AREA PROFILE: SIEVIERODONETSK AGGLOMERATION

UKRAINE, JULY 2020 Table of Contents List of Acronyms ASC Administrative Service Centre RATIONALE ...... 3 ATCs Amalgamated Territorial Communities AGORA APPROACH ...... 4 DV Domestic Violence FKIs Facility Key Informants METHODOLOGY ...... 5 FTE Full Time Equivalent GBV Gender Based Violence OVERVIEW OF TARGET AREA ...... 6 GCA Government Controlled Area OVERVIEW OF ASSESSED STRATAS ...... 7 HH Household HoHH Head of Household KEY FINDINGS ...... 8 IDP Internally Displaced Person KIs Key Informants HOUSEHOLD PROFILE ...... 10 NGCA Non-Government Controlled Area SOURCES OF INCOME ...... 13 PLW Pregnant or Lactating Women PwD Person with Disability LEVELS OF INCOME ...... 15 SESU State Emergency Service of Ukraine HEALTH ...... SOP Standard Operating Procedure 18 SRH Sexual and reproductive Health EDUCATION ...... 25 TTU Target Territorial Unit WASH Water, Sanitation and Hygiene ADMIN ...... 32 JUSTICE ...... 37 SOCIAL ...... 43 AGORA is a joint initiative of ACTED and IMPACT Initiatives, founded in 2016. AGORA pro- FINANCIAL ...... 47 motes efficient, inclusive and integrated local planning, aid response and service delivery in con- MARKETS & TRANSPORTS ...... texts of crisis through applying settlement-based processes and tools. AGORA enables more 48 efficient and tailored aid responses to support the recovery and stabilization of crisis-affected SESU ...... 49 communities, contributing to meet their humanitarian needs, whilst promoting the re-estab- lishment of local services and supporting local governance actors. AGORA promotes mul- UTILITIES ...... 50 ti-sectoral, settlement-based aid planning and implementation, structured around partner- ships between local, national and international stakeholders. AGORA’s core activities include community Mapping, multisector and area-based assessments, needs prioritisation and plan- ning, as well as support to area-based coordination mechanisms and institutional cooperation.

2 HEALTH 2 RATIONALE BOX 1. DECENTRALIZATION AND THE HROMADA APPROACH As the conflict in Eastern Ukraine enters its economic growth have mostly happened in Decentralization in Ukraine started with the Concept of Reforming Local Self-Government and sixth year, addressing long term recovery large urban centres since the early 1990s. The 3 needs in the Government Controlled Areas REACH area-based assessment (2017) and Territorial Structure of Power in April 2014. The main objective of the reform is to strengthen (GCA) of Donetsk and Luhansk oblasts the Capacity and Vulnerability Assessment local self-governance capacity via merging the obsolete administrative units of local councils remains a priority for regional and national (2018), by looking beyond administrative units (villages, townships, and towns) into larger and more capable amalgamated territorial commu- authorities, as well as for development actors. as a planning unit, showed how relevant this nities (hromadas). It has resulted in the establishment of Amalgamated Territorial Communities approach is by demonstrating for example (ATCs or hromadas), new units of basic territorial administrative level; and Rayons, new units The significant impact of this conflict isin how Mariupol acts as a health service provider of the sub-regional level, within the boundaries of each oblast (see Map 1). part due to the separation of the contact beyond its city or planned ATC boundaries. line of large urban centres in non-govern- The process has significantly gained momentum in the year 2020, as the amalgamation must ment-controlled areas from their peripheries in Overall, the joint effects of conflict, now be completed by the central government on capability basis to enable nationwide unified government-controlled areas. The separation decentralization and urbanization makes local elections in October 2020 (as of June 2020, amalgamated communities coexist with the has impacted people’s ability to access understanding actual service access councils and rayons where amalgamation was not accomplished). Due to the ongoing conflict basic services, employment and markets.1 dynamics in eastern Ukraine critical to in Donetsk and Luhansk oblasts there are no oblast councils and local councils along the Furthermore, restrictions of movement and ensure that development support effectively Contact Line, where civil-military administrations are functioning instead. It remains unclear significant changes in the dynamics of popu- targets the communities that are most in need whether those bodies will be elected in October 2020. In Donetsk Oblast, out of 15 cities of lation flows have also altered the capacities to of long-term recovery and sustainable devel- oblast significance, only three managed to voluntarily amalgamate. Thus, the major commu- deliver these services. opment support. nities will pass through the government-led amalgamation.

In parallel, the Ukrainian government has By producing unique, community-level data In comparison to former basic level administrative units, ATCs are empowered with a broader mandated that decentralization reform will on vulnerabilities and capacity gaps in ser- range of governance tools and larger budgetary resources. In addition, they are assigned be implemented across the country in vice provision, this assessment addresses with new responsibilities to make decisions about provision of most public services and 2020. Although 31 Amalgamated Territorial an important information gap and comes to development at the community level. Land management and utilities, infrastructure and local Communities (ATCs or hromadas) have been support recovery actors to provide integrated economy, education and healthcare, social and administrative services are the segments of formed in some areas of Donetsk and Luhansk and inclusive services to conflict-affected public life where ATC authorities now have executive functions to deliver those services to the oblasts, this reform remains significantly ham- communities by informing the development of population, to which they are now directly accountable. pered by the conflict (see box on the right). evidence-based recovery strategies and plans which build on community-level priorities. The capacity of newly created (or to-be-formed) executive local authorities to maintain quality Furthermore, a recent Organisation for Eco- governance practices and effectively implement the original ambitions of the reform is crucial nomic Cooperation and Development (OECD) 1. REACH, Capacity and Vulnerability Assessments in Torestsk, to the sustainable development of the targeted areas (see Map 1). By providing accurate, up 2018. study2 on decentralization in Ukraine high- to date data on specific vulnerabilities and capacity gaps in service provision at the hromada 2. OECD, “Regional development trends in Ukraine in the af- level, this assessment is supporting all stakeholders towards this common objective. lighted the importance of planning using termath of the Donbas conflict”, in Maintaining the Momentum of Decentralisation in Ukraine, 2018, OECD Publishing, Paris. “functional urban areas” especially in the 3. Ukraine Government portal, “Decentralization”. https://www. Ukrainian context where both population and kmu.gov.ua/en/reformi/efektivne-vryaduvannya/reforma-decen- tralizaciyi

3 HEALTH 2 MAP 1: Evolution of hromada creation over time and AGORA Target areas AGORA: A PROJECT AND A APPROACH This assessment is part of the 5-year project: “EU Support to the East of Ukraine - Recovery, Peacebuilding and Governance” implemented by the United Nations Recovery and Peacebuilding Programme (UN RPP, see box 2 below). One of the key objective of this project is to support evidence-based recovery and planning in conflict-affected cities and communities of Donetsk and Luhansk oblasts through area-based approaches, geographic information systems and informa- tion management. To that end, a set of activities is implemented by ACTED/ IMPACT – engaged in Eastern Ukraine since 2016 – to achieve two specific results: 1) Access to quality information for local planning is improved This report, constructed at the target area level (see Map 1), enables the identification of vulnera- ble populations, as well as of response and service provision gaps within and across stratas and hromadas. This assessment covered 38 stratas in total, which have been regrouped and adjusted to fit the composition of hromadas and target areas – i.e. urban (city of district significance) or rural (amalgamation of rural councils). When relevant and as much as possible, the information products (this report and the associated interactive dashboard and webMap) have been reviewed and designed in close partnership with relevant aid actors, and local stakeholders (through a dedicated field team in permanent contact with local authorities). 2) Capacities of local authorities for evidence-based planning is strengthened Leveraging assessment findings, ACTED/IMPACT will support local authorities in using gender and age disaggregated data and managing information for evidence-based local level planning based on participatory, inclusive and transparent processes. AGORA will link relevant aid actors and local stakeholders through a series of consultations and workshops in order to facilitate the development of hromada or target area-based recovery plans. Such plans will highlight priority needs, as well as potential solutions to resolve them, while identifying exogenous actors with resources and expertise, and linkages with local actors to effectively support crisis-affected pop- ulation.

BOX 2: UNITED NATIONS RECOVERY AND PEACEBUILDING PROGRAMME (UN RPP)

The United Nations Recovery and Peacebuilding Programme (UN RPP) is being implemented by four UN agencies: The UN Development Programme (UNDP), the UN Entity for Gender Equality and the Empowerment of Women (UN Women), the UN Population Fund (UNFPA) and the Food and Agriculture Organization of the UN (FAO). Twelve international partners support the programme: the European Union (EU), the European Investment Bank (EIB) and the governments of Canada, Den- mark, Germany, Japan, the Netherlands, Norway, Poland, Sweden, Switzerland & the United Kingdom.

4 HEALTH 2 The objective of the assessment was to enable the identification of specific sectors that should be prioritized based on current HCMETHODOLOGY service delivery systems and user priorities, as well as household specific vulnerabilities, to facilitate the emergence of informed, transparent and inclusive policies.

INITIAL MAPPING EXERCICE Mapping exercise of settlements (in hromadas) and functional urban areas (in cities) using geospatial data provided by the main mapping services available in Ukraine.

201 FACILITY KEY 39 GENDER-BASED 120 COMMUNITY 1.990 HOUSEHOLD INFORMANT (FKI) INTERVIEWS VIOLENCE KIIs KIIs SURVEYS

Facility representatives participated in a semi- In addition to the 197 FKIs, representatives of Representatives from the A quantitative investigation of service demand was conducted structured key informant interviews (KIIs) about core facilities providing GBV services have participated community (elderly people,em- through Household (HH) surveys, drawing on a structured survey indicators and qualitative measures of changes in in a semi-structured KII about the types of GBV ployed persons, and individuals that was principally focused on HH barriers to accessing services service delivery as well as challenges faced by their cases, and barriers to service provision faced by working in local services) were and HH satisfaction with the availability of services, as well as respective facility in providing comprehensive and their facilities. randomly selected and then identifying which HHs were most vulnerable to disruptions of quality services. surveyed in order to acquire a access (both due to conflict or to other conditions). general understanding about To ensure encompassing findings, representa- A census approach has been used through the area general infrastructure The survey used a two-stage stratified random sampling tives from all existing facilities that were iden- secondary data review to map out all facilities and available services. approach, allowing for a representative sample of HHs in tified by the mapping exercice have been inter- responsible (and required by law) for provision urban and rural stratas with a 95% confidence level and 5% viewed, with the seven below target sectors of GBV services within the target geographies. Data collection took place margin of error (targeted cities belong to urban strata). Data covered. Data collection in the field took place Data collection took place between 24/03/2020 alongside HH surveys. collection took place between 28/10/2019 and 4/12/2019 . between 18/11/2019 and 11/12/2019. and 30/04/2020. URBAN AREAS RURAL 7 3 17 11 84 50 29 Lysychansk SESU FINANCE SOCIAL POLICE/ JUSTICE EDUCATION HEALTH ADMIN Rubizhne AREAS Siev. Rural FKIS FKIS FKIS FKIS FKIS FKIS FKIS Sievierodonetsk Siev. Urban

OUTPUTS: ANALYTICAL REPORT, ONLINE DASHBOARD (POWER BI) & WEBMAP These mixed data collection methods have been used to inform this present report, as well as to feed an online dashboard (using the Power BI platform) to allow for further exploratory analysis using its interactive features. An interactive webMap has also been developed in order to visualize key indicators collected from all targeted facilities. OVERVIEW OF TARGET AREA MAP 2: Prospective hromadas in the Sievierodonetsk area and strata selection

KEY INDICATORS Total

% of HH members older than 60 31% % of pensioners amongst HH members 34% % of IDPs amongst HH members (with and without status) 6% % of HH members having completed higher education 22% % of HH members employed full time 31% % of HH members with an average income less than 4.000UAH 54% % of HH members working in the area where they reside 87%

Quality of healthcare Top 1 greatest concern for HHs services Access to healthcare Top 2 greatest concern for HHs services Non affordability of Top 3 greatest concern for HHs basic goods Utility with the highest proportion of dissatisfied HHs Roads (74%) Top environmental concern for HHs Air pollution

% of facilities experiencing pressure on their facilities due to NGCA residents* 26% % of facilities with not enough FTEs to manage the workload* 34% % of facilities experiencing frequent shortages of water* 29% % of damaged and unrepaired or partially repaired facilities* 4%

% of facilities not having or having only partial SOPs for GBV* 40%

The assessed area involves settlements planned to amalgamate into Sievierodonetsk, Lysychansk, and Rubizhne hromadas. All three hromadas will tentatively belong to one sub-regional body with the centre in Sievierodonetsk. As of May 2020, perspective plans of amalgamation were approved by the government and the next local elections in Autumn 2020 will be held according to these plans. *As reported by Facility Key Informants from Social + Admin + Health + Education+ Justice sectors

6 HEALTH 2 OVERVIEW OF ASSESSED STRATAS *As reported by Facility Key Informants from Social + Admin + Health + Education+ Justice sectors

KEY INDICATORS Lysychansk Rubizhne Sievierodonetsk Siev. Rural Siev. Urban

% of HH members above 60 34% 29% 26% 44% 37% % of Pensioners amongst HH members 38% 31% 29% 49% 43% % of IDPs amongst HH members (with and without status) 5% 4% 9% 1% 2% % of HH members having completed higher education 20% 22% 28% 10% 10% % of HH members employed full time 31% 34% 32% 22% 28% % HH members with an average monthly income less than 4.000UAH 53% 53% 53% 69% 61% % of HH members working in the area where they reside 92% 84% 93% 46% 61%

Quality of healthcare Quality of healthcare Quality of healthcare Access to healthcare Quality of healthcare Top 1 greatest concern for HH service services services services services Non affordability of Access to healthcare Access to healthcare Quality of healthcare Access to healthcare Top 2 greatest concern for HH basic goods services services services services Access to healthcare Non affordability of Non affordability of Non affordability of Non affordability of Top 3 greatest concern for HH services basic goods basic goods basic goods basic goods Utility with the highest proportion of dissatisfied users Roads (91%) Roads (35%) Roads (76%) Roads (63%) Roads (82%) Top environmental concern for HH Air pollution Air pollution Air pollution Spontaneous landfills Spontaneous landfills

% of facilities experiencing pressure on their facilities due to NGCA residents* 30% 32% 53% 3% 13% % of facilities with not enough FTEs to manage the workload* 20% 30% 19% 75% 24% % of facilities experiencing frequent shortages of water* 77% 16% 6% 22% 25% % of damaged and unrepaired or partially repaired facilities* 9% 3% 0% 0% 8%

% of facilities not having or having only partial SOPs for GBV* 36% 36% 37% 56% 38%

