public health system in...

Public Health System in Ukraine

1

Ihor Perehinets, Deputy Minister of Health of Ukraine 08. 12 .2015

1.1 Efficient, transparent health products public procurement system in

place

1.2 Increased access to medicines and medical products via market

deregulation

1.3 Strategic long-term planning to vaccines and essential medicines

purchasing deployed

2.1 Hospital network optimized to meet health needs of people

2.2 Autonomy of public providers of health services introduced

2.3 Access to primary care services of good quality ensured

3.3 Health services are funded on “money follows the patient” principle

3.2 Guaranteed volume of free medical care defined and provided

3.1 Cost-efficient single payer system of public funds pooling and allocation in

place

1. MEDICINES AND VACCINES

of good quality

are more accessible and affordable for

people

2. HEALTH CARE SERVICES

of better quality delivered in efficient and

patient-centered manner

3. FAIR FINANCING SYSTEM

in place with more financial protection

and less informal payments

MODERNIZED HEALTH SYSTEM capable of responding to current health needs, providing affordable services of good quality and ensuring financial protection for people

Reform Passport Health Care System Reform

4. NEW PUBLIC HEALTH SYSTEM

established and provides quality

population health services

4.2 “Health in all policies” principle in place

4.1 New Public Health Agency established and effectively operating

4.3 Health promotion system designed and deployed

New system of data management and accountability in place

STRATEGIC

GOALS

OPERATIONAL

GOALS

Attract and coordinate international donors’ support

MOH IS

RE-PROFILED

away from operational functions toward policy-making

Undue functions defined and cut down and/or outsourced

New functions implemented, respective capacities built

ULTIMATE GOAL

Ministry of Health of UkraineProject Management Office of National Reforms Council

29.09.2015

The Reform Passport summarizes commitments and plans fixed is strategic documents: Presidential Strategy 2020; Coalition Agreement; Government Action Plan; EU Association Agreement; Healthcare System Reform Strategy 2015-2020 of MOH

“Public health is the science and art of preventing disease, prolonging life and promoting health through organized efforts of society.”

Sir Donald Acheson,

1988

Other sectoral actors(beyond health systems) with health generating activities

Agriculture

Tourism

Education

Transport

Health Systems

Curative

Health Care Services:Primary, secondary, tertiary

Environment

Prevention, protection, promotion

Individual health servicies

Essential Public Health Operations

Population-based health services

*Link to Health 2020, its governance, the whole of government and the whole of society approach

PUBLIC HEALTH and HEALTH SYSTEMS

LEADING CAUSES OF DEATH IN UKRAINE

4

67%

14%

6%4%

3%

0%

10%

20%

30%

40%

50%

60%

70%

Cardiovascular diseases Malignant neoplasms Injuries and poisoning Diseases of digestive system Diseases of respiratory system

Source: WHO, 2013

5

75 7575 75

76 76 7676 77 77

7777 78 78

78 7879 79 79 79 80

80 81

7171

7172 72 72

7273

73 7374

7474 75 75 75 75 75

76 7676

77 77

70 70 70 70 70 6969 69

7071

71 71 7171 72 72 72

73 73

73 73

75 75

70

69 69

68 68

67 67 6768 68

6868 68 68 68 68 68 68 68

69

7071 71

Life expectancy at birth, WB, 2012

European Union Poland Romania Ukraine

1 829 2 3033 069

3 8912 545 2 974 3 575 3 873 3 900

7 9638 958

11 157

13 886

11 29512 304

13 385 12 72113 432

4 6525 789

8 170

9 949

8 069 8 1399 064 8 437

9 499

27 90929 651

34 162

36 613

32 599 32 382

34 921

32 91734 244

2005 2006 2007 2008 2009 2010 2011 2012 2013

GDP per capita, WB, 2013

Ukraine Poland Romania EU

6

CURRENT PUBLIC HEALTH SYSTEM OF UKRAINE

Key features

New

characteristics

• Existence of chief sanitary doctor position in the regions

• Centralized performance of functions from Kyiv to district (rayon)

level

• Main focus on infectious diseases surveillance and hygiene

• Legislation in public health is limited by sanitary norms approved

during soviet times

• Separate surveillance systems for HIV, TB, STI

• SanEpid Service was partly separated from the Ministry of Health

• Inspection functions and lab services were institutionally separated

within SanEpid Service

7

LEGISLATION: DISEASE SURVEILLANCE

Laws

Acts of the Government

MoH orders

“Basic Laws of Ukraine on Healthcare”

“On Population Protection Against Infectious Diseases”

“On Ensuring Sanitary and Epidemiological Welfare of Population”

“On combating the spread of diseases caused by the human immunodeficiency virus (HIV) and Legal

and Social Protection of People Living with HIV”

“On Combating Tuberculosis Disease”

