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Report on the Legal Environment Assessment for Tuberculosis in Ukraine

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Report on the Legal Environment Assessment for Tuberculosis in Ukraine Report on the Legal Environment Assessment for Tuberculosis in Ukraine UNITED NATIONS DEVELOPMENT PROGRAMME, STOP TUBERCULOSIS PARTNERSHIP THE LEGAL ENVIRONMENT ASSESSMENT FOR TB IN UKRAINE Final report Natalia Spivak, Sergiy Kondratyuk, Khrystyna Demchenko, Timur Abdulayev, Natalia Lukyanova, Kateryna Denysova 29 May 2018 This Report was developed with assistance from UNDP Istanbul Regional Hub HIV, the Health and Develop- ment (HHD) team and the Stop Tuberculosis Partnership. Work on the project The Legal Environment Assessment for TB in Ukraine was conducted on the initiative and funding of UNDP and the Stop Tuberculosis Partnership between November 2017 and March 2018 based on the Legal Envi- ronment Assessment for TB prepared by UNDP and the Stop Tuberculosis Partnership in July 2017. The Legal Environment Assessment for TB in Ukraine was carried out by the team of national and internation- al consultants: Sergiy Kondratyuk, Natalia Spivak, Khrystyna Demchenko, Timur Abdulayev; HHD Regional Team leader Dr Rosemary Kumwenda; Regional HHD Programme Specialist John Macauley; National Pro- gramme Specialist Natalya Lukyanova and Programme Associate Kateryna Denysova from UNDP Ukraine. REPORT ON THE LEGAL ENVIRONMENT ASSESSMENT FOR TUBERCULOSIS (TB) IN UKRAINE Table of contents Work on the project 2 List of abbreviations 4 Section I. General provisions 6 Introduction 9 The aim of the research 11 Research methodology 11 Overview of the TB situation 12 Section II. Key populations 13 Section III. National features: impact factors 19 General information 19 Integration of Ukraine into the EU 20 Military conflict in eastern Ukraine 20 Corruption 21 Medical reform 21 Financing of medical care 23 Section IV. Overview of major regulations and 25 programmes International obligations 25 The Constitution of Ukraine 28 Special regulatory acts on TB 28 State Programmes/Strategies/Concepts 31 3 REPORT ON THE LEGAL ENVIRONMENT ASSESSMENT FOR TUBERCULOSIS (TB) IN UKRAINE National strategy on human rights for the period till 2020 31 Strategy for ensuring a sustainable response to the TB epidemic, including chemo-resistance, and HIV/AIDS for the 31 period up to 2020 The Concept of the National Targeted Social Programme for 31 Tuberculosis Control for 2018–2021 Research in the field of TB in Ukraine 31 Section V. Barriers to effective TB control 35 Stigmatisation and discrimination 35 Confidentiality 37 In the field of labour 39 In the field of education 45 In the field of respect for family life 49 Access to justice, free legal assistance 51 Access to medical care 55 Quality and accessibility of medical services 55 Case Finding and Diagnosis 62 Treatment 69 The main barriers to effective treatment 69 Infection control 73 Distribution of MDR-TB and XDR-TB 75 Social and psychological support 76 Duration of hospitalisation and outpatient treatment 77 Electronic medical records, registers of patients 81 Problems of access to diagnosis and treatment among key 85 TB groups People living with HIV 85 Criminalisation of deliberate exposure to danger and HIV 87 infection Convicted and detained persons 91 Persons who are held in places of non-liberty of the police of 91 Ukraine 4 REPORT ON THE LEGAL ENVIRONMENT ASSESSMENT FOR TUBERCULOSIS (TB) IN UKRAINE Persons held in pretrial detention and Penal institutions, 95 pretrial detention facilities and prisons People who inject drugs 105 Criminalising the storage of narcotic drugs without the pur- 110 pose of selling Homeless persons 115 Persons abusing alcohol 121 Migrants and internally displaced persons (IDP), people 125 without documents/illegal migrants Roma people 133 Poor residents 137 Poor residents of cities 137 Poor residents of villages 139 Elderly people (retired people) 141 Health employees who come in contact with people with 143 TB and HIV-related TB Occupational diseases 145 Military personnel who participate in the ATO/JFO 148 Persons staying in psychiatric and geriatric institutions 151 Providing the population with medicines 154 Admission of medicines to the market and state 155 procurements Compliance of TB treatment protocols with international 155 standards Forced isolation 157 Forced isolation of patients 157 Forced hospitalisation 158 Forced treatment 163 Non-Government Controlled Areas 165 Non-Government Controlled Areas 168 5 REPORT ON THE LEGAL ENVIRONMENT ASSESSMENT FOR TUBERCULOSIS (TB) IN UKRAINE List of abbreviations ATO/JFO Anti-Terrorist Operation/Joint Forces Operation Anti-TB institution anti-tuberculosis institution Anti-TB medicines anti-tuberculosis medicines CMU Cabinet of Ministers of Ukraine Commissioner Ukrainian Parliament Commissioner for Human Rights CPC