This AGORA assessment overcomes existing administrative divisions as most of the periphery communities now belong to Popasna and Kreminna raions. The stratification enables analysis of differences between the central cities in the prospective hromadas and their periphery distributed by area type (Urban vs. Rural) resent only 12% of the population, particular to healthcare services and 3) the lack of finan- HEALTH KEY FINDINGS attention should be provided to those of them cial access to basic goods, including food. Physical access to health services: The who do not benefit from social and safety net analysis highlighted that there is a clear gap POPULATION PROFILE assistance and who therefore do not have EDUCATION in availability of secondary and tertiary health Demographic trends: The preliminary anal- any sources of income. Noticeable differenc- Education profile of the population: Find- services in the areas of Siev. Rural and Siev. ysis of the population profile depicts an age- es were found between men and women, in ings suggest that less than a quarter of the Urban, which forced the resident population ing population, encompassing a relatively low terms of unemployment rate (6% of male HH population in the targeted areas has complet- seeking these services to move to the other proportion of children, youth and Pregnant and members vs. 16% of female HH members) ed higher education, with an even lower pro- more central areas. This general unavailability Lactating Women (PLW) and a high propor- and structural causes of unemployment, but portion in the Siev. Rural and Siev. Urban ar- of secondary and tertiary services likely also tion of population above 60, with a relatively also in terms of vulnerabilities and average in- eas. Overall, 13% of the assessed population increases pressure on primary health service high prevalence of women in older population come. This suggests entrenched sociocultural was enrolled in an education facility. facilities located in the latter areas, which have groups. Moreover, findings suggest that wom- divisions between the two population groups. to deal with the demand for services they can- en on average tend to be more socio-eco- Physical access: Overall, availability of and not provide and re-direct patients to facilities in nomically vulnerable than men. Despite these GEOGRAPHIC VULNERABILITY: physical access to education facilites was other areas. For other areas (Sievierodonetsk, Figures, the population appeared to be in a Regarding the geographical spread of vulner- found to be good. However, reports of poor ac- Lysychansk and, to a lesser extent, Rubizhne) generally good health, with a very low pro- abilities, the areas of Sievierdonetsk (hence- cessibility for Persons with Disabilities (PwD) physical access to facilities is overall report- portion of HHs indicating the need for a social forth: Siev.) Rural (and to a lesser extent Siev. were widespread, which could constitute an edly good, although significant improvements worker or carer. Urban) slightly differ from the other areas, with impediment for this specifically vulnerable need to be made to adapt them to the specific a relatively higher proportion of older, vulnera- population group. needs of PwD (7% of the overall population in Economic vulnerability: There is a higher ble and retired individuals, as well as a more the targeted areas). proportion of retired people (40% of HH mem- limited amount of income-generating opportu- Financial access: Financial barriers in ac- bers) -who thus depend on pension for living nities, often reportedly forcing the few individ- cess to education do not appear to exist, Financial access to health services: Al- - than active individuals (38% of HH members) uals who are actively seeking employment to although solicitations of punctual voluntary though the vast majority of services provided who are able to contribute to pension wfunds. move to other, more dynamic areas. contributions from parents (either financial or are reportedly free, the cost of meeting health This trend appears to be symptomatic of the in-kind) seem to be relatively common at the needs remains the primary challenge reported lack of financial sustainability of the Ukrainian Displacement trends: The locations targeted community level. by HHs, particularly for the most vulnerable pension system. The relatively low average for this assessment appeared to be a relatively HHs (estimated to be 47% of the overall popu- monthly income (54% of HH members report- important hosting area for Internally Displaced Quality of Education services: Overall, HHs lation). Health associated costs constitute one edly earned less than 4.000 UAH per month) People (IDPs): they represented 6% of the and facility representatives seemed to concur of HHs’ primary expenditures, and a relative- appeared to correlate with the low pensions, overall population in the assessed areas, with on the fact that the lack of capacity (both in ly high one, when considering HHs’ average implying a limited stimulation of the local a slightly higher proportion in Sievierodonestk terms of availability of teaching staff and their monthly income. Further qualitative analysis is economy, likely further limiting demand for (9% of the local population). skills) constitutes a major impediment to qual- recommended to better understand the nature goods and services. This limited stimulation ity education in targeted areas. Additional bar- of these ad-hoc costs. might be dragged by the low reported appe- Priority Needs: In line with the population pro- riers include poor quality of educational equip- tite of youth and working-age adults in starting file (i.e. ageing and relatively poor), the three ment (particularly IT); and limited availability of Quality of health services: Overall, health fa- up new businesses (75% of them reportedly primary concerns of HHs in the areas covered psychosocial support services. cilities’ infrastructures and provision of servic- never considered it as a possibility). Even by the assessment were found to relate to 1) es appeared to be acceptable, and have seem- though unemployed individuals seem to rep- the quality of healthcare services 2) the access ingly not been impacted much by the conflict.

8 HEALTH 2 However, the enforcement of the 2017 reform lice and court system. Nonetheless, findings is generally perceived as premature. A variety suggest that citizens generally feel safe in LIMITATIONS OF METHODOLOGY: of concerns were raised amongst the facility their everyday life and conflict-related reasons representatives and households, particularly for insecurity are secondary, while road con- Not all representatives of facilities agreed to participate in the KII, which may limit the census regarding the lack of equipment and funding ditions, sidewalks in particular, are the main approach to a certain extent. Moreover, since most FKI findings are solely based on individuals’ to adequately implement the reforms. Quality reported reasons for why HHs felt unsafe. reported perceptions of the service providing facilities they work for, all FKI findings presented in and lack of access to healthcare services were this report should be considered as indicative only. Concerning the household surveys, for some the two primary concerns for households. On Findings showed that an overall low proportion subsets in the report, the confidence interval may be lower and should thus be considered as a separate, yet important note, the findings of the population are using social services, indicative only. Due to the sensitive nature of some questions included in the interview and survey clearly highlighted a gap in knowledge and most of whom were reportedly satisfied with tools, it is likely that some sensitive issues have been under-reported and remain under-repre- lack of trainings on Gender Based Violence these services. Additionally, only the three sented in this report. In addition, findings on HH members are based on reporting by proxy, and (GBV)/Domestic Violence (DV) issues from most central areas of this assessment (Siev- therefore are not reflective of the lived experiences of HH members, but rather on the perception the facilities’ perspective, as well as from the ierodonetsk, Rubizhne and Lysychansk) had of the respondent reporting on them. population’s point of view. facilities providing social services. NOTE ON REPORTING OF HOUSEHOLD DATA: ADMINISTRATIVE SERVICES AND PUBLIC CROSS-CUTTING ISSUES HH data was collected on multiple levels. Data collected at the HH level is reported as % of HHs. INSTITUTIONS: The analysis of transportation trends indicated Some questions were asked on an individual level directly to the survey respondent; these are Overall, 63% of HHs reported not having used that Siev. Rural and Siev. Urban areas were reported on as % of respondents. Other questions were reported by the respondent on behalf any administrative services in the 3 months not “functional urban areas” per se, since a of the head of household (HoHH) or on behalf of each individual member in their household, by prior to data collection. Those who did were large proportion of HHs living there reportedly proxy; such findings are reported as % of HoHHs and % of HH members. reportedly satisfied with the available ser- regularly needed to travel to other settlements vices. However, “complexity” and “length of to access services. Satisfaction towards trans- procedures” were main subjects of dissatis- portation services appeared to be “average”, faction, and should thus be considered as an with the quality of service provision (both in area of improvement. It should also be noted terms of frequency and offer of services) being that, while distance to facilities was not report- the primary causes of dissatisfaction. Roads ed as a major issue overall, it appeared as conditions were also considered by almost all a challenge in Siev. (both Urban and Rural), HHs to be “bad”. where local councils are the only administra- tive services providers. The main challenges Provision of quality water also appears to be to effective decentralization also seemingly lie an issue in Siev. Urban and Lysychansk, with in the smooth transition of responsibilities and regular shortages reported at both household mandates from local councils to Administrative level and within public facilities. Service Centres (ASCs). Finally, most facilities across the surveyed ar- Overall, findings demonstrate a low usage of eas do not have the required infrastructures in courts, but also a relatively low trust in the po- place to adequately receive PwD.

9

HOUSEHOLD HH members and 24% of male HH members. corroborated by the low proportion of pregnant Finally, the proportion of pensioners is rela- The respondents in particular tended to be rel- or lactating women (3%), and are also in line tively high among respondents particularly, PROFILE atively old and close to retirement age, with 55 with the average natural decrease in the popu- compared to the HH members sample. 1 This section provides a description of house- years old on average (see Figure 2). lation size at the national level (-0.61%). TABLE 2: % of reported vulnerabilities holds’ main socio-economic characteristics in FIGURE 2: Counts of respondents amongst HH members per location the targeted areas. In total, 1990 respondents 55% of HH members were were surveyed, out of which 83% reported to 80 women Other be the Head of Household (HoHH). HoHHs or Chronic Disability 55+45A Pensioners vulnera- illness (official) respondents acting on behalf of the HoHHs 60 bilities answered questions on the household (HH) 3% of HHs had lactating women 40 in their household, and 1% pregnant level as well as on an individual level per HH Female 39% 15% 4% 11% member, hereby representing 4.260 individu- women 20 4+96A Male 28% 9% 7% 12% als. The typical HH was female-headed (59% of HoHHs were female), relatively small (with 0 17% of HH members were Lysychansk 38% 15% 5% 12% 2 members per HH on average), with a high 18 40 62 84 minors Rubizhne 31% 12% 4% 13% proportion of elderly and a very limited number Age of HoHH 17+83A Sievierodonetsk 29% 11% 5% 11% of children and youth compared to the elderly. These findings were relatively homogenous Finally, half of HoHHs (50%) reported to be Siev. Rural 49% 14% 5% 10% across locations, except in Sievierodonetsk married, 24% were reportedly widowed (with As corroborated by the population pyramid, (Siev.) Rural, where the findings suggest the a slightly higher proportion for Siev. Rural with Siev. Urban 43% 11% 6% 7% 55% of HH members were women, similarly to population was generally older than the nation- 30%), 13% divorced and 7% single. Addition- Overall 34% 13% 5% 12% 1 the 2018 national average of 53,7% in 2018. wide average, and with less children. Overall, ally, 32% of HHs were composed of only one Furthermore, women appeared to be more The average age of HH members was 44, and 26% of HHs on average reported to have at person (and 36% in Siev. Rural). 53 when excluding minors from the calcula- least one child, and 11% of HH members were socio-economically vulnerable than men, but tion. Overall, 31% of the HH members were of school-age (from 5 to 18). These results are VULNERABILITIES there were also indications of a higher resil- reportedly older than 60; with w36% of female ience among women, such as the higher Overall, 47% of HH members were reported average life expectancy. More than half (54%) TABLE 1: Household characteristics to have at least one vulnerability, with 52% of female HH members were reported to be FIGURE 1: Population pyramid, % of total of female and 41% of male HH members. either chronically ill (15%) or pensioner (39%), HH members (4.260 persons in total) % of HHs Average % of HH More than a third of HH members (34%) were compared to 37% of male HH members. How- 1+6+10+9+9+6+3 3+12+14+10+9+5+4 Area of with at age of HH members 3% 81+ 1% interest least 1 reported to be pensioners (individuals receiv- ever, the proportion of people living with an member 60+ child official disability status was found to be higher 12% 66-80 6% ing all kind of pensions) which has to be read in line with the average age of the population and amongst men (7%) compared to women (4%). 14% 51-65 10% Lysychansk 46 34% 25% the average nation-wide retirement age.2 The 10% 9% 36-50 Rubizhne 44 29% 26% proportion of pensioners among HH members Overall, two percent (2%) of HH members 9% 9% 19-35 Sievierodonetsk 42 26% 31% appears to be particularly high in Siev. Urban were reportedly Persons with Disability (PwD) 5% 6-18 6% and Siev. Rural, where over 1 person out of 2 but did not have any officially recognized dis- Siev. Rural 51 44% 17% 4% 0-5 3% reportedly is a pensioner, which is reflected ability status. Amongst all PwD HH members Siev. Urban 49 37% 17% in the generally older population living there with an official status (5%), the most- fre Female Male Overall 44 31% 26% (Table 1). quently reported disability groups were group

1. Statistical yearbook of Ukraine, 2018, State statistics service of Ukraine 2. 59.5 years old for women and 60 years old for men III (53%), followed by group II (32%) and group FIGURE 4: Most commonly reported rea- a perspective might be relevant to consider as nomic profile section of this report (Figure 14), I (11%), and lastly PwD since childhood for 4% sons for not receiving benefits, by % of HH intra-household caretaking reduces time that IDP HHs reported income is higher on aver- of HH members.* Finally, considering the Vet- members who were reportedly entitled to could otherwise be allocated for income gen- age than for non-displaced HHs. This might eran /ATO/JFO status to be a vulnerability, 1% receive benefits but were not receiving them erating activities, impacting HHs’ availability be partly explained by the relatively young of HH members reportedly had this vulnera- 9+5+4+2+1 for employment, particularly for women, who age of IDP HHs compared to non-displaced 53% bility. Overall, this preliminary analysis of HHs’ Hard procedure might be more likely to assume caregiving HHs (IDP HHs members being 33 years old demographic and socioeconomic vulnerability Cancelled or not assigned 23% roles. on average, compared to 45 years old for all profiles suggests a high dependency on social Less than current benefit 10% non-displaced); their relatively higher level of protection schemes. Corruption 8% INTERNALLY DISPLACED PERSONS education (36% of IDPs have reportedly com- Not worth the effort 8% On average, 6% of HH members were report- pleted higher education, in comparison to 21% of non-displaced people) and the fact that the BENEFITS edly displaced, but with notable differences In contrast to the relatively high proportion of between areas, since the proportion of dis- most vulnerable populations were likely to 6% of HH members were vulnerabilities, only 3% of all HH members placed HH members varies from 1% in Siev. stay in NGCA. As a matter of fact, only 16% reportedly not receiving the bene- reportedly needed the services of a social Rural to 9% in Sievierodonetsk. This might be of IDPs were reportedly retired, compared to fits they were entitled to (7% could worker and 1% of a full-time caregiver. Only due to the fact that Sievierodonetsk might be a 40% overall. 6+94A not answer) 1% of HH members were reportedly in need particularly attractive location for IDPs since it of HH members were of these services without being officially being 98% Almost all HH members were reported receiv- has a relatively large and developed functional reportedly not considering them- entitled to receive them. ing the benefits they were entitled to. As urban area that was also assigned as the selves part of an ethnic or religious illustrated in Figure 4, the primary reported oblast center. Overall, with regard to gender 98+2A minority cause for not receiving benefits was the com- and displacement, there were no significant plex administrative procedure that had to be differences found between male and female KEY HEALTH CHARACTERISTICS HH members. There is, however, an important undertaken to claim them (as per 53% of HHs). 3+97A 2+98A Overall, the population in the targeted areas difference in terms of proportion of children The second most commonly reported reason counted 13% of chronically ill individuals and 3% of HH members 2% of HH mem- per HH: 51% of IDP HHs had at least 1 child, was that the benefits were “cancelled or not 7% living with disabilities. Out of the 18% reportedly needed a bers reportedly needed in comparison to 26% for non-displaced HHs. assigned yet” (23%), followed by the fact that of “other” answers in Figure 6 below, most social worker a carer Furthermore, and as highlighted in the eco- claiming those benefits was not financially reported issues were related to oncology. appealing compared to current income (10%). This relative independence from social ser- FIGURE 5: % of IDPs amongst HH mem- Finally, 8% of HHs reported corruption as a vices might not stand on itself. It might, for FIGURE 6: Reported types of difficulties bers, per assessed area (with IDP status) perceived barrier to access benefits. Lack of instance, coincide with strong supportive net- 6+0+9+5+4+2+1 faced by 7% of HH members with disabilities Overall 6% 43+21+18+18+18+11+6 physical access to the facilities did not appear works of people taking care of each other and Walking or climbing stairs 43% as a major challenge, except in the peripheral a prevalence of social barriers, such as a lack Memorization or concentration 21% areas of Siev. Rural and Siev. Urban, where of trust in state services. Additional (qualitative Sievierodonetsk 9% Self care (washing or dressing) 18% 18% of HHs that reported not receiving ben- and quantitative) data and in-depth analysis Lysychansk 5% efits mentioned this as a main contributing is required to further explore how such social Seeing even when wearing glasses 18% Rubizhne 4% reason for their inability to access benefits. dynamics impact social service uptake. Such Other 18% Siev. Urban 2% Speaking or understanding own language 11% * Group I: Totally disabled, incapable of doing any work, and requiring constant attendance Group II: Disabled, incapable of doing Siev. Rural 1% any work, but not requiring constant attendance Group III: Incapable of usual work (ISSA, Convention on the Rights of Persons with Hearing even if using a hearing aid 6% Disabilities & Social Security Programs throughout the world: Asia and the Pacific, , 2006)

