In 2016, Ukraine introduced the reform of the financing of the health care system (hereinafter referred to as HC). A lot was worked out, rethought, cancelled or revised. Millions of opinions, thousands of meetings and discussions, hundreds of documents, dozens of stakeholders, inspired teams of like-minded people united by a common goal... This is but the tip of the iceberg of all those processes under the health care reform umbrella. We continue to improve and foster positive results. This article highlights the role of one of the most important links of the hierarchical structure in the health care system — Regional Departments of Health — as a link between the Ministry of Health of Ukraine (hereinafter the Ministry of Health) and providers of medical services.
Regional Departments of Health (hereinafter RDHs) are structural subdivisions of regional state administrations (regional military-civilian administrations under martial law). Their operation is regulated in detail by Resolution of the Cabinet of Ministers of Ukraine No. 887 dated 26 September 2012 “On Approval of the Standard Regulation on the Structural Subdivision of the Local State Administration” which lists many functions and responsibilities of RDHs. Historically, in different periods of the development of the HC system, the role of RDHs varied greatly, from significant centralisation to a drastic weakening of positions (such as during the office of Ulana Suprun’s team). Today, there is a certain strengthening of the role of RDHs as the political representation of the head of the regional state administration.
As of today, the most powerful tool at an RDH’s disposal is the development of a plan for a capable network of healthcare facilities (hereinafter HCFs) of the hospital district. In other words, determines the status of hospitals in the oblast, their development prospects and their future (joining, merging, conversion, liquidation, optimisation or expansion). The planning should result in the development of patient movement routes within (or outside) the hospital district and state investments in reconstruction, construction, and equipment purchase, the amount of which will depend on the status of the hospitals (general, cluster, super-cluster hospitals or hospitals outside the network). The development of patient access routes to medical services itself is also among the key aspects assigned to the duties of RDHs, which makes sense since they approach the entire hospital district in terms of public administration, seeing a bigger picture so to speak. This is about the flow of patients, about assigning the points of contact of patients to a certain hospital.
Another functional responsibility of RDHs is the development of proposals for the formation of the regional health care policy through the development of budget programs and setting goals and objectives. This should also include the delegation by regional councils of the management functions of HCFs owned by them. They are the ones who usually oversee financial planning and management in regional HCFs as well as the availability and quality of health care provided in them. In practice, however, there are various options for partial delegation of the above functions. For example, the Charter of regional HCFs of the Zakarpattia Oblast lists the municipal institution “Administration of Joint Property of Municipalities” of the Zakarpattia Regional Council as the governing body.
Attestation of doctors is also within the powers of regional RDHs that issue orders to approve the requalification (upgrade or confirmation of the category) of doctors as part of their continuous professional development. However, under martial law, this function is temporarily delegated to the heads of local hospitals. RDHs are also responsible for the collection of statistical data, their summary and basic analysis.
Clinical expert commissions under RDHs review gaps and defects in the provision of medical care as well as patient complaints in an expert environment. These reviews might be a formality or have elements of influence on certain healthcare facilities, which largely depends on the integrity of healthcare facilities at the regional level. The same applies to the work of accreditation commissions that check healthcare facilities for compliance with state accreditation requirements.
Another direction of the RDHs’ work is the collection of information, analysis and estimation of the need for medicines, medical products and medical equipment purchased by the state through State Enterprise “Medical Procurement”.
Summing up the competencies of RDHs, we should primarily emphasise the significant strengthening of their capabilities in recent years, which is associated with a certain degree of centralisation of the health care system. In the future, part of the functions of RDHs should be assigned to the professional self-governance community (a form of self-organisation of the professional medical community according to the best global practices) and the Agency for Healthcare Quality Assessment (a state institution whose task should be the organisation of the development of quality health care systems and its further evaluation), and the other part (e.g. the analysis of statistical data, the development of measures to preserve and strengthen the health of the local population, the development of budget programmes) should be transferred to the municipal level as part of the decentralisation reform. RDHs, on the other hand, should focus on their coordinating function in the HC system at the regional level.