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Round-table “Health-care reform: lessons from piloting” in Dnipropetrovsk

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Although health-care reform started only 1 year ago, it is already subjected to devastating criticism. The painful reform concerns everyone, so that the round-table “Health-care reform: lessons from piloting” held by CASE Ukraine on July 4 in Dnepropetrovsk was full of people. At the event CASE Ukraine presented the analytical report on the first stage of health-care reform implementation in Ukraine and gathered local authorities, civil society representatives and doctors to talk about reforms.

“Health-care reform is hard, painful, but needed. We should not expect a ‘nicer’ reform, as it in any case will include implementation of family medicine and so unpopular move as closing ineffective clinics. However, the rush in implementing the reforms under the environment of shortage of family practitioners and available funds in many cases causes inconveniences for patients and reduce their access to medical services without any perceptible positive changes in health-care quality”, – said Kateryna Ruskykh, a CASE Ukraine economist.

“The continuation of the reform and its success depend a lot on reaching consensus on the issue with the public, otherwise the reforms can be easily stopped due to political reasons. The other condition is a well-organized retraining into family practitioners and their adequate motivation. The last, but not least, the reform cannot be implemented without additional funding by redistribution of existing funds of health-care system, as it may lead to rush and unjustified closure of clinics, hospital beds and personnel” – stressed Dmytro Boyarchuk, an Executive Director of CASE Ukraine

Sergiy Malovychko , a member of Community Council under Donetsk oblast  administration, presented his report on the reform process and drew the participants’ attention to such problems as: flaws in the recently approved normative acts on the reform and lack of some important normative documents; contradiction of some changes to the Laws, including the Constitution; delays in the planned changes; and no consultations with the public.

Olena Luhova, a deputy head of health-care department of Dnipropetrovsk oblast administration, stressed that the reform is conducted based on the existing network of hospitals, existing personnel and available funds, and this reduces efficiency of the reform implementation. Local authorities reported on the achievements of the first reform year and in response to criticism pointed to the drastic need of reforming health-care, because “Ukraine’s health-care system resembles old, but high-quality soviet car that has not been repaired for a long time and will soon be broken”. The authorities also promised to fix some most acute problems caused by the reforms.

The representatives of civil society organizations and civil society activists expressed different point of views, ranging from constructive to totally disagreeing. Larysa Babych, a head of the Community Council under Dnipropetrovsk oblast administration, told about joint inspections of newly opened primary care centers and ambulatories made by their community council jointly with local authorities. Galyna Shkutova, a civil activist from Mykolaivka village, said that the villagers managed to save their rural hospital from closure. Although she understands that the reform is needed, Galyna Shkutova stressed that they were not offered any good alternative to their rural hospital, including an equipped and staffed ambulatory, while the closest hospital is 60-70 km away. Simultaneously, representatives of the Dnipropetrovsk’s movement “For our children” expressed absolute discontent over the reform, as policlinics they got accustomed to were reorganized to primary care centers, specialists and labs were transferred to remoter hospitals and clinics; patients have to wait in 1-2 hours queues to get to a doctor. Besides this, parents are very concerned that pediatricians will be changed for family practitioners, whom they do not trust, and stand against mixing children and adults in one queue to doctor. Facing these problems, many people do not hear any explanations ragarding the drastic need of the reforms and their future benefits from them.

The tough discussion lasted 2 hours. The round table gave a hope that the counterparts heard one another and a dialog and cooperation between local authorities and civil society organizations will continue. We were convinced that the rapid pace of organization of new primary care centers led to flaws in their work, while shortage of family practitioners and unequipped primary care facilities have not yet been able to raise quality of health-care. But civil society organization should not demand a stop of the painful reforms, as it can be worse for patients that if they keep going. CSOs should demand better organization of the reform process and control the changes.

The round-table materials:

1.    Comix-presentation “Health-care reform: lessons from piloting” (ukr)

2.    Video-presentation “Health-care reform: lessons from piloting” (ukr)

3.    English summary of the analytical report “Health-care reform: taking first hard steps” (eng)

4.   Presentation of Sergiy Malovychko: “Reforming health care: pitfalls of the experiment or how not to trigger a backflash” (ukr)

July 5, 2012