11 HEALTH PROFILE 2 FIGURE 7: % of respondents per reported As indicated in Figure 8 below, the reported Quite similarly, the overall proportion of male health status consumption of alcohol did not seem to respondents who reported smoking on a 10% of respondents reported 44% particularly high, as the vast majority of daily basis was higher than the proportion of having used the internet to access respondents indicated not drinking alcohol at female respondents reporting this. No signifi- 10+90A administrative services all (56%) or only drinking for special occasions cant differences were found in the frequency 20% 28% Amongst these 10% of respondents, 88% (37%). However, there were some differences of tobacco and alcohol use between the reported to be either ‘completely’ or ‘somewhat’ 5% 3% between gender, as findings suggest that men assessed areas. comfortable doing so. are slightly more inclined towards drinking on Very bad Bad Neither good special occasion, and 10 times more likely to ACCESS TO COMMUNICATION AND On a related note, computer literacy seemed to or bad Good Very good drink during the weekends. COMPUTER LITERACY vary significantly between areas, ranging from Methodological note: the black line represents the 59% of respondents reportedly being computer weighted average of respondents’ choices. FIGURE 8: % of respondents reporting literate in Sievierodonetsk to only 36% in Siev. frequency of alcohol consumption, per Urban and 45% in Siev. Rural. Respondents commonly perceived them- gender selves as not having major health issues, but 0 0% FIGURE 10: Computer literacy and % of +1+0 of respondents of respond- a quarter of them reported being in either “very Every day 1% 97% 55% respondents who can use basic computer reported being comforta- ents were reported being bad” or “bad” health, as illustrated in Figure 7 +0+ 1 services 3-5 times a week 0% ble using a mobile phone comfortable using a smart- above. 1% +0+

1 on their own. did not phone on their own. 1% 22% Yes, can Not 2 However, given the relatively high proportion Once a week 1% + have a mobile phone. did not have a smartphone. Can do

0+ do all comfortable 2% + some of aged people, people suffering from chronic 1 basic with a actions illness(es) and PwD, and the difficulties such Only during the weekends 1% +10 The vast majority of respondents reported actions computer

10% +0 impediments create in everyday life, the pro- +32 having a mobile phone, 78% of whom report- 43 portion of HH members who reportedly used On special occasions (on 32% + Lysychansk 55% 16% 35% holidays) 43% +0 edly possessing a smartphone. This latter and needed the services of a social worker +66 proportion varied significantly between areas, Rubizhne 51% 18% 36%

66% +43 or a carer was remarkably low, as mentioned Do not drink alcohol 43% +0 as only 58% of respondents in Siev. Rural to Sievierodonetsk 59% 16% 31% earlier. 69% in Siev. Urban reportedly possessed a Siev. Rural 36% 18% 53% Female Male smartphone. Furthermore, only 33% and 45% Siev. Urban 45% 23% 42% When asked about how they would like to of respondents in these two areas reported change their lifestyle in order to improve their Overall 54% 17% 35% FIGURE 9: % of respondents reporting being comfortable with using their smart- health, respondents were commonly inclined frequency of cigarette consumption, per phone, respectively. towards changing their eating habits, with gender

37% of respondents reporting wanting to eat 9 Likewise, computer literacy skills were une- 9% more fruit and vegetables, and 22% following Every day 40% +40+0 venly spread across assessed areas, with a healthier diet (by reducing the consumption +88 lower levels of skills in Siev. Rural and Siev. 56+ Do not use 88% + of, fried and greasy food). Losing weight was 56% 0+ Urban, which could be due to the fact that 3+ a desire for 6% of respondents. Finally, 20% Other/ refuse to say 3% 3 these areas are also the areas with the reported that they would like to exercise at 3% relatively older population and the higher pro- least 3 times a week. Female Male portion of retired individuals.

PROFILE 12 SOURCES OF MAP 3: Employment catchment areas EMPLOYED HOUSEHOLD MEMBERS The vast majority of HH members were Access to work across settlements INCOME employed in the area where they live (87%), (as reported by CKIs and HHs) This section provides an overview and an anal- with the noticeable exception of Siev. Rural, ysis of the main employment statuses reported where less than half of HH members report- for adult HH members (18 and older). When edly worked and lived in the same area, and a relevant, the comparison with the International bit less so for Siev. Urban (Figure 11, Map 3 ). Labour Organization (ILO) categorization (18- 70) is made.1 FIGURE 11: % of HH members who live and work in the same settlement, per of HH members were area 38% 87+0 reportedly employed. (45% ILO) Overall 87%

38+62A +93+92+84+61+46 Overall, only a bit more than a third of the adult 93% population (38%) was found to be directly Sievierodonetsk participating to the local economy (employed Lysychansk 92% full-time, part-time and self-employed com- Rubizhne 84% bined; officially as well as unofficially), while Siev. Urban 61% the majority of HH members (40%- 31% ILO 46%

Siev. Rural +0+ subset) were reportedly retired.

FIGURE 10: % of HH members per employment status, by gender and area

Full-time Part-time Self- Retired In education Unemployed employed employed employed

Female 33% 37% 17% 6% 6% 4% Male 45% 26% 11% 16% 3% 2%

Lysychansk 44% 31% 15% 9% 4% 2% Rubizhne 37% 34% 14% 13% 3% 3% Sievierodonetsk 35% 32% 14% 13% 5% 4% Siev. Rural 52% 22% 11% 12% 3% 2% Siev. Urban 47% 28% 11% 11% 4% 2% TOTAL 40% 31% 14% 12% 4% 3% 1. Key Indicators of the Labour Market, Ninth edition; Geneva, International Labour Office, 2016

13 HEALTH PROFILE 2 These notable differences are well captured in tors, which nevertheless only represents 2% of UNEMPLOYED HOUSEHOLD MEMBERS FIGURE 13: % of unemployed HH mem- Map 3, which illustrates the strong attraction the total workforce. Overall, 12% (14% based on the ILO subset) bers by most commonly reported causes that Lysychansk and Sievierodonetsk areas of adult HH members were reportedly unem- of unemployment, per gender exert over their peripheral areas, which could The primary reported source of income was the 72 9 ployed. However, these standard labour Homecarer 72% + 0 even be considered as their hinterlands in that service sector, reported by 37% of employed market indicators need to be considered in 9% + regard. Conversely, it also strongly suggests HH members (trade, logistics, security, etc..), +10 light of the specificities that characterize the Physically unable 10% +30 the lack of work opportunities in the other in both urban and rural areas, followed by the 30% +0

Ukrainian labour market. For instance, unem- +7 areas of Siev. Rural and Siev. Urban. Despite industrial sector (16% of HH members’ pri- ployment rates tend to be artificially deflated No vacancies available 7% +21+ the relative distance, 4% of HH members were mary source of income), and construction and 21% 0 by a high proportion of “Not in Education, +10 reportedly working outside Ukraine . education (both 9%). Company closed / downsized 10% +17

Employment, or Training” individuals (NEETs) 17% +0

among working-age school drop-outs and +10

5% +17 Finally, the proportion of HH members being Interestingly, in Sievierodonetsk rural area, 1 Dismissed due to own will graduates (almost 30%) . Similarly, informal 17% +0 employed in the area where they live did not the agricultural sector was the third primary +1 employment, and total or partial undeclared Due to end of contract 1% +6 vary significantly across work sectors, except source of employment (12%). Overall, only 1% work can be hard to capture in standardized 6% for the construction sector where 76% of HH of HH members were reportedly employed in surveys, whereas such types of employment Female Male members were working and living in the same the military sector. are likely relatively common in the context.1 area, and the legal, military and non-profit sec- Figure 13 also shows that the primary causes TABLE 3: Type and location of work of HH members disaggregated by assessed areas. As highlighted in Figure 10, findings suggest of unemployment vary by gender, with men that women in the assessed areas are more being more likely to be affected by exoge- likely to be unemployed than men (16% vs. nous factors and women by more endogenous 6%, respectively, and 19% vs. 7% with ILO ones. In fact, the primary cause of women categorization). In addition, 52% of male unemployment was associated to HH duties Types of work / sector Average HH members reported having been actively (“home carer”), as was reported for 72% of Rubizhne Siev. Rural Siev.

Siev. Urban Siev. searching for a job in the 30 days prior data Lysychansk unemployed female HH members, which was

Sievierodonetsk collection, compared to 20% of female HH considered as a barrier for only 9% of unem- Service (trade, logistics, security, cleaning) 37% 34% 36% 41% 35% 35% members. ployed male HH members. On the other hand, Industry (engineer, plant worker) 18% 12% 26% 20% 19% 17% male HH members more commonly identified Construction (handyman, plasterer, foreman) 9% 9% 11% 8% 9% 6% exogenous factors as their primary barriers In education (including distance learning) 8% 12% 8% 5% 7% 6% to employment, such a lack of employment opportunities, downsizing/shutting of an enter- Health care (doctor, orderly, nurse) 7% 9% 5% 6% 4% 7% prise, or end of contract (the sum of these Municipal sector 4% 4% 4% 4% 5% 5% 52+48A 20+80A barriers totalled 44% for male HH members, State service (incl. judges, prosecutor) 4% 4% 4% 5% 2% 1% of unem- of unem- in contrast to 18% for female HH members). Mines 6% 0% 0% 2% 11% 52% 20% 3% ployed male HH ployed female HH Nevertheless, 94% of HH members were Agrarian sector (machine operator, agronomist, tractor driver) 2% 3% 2% 0% 12% 5% members have been members have been reportedly willing accept a new employment looking for a job in looking for a job in opportunity if offered, irrespective of their 1. “Inclusive Labour markets for job creation in Ukraine”, ILO website, 2017 https://www.ilo.org/budapest/what-we-do/ the last three months the last three months gender. projects/WCMS_617840/lang--en/index.htm

PROFILE 14 Despite the high proportion of vulnerable ENTREPRENEURS AND SELF-EMPLOYED LEVELS OF The higher proportion of vulnerabilities individuals in the population, the vast major- HOUSEHOLD MEMBERS amongst female HH members that was iden- ity of HH members were reported to not need tified in the previous section of this report Although self-employment constitutes the most INCOME the services of a state social worker or carer (higher proportion of pensioners, chronically profitable income generation source (Figure (97% for both, see also health section), whose As previously mentioned, findings suggest ill, and unemployment as well as overall higher 18), only 3% of the overall assessed popula- services could potentially free up time for HH that only 38% of the population is directly par- age) might be correlated with their relatively tion appears to be self-employed (Figure 5), members to engage in income generating ticipating to the local economy through income lower reported income. As illustrated in Figure an image that is traceable in the ILO disag- activities. Finally, the absence of employment generating activities, while 40% is retired. This 16, the data suggests that women are likely to gregation as well (3% of the population). This opportunities was particularly reported in Siev. necessarily translates into a high economic earn less than men, with 66% of female HH tendency is directly reflected in the fact that Rural area (24% vs. 11% for HH members dependency upon pensions. An analysis of members reportedly having an income lower starting a business or becoming entrepreneurs overall). adult HH members’ levels of income shows than 4.000 UAH per month, compared to 37% did not appear as an appealing income gen- that it also means a relatively low average of men. Likewise, 52% of male HH members erating option for HH members, as 76% were RETIRED HOUSEHOLD MEMBERS monthly income per HH member. As shown had a reported monthly income of more than reported to never have considered this option, in Figure 15 below, the majority of adult HH 4.000 UAH, compared to only 23% for women. 16% having thought about it but not actually members reported earnings are lower than the 40% of HH members are having started one, and 6% who reportedly recently increased national official minimum The disaggregation by geographic area illus- retired (31% ILO) have started a business in the past. . 40+60A wage (4.273 UAH). trates that Siev. Rural and Siev. Urban areas are poorer on average than the other areas, The relatively high proportion of retired people Among the subset of HH members who had FIGURE 15 % of HH members by income has to be read in line with the relatively aged reportedly considered starting up a business bracket* (over the last three months) FIGURE 16: HH members’ income distribu- population (Figure 1 and Table 1) and the offi- (24%), lack of start-up financial capital was tion disaggregated by gender identified as the most commonly reported bar- cial retirement age in Ukraine (59.5 for women 0 7% rier preventing these members form realizing 70% and 60 for men). < 4000 54% this consideration (81%), followed by risks 4001-8000 26% 60% associated to starting up businesses (27%), 66% Overall, the highest proportions of retired HH 8001-12000 7% inability due to family reasons (11%), and members were found in Siev. Rural and Siev. + 12000 3% 50% (perceived) corruption and the lack of skills to Urban, in line with the older population on Don’t know 3% 37% 40% average in these areas (57 and 54 years old implement their idea (both 10%). 35% respectively). Accordingly, these proportions 7+54+26+7+3A FIGURE 14: % of adult HH members who INCOME ANALYSIS 30% were even higher for HoHHs; on average, 53% reportedly have thought about starting up of HoHHs were reportedly being retired, while 20% a business The following section proposes a disaggre- population % of surveyed this proportion was 66% in Siev. Rural. 7% 12% gated analysis of income levels by gender, 19% 76% No 10% 5% geographic areas, vulnerability profiles, and 6% 16% Yes, but haven’t started 3% 1% displacement status to better identify overlap- 0% 0 Up to 4000 4001-8000 8001-12000 More than 6% Yes, have started ping and coinciding HH-level vulnerabilities. UAH UAH UAH 12001 UAH 76+1662z 2% Don’t know/ refuse to answer Female Male * Income was defined here as all types of financial sources, salary, pension, benefits, trade, relatives’ help)

