Ukraine's Health Sector: Sustaining Momentum for Reform

"For the last year,...an important linchpin of reform - the health sector - has been the subject of intense new development and debate across Ukraine....The moment of possibility has arrived. A major success in health reform is within reach."

This report from the Center for Strategic and International Studies (CSIS) Global Health Policy Center describes a paradigm shift happening in Ukraine, representing what may be a narrow window of opportunity to overcome corrupt, entrenched interests in a country that still clings to the remnants of the Soviet system of health care. As author Judyth Twigg explains, there has been an increasing sense among the Ukrainian public that their health care is far from international state-of-the-art. Recent outbreaks of polio, measles, and diphtheria have been a wake-up call, changing family and community perceptions of the old system's adequacy. Opinion polls show support for systemic health reform - growing from 40% several years ago to over 70% now. International backing of and collaboration in the effort has been, and continues to be, essential, Twigg asserts.

Having laid out the health situation in Ukraine - where, until recently, many routine medications and vaccines were not just prohibitively expensive, but completely unavailable - Twigg describes a champion of reform: Dr. Ulyana Suprun. Suprun is a Ukrainian-American radiologist who came to Kyiv in the fall of 2013, with the intent of promoting Ukrainian writers and culture by translating Ukrainian books into English. She was appointed as acting health minister in July 2016. "Her one condition for taking the job: that she be allowed to appoint her own leadership team. Many posts are now filled by young, energetic, in many cases Western volunteers, replacing obstructionist political appointees with vested interests in the old system."

A comprehensive overhaul of the entire system is in the works. The reform's public relations strategy has featured an energetic social media presence (in addition to the ministry and the minister, the reform legislation itself has active Facebook and Twitter accounts), radio and television blitzes, and extensive outreach to Ukraine's regions and localities. Defenders include a broad array of civil society groups, including patients' organisations and anticorruption activists. Since Suprun's appointment, international donors and implementing partners seem enthusiastically on board with health care reform in Ukraine. For example, the United Nations Children's Fund (UNICEF) has contributed to communications support around immunisation and maternal/child health, as well as procurement reform.

However, there is opposition. For instance, the Ukrainian Anti-Corruption Action Center has analysed the dominant antireform social and broadcast media messaging and traced its origin to media channels with direct ties to the Opposition Bloc, controlled by ousted President and Russian ally Viktor Yanukovich. Websites run by pro-Russian Ukrainian businesspeople regularly intermingle attacks on the health reform with blasts against the Euromaidan and praise for the annexation of Crimea. In the face of this onslaught, maintaining a cohesive communications and implementation strategy is key, Twigg contends. Although much of the opposition is pushing "fake news" to safeguard narrow, lucrative interests, there are legitimate concerns worthy of engagement - for example, that the country's existing internet service and computer hardware are inadequate to support e-health and that communication channels between national and local authorities are underdeveloped.

In this context, Twigg says, "Ukraine's population is well educated and sophisticated in its media consumption; they need to be kept well informed and reassured. It will be tragic if hard-fought passage of reform legislation is squandered due to inadequate or ineffective communication, planning, and buy-in across the country."

In conclusion, Twigg urges the United States (US) to make consolidation of health reform in Ukraine a policy priority, drawing on a strategy of high-level diplomatic engagement, continued strong bilateral support through the United States Agency for International Development (USAID), and continued collaboration with key multilateral partners, including the United Nations (UN) agencies, the World Bank, and potentially the European Union (EU).