MEMBER STATES BRIEFING ON HEALTH REQUIREMENTS IN UKRAINE

Geneva

15 January 2014

Dr. Dorit Nitzan

WHO Representative, Ukraine

Health Crisis • More than 5.1 million people are affected by the crisis in

eastern Ukraine • In and around the cities of Donetsk and particularly Luhansk

Government services broke down, including water and power supplies

• Health care provision is reduced to a minimum or unavailable. • Lootings and destruction of health care facilities are common; • More than 50 health care facilities are partly or completely

destroyed • More than one million people fled their home and are IDPs or

Refugees to neighboring countries, particularly to Russian Federation.

• In the past weeks there is an increase in registered IDPs in Ukraine (736,169)

Health System in Ukraine

• The Ukrainian health system was weak already before the crisis and is now completely collapsing in fighting areas and areas with high IDP load

The impact of the financial crisis is also the greatest in the health sector

Source: UNDP Vulnerability Risk Assessment

1.4 million are considered to be highly vulnerable

They were vulnerable pre-conflict and are therefore disproportionately affected by:

Displacement

loss of income/pensions

eroded purchasing power

reduced access to markets

breakdown of essential services

harsh winter conditions

Distance and lack of means create a barrier for IDPs leaving in remote villages • Community health Points (FABs )do not have GP no

possibility to prescribe mediations and structures underutilized

• Insufficient presence of GPs to treat patients referred from FABs

• No outreach activities foreseen for IDPs in remotes areas • No GPs added after massive arrival of IDPs to

communities • Many IDPs hosted in precarious housing in remote

villages

Summary of Major Findings • Health services damage and lack of ownership

– Health infrastructure – Health workers – Lack of pharmaceuticals

• Access to adequate and quality health services limited – Physical (roads, security, specialized care for Donbas is under rebel

control) – Financial

• Access to basic public health functions and basic health services impeded

• Increased health needs of affected people • Reduced supply and shortages of medicines, vaccines,

equipment, supplies • Weak emergency/urgents medical system

Humanitarian Situation Monitoring (OCHA/WHO)

Humanitarian Situation Monitoring 2

Humanitarian Situation Monitoring 3

Humanitarian Situation Monitoring 4

Health Needs

Trauma and Injuries

Upgrade the emergency medical services, to ensure:

–Well equipped ambulances, intensive care, surgeries, burn units

– Trained first-aid personnel and health workforce

–Adequate access to medications and consumables

Emergency/Urgent Primary Health Care • Emergency and primary health care services in

affected areas are exhausted

• Shortages of water and power supply

• Extreme lack of pharmaceuticals, consumables, human resources and logistics constrains

• Many are deprived from access to health services, including NCDs, mental health, injuries, GBV, mother and child care, dentistry, rehabilitation and more

Health Needs 2

Immunizations

• Vaccine coverage is the lowest it has ever been

• Immunity gaps have been exacerbated over the past year

• A historically quite strong surveillance system has been compromised (including for AFP), particularly in rebel-controlled areas where there is no AFP reporting to the central authorities

Health Needs 3

HIV and Hepatitis

1. Access to seamless and full packages of care and prevention, including for HIV, TB & Hepatitis

2. Blood safety

3. Training of MEPUs and EPPs teams to provide HIV, TB, OST and Harm Reduction, Hepatitis treatments and follow-up

Health Needs 4

Increased IDPs and Disease Burden

• When services exist, people are required to pay out-of-pocket for primary and secondary care

– Only emergency care is provided free of charge

• This represents a heavy burden for the vulnerable groups, predominantly IDPs, children, women, elderly, disabled, the chronically sick and Roma

Health Needs 5

Government Funded Pharmaceuticals

• Ukraine is facing incredible challenges in Health System including public PHS

• Government regards UNICEF and WHO assistance in procurement of medicines as critical to avoid health catastrophes

Health Needs 6

WHO Critical Functions • Leadership and Coordination

– Health cluster response in support of the national and local health authorities;

• Coordination of the health cluster response – through analysis and dissemination/communication of

essential information on health risks, needs, gaps and performance ;

• Provision of technical assistance; • Provision of health services

– for filling the identified gaps through partners interventions, mobile clinics, Community and Roma Health Mediators, provision of medicines and consumables; and