15 HEALTH PROFILE2 since 69% and 61% of HH members, respec- The disaggregation of income levels by vul- Lastly, IDPs were reportedly generating a tively, reportedly received a monthly income 24% of unemployed HH nerability types further confirms that socially slightly higher income than the overall popu- lower than 4.000 UAH (compared to 53% on members reportedly did not vulnerable HH members, such as pension- lation, with 50% of IDP HH members earning average across all locations). Those two areas 24+76A receive any form of income. ers, chronically ill people, disabled people, more than 4000UAH per month, compared to are also the two areas with the highest propor- and veterans, are also the most economically 39% for non-displaced HH members. This has tion of HH members depending on pensions The above finding suggests a gap in safety net vulnerable. In fact, 73% of socially vulnera- to be correlated with the fact that IDPs were for income (Table 2) and the oldest population systems. This also suggests that the unem- ble HH members belonging to these groups generally found to be younger, and as a con- (Table 1), indicating elevated economic vulner- ployed population likely constitutes the most reportedly earned an income lower than 4000 sequence, there were three times less retired ability in these areas. Figure 18 corroborates economically vulnerable group in the assessed UAH per month, compared to 46% of (report- HH members within the IDP category (16% the fact that retired HH members are in fact the areas. Employed HH members constitute the edly) non-vulnerable HH members. This has compared to 40% overall). However, it has to poorest population group, 75% of which having second better off group, the majority of whom to be read in line with the fact that pensioners be noted that 20% of IDP HH members were an income of less than 4.000 UAH, alongside were reportedly earning more than 4.000 UAH constitute the bulk of this group of socially vul- reported to be unemployed, and 24% of them unemployed individuals (86%). Self-employed per month (67%). nerable HH members; with pensions benefits were reportedly enrolled in education pro-

HH members, on the other hand, were found 1. USAID, Key issues in pension system reform in Ukraine, 2018 that can be as little as 1.300 UAH per month, grammes; these proportions are both higher to be financially better-off, with half of the sur- http://www.fst-ua.info/wp-content/uploads/2019/02/Key-Issues- and with 79% of them amounting less than than the overall average (respectively 12% veyed HH member entrepreneurs reportedly in-Pension-System-Reform-in-Ukraine_Aug2018_EN.pdf 3.000 UAH per month in 2018.1 and 14% overall). generating more than 8.000 UAH per month. FIGURE 17: HH members’ income distribu- FIGURE 18: HH members’ income distribu- FIGURE 19: HH members’ income distribu- FIGURE 20: HH members’ income distribu- tion disaggregated by area tion disaggregated by employment status tion disaggregated by vulnerabilities tion disaggregated by displacement status

80% 75% 60% 70% 69% 70% 70% 50% 60% 60% 70% 55% 60% 40% 50% 62% 47% 50% 40% 50% 36% 30% 40% 40% 40% 30% 24% 31% 30% 30% 30% 23% 20% 26%

20% % of surveyed population 13% 20% 20% % of surveyed population 10% 11% % of surveyed population % of surveyed population 10% 22% 10% 10% 10% 10% 5% 4% 6% 3% 7% 3% 0% 0% 0% 3% 1% 0% 0 Up to 4000 4001-8000 8001-12000 More than 0 Up to 4000 4001-8000 8001-12000 Mor e th an 0 Up to 4000 4001-8000 8001-12000 More than 0 Up to 4000 4001-8000 8001-12000 More than UAH UAH UAH 12001 UAH UAH UAH UAH 12001 UAH UAH UAH UAH 12001 UAH UAH UAH UAH 12001 UAH No vulnerability Siev. Urban Lysychansk Retired Full-time employed Not displaced Rubizhne Siev. Unemployed Self-Employed With at least one vulnerability All displaced status Siev. R ural Overall

PROFILE 16 KEY FINDINGS

The preliminary analysis of the population profile depicts an ageing population (low pro- portion of children, youth and PLW vs. high proportion of population above 60), with a high prevalence of women in older population groups. Moreover, women on average tend to be more socio-economically vulnerable than men. Despite these figures, the population appeared to be in a generally good health, with a very low proportion indicating the need of a social worker or carer.

Findings indicate a higher proportion of retired people (40%), who thus depend on pension for living, than active individuals (38%) who contribute to pensions funds, which appears to be symptomatic of the lack of financial sustainability which is at the heart of the Ukrainian pension system crisis.2 The relatively low average monthly income (54% of HH members earn less than 4.000 UAH per month), itself directly correlated with the low pensions, might imply a limited stimulation of the local economy, further dragged by the seemingly low appe- tite of youth and working-age adults in starting up new businesses (3/4 never considered it as a possibility).

Even though they represent only 12% of the population, particular attention should be payed to unemployed individuals who do not benefit from social and safety net assistance and who often do not have any sources of income. Noticeable differences were reported between men and women, be them in terms of unemployment rate (6% for men vs. 16% for women), structural causes of unemployment or socioeconomic vulnerabilities and average income. This suggests entrenched sociocultural gender divisions.

In terms of geographic differences, the population in the areas of Siev. Rural (and to a lesser extent Siev. Urban) were older, more vulnerable, and with more retired people; but also with more limited employment opportunities. Finally, the presence of IDPs was rela- tively low (6% of the overall population), apart from the Sievierodonetsk area (9%).

1. USAID, Key issues in pension system reform in Ukraine, 2018, http://www.fst-ua.info/wp-content/uploads/2019/02/Key- Issues-in-Pension-System-Reform-in-Ukraine_Aug2018_EN.pdf 2. Ibid

17 HEALTH PROFILE 2

particular was limited: only 22% of health ser- MAP 4: Available healthcare facilities vice FKIs reported being able to provide these services, either partially or fully, and only 22% This section describes the level of access, reported having sufficiently qualified personnel availability and quality of health services in the to do so. Besides, the most commonly reported targeted locations. Findings are derived from services needed by health FKIs were MRI, 50 interviews with FKIs, all HH surveys and tomography, and X-ray machines. According 120 CKIs. As an introductory note, it should to health FKIs, a lack of funding was the main be noted that “quality of healthcare services” reported reason why their facility could not pro- and “access to healthcare services” were the vide adequate services. two most commonly reported main concerns across all assessed sectors (see also over- TABLE 5: Available healthcare services view of assessed area at the beginning of the per area, reported by FKIs report).

AVAILABILITY OF HEALTHCARE FACILI- TIES AND SERVICE PROVISION Rubizhne Siev. Rural Siev.

TABLE 4: Number and type of available Urban Siev. Lysychansk Sievierodon. healthcare facilities, per area Outpatient services Primary Secondary Tertiary Ambulance Referral capacity g g care care care & first aid Visiting patients (in-home care) g Lysychansk 8 5 3 1 Emergency and first aid g Rubizhne 3 1 Basic laboratory services g  g Family doctor g Sievierodon. 6 4 6 1 Inpatient capacity g g g Siev. Rural 8 Pediatrics g g Siev. Urban 4 Ambulance g g g g Intensive care unit g g g   Results of the mapping indicate that most Basic imaging service g g g  g g g g g g facilities were located in the central areas of Post-surgery rehabilitation Psychiatry g g g   Lysychansk, Sievierodonetsk and to a lesser Blood bank service g g g   extent Rubizhne (Table 4 and Map 4). As a Dental care g g g g  result, all services that are associated with Pharmacy - essential drugs g  g g  g g g   secondary and tertiary care were unavailable Primary injury care Trauma & surgical care g g g   in the more peripheral areas of Siev. Rural and Maternity ward g g g   Siev. Urban (Table 5), obliging HHs seeking these types of services to travel across settle- More than 33% of facilities provide the service ments (Map 5). Findings also suggest that the g Less or equal to 33% of facilities provide the service availability of reproductive health services in  No facility provide the service While primary care focuses on general care for overall patient education and wellness, secondary care and tertiary care treat more severe conditions that require specialized knowledge and more intensive health monitoring. Once a patient is hospitalized and needs a higher level of specialty care within the hospital, he may be referred to tertiary care. HOUSEHOLD ACCESS AND USAGE and Sievierodonetsk to access secondary MAP 5: Household access to secondary healthcare facilities across settlements healthcare services; and to a far lesser extent Overall findings suggest a relatively good to Rubizhne. access to health services. Only 3% of HHs reporting having needed to go to a healthcare These spatial interpretations are confirmed by facility but not having been able to in the three the proportions highlighted in Table 6: while months prior to the assessment, while more almost all HHs reported accessing secondary than half of HHs (58%) had reportedly visited a healthcare services within their settlement in healthcare facility in the three months prior to Lysychansk, Sievierodonetsk and Rubizhne, data collection. almost none indicated doing so in Siev. Rural and Siev. Urban. This spatial pattern is also reflected in the reported access to tertiary of HHs have reportedly 58% healthcare services. visited a healthcare facility in the 58+42A three months prior to data collection. TABLE 6: % of HHs accessing healthcare services in their own settlement FIGURE 21: Most accessed health services by HHs 61+38+19+17+7 General practitioners 61% Primary Secondary Tertiary healthcare healthcare healthcare Specialists 38% services services services Inpatient care 19% Pediatricians 17% Lysychansk 100% 95% 68% Dentists 7% Rubizhne 99% 85% 57% Sievierodon. 100% 98% 85% Among those HHs who had reportedly not Siev. Rural 54% 3% 0% visited a healthcare facility while needing to, the most commonly reported reasons were the Siev. Urban 81% 5% 1% high costs of treatment (92% of HHs) and the TOTAL 97% 85% 65% cost of medication (28%). The most commonly Additionally, the proportion of healthcare FKIs accessed services reportedly were general who considered the number of patients in their practitioners (61% of HHs) and specialists facilities as “too many” was the highest in Siev. (38%). Urban (25%) and Rubizhne (25%), suggesting Map 6 on HH and Community Key Informant a limited capacity of health services to cope (CKI) access to healthcare facilities clearly indi- with the demand. These reported proportions cates that most HHs using health service were were lower in Lysychansk (18%) and Sievier- traveling to the central areas of Lysychansk odonetsk 12%).

18 HEALTH HEALTH 2 OVERALL USER SATISFACTION and high treatment costs (69%) were the pri- HOUSEHOLD HEALTH EXPENDITURES cines Program” launched in 2017, which was mary reasons of dissatisfaction, while financial precisely meant to ensure free medication for As illustrated in Figure 22 below, the majority 2 support for medical expenditures was also the certain chronically ill patients. of HHs were dissatisfied with state healthcare 27% of healthcare users most frequently reported primary recommen- services that were available to them (67%). needed to provide extra payments FIGURE 26: Average HH expenditures on dation (73% of HHs). Lack of professionalism 27+73A health during the 3 months prior to data FIGURE 22: Users’ satisfaction towards and incorrect attitudes were the secondary More than a quarter of HHs reported having collection, by income bracket state healthcare services*,** main sources of dissatisfaction for 42% of needed to provide extra payments in order to 4000 3759 41% HHs reportedly using healthcare, and was also get a necessary state medical service during 6% pinpointed as a main area of improvement (as the 3 months prior to data collection. The dis- 3500 21% crepancy between this finding and the fact that 26% per 51% of them). Finally, the poor quality of 3000 equipment was also an important source of just a few facilities were reported to charge 2416 8% 2500 1977 1893 dissatisfaction (reported by 28% of dissatis- their patients (Figure 25), might be explained 2000 fied HHs), and reported as an important area by the prevalent, although decreasing, culture 1545 Comp. dissatisfied Dissatisfied Neutral of improvement (47%). The reported causes of to thank for services by giving gifts or rewarding 1500 Satisfied Comp. satisfied / don’t know dissatisfaction were consistent across areas, all doctors.1 1000 Spendings (UAH) Spendings According to the subset of HHs that reported apart from “distance to facility” which rises from FIGURE 25: Most commonly reported facil- 500 being dissatisfied or completely dissatisfied, 9% on average to 40% of HHs for Siev. Rural ity pricing policies according to healthcare 0 the costs of healthcare and the quality of and Siev. Urban settlements, which corrobo- 4000- 8000-

FKIs 73+24+14+11 0 <4000 >12000 8000 12000 healthcare services were both the primary rates the absence of available facilities there. Everything is for free 68% Income bracket (UAH) causes of dissatisfaction as well as the first rec- Nevertheless, most HHs (71%) reported feel- Only some medication/ supplies charged 22% Methodological note: the beige line represents the ommendations for improvement. According to ing confident that the state emergency medical overall average of households’ spendings on health Free care for vulnerable 16% these HHs, the high price of medicines (87%) services would be available if needed. Free care, medication and supplies paid 10% TABLE 7: Average HH expenditures on FIGURE 23: Top reported reasons for dis- FIGURE 24: Most commonly suggested health during the 3 months prior to data satisfaction among dissatisfied users areas of improvement for healthcare ser- Such additional expenses might be particularly

87+69+42+28+19+15+14+12+9 collection, by vulnerability type vices by users taxing on low income HHs, as the financial High price of medicines 87% 73+51+47+25+19+8+5 burden of health is likely to be relatively higher Spendings on Support with medical expenditures 73% Type of vulnerability High treatment costs 69% for them compared to middle-to high income health Lack of professionalism Improve quality of health staff 51% 42% HHs. For instance, health expenditures corre- Chronical illness 3.399 UAH Lack of modern equipment 28% Improve quality of medical equipment 47% spond to 1/6th of the income of the poorest Pension age without pension 3.340 UAH Long waiting lines 19% Improve attitude of staff to patients 25% population groups (with 2157 UAH on average Disability - unofficial 3.036 UAH Lack of medical staff 15% Improve availability of information 19% spent over the last three months for all HHs) Disability - official 2.873 UAH Rude treatment by staff 14% Improve transport to facilities 8% (Figure 26). Further, as indicated in Table 7, there seems to be a link between relative Pensioners 2.470 UAH Unofficial payments 12% None 5% vulnerability of a HH and the HH’s health At least one vulnerability 2.466 UAH Distance to facility 9% expenditures. Overall, these findings question Low income family 2.374 UAH * Note: the term “users” refer here and throughout the report to the subset of HHs who reported having used the services in the three months prior to to this assessment. ** The merger of “don’t know” and “neutral” answers was made for illustrative purposes only. the exhaustiveness of the “Affordable Medi- No vulnerability 1.673 UAH 1. Ministry of Health of Ukraine, “How the healthcare system has changed” , web article, 2019 2. Ukranian Government portal, “Health care system reform”, web article, 2019

HEALTH 19 FACILITY CONDITION In the same vein, it should be noted that 94% of IMPACT OF CONFLICT ON FACILITIES As illustrated in Figure 30, a bit less than half healthcare FKIs reported that they would rec- of FKIs (43%) reported experiencing pressure Overall, healthcare facilities seem to be in aver- ommend their facility to other patients to get Overall, findings suggest that the impact of on their facility from NGCA residents, and par- age and acceptable condition, with relatively treatment. Facilities appeared to be equipped conflict on healthcare facilities has been mod- ticularly so in Lysychansk (67%) and Rubizhne few shortages of utilities (except for water) and with adequate heating, as 74% of FKIs erate, yet widespread. According to healthcare (50% of FKIs). sufficient equipment and supplies to function evaluated the temperature in the facility as FKIs, during the period 2014-2019, around half effectively. of the healthcare facilities in Lysychansk and a “somewhat comfortable” or “at the right level”. FIGURE 30: % of FKIs experiencing pres- quarter of facilities in Siev. Urban and Rubizhne In fact, facilities were reported to be in “satis- Electricity shortages were reported being “rare” sure on their facilities due to NGCA resi- were damaged as a result of shelling. All these factory condition” by most healthcare FKIs and by 30% of FKIs, and “frequent” by 12%. dents facilities have reportedly been reconstructed IMPACT enumerators (Figure 27). Regarding WASH, water shortages were found since then. It is noticeable in that regard that no Overall 43% 9% 48% to be unequally spread, with 88% of health- facilities were reported to be damaged without FIGURE 27: Estimation of facility condition care FKIs in Lysychansk and 38% in Siev. having been recovered to a functional state as by FKIs and IMPACT enumerators Rural reporting frequent shortages, in com- of the time of assessment. Lysychansk 58% 8% 33%

10+ parison with almost none in Sievierodonetsk

4 Rubizhne 50% 50% Excellent 10% FIGURE 29 : % of FKIs reporting damage to 0 and none in Rubizhne. In addition, only 56% 4% + their facilities sustained during the conflict +16 of healthcare FKIs reported that their facilities Sieviero. 36% 9% 55% 16% +24 (2014-2019), per area.