“Some Aspects of Registration, Accounting and Reporting of Infectious Diseases” dated 21.02.01

“Regulation on State Sanitary and Epidemiological Surveillance in Ukraine” dated 22 June, 1999

“Rules of Sanitary Protection of the Territory of Ukraine” 22.08.2011

“Some Aspects of TB and HIV/AIDS Control” dated 11.07.2007

“On Provision of Early Reports to the Ministry of Health of Ukraine” dated 23.05.2002

“On Approval of the List of Especially Dangerous Infectious and Parasitic Diseases in Humans and

Carriers of Pathogens of these Diseases” dated 19.07.1995

“On Approval of Special Sanitary-Quarantine Units” dated 23.02.2000

“On Improvement of the System of Indication of Biological Pathogenic Agents” dated 21.03.2003

“On Approval of the Forms of Primary Registration Documentation of Infectious,

Dermatovenereological, Oncological Morbidity and Instructions for Their Filling” dated 10.01.2006

“On Approval of the Reporting Forms for Infectious and Parasitic Diseases, Vaccinations against

Individual Infectious Diseases and the Instructions on their Application” dated 02.06.2009

CURRENT INSTITUTIONAL SET-UPNational Academy

of Science of

Ukraine

National Academy

of Medical Science

Other Scientific

Institutions*

CABINET OF MINISTERS OF UKRAINE

Ministry of Health

State Sanitary and

Epidemiological

Service

Center for

Control and

Monitoring

Diseases

Ministry of HealthUCDC Ministry of

HealthOther state

bodies and

enterprises**

Other state bodies and enterprises**Other state bodies

and enterprises**Regional

SanEpid/Chief

Sanitary Officer

District SanEpid/

Chief Sanitary

Officer


and enterprises**Regional Lab

Centers

District Lab

Centers


and enterprises**Regional

HIV/AIDS Centers

State executive bodies

Institutions subordinated to local authorities

State institutions and enterprises

Scientific institutions

Minister


and enterprises**Regional TB

Clinics

10

EXISTING PROBLEMS

Fragmented and duplicated public health functions with lack of overall coordination of the activities

Focus on infectious diseases prevention and control though cause for 80% deaths in Ukraine are non-communicable

diseases

Lack of human resources development plan: limited capacity in epidemiology and outdated practices that need to be

revised; training curricula need to be updated according to the international standards

Low quality of surveillance data management and analysis

Huge but out-of-date infrastructure, including labs network

The system is not responsive to “new” challenges for public health, for example antimicrobial resistance

Medical science is not integrated into “world environment”, scientific and research institutions do not provide support for

the system development and have not consolidated priorities.

THE SYSTEM REFORM: FIRST STEPS IN 2015

Ministry of Health approved an order # 604 dated of September 2015 “On establishment of Public Health Center”

Revised decision of the Government – epidemiological surveillance functions will be performed by the Ministry of Health, relevant budget line for 2016 is planned for the Ministry of Health (around 1 bln UAH), infrastructure of SanEpid labs will be transferred to the Ministry of Health (Public Health Center)

Epidemiological surveillance system of communicable diseases in Ukraine is assessed during May – October by EC, ECDC, Support Group of Ukraine

Ukraine joined to Global Health Security Agenda Initiative, assessment has been performed in November 2015

Draft Concept on Public Health System Reform is prepared and ready for public consultations

New approach for training system in public health area is under discussion

11

Ministry of Health

Center for Control

and Monitoring of

Diseases

Ukrainian

Antiplague

Institute (Odesa)UCDC

Regional Lab

Centers

District Lab

Centers

PUBLIC HEALTH CENTER

Transport

Medicine

Institute

Road Safety

Center under the

MoH

Institute of

Strategic

Researches

Food Safety and

Nutrition

Institute

Lviv Infectious

Diseases Institute

REORGANISATION OF SANEPID SERVICE

13


Minister of

Health

Minister of

Economy

Minister of

Agricultural Policy

SanEpidService of Consumer

Protection

Veterinary

Service


Minister

of Health

Minister

of

Economy

Minister

of

Agricultur

al Policy

Service of

Food Safety

and

Consumer

ProtectionEpidemiology

Surveillance

Functions

CURRENT STATE OF PLAY NEW SYSTEM

TARGET MODEL OF PUBLIC HEALTH SYSTEM

14

Ministry of Health (Public Health Department)

Public Health Center (consolidates some functions of SanEpid, other

institutions under the MoH)

Network of

interregional PHC

Regional

Department of

Health Regional Public

Health Center

Public & private

Labs

Food Safety Service

National Academy

of Science of

Ukraine

National Academy

of Medical Science

Other Scientific

Institutions

Other ministries

Regional Unit

Food Safety Service

procurement

THANK YOU!

15

Ihor Perehinets, Deputy Minister of Health, Ukraine 08. 12 .2015

public health system in...

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