Ukraine's healthcare transformation progress in the context of European integration

On June 26, 2018, the EU-Ukraine Sub-Committee on Economic and Other Sector Cooperation cluster meeting participants, including representatives of the Ministry of Health of Ukraine, discussed the major accomplishments and future prospects for bringing the Ukrainian healthcare in line with the European standards in the context of the EU-Ukraine Association Agreement implementation.

The Ukrainian government is implementing a fundamental transformation of the health care system in Ukraine, which envisages a number of important steps towards bringing the Ukrainian healthcare in line with EU standards and making progress in the European integration process.

To achieve these objectives, the following actions were taken last year:

• the International Classification of Primary Care (ІСРС-2), which is the most widely used classification instrument in clinical settings, was introduced. This system allows primary care physicians to focus on patients' needs rather than on coding and medical statistics.
• the evidence-based guidelines for public health care were introduced and the medical report forms were simplified.
• the state procurement system was improved by the implementation of the procurement through international organizations as an effective tool for providing Ukrainians with quality medicines and vaccines. The specialized procurement agencies, namely the UNDP, UNICEF, and Crown Agents, comply with all international and European quality standards, ensure transparent bidding process and negotiate the best prices.  
• The "Affordable Medicines" program was launched and successfully developed. To date, every third pharmacy in the country releases certain fully or partially reimbursable prescription drugs, making prescribed medicines more accessible and affordable to patients.   
• The updated version of the National List of Essential Medicines was implemented. The NLEM was expanded to 427 international nonproprietary names (INN) to satisfy 100% of the priority health care needs of the population and to ensure that the essential medicines are available in sufficient amounts and provided free-of-charge in hospitals nationwide.

The laws providing for the introduction of the modern healthcare financing model were adopted in late 2017 and starting 2018 the new payment mechanism – the "money follows the patient" principle – is being implemented in primary care.

As of June 5, 2018 the National Health Service of Ukraine (NHSU) signed contracts with 149 communal and 12 private primary care providers nationwide. Starting July 1, all contracted facilities receive funding under the new financing model. In total, 21 oblast of Ukraine has already joined the transformation process and over 10 million Ukrainians have already chosen the primary care providers (family doctors, general practitioners and pediatricians).

"Our responsibility is to ensure access of each and every citizen of Ukraine to high-quality and evidence-based medicine, to improve the accessibility and affordability of medicines to the population, to reduce and prevent self-medication, to ensure effective monitoring and quality control of pharmaceuticals, to reform the state procurement system", underlined Olha Stefanyshyna, deputy Minister of Health of Ukraine for European Integration.

Owing to the effective medicine procurement through international organizations, in 2018, for the first time ever, Ukraine is fully equipped with vaccines – reliable, safe and effective. In addition, medicine procurement through specialized procurement agencies allows negotiating on prices, and therefore, increasing the purchase volume.

Five countries in the region, namely Bosnia and Herzegovina, Kazakhstan, Moldova, Turkmenistan and Uzbekistan, have followed the successful experience of Ukraine in the medicine procurement through international organizations.

The meeting participants also discussed the most important actions and results of the implementation of the Association Agreement between the European Union and Ukraine, further steps towards implementing EU acquis on public health and the European integration policy, as well as major changes in the public healthcare system and the development of a national blood safety system.

The EU Commission representatives also commended the progress achieved by Ukraine in establishing the Public Health Center, as well as developing proposals for drafting the current version of the law "On Public Health System", new approaches to implementing the national blood system strategy and the national action plan for non-communicable disease prevention, control and health promotion in Ukraine.

Particular attention was paid to promoting childhood and adult immunizations and to strengthening the national capacity and legislation for tobacco control aimed at reducing the burden of tobacco-related diseases and deaths, in particular, by implementing the Protocol to Eliminate Illicit Trade in Tobacco Products.