Good 0 24% + had access to drinking water. Siev. Rural +58 Overall 33% 33% 33% 54+ 6% 28% 66% 58% + Satisfactory 54% 0 Finally, 76% of healthcare FKIs reported that Siev. Urban 20% 80% +16 their facility was equipped with sufficient toilets Poor 16% +18 18% for their staff or users, and 94% reported having Lysychansk 47% 53% ExperiencingExperiencing pressure pressure due due to to NGCA NGCA residents residents access to basic handwashing stations. Not experiencing pressure due to NGCA residents FKIs IMPACT enumerators Rubizhne 25% 75% Do not know Do not know Sieviero. 18% 18% 64% Not experiencing pressure due to NGCA residents FIGURE 28 : % of FKIs reporting their facilities encountering the following shortages Siev. Rural 13% 87% Incidentally, tertiary healthcare FKIs reported Siev. Urban 25% 75% experiencing more pressure on their facilities due to NGCA (71%) than primary healthcare WasWas damaged damaged and and moved moved to another to another building FKIS and secondary healthcare FKIs (respec- Water shortage 48% 44% 6% Wasbuilding damaged and fully recovered tively 33% and 29% for both). WasWas not damaged damaged and fully recovered Electricity shortage 58% 30% 12% Finally, no facilities had reportedly ceased Overall, the most commonly requested ser- Gas shortage 28% 72% delivering services due to the security situation vices from NGCA residents were those related during the 12 months prior to data collection. In to inpatient capacity and outpatient services Heating shortage 88% 6% terms of preparedness, 46% of healthcare FKIs (as per 30% of FKIs), followed by primary care reported that their facility had a bomb shelter, services (27% of FKIs); and then family doc- No Yes, rarely Yes, often Not applicable with 87% of them considering that its safety tors, pharmacy products and first aid (20% for level was satisfactory. all services) .

20 HEALTH HEALTH 2 ACCESSIBILITY FOR PERSONS LIVING FACILITY EQUIPMENT AND SUPPLIES shortages, the least available basic medica- Finally and as illustrated in Figure 33 below, WITH DISABILITIES (PWD) tions were painkillers and antibiotics (59% of most facilities were sufficiently equipped to treat In terms of IT equipment, 55% of primary FKIs reporting shortages), and then insulin and tuberculosis and AIDS patients, but were still Only 6% of facilities were reported by IMPACT healthcare FKIs reported that their facilities treatment for hypertension; as well as cough lacking supplies to treat and support patients enumerators to be “accessible” for PwD, and had a ‘sufficient number’ of computers for work and antifebrility drugs (29% each). with mental health issues. In that regard, only 40% as “partially accessible”. These findings purposes, while 41% reported ‘insufficient’ 44% of all facilities were reportedly having suf- were reflected in the reports of healthcare FKIs, numbers. On the other hand, 70% of second- FIGURE 32: Least available basic medica- ficient equipment (and 36% considered this as a large number of amenities were reportedly tion according to FKIs reporting having ary healthcare FKIs reported having sufficient question as non-applicable to them). This is lacking to facilitate the access of PwD as illus- shortages computers, and only 46% of tertiary healthcare 60 particularly concerning when considering the trated in Table 8. FKIs. The majority of the healthcare FKIs (60%) Painkillers 57% potential impact of residing in close proximity + 60+29+29+29+29+14 TABLE 8: % of FKIs reporting their facilities reported all their computers to be adequately Antibiotics 57% to the contact line on individuals’ psychosocial to be lacking the following inclusive amen- updated, while 8% reported that ‘almost half’ Insulin 29% wellbeing, as highlighted in a recent protection ities of the computers at their facility were updated, assessment report conducted by REACH.1 Treatment for hypertension 29% and 16% reported that most of their computers Cough drugs 29% Type of missing amenities % of FKIs were not adequately updated. Likewise, 60% FIGURE 33: % of FKIs reporting having of healthcare FKIs reported that their facilities Antifebrility drugs 29% adequate supplies and equipments to treat Guiding strip to the entrance 91% were equipped with a landline or a cellular tele- Sedative 14% patients with following conditions: Information signboards in braille 91% phone available to call 24/7, and 34% reported HIV/ AIDS 69% 12%17% Restroom with appropriate having a landline or cellular telephone but not Similarly as for basic medication, findings indi- 89% pictogram being available 24/7. Only 6% reportedly were cate significant differences between types of Doorplates with contrast colours 79% not equipped with telephones at all. Finally, facilities in terms of medical supplies: if only Tuberculosis 64% 19% 13% Sound beacon at the entrance 79% most facilities (73%) were reported by FKIs to 7% of the primary healthcare FKIs reported having faced a lack of any medical supplies in Information signboards with large have transport to provide services to people. 77% the 3 months prior to the assessment; 10% of Mental health 44% 16% 37% font and contrasting color secondary healthcare did so, and 33% of ter- Yes Ramp inside of the building 72% 14% of FKIs reported their Don’t know/ refuse to tiary healthcare FKIs. Almost all of these FKIs Partially Handrails on stairs outside 72% facility to have lacked any basic No answer/ hard to say were situated in the Lysychansk (18%) and No medication in the past three months. Don't know/ refuse to answer/ hard to say Handrails on stairs inside 70% 14+86A Sievierodonetsk Rural (25%) areas. Amongst Ramp outside of the building 64% all choices that were suggested during the With regard to basic medications, findings Regarding waste management, 70% of health- survey, almost all of them were selected by Lift 45% indicate significant differences between types care FKIs reported that their facilities collected these FKIs; with bandages, cotton, ethanol, IV Elevator 36% of facilities, as 3% of primary healthcare FKIs and sorted their medical waste for recycling systems being the supplies that were reported reported lacking basic medications in the 3 or further disposal, while 60% reported stor- to be lacking by 67% of FKIs, while beds, Nevertheless, the majority of healthcare FKIs months prior to this assessment, in comparison ing and transporting waste in a secure place. gloves and syringes were reportedly lacking (60%) reported having PwD among their staff to 30% of secondary and 33% of tertiary health- Lastly, 24% opted to treat their medical waste by half of these FKIs. members. Out of an average of 164 staff care FKIs. During the three months prior to the (for instance via incineration). members per healthcare facility, the average assessment, and according to FKIs reporting reported number of PwD per FKI facility was 6. 1. REACH, Protection Assessment of Isolated Settlemnts in GCAs along the contact line, February 2019

HEALTH 21 HUMAN RESOURCES dates” (as per 69% of the FKIs who reported year prior to data collection, and 35% of FKIs The vast majority of HHs (79%) reported being that not all of their FTEs were occupied), as reported this to have been the case for nurses. aware of the new healthcare reform, half of well as the “low salaries” (56% as well), which The relatively high proportion of stress and whom (50%) considered that it would nega- was itself explained by the “low availability of emotional load might be partially explained by tively impact their access to healthcare. 80+20A 62+38A candidates” in the area (as reported by 91% these chronic shortages. FIGURE 35: HHs’ opinion on the impact of of the FKIs who reported a lack of candidate). 80% of FKIs 62% of FKIs esti- reform on their access to healthcare estimated their staff to mated their managerial This lack of qualified candidates can be corre- 82% of FKIs reported that 37% consists mostly of female staff to consists mostly of lated with the more general population decline stress and emotional load were staff members female staff members resulting from low fertility rates, ageing popu- common among the staff members 49% lation and migration outflows to urban centres. 82+18A 14% Findings from FKIs suggest that the gender Interestingly, the concern around low salaries However, findings suggest the workload is breakdown of the workforce in health facilities was also brought forward in another, unrelated manageable for most facilities, as “only” 16% is markedly skewed towards female workers. Negatively Don’t know Positively question: while 50% of FKIs would recommend of FKIs estimated the number of users in their According to the majority of healthcare FKIs their hospital/ facility to other doctors as a place facility as “too many”, and 74% as “about right”, It should be noted here that half of HHs did not (68%), the staff at their facilities was mostly to work at, 38% reported being willing to do so with 14% of primary healthcare FKIs reporting seem to be interested in getting more informa- middle-aged (between 36 and 55 years old). “only with a higher salary”. “too many” users versus 20% of secondary tion on the reform. On the other hand, 47%, In addition, 56% of facilities have IDPs among healthcare FKIs. would welcome “general information” about the their staff members, with 11 IDP staff members FIGURE 34 : Most commonly reported reform, while 7% mentioned being interested in on average per facility with reported presence least occupied FTEs by healthcare FKIs Finally, 66% of healthcare FKIs estimated that

79+43+14+7+7 “specific guidelines on how to use the services of IDP staff members. none of their staff members required additional Senior medical staff (doctors) 75% online”, and 6% would reportedly be interested training in order to improve service provision; Junior medical staff (nurses) 44% in “specific guidelines about registration”. From of FKIs reported that all although 51% of HHs using healthcare services 66% Administrative staff 19% the facility perspective, 98% of FKIs reported their FTEs were filled at the time considered the improvement of the quality of Management staff 6% that their staff had enough information/ training 66+34A of assessment staff as a priority (see Figure 24). about the reform. Technical staff 6% More specifically, 83% of primary healthcare FKIs appear to be more optimistic than health- FKIs reported that all their full-time equivalent As illustrated in Figure 34 above, FTE positions BOX 3: HEALTHCARE REFORM care users concerning the reform, as 46% (FTEs) were filled at the time of assessment; in that were reportedly the least often occupied In late 2017, a series of laws were passed either “agreed” or “strongly agreed “that the contrast to 50% of secondary healthcare FKIs, were those for doctors and nurses. This chal- to build a new patient-oriented healthcare reform would positively impact user’s access and only 22% of tertiary healthcare FKIs. Cor- lenge seems to also be faced by other rural service.2 For instance, citizens are now to healthcare services (and 30% thought the respondingly, 78% of healthcare FKIs reported communities across the country, to the extent supposed to be assigned one physician reform would have a negative effect). Half that their facility had enough FTEs to manage that some rural communities are reported to of their choice.3 Furthermore, the “Money of the healthcare FKIs (44%) also agreed or the workload, with 83% of primary healthcare be offering free accommodation for their doc- follows patient” principle means the gov- strongly agreed that the healthcare reform will 1 FKIs reporting so, 70% of secondary health- tors. Accordingly, findings indicate that, of all ernment will allocate money for the specific make the sector more effective. care FKIs, and 67% of tertiary healthcare FKIs. medical professions, the workload might be needs of a patient instead of financing hos- The main reasons that were brought forward by perceived to be highest for doctors and nurses, 2 pitals, doctors, and inpatient beds. of FKIs agreed that the FKIs to explain this gap in human resources as 38% of FKIs reported doctors have been 70% healthcare reform was not “timely’ were principally the “lack of qualified candi- the most ‘overloaded’ medical staff during the 70+30A

22 HEALTH HEALTH 2 However, and despite these positive percep- ties had internal quality assurance mecha- tions, there is a relatively high proportion of nisms and operating feedback mechanisms KEY FINDINGS healthcare FKIs who either “strongly agree” for users (reported by 88% of FKIs, and 98% The analysis highlighted that there is a clear gap in availability of secondary and tertiary (42%) or “somewhat agree” (28%) that the respectively). Users were mostly reported healthcare services in the areas of Siev. Rural and Urban. “Findings suggest that, while healthcare reform was not timely (in terms of to access these mechanisms either “often” physical access to healthcare facilities is generally perceived to be good, barriers remain for readiness of users and providers). This might or “periodically” (by 55% and 33% of FKIs PwD, who constitute 7% of the population. Moreover, finding suggest that primary challenges be partly explained by the fact that 50% of FKIs respectively), and most commonly for personal are associated to the costs of meeting health needs, particularly for most vulnerable HHs (52% of primary healthcare FKIs, 40% of sec- queries (73%). (estimated to be 47% of the overall population). ondary and 45% of tertiary healthcare FKIs) considered that they are sufficiently equipped GENDER-BASED AND DOMESTIC Although the vast majority of services provided are reportedly free, the proportion of HHs’ to harness the change the reform would VIOLENCE RESPONSE expenditures for health remains relatively high compared to HHs’ average income. This could require, while 36% of them reported being be associated to the ad-hoc costs of treatments, such as medicine purchase. Additional quali- Overall, 14% of healthcare FKIs reported that “partially equipped” and 14% “not equipped”. tative analysis is recommended to analyse whether other patterns (such as systematic bribes their facility had effectively registered pos- or norms of reciprocity) could explain this discrepancy. Overall, health facilities’ infrastructures sible/actual cases of DV and/or GBV among and provision of service appear acceptable. However, the enforcement of the 2017 healthcare of FKIs reported their 50% their staff or beneficiaries, and subsequently facilities were fully equipped to reform is generally perceived as being premature; a variety of concerns were raised amongst comply with the new requirements informed the police or the adequate social the FKIs and HHs notably with regards to the lack equipment and funding to adequately 50+50A affair services. Facilities registered 19 GBV/ implement the reform. In that regard, 62% of FKIs reported that their DV cases on average during the year prior to institutions were using the “eHealth system”, a this assessment. series of new instruments to make all medical records electronic (medical e-history, e-referral, 72% of FKIs reported that e-prescription for Affordable Medicine).4 their facilities have effective Stand- ard Operating Procedures (SOPs) GOVERNANCE to react to cases of domestic vio- 70+30A lence or GBV. 14% have partial SOPs 62% of FKIs reported their facilities to make their annual Amongst the 24% of FKIs who reported not 62+38A report publicly available having or partially having SOPs in place, 92% of FKIs indicated lacking the capacity to issue The main reasons given by FKIs for not pub- an “order” on a GBV case and 83% lacking a licizing their annual reports were a “lack of registration journal; another commonly reported practice” and “confidentiality” as per 75% and barrier to SOPs was limited staff awareness 25% of FKIs respectively. Additionally, it should around the legal framework governing GBV be noted that almost all FKIs (92%) reported survivors’ rights (as per 42% of FKIs). Finally, a 1. Vox Ukraine, “Unchangeable? How medical reforms work and where they slow down” web Article, December 2019 collecting data and using it for decision-making. third of FKIs (33%) reported that their facilities 2. Ministry of Health of Ukraine, “Key Steps to Transforming Ukrainian Healthcare”, 2019 3. Ministry of Health of Ukraine, “How the healthcare system has changed” , web article, 2019 Similarly, findings indicate that almost all facili lacked a referral system. 4. Ukranian Government portal, “Health care system reform”, web article, 2019

