MoH), professional organizations (VULT), patient groups (PF “Patients of Ukraine”) and international partners (World Bank, WHO and IMF). The members of the Expert Group were selected through an open competition. From more than 100 submitted questionnaires, 12 experts were chosen: Ain Aaviska (Estonia), Tetiana Dumenko (Ukraine), Antonio Duran (Spain), Roman Fishchuk (Ukraine), Andriy Huk (Ukraine), Oleksandr Kvitashvili (Georgia), Volodymyr Kurpita ( Ukraine), Oleg Petrenko (Ukraine), Mykola Prodanchuk (Ukraine), Tyhomyr Strytsrep (Croatia), Ihor Yakovenko (Ukraine), Robert Yates (Great Britain).
We would like to express our special thanks to the Secretariat of the SDG: Olga Stefanyshina, Pavlo Kovtanyuk, Kateryna Telehina, Inna Boyko, Oleksandra Zakhovaeva, Marichka Makovetska and Inna Golovanchuk.
The group would like to thank the national and international experts who provided significant assistance to the work of the group by providing additional information and directly participating in individual group meetings.
The current state of the health care system of Ukraine (hereafter POP) is characterized by high rates of morbidity, mortality and disability, especially from non-communicable diseases (NCDs), such as cancer, cardiovascular and cerebro-vascular diseases, and metabolic diseases. Combined with migration, this contributed to a deep demographic crisis in Ukraine, with the population shrinking by 7 million (from 52 to 45.3 million) over two decades.
Alarming figures show that the vast majority of Ukrainians:
Are exposed to serious risk factors such as smoking, excessive alcohol consumption, poor diet, lack of physical activity, air and water pollution.
they do not receive effective and high-quality assistance at the level of civilized countries. In addition, our citizens remain unprotected from financial impoverishment in case of illness, despite the fact that Ukraine spends a significant amount of its budget on medicine.
The main determining reasons for this situation are the significant shortcomings that have accumulated in the national health care system as a result of a long-term lack of modernization, leveling of the needs of the population and modern international trends in strengthening health care systems, economic inefficiency and a high level of corruption.
To solve these problems, it was proposed to develop a National Strategy for Health Care Reform, which will become part of the national reform plan announced by the Government of Ukraine.
The National Strategy for Reforming the Health Care System (hereinafter the Strategy) is a framework document that defines the content, vision, principles, priorities, tasks and main measures for the Ukrainian health care system over the next 10 years. The implementation date of 2025 was chosen because it provides enough time to implement and evaluate policy changes.
The strategy should become the basis for policy development and determining the order of decision-making in the field of health care, including decisions on the filling and distribution of budget funds for health care. The purpose of the Strategy is not to develop a lengthy list of measures that will be implemented to achieve goals and objectives in each segment of health care. Instead, the strategy provides clear and compelling reasons and explains why certain proposals should be considered a priority. Thus, it will create a basis for evaluating and revising existing operational regulation and developing new, complex measures and specific actions in certain segments of the health care sector. (For example, a strategic plan for the development of human resources, a general plan for the development of hospitals, a strategic plan for the development of palliative care, a strategic plan for the development of public health).
In general, the Ukrainian Health Strategy is based on three fundamental principles, which the Ministry and the government consider as fundamental. These principles should be applied across the industry and should be reflected in further documents, namely:
the center of attention and interest of the system should be a person (patient). This means the following (i) system measures should be aimed at satisfying human needs, taking into account the voice of patients; (ii) quality, safety, duration of services, closeness to the community, quick response to changes should become the cornerstones of the new POP that we plan to create; (iii) health care is a system that must manage relationships between different actors, including managers, service providers, service recipients and researchers, each of whom occupies a specific niche and has clearly defined responsibilities. Thus, the system will be based on trust, dialogue and mutual respect of all participants, and the effectiveness of the entire system will ultimately depend on the quality of their interaction.
POPs should be result-oriented, which means (i) expected results (health indicators, financial security of patients, cost-effectiveness and satisfaction with services) should guide the decision-making process at all levels; (ii) the system should maintain an atmosphere where staff performance evaluation should be based on the effectiveness of the services provided, carried out regularly and continuously improved; (iii) systemic reforms such as the development of the private sector can and should be initiated if it is confirmed that they will lead to improved outcomes, such as reducing the cost of services while maintaining the appropriate quality of services. This requirement is an essential priority for the creation of a high-quality and working information base, based on the data of which appropriate decisions are made. We must state that the currently available evidence is of poor quality and limited.
focusing on the implementation of the set goals means that it is not enough to have good ideas, but it is important to develop, implement and monitor the implementation of detailed reform plans that clearly define responsibilities, time frames, reporting mechanisms. It is important to consider that reforms depend on the availability of funding and should not promise things that the state is unable to fulfill (for example, free medical care for all).