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Impact of Healthcare Reform on the Primary Healthcare Level in Conflict-Affected Areas of Donetsk and Luhansk Oblasts About Mdm

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Impact of Healthcare Reform on the Primary Healthcare Level in Conflict-Affected Areas of Donetsk and Luhansk Oblasts About Mdm Funded by the European Union IMPACT OF HEALTHCARE REFORM ON THE PRIMARY HEALTHCARE LEVEL IN CONFLICT-AFFECTED AREAS OF DONETSK AND LUHANSK OBLASTS ABOUT MDM MdM is an independent international movement outreach teams consisting of a family doctor, a of active campaigners, who provide care, bear midwife, a nurse, a psychologist and a pharmacist witness, and support social change. are conducting daily visits to carry out consultations MdM campaigns for a world without any barriers to and provide essential medical services. healthcare, a world in which health is recognized In Bakhmut Raion the outreach team consisting as a fundamental right. of a midwife and one psychologist, visits remote locations together with family doctors from the Médicos del Mundo» and «Ärzte der Welt» are respectively the Spanish and the German divisions local PHC system. of the international MdM network and jointly In Stanytsia Luhanska town MdM provides MHPSS implement humanitarian assistance programmes services (group and individual consultations) for in Luhansk and Donetsk Oblasts of Eastern host community and individuals coming arriving Ukraine. from NGCA. The MdM mission in Ukraine was established In Luhansk and Donetsk Oblasts, both GCA following the emergency assessment conducted and NGCA, MdM supports local health system in April 2015 and focused on changes in availability through humanitarian assistance and COVID-19 of and access to healthcare, particularly for the related response: most vulnerable population, including the elderly and those with chronic diseases. • Donations of medical equipment, medication, and consumables to PHC and One of the main goals of MdM is extending the Secondary Health Care facilities in Donetsk access of Ukrainian population to timely and and Luhansk (GCA). And donations of quality primary healthcare (PHC), Sexual and emergency medical equipment to key health Reproductive Health (SRH), Mental Health and facilities in Luhansk NGCA. Psychosocial Support (MHPSS) services and Gender Based Violence (GBV) prevention and • Trainings and supervision to the healthcare response. staff on SRH, MHPSS, GBV, and COVID-19. In Luhansk and Donetsk Oblasts MdM is targeting • Institutionalization of knowledge, establishing the most vulnerable communities through a mobile the community of practice through partnering outreach unit approach covering remote locations with educational institutions for transfer of in the area close to the Line of Contact, where the knowledge. Strengthening and empowering health system has been severely disrupted due to communities. the armed conflict. • Support of the healthcare system to respond In Sievierodonetsk and Shchastia Raions 2 to COVID-19. CONTACT INFORMATION: Advocacy Manager of Médicos del Mundo Valeriia Bozhenko email: [email protected] tel.: +380 63 530 25 62 2 Medicos del Mundo, June 2021 EXECUTIVE SUMMARY THE PRESENT DOCUMENT AIMS TO ANALYZE THE ISSUES ON THE PRIMARY HEALTHCARE LEVEL IN CONFLICT-AFFECTED DONETSK AND LUHANSK OBLASTS (GCA) THAT RESULT FROM THE CONSEQUENCES OF THE CONFLICT IN THE CONTEXT OF THE RECENT HEALTH REFORM AS WELL AS CHALLENGES POSED BY ITS IMPLEMENTATION FOR THE FRAGILIZED HEALTHCARE SYSTEM. The following barriers to access quality public ▶ Complicated access to health care health care (PHC) services are analyzed as directly services for the population residing in resulting from the conflict: isolated settlements near the LoC; • Shortage of primary care doctors and a specific ▶ Inability to effectively implement State demographics of the health staff in Luhansk programmes, such as the Affordable and Donetsk Oblasts (in the majority they are Medicines Programme and telemedicine of retirement and a pre-retirement age); since national and regional governments do not provide the necessary support to • Damaged infrastructure; alleviate the pressure on the healthcare in • Power and water outages, problems with the conflict-affected areas, for instance: the Internet, poor network in primarily rural - Meaningful increase of the remuneration settlements; of the health staff; • Absence of pharmacies and pharmacy points - Supplements to the income related in settlements near the Line of Contact (LoC); to the hardship of work in a conflict- • Demographics of the majority of 60+ population affected area and in the rural areas with in Luhansk and Donetsk Oblasts that requires reduced public transportation available; additional medical attention; - Government programmes to attract • Impact of the consequences of the conflict on qualified medical staff to the conflict- the mental health of the population that reduce affected area; opportunities to achieve qualitative results - Transition periods to adapt the impelled by the health reform, as the current implementation of the reform to the situation creates: realities of the region; ▶ Inability of Luhansk and Donetsk Oblasts The burden of the aforementioned issues to the to attract qualified medical professionals; healthcare system is further complicated by the ▶ Overwork and burnout among primary COVID-19 pandemics impact in the area. healthcare staff; The factors described in the document consider that the conflict-affected areas require additional government support in the implementation of healthcare reform. 