HEALTH 23 Key indicators on community FKIs’ estimation of the change in the FKIs’ estimation of the change in the num- number of people in the community with ber of people’s deaths in the community alcohol disorder compared to the previous from non communicable diseases (cardi- well-being according to Health FKIs year. ovascular diseases, cancer, diabetes and chronic respiratory diseases) compared to 53% the previous year. FKIs’ estimation of the frequency of FKIs’ estimation of the proportion of chil- 47% suicides and attempts in the community in dren who are completely unvaccinated in 28% 32% the year prior to this assessment. the year prior to this assessment. 30+21+6+42 6+3+45+35+10 11% 8% 12% Periodically/sometimes 30% Almost 1/3 6% 0% 2% 5% 0% Very rarely 21% Almost 1/4 3% Decreased Don`t No Increased Significantly Significantly Decreased Don`t No Increased Significantly Don`t know 6% Less than 1/4 45% 11+8+53+28+0know change increased decreased know change increased Never 2+12+5+47+32+0 42% None of them 35% Don`t know 10% FKIs’ estimation of the change in their FKIs’ estimation of the change in the num- patients’ substance use compared to the ber of people’s deaths in the community previous year. from communicable diseases compared to FKIs’ estimation of the incidence of mater- FKIs’ estimated reasons as to why parents the previous year. nal mortality in the community in the year keep their children unvaccinated. 56% 49+26+26+23+13 prior to the assessment. Do not know 49% 48% 7+79+14 Very rarely 7% Lack of awareness/ sensibilization 26% 26% Never 79% Religious/ethnic beliefs 26% 18% 16% 15% Don`t know 14% Other 23% 9% 6% 3% 3% Vaccination is not available 13% Decreased Don`t No Increased Significantly Significantly Decreased Don`t No Increased 6+26+48+16+3know change increased decreased3+15+18+56+9know change FKIs’ estimation of the frequency of FKIs’ estimation of the change in their FKIs’ estimation of the change in the number FKIs’ estimation of the change in the num- preventable deaths under 5 years of age in patients’ alcohol disorder compared to the of people in the community with substance ber of HIV positive patients in the commu- the year prior to this assessment. previous year. use compared to the previous year. nity compared to the previous year. 16+3+10+19 Very frequently 16% 64% Often 3% 40% 37% 41% Don`t know 10% 23% 27% 15% Very rarely 19% 8% 19% +52 8% 7% 7% Never 52% 0% 3% Decreased Don`t No Increased Significantly Decreased Don`t No Increased Significantly Decreased Don`t No Increased 8+8+64+19+0know change increased 7+23+40+27+3know change increased 7+15+37+41know change

24 HEALTH HEALTH 2 EDUCATION all stages of school education. It should also MAP 6: Available education facilities in the target area be noted that it is also in those areas where This section presents available education education FKIs commonly reported that the services in the area of Sievierodonetsk, their number of students was “too low” (see Table principal characteristics and gaps in their 9). This perceived scarcity of students might capacity. It also highlights HHs’ satisfaction be partially explained by the fact that, over- and their principal barriers to accessing these all, only 11% of HH members were reported services. In order to obtain this general picture, to be of school age (5-18 years old). As indi- 84 FKIs were surveyed, a subset of the overall cated in Map 6, half education facilities (42 assessment sample composed of the 515 HH out of 84) reportedly comprised the first three members who were reported to access educa- stages of school education in the same facility. tional facilities, as well as 120 CKIs. Additionally, centres for vocational education were relatively well represented (20 out of 84 AVAILABLE FACILITIES assessed facilities).

TABLE 9: Number of facilities per area and ACCESS TO EDUCATION FACILITIES average number of students TABLE 10: Indicators on education acces- Area of # of Avg. nb Perception sibility, by HHs accessing education services interest facilities of stud. of FKIs Area of % of HH HH HH Lysychansk 28 385 About right interest members members members Rubizhne 15 436 Too few taking accessing accessing more than schools vocational Sievierodonetsk 28 494 About right 30mn in same centres settlement accessed Siev. Rural Too few 4 79 in same Siev. Urban 9 200 Too few settlement TOTAL / Lysychansk 22% 83% 91% 84 396 About right AVERAGE Rubizhne 17% 91% 86% Sievierodonetsk 10% 91% 100% As shown in Table 9 and Map 6, most of the education facilities were concentrated in the Siev. Rural 38% 56% 0% major urban centres of Lysychansk and Sievier- Siev. Urban 26% 80% 0% odonetsk, while Rubizhne had around roughly Overall 17% 86% 87% half the number of facilities as the major urban centres. In Siev. Rural and Siev. Urban areas, Physical access to educational services does there were even less education facilities. In not appear to be of particular concern for its addition, these two areas were also found to users, as only 6% of HHs reportedly consid- have the lowest number of students on aver- ered distance as a source of dissatisfaction age, but nevertheless had facilities providing in general. However, HHs from Siev. Rural 25 MAP 7: Network map of education access and Siev. Urban reported spending more time More than half of HH members were reported in transportation than HHs from other areas, to have completed vocational training, which which is corroborated by the lower proportions coincides with the relatively high number of of HH members reporting accessing their edu- vocational training centres available in the cation facilities in their own settlement (Table area, and is also a legacy of the soviet system. 10); and the movement trends reported by CKIs On the other hand, less than a quarter of HH captured in Map 7. These findings are indic- members (22%) were reported to have com- ative of a lack of education facilities in these pleted higher education. This Figure drops two areas; which is even more the case for significantly in the areas of Siev. Rural (10%) vocational centres as none of HH members and Siev. Urban (10%). reportedly accessed these services. STUDENT PROFILES OVERALL LEVEL OF EDUCATION FIGURE 38: Gender breakdown of students, FIGURE 36: Most commonly reported level as reported by FKIs of education of Male (left) and Female Students (right) HH members Students 51 Vocational 52% / 51% + 21+10+5+3+5+5+0 Graduates Graduates Complete Higher 21% / 21% Complete Secondary 9% / 10% IDP students IDP students Basic Higher 6% / 5% Basic Secondary 4% / 3% Dropouts Primary Education 5% / 5% Dropouts Preschool 3% / 5% NoNo male/ male/ Mostly Mostly female female Postgraduate 0% /0% Sightly higher % of female

0+3+5+4+6+9+15+52 Sightly higher % of female AlmostAlmost even even proportion proportion FIGURE 37: Most commonly reported edu- DoDo not not know know cation facilities accessed by HH members Sightly higher % of male 33+32+15+11+8+ Sightly higher % of male Middle (level 2) 33% NoNo female/ female/ Mostly Mostly male male 32% Primary Education Data made available on the gender breakdown Tertiary 15% of students, graduates, IDP students and stu- Vocational 11% dent dropouts do not demonstrate a particular Secondary 8% gender discrepancy, which is also in line with 1 1 Preschool 1% national level statistics. According to educa- tion FKIs, an estimated average of 16 students 1. World bank data, Ratio of female to male lower secondary completion rate, World bank, 2018

26 HEALTH EDUCATION 2 drop out per facility per year, which represents staff members, with 2 PwD staff members the everyday life of the community. According deprived of parental care (reported by 77% of only 4% of all students. The main reasons that on average per facility. Accessibility for PwD to education FKIs, medical services were the FKIs), children of military personnel (40%), and were brought forward to explain this number within the school facilities was reportedly poor most commonly reported services provided by children of IDP families or large families (28% were a “change in community” (as reported by (as reported by enumerators). This observa- the facilities, as well as the most commonly for both). 88% of FKIs reporting dropouts) and because tion was also reflected in the 76% of IMPACT used service by HHs (as reported by 53% of TABLE 12: Available educational services, of “family issues” (39% of FKIs). The vast enumerators reporting that facilities were “not HH members). Extracurricular activities (27% according to FKIs majority of FKIs (92%) reported that their facil- accessible”, and 24% “partially accessible”, for of HHs), afterschool care (36%), psychological ity was hosting IDPs amongst their students PwD. This indicates that very few facilities have support (33%) and social/ pedagogical services (with 30 IDP students on average per facility), the required amenities needed, which may (18%) were also reportedly used by many HHs but also amongst their staff members (68% of push students living with disabilities towards in the area. However, very few FKIs reported FKIs, with 3 IDPs on average per facility). This alternative educational services. that their facility provided bus services, apart Rubizhne

proportion varied quite substantially between from Sieviero. and Siev. Urban facilities, and Rural Siev. Siev. Urban Siev.

TABLE 11: % of IMPACT enumerators Lysychansk Sievierodon. assessed areas, with Sievierodonetsk facilities reporting their facilities to be lacking the as a consequence, almost no HH members % of Education FKIs reportedly hosting proportionally twice as many following inclusive amenities reported using it at all apart in Siev. Urban and IDP students as facilities located in other areas. Rural (23% and 17% of HH members in com- Mine risk education 87% Career orientation 85% These findings match closely with the overall parison to 3% on average). The main reasons Type of missing amenities % of FKIs Psychological support 80%  proportion of IDP HH members reported in the reported by FKIs for not providing additional Education for PwD 79% household profile section (Figure 5 page 10). Information signboard in braille 96% services were lack of finance (reported by 70% Medical support 79% Guiding strip 95% of FKIs) and lack of staff (41%). Extracurricular activities 75% FIGURE 39: % of IDPs amongst education School supplies 71%   Restroom pictogram 92% Most of the assessed education facilities were facilities reported by FKIs, by areas Social, pedagogic support 68% Sound beacon 92% reported to provide courses on human rights Education at home 62% 12+5+4+3+3 Sievierodonetsk 12% Ramp inside 87% and global citizenship in their curriculum Bus for students 19%    Certificate training courses 19%     Lysychansk 5% Handrails on stairs outside 84% (according to 92% of education FKIs). More- over, 75% of vocational training centre FKIs Rubizhne 4% Information signboard with (Squares: more than 50% of facilities) 83% reported that their facility provided courses on Siev. Urban 3% contrasted colors and large font Doorplates with contrast colours 81% business and entrepreneurship, expressing 93% of FKIs reported their Siev. Rural 3% their stronger inclination towards the needs of facility having a functioning library, Handrails on stairs inside 80% the labour market (versus 28% of FKIs from all of which 51% reported having new ACCESSIBILITY FOR PERSONS WITH Ramp outside 66% others facilities). 95+5A books DISABILITIES Elevator 65% Findings indicate that most education facil- of FKIs reported their Lift 60% 90% The vast majority of education FKIs reported ities provide additional support to vulnerable facility provides books for free, and 4% partially. providing education services to persons with SERVICES PROVIDED BY FACILITIES families, for example through the provision of 89+11A disabilities (PwD) (88%), although seemingly free lunch. Almost all education FKIs (91%) in relatively small numbers (with 10 students Findings indicate that the majority of education reported providing free lunch to low-income 68% of FKIs reported their per facility on average). Similarly, 75% of FKIs facilities provide a relatively large array of ser- families, other groups that reportedly received facility provides free lunch, and 12% partially. reported the presence of PwD amongst their vices, suggesting their relative importance in free lunch at education facilities were children 69+31A

EDUCATION 27 ATTENTION FIGURE TOTIO

PRICING POLICY AND HOUSEHOLD doing so through class funds (89%), directly OVERALL USER SATISFACTION From the users’ perspective, even though the EXPENSES to the facility (61%) or through targeted funds quality of staff was their primary concern, it The majority of HH members (79%) were (47%) (for curtains, windows, amenities, etc..). was not widely considered as sufficiently poor reportedly either ‘completely satisfied’ or ‘rather to justify a change of school facility. In fact, only satisfied’ with education services , with no sig- 73% of FKIs (all except voca- FIGURE 41: Most commonly reported 9% of HH members were reportedly planning tional centres) reported providing free modalities of informal payments made by nificant differences across all assessed areas. education for their students (and 45% on changing facility for the abovementioned HH members (according to HH members 73+27A of vocational centres) FIGURE 41: HH members’ satisfaction reasons. reportedly paying through contributions) towards state education services* The most commonly reported paid-for services 89+61+47+41 43% 86% of HH members report- by students, according to education FKIs, Class funds 89% edly do not plan to change their 5% education facility (9% plan to were school funds (56%), followed by tuition Facility funds 61% change and 5% do not know) fees (37%), and less frequently extra courses 12% 36% 86+9+5A Targeted payments 47% (15%). On the other hand, a bit more than a Gifts for teachers 41% 3% The following sections will further explore the quarter of facilities were reportedly providing three main reasons of dissatisfaction, from a stipends to their students (29% of FKIs), which Comp. dissatisfied Dissatisfied Neutral Satisfied Comp. satisfied / don’t know user (HH) and facility (FKI) perspective. were most notably based on merit (23% of 74% of HH members report- FKIs), and on needs (17%). edly received free books from their Among dissatisfied HH members, the quality of LACK OF QUALIFIED TEACHING STAFF teaching staff was reportedly the most common These FKI findings are not completely in line facility, 20% received some books 74+203+3A (3% none and 3% do not know) source of dissatisfaction, as 53% of them were with the HH findings, since a bit less than half reported to indicate this reason. This was fol- of FKIs reported that (44%) of HHs using education services reported 61% lowed by the insufficient use of computers and all their FTEs were filled at the not paying for education, while a sensible pro- Overall, 34% of HH members were reported the outdated curricula (26% of HH members for time of assessment portion reported paying either indirectly (45%) 60+40A to spend up to 500 UAH on school books and both), as well as the perceivably bad conditions Similar to the above finding, 27% of FKIs con- or directly (9%) to the school. other educational supplies for themselves, 32% of facilities (16%). sidered that their facility did not have enough reported this amount to lie between 501 and FIGURE 40: % of HH members reportedly FTEs to manage the workload. According to 1.000 UAH, and 21% between 1.001 and 2.000 FIGURE 42: Most commonly reported paying for education, and associated education FKIs, teachers were the main FTEs UAH for the last academic year prior to this reasons for dissatisfaction among HH payment modalities currently lacking in education facilities, as 76% 45+44+9+1

assessment. members 53+26+++22+16+15+11+11 Pay indirectly through contributions 45% of FKIs reporting a lack of FTEs reported that Quality of teaching staff 53% Don’t pay anything 44% Expenses for uniforms and athletic clothing this lack mainly concerned a lack of teachers. were more likely to be a burden on HH budg- Insufficient IT, outdated curricula 26% Pay directly 9% ets, as 22% of HH members were reported Outdated facilities and premises 22% FIGURE 43: Most commonly reported Pay for additional subjects 1% 16% types of unoccupied FTEs (as per FKIs) having spent between 2.001 and 3.000 UAH Facility is in bad condition 74+29+6 on school (athletic) uniforms, and 38% of HH Quantity of teaching staff 15% Teachers 76% As illustrated in Figure 41, HHs that reportedly members having spent even more than 3.000 Corruption 11% Administrative staff 27% paid for education most commonly reported UAH for the same time period. 11% Technical staff 6%

Quality of management staff +

* The merger of “don’t know” and “neutral” answers was made here and throughout the report for illustrative purposes only.

