What’s Going on in Ukraine’s Health Ministry Amid the COVID-19 Outbreak5 min read
As if pressures on Ukraine’s healthcare sector weren’t high enough due to COVID-19, on March 30th, Ukraine’s Ministry of Health lived through another shake-up — it got a new minister. Forty-four year-old Maksym Stepanov has replaced his controversial predecessor Ilya Yemets. The former minister served less than a month in office since he was brought in during President Zelensky’s major cabinet reshuffle at the beginning of March.
While Yemets has come under attack from civil society, there remains the question whether now was a really good time to swap ministers as cases of COVID-19 are surging and some sort of political stability is needed to respond adequately. The intuitive answer is no. However, if the new healthcare minister is able to mobilize resources swiftly to help Ukraine in its fight against the pandemic, he may be able to already achieve more than his forerunner.
Although Ukraine’s government acted quickly in response to COVID-19 by closing borders and halting international travel, it did so out of necessity. Most of the developed world was not prepared to deal with a major viral outbreak, let alone Ukraine, which has just started to undergo major transformations in its Soviet-era health-care system in the past few years. Like the rest of the world, Ukraine has a shortage of the necessary equipment such as ventilators, test kits, and protective gear, as well as hospital beds for the ill.
Moreover, the COVID-19 situation is complicated by the war in the East — troops are as vulnerable as everybody else in the country, but social distancing is more difficult on the frontline. There are also major shortages in protective equipment and non-profits both locally and from abroad are flocking to help.
The former health minister Yemets — an ex-Yanukovych official — seems to be at the forefront of this scarcity. The government watchdog Patients of Ukraine report that in mid-February the government of Prime Minister Honcharuk had approved a contract for the purchasing of coronavirus-related equipment for 67 million hryvnias (approximately $2.4 million USD). However, once the administration had changed and Yemets became minister, this contract was not used to acquire the necessary equipment leading to shortages. Civil society organizations have criticized Yemets for blocking the annual purchase, which was supposed to include test kits and other essential equipment to help medical staff across the country fight COVID-19.
What is known about Yemets’ replacement? While Maksym Stepanov has a medical background having graduated from Donetsk National Medical University, he has never worked in the field, taking up various management positions in the energy sector as well as the public service. His most prominent public service role was as the chairman of the Odessa regional state administration.
However, it seems that Stepanov is just a new face with old ties. He is the godfather of the children of MP Ihor Palytsya, an old friend of Ihor Kolomoyskyi — one of Ukraine’s top oligarchs who allegedly financed Zelensky’s presidential campaign. Stepanov’s swift appointment suggests that he was brought in because of connections in an attempt to fill the position as quickly as possible rather than for his qualifications. While it is still too soon to judge the new minister, the fact that Ukraine is onto its third health minister in less than a year is alarming.
Ukraine needs a sturdy and competent leader for its top healthcare post not only to respond to the COVID-19 outbreak but to head the country’s healthcare reform. This reform was first introduced in a legislative format in 2014-2015 during Petro Poroshenko’s presidency. The next major changes to the reform came into effect on April 1st, 2020 and it was expected that this wouldn’t be a smooth rollout; some officials have even considered cancelling the reform.
In addition to the introduction of a guaranteed benefits package, one of the most important achievements of the first stage of the reform was a switch to a practice of family medicine according to Western standards. This change involves the introduction of a practice whereby patients declare their family doctors. In 2018, 25.4 million Ukrainians declared their new family doctors. The next stage of the reform is to see through changes to specialized forms of health care. As of April 1st, only GPs have the right to make electronic referrals to specialized doctors whose services patients will be able to access free of charge.
While the numbers show that many Ukrainians have understood the steps that they need to take to receive medical care under the new rules, a major roadblock in the reform’s implementation has been the lack of clear government communication and guidance in particular to health care sector workers, Kyiv-based activist Vladyslav Greziev told me in an interview. The rules had changed, but many medical professionals across the country were left in the dark as to what these new rules actually meant in practice. It is expected that this will continue to be a challenge with further implementation phases.
With all of the chaos as a result of COVID-19 and the ministerial changes, it is expected that phase two of the reform will be neglected in its implementation. The resources to roll it out effectively are simply not there. Of course, of all people it will be the frontline medical professionals who will have to deal with the burden of both the virus and any healthcare policy blunders. Let’s hope that the health ministry under its new leadership is able to recognize both challenges and attempt to relieve healthcare workers from the imminent pressures.