In July 2022, the Law of Ukraine “On Amendments to Certain Legislative Acts of Ukraine Regarding Improvement of the Provision of Medical Assistance” No. 2347-IX entered into force. This was the start of the infrastructural stage of the healthcare reform in the country. At the info session, representatives of the municipalities of the Zaporizhzhia and Dnipropetrovsk oblasts learned about the main powers of municipalities at this stage of the reform as well as factors and risks that should be taken into account by local self-government when managing healthcare facilities in the new conditions.
The experts of U-LEAD with Europe told the representatives of local self-government about the changes to be introduced in health care in 2022 and 2023 and offered advice on the directions to focus on.
“There is a war going on in Ukraine. The circumstances of each municipality’s situation vary: there are battles on the territory of some municipalities; others are temporarily occupied but continue to provide health care services to their residents; there are those who accept IDPs and ensure the provision of services with limited resources. Still, the healthcare reform continues, and municipalities face new challenges and opportunities,” said Tetiana Bordiuh, Head of the Regional Office in the Zaporizhzhia Region.
Alisa Makarikhina, External Expert at U-LEAD, worked with municipal officials. She presented the main principles of forming and clustering hospital districts, talked about the Electronic Health Care System — the basis for contracting, payment and monitoring of the National Health Service of Ukraine — and highlighted the approaches to the management of healthcare facilities in view of the next stage of the reform. In addition, the info session considered KPI for health care institutions for local self-government based on depersonalised electronic medical data.
According to Alisa Makarikhina, this stage of healthcare reform is one of the most difficult and important.
“The infrastructural stage fundamentally changes the way the people in any municipality receive medical care. It will affect everyone: both municipalities that own healthcare facilities and those that do not. These changes can be compared with the transformations that took place during the reform of the primary health care level, when the principle of financing and management of healthcare facilities was changed,” the expert said.
She reminded the definition of the hospital district and cluster, emphasising the main principles of their formation.
“Each region is defined as a single hospital district, which consists of hospital clusters. The clusters will serve the area with a population of 150,000 or more and within 90-minute drive to a highly specialised healthcare facility. A single effective healthcare network must be formed. And this division into clusters and hospital districts allows for the optimal calculation of the patient traffic and ensuring equal access to medical care,” said Ms Makarikhina.
According to her, clusters are not defined by the boundaries of administrative units. They are formed by the submission of the hospital council and the regional health department to the Ministry of Health and are approved by a resolution of the Cabinet of Ministers of Ukraine. As the case may be, one district may have several hospital clusters, while two or three districts may have one shared cluster — a new hospital that will act as the main hospital.
“Everything depends on the calculations of the population’s needs for medical services, logistical routes and the capacity of hospitals and municipalities that own healthcare facilities,” the expert said.
The info session participants received advice on the effective management of healthcare facilities in view of the infrastructural stage of the healthcare reform. Municipalities need to:
-
Create a supervisory board and actively involve it in the process of adaptation of healthcare facilities to new conditions;
-
Consolidate the vision of healthcare development in the municipal documents, local programmes, etc.;
-
Determine the minimum scope of medical services needed by the residents of the municipality and patient routes to receive these services;
-
Build staff capacity, motivate the personnel of healthcare facilities to obtain additional specialisations, each how work with electronic services;
-
Continuously analyse activities based on depersonalised medical data to make more informed decisions regarding management, investment and development.