28 HEALTH EDUCATION 2 This finding is concerning, as a lack of teaching courses not provided by the school (41%), fol- Regarding quality of infrastructures and equip- However, there were some FKIs in Lysychansk staff might indicate a general inability to provide lowed by the need for extra help in general ment, the vast majority of education FKIs (83%) (46%) and Siev. Urban (22%) who did report adequate education and attention to students. (34%) and preparation for exams in particular reported their facilities not having enough that water shortages happened frequently. (28%). For only 8% of HH members, HoHHs space and supplies for education purposes. Regarding sanitation, 70% of FKIs reported Among FKIs reporting not having enough explicitly reported the need for a private tutor as that their facilities have a sufficient number of FTEs, the main reasons that were brought As a consequence, facilities were reportedly a consequence of the “bad quality of teaching gender-segregated toilets, while 19% of FKIs forward to explain this gap were the lack of unable to function properly due to the lack of staff”. reported an insufficient number instead. Staff qualified candidates (70% of FKIs), followed supplies (Figure 44). and students reportedly have access to basic by the low expected salary (67%). The lack INSUFFICIENT EQUIPMENT handwashing in most educational facilities, as of qualified candidates itself was explained FACILITY CONDITION AND IMPACT OF 99% of FKIs reported their facilities enabled through several reasons, the main one being The insufficient use of computers, technology, CONFLICT basic handwashing. However, access to drink- the “low supply of candidates” as per 70% of and outdated curricula was the second most As shown in Figure 45, 67% of FKIs considered ing water was only reported by 49% of FKIs FKIs that reported lacking qualified candidates, commonly reported reason of dissatisfaction that their facility’s condition was “satisfactory”. to be available at their facilities. Finally, 77% as well as the “current situation in the settle- amongst users. This finds a direct echo in the 86% of FKIs reporting having computers “in of FKIs rated the overall temperature in class- ment” (39%). Interestingly, only 4% of FKIs FIGURE 45: FKIs’ estimation on the overall rooms at the ‘right level’ or ‘comfortable’, while linked this labour shortage to the conflict. All insufficient numbers”, and with the fact that condition of the facility 1+22+67+10 23% reported considering the temperature to these figures pinpoint the fact that there is a 68% of all FKIs reported that “most of their Excellent 2% be either “not comfortable” or “not comfortable clear lack of available qualified staff. computers” were obsolete”. Finally, 56% of all education FKIs reportedly considered that the Good 20% at all”. This appears to be a structural challenge asso- internet connection was “slow” and thus insuf- Satisfactory 69% Levels of infrastructural damage as a result of ciated to the lack of incentives and orientation ficient for educational purposes. Poor 8% shelling varies significantly from one location for the educated workforce towards this career to another, with Lysychansk being the most path. From the facility perspective, virtually all Overall, findings illustrated in Figure 46 indicate impacted both in terms of reported damage FKIs (96%) reported that teachers were teach- of FKIs reported not 83% that most education facilities did not experience and lack of repairs (Figure 47). Some FKIs ing more than one subject, although only 13% having sufficient space and sup- frequent shortages of basic utilities such as from Rubizhne (7%) reported their facilities were teaching subjects in different fields (e.g. plies at their facility 86+14A water, electricity, heating and/or gas. had been damaged and were not renovated history and biology). The main reasons that were brought forward to explain why teachers FIGURE 44: Type of supplies that FKIs were teaching in different fields were “staffing” reported lacking for their facilities FIGURE 46: % of FKIs reporting their facilities encountering the following shortages 90+81+67+66+33+33 (as per 63% of FKIs reporting that this was the Lab equipments 86% case), followed by “lack of specialists” (28%), Water shortage 68% 13% 19% Furniture 79% and then financial reasons (26%). Books 64% Electricity shortage 79% 19% 1% In the same vein, and even though a relatively Stationary 64% high proportion of studying HH members (19%) Gas shortage 22% 78% Office space 33% were reported to have a private tutor, the most Other* 33% commonly reported reasons for hiring such a Heating shortage 77% 18% 4% private tutor were primarily to acquire additional * Computers, didactic material, games, etc.. No Yes, rarely Yes, often Not applicable

EDUCATION 29 since, while facilities in Sievierodonetsk and With regard to the impact of NGCA residents, military presence was reported to be a matter According to 77% of FKIs, stress and emotional Siev. Rural had seemingly been exempted from FKIs in Sievierodonetsk reported experiencing of concern only in the Siev. Urban area, as load were common problems among their damages due to shelling. more pressure on their services due to NGCA 28% of HH members accessing educational staff members. This relatively high proportion residents than in other areas, but overall facilities respondents reported this concern. In should be put in perspective with the current FIGURE 47: % of FKIs who reported dam- this remains a minor concern (see Figure 48 addition, 11% of education FKIs in this area shortage of FTEs that has been outlined above. ages on their facilities as a result of shell- above). Psychological support was perceived also reported military presence to be a primary However, almost every FKI (96%) would report- ings (2014-2019) to be the most commonly requested service by concern. Finally, Sievierodonetsk was also the edly recommend the facility to other teachers Lysychansk 11% 43% 46% NGCA residents (as per 31% of FKIs), followed only location where mines were reported to be as a place to work at, and 100% as a place to by social and pedagogical support (27%) and safety concern on the way to the education study in. It is also noteworthy that 52% of FKIs Rubizhne 7%7% 87% school supplies (12%). facility, as it was reported by 6% of HHs, while reported their facilities had all their teachers no FKIs reported this concern at all. pass their NUS training during the year prior to Sieviero. 100% SAFETY data collection, and 22% reported this was at HUMAN RESOURCES Siev. Rural 100% For 95% of all school-going HH members, least 1/3rd of the teaching staff. respondents reported considering the educa- Siev. Urban 33% 67% GOVERNANCE AND FEEDBACK tion facility to be safe. Those respondents who MECHANISMS Was damaged and not recovered did not consider the facility their HH members Findings suggest that, despite the newly Was damaged and recovered partially attended to be safe most commonly reported 95+5A 86+14A established State Service for Education Qual- Was damaged and fully recovered their primary concern to be the “condition of of education of educa- ity (SSEQ), institutional capacity of facilities at Was not damaged the facility” (89%). Both the HH and FKI find- 98% 85% FKIs reported the staff tion FKIs reported the the central and regional level remained rela- ings indicated that safety appeared to be a at their facility to consist managerial staff at tively weak, especially in rural areas. However, FIGURE 48: % of education FKIs reporting minor concern across all locations. Physical “mostly” or “completely” their facility to consist some good practice examples in hromadas their facility experiences pressure on access to the education facility was reportedly of female members. “mostly” or “completely” were recognized and should be further devel- their services due to NGCA residents considered “safe” for 81% of school-going HH of female members. opped.4 Overall, most education facilities were members. Overall 14% 44% 42% The gender breakdown of the workforce in edu- reported to have functioning self-governance The main safety concerns that were reported cational facilities is markedly skewed towards bodies, which were mostly involved at planning by both HHs and FKIs were associated with Sieviero. 25% 39% 36% female workers, which is in line with national stages (as per 68% of FKIs) and in advisory the prevalence of stray dogs or other animals level statistics, where the education sector is roles (35%). Only 10% reported that their facil- Lysychansk 14% 54% 32% (reported by 42% of HHs and 71% of FKIs the only overall sector where women managers ity did not have self-governance bodies. Rubizhne 7% 67% 27% reporting safety concerns), while the low qual- prevail compared to male managers (69% of ity and low safety standards on the roads were managers being women)2. Moreover, findings Siev. Rural 100% of FKIs reported that also commonly highlighted (62% of HHs and suggest that the staff at education facilities is 96% their facility had publicly available Siev. Urban 100% 56% of FKIs); due, for instance, to fast traffic mostly middle aged or older, with 88% of FKIs annual reports and lack of appropriate crosswalks. Another reporting most of their staff being middle aged 96+4A Experiencing pressure due to NGCA residents Experiencing pressure due to NGCA residents important safety concern was the presence of (between 36 and 55 years old) and 5% of FKIs In the same vein, 96% of FKIs reported their DoNot not experiencingknow pressure due to NGCA residents ‘hooligans’, as indicated by 12% of HHs and reporting most of their staff being ‘elderly’ (older facilities collected quantitative data at least NotDo experiencing not know pressure due to NGCA residents 19% of FKIs reporting safety concerns. Finally, than 55).

30 HEALTH EDUCATION 2 annually and used it in decision-making. However, only 48% of FKIs who were aware of Amongst the 18% of FKIs who reported not 2. Women and men in leadership position, UNDP, 2018. Almost all (99%) FKIs reported that their facil- NUS agreed that their facility was sufficiently having or only partially having GBV/DV SOPs 3. Ukrainian decentralization portal, “Investment volume in the New Ukrainian School makes up UAH 7 billion, New ity had quality assurance mechanisms in place, equipped and ready to implement the NUS in place, 87% indicated lacking the capacity to Educational Space needs to be further developed, claims and all of them have an operating feedback approach in practice at the time of data collec- issue an Order on a GBV case, 27% lacking a Prime Minister” , web article mechanism for users. This feedback mecha- tion (as shown in Figure 49 below). registration journal, while other reported rea- 4. Review of the education sector in Ukraine, World bank, nism appears to be quite useful for students sons for not having the SOPs in place were 2019. FIGURE 49: % of FKIs reporting that as they were resorting to it either ‘occasionally’ the need to increase staff awareness around the facility is sufficiently equipped to or ‘very frequently’ according to 43% and 51% the legal framework governing GBV survivors’ implement NUS approach in practice of FKIs, respectively. The most common forms rights and the lack of a referral system (13% of 5% of feedback reportedly were personal queries 38% FKIs for both answers). (81% of FKIs) and recommendations (11%). On 27% the other hand, only 27% of FKIs reported that KEY FINDINGS 18% their facilities had undergone an external eval- 12% uation in the 12 months prior to data collection. Overall, both education users (HHs) and facility representatives (FKIs) concurred on the fact Comp. disagree rather disagree Neither/ that the lack of capacity (both in terms of avail- Comp. agree don’t know ADOPTION AND READINESS TO THE Agree ability of teaching staff and skillset) constitutes “NEW UKRAINIAN SCHOOL” REFORM a major impediment to quality education in tar- GENDER-BASED AND DOMESTIC geted areas. In combination with SSEQ, the “New Ukrainian VIOLENCE RESPONSE Additional barriers include poor quality of School” (NUS) is a UAH 7 billion key reform Regarding DV and GBV, 18% of FKIs reported educational equipment (particularly IT); and launched in 2018 to improve the education that their facility had effectively registered pos- limited availability of psychosocial support system as a whole, in an attempt to “better sible/actual cases of DV or GBV among their services. Poor accessibility for PwD was found equip schools and pupils to the challenges of staff or students, and subsequently informed to be widespread and could also constitute an the 21st century.” 3 the police or the adequate social affair ser- impediment for this specifically vulnerable pop- vices. Facilities reportedly registered 2 GBV/ ulation group. DV cases on average per year. 94% of FKIs reported being There do not appear to be specific financial bar- aware of the NUS concept riers restraining access to education, although 81% of FKIs reported their 94+6A solicitation of punctual voluntary contributions facilities have effective SOPs to react 52% of FKIs reported that to DV/GBV. 13% reported having par- from parents (financial or in-kind) seem to be all their teachers have passed the 70+30A tially effective SOPs. relatively common at the community level. NUS training 53+47A Finally, less than a quarter of the population Amongst the 94% of FKIs who were aware has completed higher education, with an even 93% of FKIs reported their of the NUS concept, 99% of FKIs somewhat facility disseminates information on lower proportion in the Siev. rural and Siev. agreed or strongly agreed that their facility had DV/GBV issues. 4% reportedly dis- Urban areas. sufficient skills to implement the NUS approach. 94+6A seminates partially.