3 Medicos del Mundo, June 2021 INTRODUCTION In the area affected by the conflict, any trans- fected regions, as, for instance, demonstrated formation produces a tremendous impact on in the COVID-19 response. Disruption of the re- the access to basic services. The healthcare ferral system in the region, damages to the civ- reform initiated in 2018 has been implement- il infrastructure, weak patients’ transportation ed in Ukraine in all oblasts with no exception system coupled with long distances and bad and adjustments specific for the GCA despite road conditions, lack of medical staff, and insuf- the complex situation of the healthcare system ficient coverage of the emergency care exacer- in that area. While transformations induced by bated the vulnerability of the healthcare system the healthcare reform to optimise the limited re- during COVID-19 pandemics and reduced even sources of the outdated post-soviet healthcare more the opportunities for the population to ac- system (Semashko model) and to transform the cess the healthcare. financing model of the healthcare services were The present document analyses first — the con- highly needed, today, the new system needs to sequences of the conflict on the access to health- be reassessed, and transformation monitored care services (1) and the specific factors affecting to be in condition to bring critical adjustments. the quality of healthcare services in conflict-af- Besides, any health-related programming in two fected Luhansk and Donetsk Oblasts related to conflict-affected oblasts should be built on a the healthcare reform (2). MdM considers both comprehensive analysis of specific factors af- aspects impacting each other, therefore, they fecting the access to healthcare in conflict-af- should be considered together. METHODOLOGY THE ANALYSIS BELOW IS BASED ON THE REVIEW OF LEGISLATIVE DOCUMENTS, RECENT MDM ASSESSMENTS IN THE SETTLEMENTS ALONG THE LINE OF CONTACT AND MORBIDITY DATA COLLECTED BY MDM IN DAILY OUTREACH WORK OF MOBILE UNITS, AVAILABLE ASSESSMENTS PRODUCED BY PARTNER ORGANIZATIONS, INTERVIEWS WITH THE REPRESENTATIVES OF THE LOCAL AUTHORITIES AND HEALTH FACILITIES OF LUHANSK AND DONETSK OBLASTS (GCA). 4 Medicos del Mundo, June 2021 CONSEQUENCES OF THE CONFLICT ON THE ACCESS 1 TO HEALTH SERVICES 1.1. Shortage of primary care physicians significant factor affecting the access to and a large number of physicians of healthcare and quality of life (Figure 1)4. retirement and pre-retirement age. In the locations near the LoC, there is 1.2. Destroyed infrastructure. 35% of primary a shortage of medical staff (from 20% health care facilities have sustained to 40% depending on the settlement1), damages or are left it in a state of disrepair while about 60% of available primary due to the lack of maintenance, especially care physicians are of pre-retirement in rural areas.5 Moreover, according to and retirement age.2 Some localities an Assessment conducted by MdM6, where MdM works are not covered by 57,9% of healthcare facilities near the family doctors at all (out of 14 medical LoC in Popasna, Stanytsia Luhanska, and ambulatories, where a primary care Bakhmut Raions were damaged due to the physician should be permanently conflict, 94,7% require restoration.7 In the assigned, three medical ambulatories are meantime, physical access to healthcare not covered by primary care physicians facilities along the contact line remains a at all, in five medical ambulatories, a key issue due to the limited public transport primary care physician works 1-2 times and damaged road infrastructure. 52% of per week).3 In Luhansk Oblast, in locations IDPs living in rural areas reported that the along the LoC, community members lack of public transport did not allow them identified a lack of medical professionals to visit medical facilities, compared to 36% and medical examinations as the most in urban areas.8 Figure 1. The most significant resources lacking are related to health and quality of life, according to community members. Medical Specialists 96,52% Free/Low Cost Dental Care 80,86% Health Screenings 74,97% Transportation 59,57% Mental Health Services 56,76% Free/Low Cost Medical Care 31,86% Health Education/Information/Outreach 24,77% Pharmacy 22,36% Subsidized
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