bne: Gloves off for Ukraine’s health minister as long-awaited reforms begin

Article published on the bne Intellinews website on April 16, 2018.

When the Ukrainian Health minister announced the start of the country’s most ambitious healthcare reform of its post-soviet history, 32 years-old doctor Svetlana Bulatova could not hide her anxiety. In the state polyclinic where she works – a moth-eaten building with an imperial façade and a large classical staircase in the centre of Odessa– talks of an imminent restructuring has left many wondering if they would still have a job in a few months time.

For the long-suffering health workers reforms just adds another layer of uncertainty to an already difficult job: “Reforms is very suitable, especially for our patients,” Bulatova said. “But… it means we have to destroy everything in order to create something new, and every time this happens, things get very difficult for everyone.”

Uncertainty has been the key word as Ukraine attempts to overhaul its corrupt, inefficient, Soviet-era healthcare system. Although the country spends about 7% of its GDP on healthcare (most developed countries spend between 9% and 12%; the US being the exception with 17%), Ukraine has among the lowest life expectancy in Europe (71 years, ten years less than the European average). Abysmal vaccination rates have also lead to multiple epidemics, including a wave of measles that killed 8 people last winter.

But despite a general consensus on the pressing need to upgrade healthcare, pushback has been strong, due to political pressure, the influence of vested interests in the pharmaceutical business and the concerns of medical professionals. It took Ukraine’s reformist government almost four years to vote in new legislation on healthcare: adopted in October 2017, the reform implementation began on April 1st this year.

Since the country’s independence, healthcare has never ceased to be a sensitive political issue. In 27 years, Ukraine went through 22 Health ministers, with most attempts at change ending dead in the water.

The in 2014 the revolution began. Dr Ulana Suprun was appointed as Health Minister and took over the ministry in July 2016. Her arrival was described by civil society as an unprecedented opportunity to transform the system. Suprun, a Ukrainian-American who first worked in 2014 with an NGO that distributed medical equipment to Ukrainian soldiers, certainly contrasts with the rest of Ukraine’s political class. The American accent, long blond hair casually falling over her shoulders, and her outsider status (she was never involved in Ukrainian politics before 2014) are all things rarely seen in a Ukrainian political office.

Talking to bne IntelliNews in late March, Suprun described a chaotic arrival at a ministry that had been largely vacated by the staff of the previous minister, Viktor Shafransky. Shafransky lasted only three months before being shown the door because of alleged corruption by one of his deputies. “I walked into the ministry with no transition period at all, I didn’t even know where my office was or what documents I was supposed to sign,” Suprun said, calling it her “baptism of fire.”

But even she hasn’t been immune from political boondoggling: she is still officially considered “acting minister” as disputes in the parliament prevented her from being duly appointed.

Read the rest on the website of bne IntelliNews.

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