The municipalities of Batiovo, Koson and Velyki Berehy finalised the creation of a joint municipal non-profit enterprise, Primary Healthcare Centre, in March 2024. Pavlo Riabokon, Adviser on Decentralisation and Local Self-Government of the Regional Office of U-LEAD with Europe in the Zakarpattia Oblast, commented on this.
“Inter-municipal cooperation helps small municipalities solve big problems. Earlier, the Law of Ukraine ’On International Territorial Cooperation’ has been amended to significantly simplify the process of entering into cooperation agreements, so I believe that municipalities should learn from their colleagues. Note that this is already the second agreement in health care among the municipalities of the Zakarpattia Oblast, and it can become a blueprint for others.
According to the deputy head of the settlement of Batiovo, Gabriella Galambosh, the cooperation agreement was signed to consolidate efforts in providing high-quality and affordable primary health care services to the residents of these three municipalities. Each has equal rights and makes contributions proportionally:
The Centre was licensed, and our family doctors immediately started signing declarations with patients. In our healthcare system, money ’follows the patient’, i.e. the doctor’s work is paid based on the number of patients and the quality of the services provided. You choose a facility and a doctor yourself, and the state must pay for the services provided. Municipalities that plan to start cooperation in this format should keep in mind that signing declarations takes a while, so municipalities should provide financial support for this period to smoothly run the facility.”
Signing a cooperation agreement enabled expanding the range of medical services, purchasing more modern equipment, attracting specialists and opening a laboratory. As a result, almost 25,000 residents of the three municipalities will receive quality medical services.
“It is important for us to have a direct say in the development of medical services in our municipality. The agreement stipulates that if the municipality has funds and is ready to allocate them to the Centre, it can develop certain directions within this framework. Our municipality is currently working on the purchase of an ultrasound machine so that our residents can receive these services for free. At the same time, the team of the Centre itself is working on launching new packages to expand the list of medical services on the ground,” said the Deputy Head of Batiovo.
She added that cooperation helped recruit a doctor from Kramatorsk and another one from Mariupol. She also stated:
“From the earliest days of the municipality and to this day, we feel the support of U-LEAD. We have come a long way since then, and they led us step by step in certain issues. Whenever we face problems, we turn to their experts. As for the Inter-Municipal Cooperation Agreement, they provided us with support from the earliest concept stage to the submission of documents for registration.”
Gabriella Galambosh also said that inter-municipal cooperation had been established even before the signing of the agreement, but formalising it was a fundamental goal for all three participants:
“You can cooperate even without a formal agreement, but the senior officials of our municipalities believe that informal cooperation strongly depends on external factors and political influences. Therefore, it is important to enter into agreements. Official inter-municipal cooperation projects can attract donor funds for development and join grant projects.”
Municipalities might cooperate in various formats. As Pavlo Lohvinov, Head of the Regional Office of U-LEAD in the Zakarpattia Oblast, said:
“The format of the agreement executed by and between the municipalities is the joint financing and maintenance of a joint non-profit enterprise by the municipalities of the Berehove District. I would like to stress that this partnership requires a careful approach to the development of a mechanism for financing the facility that is fair for each municipality, which is being implemented in practice.”
According to the Ministry of Infrastructure and Reconstruction, during 2023 and January 2024, 686 municipalities from 21 oblasts used the tools of inter-municipal cooperation and entered into 431 agreements.