The rural municipality of Polytsi, Rivne Oblast, is quite small but very ambitious. Although many experts do not see running Primary Healthcare Centres (PHCCs) as a viable option for small municipalities, they dared to attempt this process on their own. As a result, the municipality has been providing quality medical services to its residents for about three years.
Mykhailo Shelep, Adviser on Decentralisation and Local Self-Government of the Regional Office of U-LEAD with Europe, told more about this:
“The central village of the municipality, Polytsi, opened a new outpatient primary care clinic in the summer of 2021. The modern medical facility was built as part of the state programme and financed from the budgets of various levels. However, the new facility did not solve all the needs related to the primary healthcare provision — a former district municipal non-profit (MNP) provided the relevant services. There were certain misunderstandings, and the village council had no real say over these processes at that time. That is why the Polytsi Village Council decided to create its own MNP.”
According to the adviser, this decision was preceded by a series of consultations and training organised by U-LEAD: experts and advisers explained the procedure for creating the MNP, the National Health Service’s requirements for its operation and the mechanism of financing it to local self-government officials. At the end of 2021, the Polytsi Primary Healthcare Centre was created, and already at the beginning of 2022, the MNP was properly licensed.
However, the full-scale invasion prevented the immediate launch of an active campaign to sign declarations with the population of the municipality, so once the MNP was established, the main burden of its financing was taken over by the village council. To date, the number of registered declarations already enables the MNP to pay employees’ salaries independently, while the village council helps pay their utility bills. Mykola Ozeruha, village head of Polytsi, commented on it:
“When the municipality planned to create its own PHCC, everyone was aware of the difficult road ahead. We sought specialists, built an outpatient clinic with the support of the state and worked out options for creating and supporting our own medical unit. And when we finally got the first results, people wondered if a private clinic had opened in the village, as conditions, so modern could not exist in municipal healthcare facilities. But they can and they do. Despite the facility’s self-sufficiency today, we allocate funds to it from the local budget under our support programme.”
According to Mykola Ozeruha, the municipality is already sharing its experience of creating a PHCC with other municipalities.
How does MNP operate in the Polytsi municipality? In addition to appointments at the outpatient clinic, the family physician makes regular appointments in remote villages, which they reach by a special car donated by international partners. The team is committed to continuous improvements of its services.
Maria Horelova, Director of the Primary Healthcare Centre:
“Back when our facility just opened, locals had varying opinions about it: people kept going to regional hospitals and did not understand whether they would receive the full range of services in their municipality. In order to become self-sufficient, we had to overcome this barrier, to earn people’s trust and present high-quality medical services on the ground. Another problem was financing, because the institution was created at the beginning of the year, and the contracts with the National Health Service are executed at the end of the year. Staring out was difficult, doctors’ salaries were paid from the funds of the village council.”
The Centre currently has the Affordable Medicines Programme and two packages of services from the National Health Service: Primary Healthcare as well as Primary Support and Treatment of Adults and Children with Mental Disorders. The Centre includes an outpatient clinic and 4 rural health posts and employs 5 doctors.
“In 2022, we received UAH 1,300,000 from the municipality to provide salaries, utilities, medicines — everything necessary to start this work. In 2023, we have already reached self-sufficiency thanks to the packages of the National Health Service. The number of declaration filers has increased: we received about UAH 1,700,000 for declaration filers in 2022 compared to UAH 2,700,000 in 2023,” says Maria Horelova.
Mykhailo Shelep firmly believes that the Polytsi municipality chose a difficult path, because, with the creation of its own Primary Healthcare Centre, the burden of supporting a non-profit and responsibility for its work fell on the village council. However, this allowed the village council to have a direct influence on the provision of these services to the population; the village council allocates funds for the purchase of new equipment for the MNP and coordinates the cooperation between doctors and educational institutions:
“The experience of the Polytsi municipality shows that even small municipalities are capable of independently providing quality medical services.”