Ukraine Civil Procedural Code of Ukraine CPMC centre of primary medical (medical-sanitary) care CPO centralised procurement organisation CT counselling and testing DC detention centre DR-TB drug-resistant tuberculosis ECRI European Commission against Racism and Intolerance ECHR European Court of Human Rights Employees of BIA FG employees of the bodies of internal affairs focus group HCI healthcare institutions HIV human immunodeficiency virus IDP internally displaced person LEA legal environment assessment MIA Ministry of Internal Affairs MDR-TB multidrug-resistant tuberculosis MoH Ministry of Health NGO non-governmental organisation nmic non-taxable minimum incomes of citizens OST opioid substitution therapy 6 REPORT ON THE LEGAL ENVIRONMENT ASSESSMENT FOR TUBERCULOSIS (TB) IN UKRAINE PHC Public Health Centre of Ministry of Health of Ukraine PLHIV people living with HIV PMC primary medical care PWTB people with TB PWID people who inject drugs SCU Supreme Court of Ukraine SIZO pretrial detention centre (sledstvenniy izolyator) State Drugs Service State Service of Ukraine on Medicines and Drugs of Ukraine Control TB tuberculosis TDF temporary detention facility (ITT) UCDC State Institution "Ukrainian Centre for the Control of Socially Dangerous Diseases of the Ministry of Health of Ukraine" WHO World Health Organisation XDR-TB extensively drug-resistant TB 7 REPORT ON THE LEGAL ENVIRONMENT ASSESSMENT FOR TUBERCULOSIS (TB) IN UKRAINE 8 REPORT ON THE LEGAL ENVIRONMENT ASSESSMENT FOR TUBERCULOSIS (TB) IN UKRAINE General provisions Introduction____________________ Tuberculosis (TB) control in Ukraine is one of the national policy priorities in the area of health and social development and the subject of internation- al obligations. According to the WHO, the TB epi- demic in Ukraine began in 1995.1 The increase in the incidence of TB, which has been tracked in the country since 1998, stopped in 2005 due to cen- tralised coordinated measures of the government, including beginning to fund anti-TB medicine sup- plies from the state budget in 2000 and launching the first national TB treatment program in 2002.2 As a result, since 2007, incidence rates have been falling. According to the WHO, since 2007 the prevalence and incidence of TB in Ukraine are de- creasing by an average of 4.4% and 3.3% each year, respectively. In 2014, Ukraine had (and it contin- ues to have) one of the five highest rates of Mul- tidrug-Resistant Tuberculosis (MDR-TB). The rate of successful treatment of MDR-TB in Ukraine, 46% is one of the lowest in Europe.3 Despite the fact that in recent years the rate of TB has tended to fall, the 1 According to the unified clinical protocol of primary, secondary (spe- cialised), and tertiary (highly specialised) medical care for adults “Tu- berculosis” approved by Order of the Ministry of Health No. 620 dated 9 April 2009, in 1995, the TB epidemic was declared in Ukraine: the in- cidence of tuberculosis rapidly increased and exceeded the epidemic threshold (50 cases per 100,000 people). 2 TB epidemic in Ukraine: historical aspects and the current state of the problem. Y.I. Feshchenko, S.A. Cherenko, 2012http://www.irbis-nbuv. gov.ua/cgi-bin/irbis_nbuv/cgiirbis_64.exe?C21COM=2&I21DBN=U- JRN&P21DBN=UJRN&Z21ID=&IMAGE_FILE_DOWNLOAD=1&Image_ file_name=PDF/njmoz_2012_1_6.pdf 3 The Concept of the National Targeted Social Programme for Tubercu- losis Control for 2018–2021 approved by Decree of the Cabinet of Min- isters of Ukraine No. 1011-p dated 27 December 2017. 9 REPORT ON THE LEGAL ENVIRONMENT ASSESSMENT FOR TUBERCULOSIS (TB) IN UKRAINE level of morbidity still exceeds the epidemic threshold. Among TB patients, more than three-quarters are of working age, of whom more than half are between the ages of 25 and 44. There is increasing incidence of TB among children under 14 and combined infection (TB/HIV/AIDS).4 The high morbidity and distribution of MDR-TB are due to the following main factors: • Untimely detection of patients with open TB forms due to the imperfection of the healthcare sys- tem for the diagnosis of sensitive TB and MDR-TB and and co-infection — HIV/AIDS TB; • Low level of motivation of the population to seek medical assistance on time; • Improper organisation of treatment for patients with prevailing treatment in a hospital setting, which facilitates intrahospital infections of TB patients resistant to anti–TB drugs by strains of Myco- bacterium tuberculosis; • Ineffective use of funds to finance TB control measures and maintain an existing network of anti–TB facilities with an excessive amount of beds in poor condition; • Insufficient funding for TB control; • Imperfection of the laboratory network for microbiological diagnostics of TB; • Insufficient access to the latest anti–TB drugs for patients with MDR-TB and TB with expanded re- sistance; • Limited access to methods of rapid diagnosis
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