• Core services

Health Cluster Strategic Objectives 2015

1. Fill in gaps and enhance access to quality preventive and curative health services, including medication and health technology;

2. Provide reliable health information for evidence based emergency response, monitoring and policy decision-making;

3. Strengthen disease surveillance and response, including laboratory capacities and technical guidance on priority public health issues and threats;

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Health Cluster is Filling the Gaps • To enhance patient-centred quality emergency/urgent

primary health care services in areas affected by fighting, as well as for IDPs and hosting communities;

• To facilitate access to community-based health services, including mother and child, chronic diseases, communicable diseases, including TB and HIV/AIDS, and provision of mental health/ psychosocial support and dental services for people in need;

• To form real-time, web-based, people-centered, integrated-care health information system;

• To pilot tele-medicine consultation services; This Project will provide the platform on which the rural health services and the foundation for health information management system.

Geographical priorities 2015

Humanitarian Caseload 1.37 million

• 100,000 (7%) children under 59 months of age (infants require monthly follow-up for the first 12 months)

• 15% adolescents • 3% pregnant and lactating women, including at

risk pregnancies, unwanted pregnancies • 20% elderly • 10% disabled • 16% communicable and non-communicable

diseases

• Strategic Objective 1:

1. Improve access to comprehensive primary health care services and care at secondary and tertiary levels, including CD, NCD, SRH, SGBV, MHPSS, TB & HIV/AIDs and dentistry;

2. Strengthen the preparedness for and management of trauma care;

3. Promote an enabled working environment for volunteers and provide specialized training according to needs;

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Key Activities for 2015

• Strategic Objective 2:

1. Strengthen the HIMS for emergency and regular health care;

2. Strengthen the health sector coordination to address the protection needs of the crisis affected and displaced people including pregnant & lactating women, survivors of sexual and gender based violence, disabled, older persons, young girls and boys, people living with HIV & TB and other chronic infections & non-communicable diseases;

3. Support selected health services & infrastructure affected by the crisis, in line of the health system reform, and enhance revitalization of health services and restoration of health facilities in affected areas.

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Key Activities for 2015

• Strategic Objective 3:

1. Strengthen the Syndromic Disease Early Warning System;

2. Prevent, early detect and respond to epidemic prone diseases (e.g. Polio and Measles);

3. Pre-position emergency medical supplies & material ensuring timely response to epidemic-prone diseases outbreaks;

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Key Activities for 2015

Lead agency: World Health Organisation (WHO) Contact information: Dr. Dorit Nitzan (don@euro.who.int) Ms Patricia Kormoss (kpj@euro.who.int)

# OF PARTNERS 38

PEOPLE IN NEED 1.37 million

PEOPLE TARGETED 900,000

REQUIREMENTS (US$) 23 million

Health Cluster Funding needs 23 millions US$

Members of the UKR Health Cluster

UN Partners UNICEF

UNHCR

UNFPA

UNDP

UNAIDS

OCHA

Local NGOs & Ministries UKR Red Cross

Donors and Embassies

USAID

ECHO & EU

US, France, Czeck Republic, Hungary, Lituania, Latvia, Canada, Israel, Norway & Sweden

NGOs Caritas US CDC Handicap Intl Intl Medical Corps Médecins du Monde Save the Children/ UK Terre des Hommes PIN More…..

Non-UN Partners

Observer

ICRC

MSF

Basic structure - the WHO health systems framework functions

INCEPTION PHASE • Development of training manuals and handheld

health information systems, as well as pharma for MEPUs

• Partnership, recruitment and training of health workers in MEPUs

• Provision of MEPUs care for 100,000 IDPs residing in temporary shelters in Kharkiv, Luhask, and Donetsk oblasts (equitable and timely access)

• Link them with primary and secondary health facilities (EPPs).

HEALTH RECOVERY WILL BE LONG AND DIFFICULT

• Recovery needs in Health are higher than in any other sector, save for transportation

• Rebuilding of bridges and roads is expensive but the country can more or less function with dysfunctional roads, with non-functional health systems people will die

Source: UN/WB Recovery & Peacebuilding Assessment

THANK YOU!

Dr. Dorit NITZAN,

WHO Representative in Ukraine

don@euro.who.int

• Thank You!!