NATIONAL HEALTH SERVICE 2020 OF UKRAINE ANNUAL REPORT Annual Report 2020 National Health Service of Ukraine This report is made possible by the support of the American and British People through the United States Agency for International Development (USAID) and through the UK Good Governance Fund/UK Government (UK aid). The contents of this report are the sole responsibility of Deloitte Consulting, LLP and do not necessarily reflect the views of USAID, the United States Government, UK aid, or the UK government’s official policies. This report was prepared under Contract Number 72012118C00001. 1 TABLE OF CONTENTS I. Overall situation and international partnership Overall situation in Ukraine . 6 International partnership. 7 ІІ. Implementation of the Program of Medical Guarantees National Health Service and universal health coverage . 14 Patient-centeredness. 15 NHSU and doctors’ status change. Impact of transformation on the health labor market. 19 III. NHSU and civil society Public Oversight Board at the National Health Service of Ukraine. 22 Cooperation with patient organizations. 22 IV. Cooperation with the health community NHSU interregional departments . 26 Teams of experts developing the Program of Medical Guarantees 2021. 33 NHSU Academy. 33 V. NHSU and transparency Accountability of public funds. 36 NHSU and open data: Open Data Government Awards winner. 37 NHSU and digital transformation: development of eHealth and electronic services for people. 37 VI. NHSU and decentralization VII. Results of the health financing system transformationin 2020 Program of Medical Guarantees . 43 Primary and specialized health care. 71 COVID-19: contracts, testing and treatment. 128 Electronic medical records. 155 Affordable medicines . 182 2 happened, in my opinion, because the NHSU is not a one-actor theater. It is a story created by dozens of professionals with their own standpoints and unique Acting NHSU Head expertise, who at the same time share a vision of the future and the desired result. in 2020 Oksana MOVCHAN In 2020, Ukraine fully launched the Program of Medical Guarantees (PMG) for the first time and shifted health financing towards contracts. The entire system works in electronic format; we have no paper- based documents. We contract only autonomized Dear colleagues! We often hear that in order to make enterprises. This is important because healthcare changes irreversible, we need to invest in institutions. facilities must become independent entities before These are the recommendations of international they can modernize. partners; we hear it from various government officials. We keep repeating these words to ourselves We have also created a unified coding system and can in the National Health Service of Ukraine (NHSU). cost services. Now, one service has one name and code in the electronic system. Previously, the same Institutions should not exist on paper only. They service had different names and codes. This caused should be created in the right way; they should have confusion in clinical protocols, as well as a mess in supervisory boards and be impartial. Managers and statistics and in payment. Now our rules are unified, employees of these institutions should be selected transparent and clear. through transparent and clear procedures. The NHSU is one of the best examples of such an institution, When you implement complicated structural because we have all this; there is a supervisory board, changes, you bear huge responsibility because you and all three hundred employees were selected are making decisions that may affect the health of through open competition. 37 million people. If something goes wrong, you have to understand that you were not just a civil servant The NHSU has changed its top manager three times in who signed documents. It was your standpoint that three years, and all this happened through transparent influenced the decision. selection procedures and without violating the law «On Civil Service». This is our achievement. At the NHSU, we make decisions at a round table. This principle exists not only at the level of the top The NHSU survived three different governments. management of the NHSU, but also in departments. The Ministers of Health and the Ministers of Finance This is the most democratic process. Such a culture changed, but our vector of movement has not deviated was established with the creation of the NHSU. This from the Health Financing Reform Concept approved is what shaped and strengthened our team into team five years ago. The Concept was approved through the players, and our team is only three years old. CMU Resolution, and it included the Action Plan by 2021. Now I can say with confidence that everything We often look up to the British National Health written there has been 95% completed. Service (NHS), which celebrated its 75th anniversary this year. While we are very self-critical at the NHSU This is one of the unique cases in modern Ukrainian and we have many external critics, it is important to history when the developed reform concept was remember that this is our first three years out of 75. implemented within a clearly defined timeframe. The We have at least another 72 years ahead. five-year concept implementation has included three years of NHSU operation. In three years, we have changed the rules of the game. Now everyone has to accept these rules and When creating a concept and strategy design, all start moving towards tangible results for patients. possible external risks are taken into account. We will achieve these goals in the coming years. They 2020 was the year of all such risks. All bombs have must be approached with dignity so as not to lose the detonated. However, we have achieved the goal. This idea of transformation and the task at hand. 3 There are two catalysts for change in health. One: health care contracts under the PMG between healthcare facilities and the NHSU. These contracts use performance-based financing to ensure a fair distribution of funds in health and to support the Acting NHSU Head development of health care providers that work in the Andrii VILENSKYI interests of their patients and create opportunities for the support and development of their own employees. Two: open data in eHealth. These data inform the decisions of all stakeholders: of patients - when Dear colleagues! 2020, another year of the health choosing a doctor and healthcare facility where reform, is over. It was an extremely important year, they will receive quality care; of managers – when as we launched the PMG for all types of health care developing and implementing the healthcare facility and tried to overcome the coronavirus pandemic. development strategy; of doctors, other health and non-health workers - when planning their own For three years, the NHSU team has been persistently career, professional and personal growth; of local transforming the health system to ensure the governments – when building a strong network of implementation of the principle of universal health healthcare facilities to improve the quality of life of coverage, when every citizen of our country has citizens; and of public authorities – when developing the right to and receives necessary care of proper and implementing health policy. quality and without catastrophic personal financial expenditures. The transformation of the health sector is ongoing, and the National Health Service of Ukraine will Changes in the system are long overdue. All of us – continue to persistently develop the PMG and the key patients, health professionals, local authorities – mechanisms of its implementation, to create new want to quickly see improved health care quality, services and tools to improve each patient’s access improved working conditions for health professionals, to quality health services. and healthcare facilities transformed into successful healthcare enterprises. Therefore, the community’s To be continued! expectations for the transformation have so far outpaced the outcomes. However, the transformation has only just begun, and the pace and quality of change depend on the joint efforts of all stakeholders. OVERALL SITUATION AND INTERNATIONAL PARTNERSHIP Section I 6 Overall situation and international partnership OVERALL SITUATION IN UKRAINE In 2020, the transformation of the health system It should also be noted that, due to the political cycle successfully entered its second phase. On April 1, in Ukraine, changes in Ministry of Health leadership 2020, changes began at the level of specialized health continued in 2020. Establishing institutional care. They finally started where they were most cooperation has been one of the challenges of the year. expected by patients and health professionals - at the For its part, the NHSU provided clear and thorough level of polyclinics and hospitals. These changes took information on the mechanisms of transformation, place during a very difficult situation for the health its mission and vision. Additionally, the NHSU system, the COVID-19 pandemic. No health system in implemented absolute operational transparency to the world was ready for it, and doctors had to take on preserve institutional memory; anyone who started to heavy workloads in difficult conditions of uncertainty. work in health system management had full access to No one had out-of-the-box solutions, but pandemic all data related to healthcare facility financing during response mechanisms have been developed quickly the entire health system transformation period. around the world and the National Health Service