In April 2023, the Regional Offices of the U-LEAD with Europe Programme held a series of dialogue events with the participation of interregional departments of the National Health Service of Ukraine (hereinafter the NHSU), local self-government bodies and heads of healthcare facilities. This initiative offered us a great opportunity to listen to representatives of municipalities from all over the country in order to get a better understanding of their needs and expectations regarding issues related to the organisation of the healthcare system at the local level.
The most popular topic in terms of the number of questions raised by municipalities during dialogue events undoubtedly was the process of planning hospital districts with a focus on the formation of clusters and further practical aspects of the implementation of the infrastructural stage of healthcare reform in municipalities. Even though the formation of a capable network of healthcare facilities as part of the infrastructural stage of the healthcare reform is outside the scope of powers of the NHSU. The aspects of further contracting under the Medical Guarantee Programme (hereinafter the MGP) were at the forefront of attention of the owners of those specialised healthcare facilities that would potentially not be part of a capable network. They were concerned about further cooperation with the National Health Service and approaches to the management of such facilities, namely:
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Reorganisation by combining several healthcare facilities with different facilities providing medical services;
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Merger of a less capable healthcare facility with a more capable one;
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Optimisation due to the lack of necessary financial resources in the local budget in order to finance the further functioning of certain healthcare facilities.
In their answers, the representatives of the NHSU pointed out to the audience that the formation of MGP packages for 2024, as well as the specifications and tariffs for them, will be started closer to the second half of 2023. Traditionally, it will be based on the analysis of statistical data from the electronic healthcare system regarding the provided medical services, the priority of medical services as well as healthcare laws and regulations. The procedure to account for the new statuses of facilities when contracting will be specified after the approval process of the capable networks of hospital districts and when planning procurement of the NHSU for the following periods.
Nevertheless, based on the answers provided by the representatives of the National Health Service at the dialogue events, we can assume that medium-term contracting of healthcare facilities might become one of the main priorities in approaches to contracting within the 2024 MGP for facilities that are part of a capable network. Accordingly, healthcare facilities that are not part of a capable network will be contracted for a shorter term, according to the procurement conditions and specifications, the demand for various types of medical services, the principle of resource concentration and their effective use.
Thus, today municipalities need first to figure out for themselves how to answer the following strategic questions:
- Which areas of medical services in the municipality are critically important for them?
- What resources are needed to ensure the stable provision of these services?
- What urgent measures should be taken to ensure this now, taking into account the circumstances listed above?
Although the main focus is currently on specialised healthcare facilities, participants had a significant number of questions regarding the organisation of primary healthcare (hereinafter PHC) in municipalities. Depending on the regions, the broad range of these questions included, among other things, the relocation of healthcare facilities to controlled territories, the increase of the capitation rate, the expansion of services of primary healthcare centres to diagnostic studies and the provision of outpatient services by speciality doctors, the organisation of mobile teams and remote counselling, etc.
However, all municipalities that have pre-medical care centres raised the issue of the functioning of paramedic stations and health centres. Municipalities with a low population density and complicated logistics are actively advocating for increased funding under the MGP for the Primary Care Package, arguing for unequal conditions compared to more densely populated municipalities with adequate logistical solutions. In response to this, representatives of the National Health Service emphasised that the issue of introducing a rural coefficient was not on the agenda within the GMP, since the GMP provides for the payment of medical services while contracting to preserve personnel potential is an option only in occupied territories or territories affected by active hostilities.
There are two considerations here. First, primary care is closest to the patient. And secondly, the infrastructural stage of the healthcare reform introduces a certain degree of centralisation of the specialised level. As a result of both, PHC facilities have ample opportunities for developing additional functional areas and signing additional packages with the National Health Service. This can potentially strengthen their financial sustainability and make health services more comprehensive and logistically available for the people of municipalities.
According to the representatives of the National Health Service, another key task and sometimes a challenge for the local self-government bodies is the organisation of comprehensive and extensive access to medical and pharmaceutical services at the municipal level. Local self-government representatives seldom have many questions about the Affordable Medicines Programme, because only a small number of municipalities own municipal pharmacies. That is why the National Health Service proactively pointed out the low level of use and insufficient logistical availability of the Affordable Medicines Programme for the people of a number of municipalities in different regions of Ukraine.
Summing up, it should be noted that local self-government bodies are most interested in the practical implementation of the infrastructural stage of healthcare reform. This reflects their strategic desire to adapt to new realities and implement new approaches to management both in primary and specialised health care. The central executive authorities are to provide local self-government with all the necessary information shortly to facilitate overcoming the challenges of this vital stage of healthcare reform.
