The Ukrainian government, at the request of the International Monetary Fund (IMF), is conducting a reform of the country’s healthcare system. Despite the government’s promise to carry out the reform in a systematic and comprehensive manner, the Health Care Workers’ Union of Ukraine notes that the reform procedure is haphazard and disorganised and is in flagrant violation of Ukraine legislation and social dialogue.
From the union’s findings, systemic crisis in the sector has resulted from continued and significant underfunding of healthcare. A key element of this situation is that the public health system covers, on average, only 40-60% of demand from the population.
Even though the budget for Ukraine healthcare spending in 2012-2017 increased by 150%, sharp devaluation of the national currency means that healthcare spending in terms of USD actually decreased from 738 billion USD in 2012 to 329 billion USD in 2017. Thus, less than half of what was made available for public health in 2012 is what was budgeted for 2017.
The Union further notes that each ‘further reform’ of the sector is accompanied by downsizing, increasing intensity of labour and functional responsibilities without adequate wages, and removal of social and professional benefits. This is having a negative effect on health professionals’ wages and living conditions. In addition, it has led to massive wage freezes in the sector because of spending cuts of almost 3.9 million USD in the 2017 payroll.
The Union continues to persistently defend the necessity and feasibility of healthcare reforms that will lead to structural changes and increased funding which can curtail the systemic crisis of health care delivery in Ukraine. Such a system will provide the citizens with the constitutional right to healthcare and medical assistance, equal and fair access of everyone to health services, and will go towards creating adequate working conditions and social protection of healthcare workers. The current healthcare reform is running on opposite principles.
On 30 November 2016, with complete support and facilitation of implementation of healthcare reform measures by international organisations, including the IMF, the Cabinet of Ministers of Ukraine (CMU) adopted a number of regulations submitted by the Ministry of Health of Ukraine (MHU), including the CMU Decree on: Approval of Healthcare Funding Concept Reform in Ukraine; Approval of Public Healthcare Development Concept in Ukraine and; Approval of Establishment of Hospital Districts.
Collectively, these laws have laid the basis for far-reaching reforms of the health system in ways and manners that undermine the possibility of achieving the Sustainable Development Goal of “universal health coverage”.
Further steps were taken in April 2017 to consolidate this liberalisation of health process. One of these was the establishment of the National Health Service of Ukraine as the main manager of funds and programmes of responsible provider of healthcare through the mechanism of public solidarity health insurance. This will undermine the principles of compulsory state social insurance and lead to the introduction of non-transparent management of funds of solidarity health insurance.
According to the Union, such innovations contradict the Constitution of Ukraine and the Decision of the Constitutional Court. We have thus raised our concerns in a letter to the President of the Verkhovna Rada (parliament) of Ukraine, heads of relevant committees of the Parliament, leaders of parliamentary factions and personally to each Member of Parliament of Ukraine.
Despite this, the MHU dispatched Guidelines on Reorganisation of State Healthcare Facilities into Public Non-Profit Enterprises to the local governments and administrations of local healthcare authorities on 24 April.
Ignoring the Union’s remarks and warnings on sectoral funding, implementation of healthcare reform, neglect of principles of social dialogue and failure to comply with court decisions, the CMU and the MHU are unacceptable. The union will continue to take a stance against these surreptitious and illegal steps aimed at commodification of health care delivery. Our stance for the right to health and decent work for the health workforce remains unshaken.