EDUCATION 31 ADMINISTRATIVE The tendency of HHs and CKIs to seek admin- MAP 8: Available administrative facilities per area SERVICES istrative services in Kreminna and Popasna, strongly suggest a lack of sufficient admin- This section describes the level of access, istrative services in almost all settlements availability and quality of administrative ser- except Sievierodonetsk and Lysychansk. Nev- vices in the targeted locations. Findings were ertheless, these two central areas (especially developed as a result of the analysis of 29 Lysychansk) seem to exert a lesser attraction FKIs, all HH surveys and 120 CKIs. on their surrounding areas than for any other sectors (for instance see Map 5 on health or AVAILABLE ADMINISTRATIVE FACILITIES Map 7 on education). This is clearly visible in AND ACCESS TO FACILITIES the instance of Popasna, which attracts HHs TABLE 12: Number of available facilities from Siev. Rural and Siev. Urban areas. In the by area case of settlements surrounding Rubizhne, most HHs and CKIs indicated going to Krem- BTI inna instead of Rubizhne itself. This might be Local Marriage Passport Pension ASC (Bureau of Council center centre fund (TsNAP) Technical explained by the lack of pension fund centres Inventory) there, which happens to be the primary sought after service (see Figure 50). Lysychansk 1 1 1 1 1 1 Rubizhne 1 1 1 1 1 According to administrative FKIs, administra- tive facilities generally offer a large array of Sievierodon. 1 2 2 1 1 1 services, with ASCs facilities regrouping most Siev. Rural 2 of these services in one place. Commonly Siev. Urban 8 reported functions for all facilities included online services (100%), Mobile TsNAP (100%), At the time of assessment, the only administra- digital suitcase for remote service provision tive facilities available in the Siev. Urban and (67%), digital payments (67%), and E-docu- Siev. Rural areas were local councils. Admin- ment management systems (33%)). istrative Service Centres (ASCs) (also called TsNAPs) were only available in the three more USAGE AND USER SATISFACTION central areas of Lysychansk, Rubizhne and Sievierodonetsk. Consequently, most HHs 37% of HHs reported having from Siev. Rural and Siev. Urban reported used at least one administrative leaving their settlement to access their local service in the 3 months prior to administrative centres (respectively 67% and 37+63A this assessment 77% of HHs, compared to 8% overall). Map 8 As shown in Figure 50, the provision of sub- and Map 9 below illustrate, first, that the high sidies was the primary reason for HHs to number of facilities in Sievierodonetsk appear access administrative facilities, followed by to provide administrative services to individuals the processing of contractual or administrative residing in a variety of other settlements, too. documents and/or utility bills. MAP 9: Network Map: access to administrative facilities across settlements FIGURE 50: Most commonly used admin- as a matter of dissatisfaction and subject to istrative services, by % of HHs improvement. 63+13+10+6+4 None 63% On the other hand, while distance was not Provision of subsidies 13% considered as a particular issue by most HHs (reported as a main reason of dissatisfaction Utilities (bills,contracts, etc..) 10% for ‘only’ 15% of HH members), the propor- Acquire a passport 6% tions of HH members for whom distance was Resolve pension issues 4% FIGURE 52: Most commonly reported FIGURE 51: HHs’ satisfaction towards reasons for dissatisfaction according to of HHs using administrative services

administrative services 61+58+28+24+23+18+15+15+15 Procedure is time consuming 61% 11% 39% Excessive bureaucracy 58% 25% Quality of staff 28% Lack of information 7% 18% 24% Issues with the referral system 23% Comp. dissatisfied Dissatisfied Neutral Other costs (notary, printing) 18% Satisfied Comp. satisfied / don’t know Corruption 15% Cost for service 15% Overall, 57% of HHs reportedly accessing Distance to the facility 15% admin. services were “rather” or “completely satisfied” with their administrative facilities, with FIGURE 53: Most commonly reported no significant variation between areas. priority areas of improvement according Lengthy and excessive procedures appeared to HHs using administrative services 67+61+18+17+16+14+13+9+5 to be the most commonly reported reasons for Simplify the procedure 67% dissatisfaction among dissatisfied HHs (Figure Speed up the procedure 61% 52). Correspondingly, the most commonly Improve availability of information 18% reported top priority areas of improvement were respectively “simplifying the procedure” Improve quality of staff 17% and “speeding up the procedure” (Figure 53). Reduce the price 16% Improve online service provision 14% Quality of staff was then mentioned as an important, although secondary, reason of None 13% dissatisfaction and priority of improvement. Add opportunities for self-service 9% The lack of information was also pinpointed Improve transport to facilities 5%

ADMIN. 33 a reported reason for dissatisfaction were According to administrative FKIs, the supplies facilities being the most frequently affected FIGURE 58: % of FKIs reporting experiencing significantly higher in Siev. Rural and Siev. that facilities were lacking the most of were (50% of Lysychansk administrative FKIs pressure due to NGCA residents Urban (64% and 40%, respectively) compared computers (92%), followed by furniture (58%), reported being affected). However, heating or Overall 38% 14% 48% to other areas. This variation might be due to stationary (50%) and office space (33%). In gas supply was not a particular area of concern the absence of administrative centres in those fact, 41% of FKIs reported “not having enough” according to FKIs (see Figure 57). areas, except for the local councils. computers for work purposes: with 54% of local Sieviero. council FKIs, and 62% of FKIs from other facil- 50% 13% 37% IMPACT OF CONFLICT ON FACILITIES ity types. Most computers were considered FACILITY CONDITION AND EQUIPMENT Lysychansk 50% 33% 17% to be “obsolete”, according to 38% of FKIs, During the period 2014-2019, and according to while only 24% were considered up to date. Rubizhne 60% 20% 20% FIGURE 55: Overall condition of facilities FKIs, no facilities in Rubizhne, Sievierodonetsk On another note, all facilities reported having a according to FKIs (red) and IMPACT enu- nor Siev. Rural were damaged as a result of separate place for people with children. Siev. Rural 100% merators (beige) shelling. However, in Lysychansk, 17% of FKIs

7+ In terms of Water, Sanitation and Hygiene reported their facilities had been damaged and Siev. Urban 13% 87% Excellent 7% 10+ 10% 0 (WASH), the majority of facilities were reported had not recovered, and 17% of FKIs reported Experiencing pressure due to NGCA residents +41 to have a sufficient number of toilets (reported Experiencing pressure due to NGCA residents Good 41% +17+ their facilities to be damaged and only partially Not experiencing pressure due to NGCA residents 17% 0+38 by 62% of administrative FKIs) and basic hand recovered. Finally, 13% of FKIs in Siev. Urban DoDo not not know know Satisfactory 38% +52+0 washing facilities (86% of administrative FKIs); reported that their facilities had been damaged 52% Less than half of administrative FKIs (38%)

+14 but less than half of the administrative FKIs but had fully recovered. No facilities had report- Not experiencing pressure due to NGCA residents

14% +10 agreed that NGCA residents were causing Poor (45%) reported their facilities having access edly needed to stop service delivery due to the 10% additional pressure on their facility, ranging from to drinking water. Two third of FKIs (67%) in security situation during the 12 months prior 60% of FKIs representing Rubizhne facilities Lysychansk reported frequent water shortages, to data collection. In terms of preparedness, Most facilities were reported to be in “satisfac- to none of the FKIs in Siev. Rural and almost which is considerably higher than the 31% of 31% of FKIs reported that their facilities have tory” condition (Figure 55), and quite similarly, none (13%) in Siev. Urban. The most frequently FKIs reporting shortages at their facilities over- a bomb shelter, with almost all (89%) of FKIs an almost even proportion of FKIs reported to requested services by NGCA residents were all. Electricity shortages also seemed to vary reporting having a bomb shelter considering be satisfied and dissatisfied dissatisfied regard- certificates from the registry of territorial hro- significantly between areas, with Lysychansk that its safety level was satisfactory. ing the material and technical supply in their mada, reported by 58% of FKIs, followed by facility (Figure 56). acts of residence registration/ de-registration FIGURE 57: % of FKIs reporting their facilities encountering the following shortages (32%); and social protection services (26%). FIGURE 56: FKIs satisfaction with material and technical supply of facilities Water shortage 62% 7% 31% ACCESSIBILITY FOR PERSONS WITH DISABILITIES 7% 24% 24% Electricity shortage 45% 31% 24% Only 7% of facilities were observed by IMPACT enumerators to be “accessible” for PwD, while 28% 17% Gas shortage 55% 45% 24% were deemed to only be “partially acces- sible”. In fact, as highlighted in the Table 13 Heating shortage 79% 4% 17% below, very few administrative facilities have Comp. dissatisfied Dissatisfied Neutral their amenities adequately adapted to facili- Satisfied Comp. satisfied / don’t know No Yes, rarely Yes, often Not applicable tate the access of PwD. Nevertheless, half of

34 HEALTHADMIN. 2 administrative FKIs (48%) reported their facil- Similarly to other assessed facility types, the tralized service provision. Indeed, 28% of FKIs INTERACTION WITH USERS ities to have PwD among their staff members, gender breakdown of workforce in adminis- considered this proposition as being ’extremely Most of FKIs reported that their facilities were with 3 persons on average per facility. trative facilities is markedly skewed towards relevant’ and 41% as ’rather relevant’, which engaging users in the cycle of service provision female workers. Most FKIs (79%) reported their might indicate a capacity gap, and conse- TABLE 13: % of administrative FKIs (59%). Amongst those who did, 65% reported staff to be “mostly middle aged” (between the quentially, a potential area of improvement. reporting their facilities to be lacking the doing so in the monitoring and evaluation age of 36 and 55), and facilities had 43 staff on This intervention would also address one of following inclusive amenities plan, 53% KIs reportedly engaged with users average (but 11 in median, which corroborates the main reason of users’ satisfaction, namely in the needs assessment/planning stage, and the variety of facilities’ sizes). Moreover, 31% the quality of staff (Figure 52 and 53 above). 47% in the reporting stages. It is noteworthy Type of missing amenities % of FKIs of facilities reportedly had IDPs among their that all facilities have an operating feedback staff members, with 8 IDP members reported Restroom with appropriate INTERNAL AND EXTERNAL GOVERNANCE mechanism for their users, to which most 79% on average per facility at the time of data col- pictogram users are reportedly applying either ‘frequently’ lection. In terms of internal governance, most facilities (72% of FKIs reported this) or ‘occasionally’ Information signboards in Braille 66% were reported to have one or several mech- (21%). According to the FKIs, most feedback Guiding strip to entrance 59% anisms in place to ensure feedbacks and 72% of FKIs reported that received from users concerns personal que- Handrails on stairs outside 55% improve management practices. First, all FKIs all their FTEs were filled at the ries (reportedly received by 69% of FKIs) and Handrails on stairs inside 52% time of assessment reported their facilities collected quantitative 68+32A administrative queries (14%). The most popu- data on various aspects of the facility, further Ramp inside of the building 48% lar modes of engaging with users for FKIs were Lack of qualified candidates (50%) and low reporting using this data in decision-making. Ramp outside of the building 48% via team discussions (76% of FKIs reported salaries (38%) were reported by FKIs so as to Similarly, 93% of FKIs reportedly had an inter- this), personal interviews (65%) and through Sound beacon at the entrance 45% explain these Human Resources (HR) gaps. nal quality assurance mechanism in place at Information signboards with large the available feedback mechanism (29%). 45% Consequently, 28% of administrative FKIs con- their facility, and most facilities reportedly pub- font and contrasting color sidered that their facility had not enough FTEs lished their annual reports (as reported by 86% Finally, administrative FKIs reported using Doorplates with contrast colours 38% to manage with their workload. This may par- of FKIs). The main reason given by FKIs for many different channels of information for their Elevator 38% tially explain why 21% of FKIs considered that not publishing their annual reports was “confi- users, as indicated in Figure 59: Lift 34% the number of users was ‘too high’ (and 66% dentiality”, which was reported by 67% of FKIs “about right”). However, the reported high num- reporting not publishing annual reports. In the FIGURE 59: Most commonly used commu- bers of users might cause a strain on the staff same vein, more than to thirds of FKIs (69%) nication channels according to FKIs

HUMAN RESOURCES 93+76+69+55+52+52+38+21 members, negatively impacting staff well-be- reported that their facilities have undergone an In the facility itself 93% ing, as the indicator below suggests: external evaluation or audit in the 12 months Mass media 76% prior to the assessment. Interestingly, 62% of On the facility website 69% 76% of FKIs reported that FKIs reported their facilities to have established 88+12A 68+32A stress and emotional load were collaboration with other institutions to which Social networks 55% common among the staff mem- users can be referred. The majority of FKIs con- Information sheets 52% of FKIs esti- of FKIs esti- bers 90% 69% 80+20A sidered that the inclusion of non-governmental Message Boards 52% mated their staff to consist mated their managerial “mostly of female” (59%) staff to consist of “mostly of Additionally, a considerable proportion of FKIs actors in service provision has made the pro- Via partner organizations 38% indicated the need to have more capacity cess more effective either “to a great extent” or “without males” (31%) female” (17%) or “without Home-visits 21% males” (52%) building/trainings for the facility staff on decen- (as per 21% of FKIs) or “to some extent” (14%).

ADMIN. 35 GENDER-BASED AND DOMESTIC VIOLENCE RESPONSE KEY FINDINGS Overall, 27% of FKIs reported that their facility Overall, HHs were commonly satisfied with the has effectively registered possible/actual cases available services, but ”complexity” and “length of DV or GBV among their staff or beneficiar- of procedures” were were commonly reported ies, and subsequently informed the police or reasons for dissatisfaction. the adequate social affair services. Facilities Findings furthermore indicate that the possi- reportedly registered 32 GBV/DV cases on bility of reinforcing e-administration might be average per facility per year (but 6 in median, explored but in a geographically differentiated reflective of the different sizes of facilities). manner, and also taking into account the over- all low readiness of users. of FKIs reported that their 59% The main challenges of an effective decen- facility had effective SOPs to react to cases of domestic violence or GBV. tralization and almagamation will also be 64+36A 10% have partial SOPs crystallized in the smooth transition of respon- sibilities and mandates from local councils to Amongst the 24% of FKIs who reported either ASC, as well as all other public administrative not having any SOPs or partially having SOPs services into these entities. in place, half of FKIs indicated lacking a reg- istration journal, needing to increase staff awareness around the legal framework gov- erning GBV survivors’ rights and lacking an adequate referral system. Other reported rea- sons for not having SOPs or partially having SOPs were lacking an order on algorithm of activities for relevant response to GBV/DV cases.

36 HEALTH ADMIN. 2

JUSTICE & a lesser extent Rubizhne, where courts and MAP 10: Available courts, centres for legal aid and police station per area centres for free legal aid are present. It is also SECURITY interesting to note that an important proportion of CKIs and HH members from Siev. Rural and This section explores the level of access, Siev. Urban seeking justice services reportedly availability and quality of justice facilities in preferred to go to Popasna in the neighbouring the targeted locations. It also provides some raion, instead of the closer areas of Lysychansk insights on the main drivers of insecurity as well and Sievierodonetsk. as on the relations with the police. Findings are based on structured key informant interviews TYPE OF SERVICES PROVIDED with 11 FKIs, amongst whom representatives from 3 police stations, 3 centres for legal aid In terms of available services within the facil- and 5 legal courts; as well on the analysis of ities, all police FKIs reported that their facility all 1.990 HH surveys and 120 CKIs. had a juvenile police department. Overall, a bit more than a third of FKIs (36%) AVAILABLE JUSTICE FACILITIES AND reported that their facilities provided interpre- ACCESS TO FACILITIES tation (translation for non-Ukrainian speaker) TABLE 14: Number of available facilities services for free. To the question whether their per area facilities provided free legal assistance for indi- gent defender, 2 out of 3 centers for legal aid Non- Centres for Central permanent replied that they only had the capacity to refer free legal Courts Police police station the demands to other regional centres (namely aid stations (excluded from analysis) in Kharkov), but not to provide free legal aid Lysychansk 1 1 1 8 themselves. Rubizhne 1 2 1 6 USAGE OF COURTS AND FREE LEGAL Sievierodonestk 1 2 1 7 AID CENTRES Siev. Rural 2 Siev. Urban 7 FIGURE 60: Most commonly reported legal disputes, by % of HHs 26 At the time of assessment, the areas of Siev. Legal disputes in family 26% Rural and Siev. Urban did not have any cen- + 19+15+10+8+8 Labour disputes 19% tres for free legal aid, courts nor central police Administrative offenses 15% departments. On the other hand, the three urban centres were regrouping all justice ser- Traffic violations 10% vices in their vicinity. Map 11 indicates a clear Petty theft 8% centralization of justice services around the Loans, tax payment, fraud 8% areas of Lysychansk, Sievierodonetsk and to

Note on Map 10: “Not permanent police stations” (displayed in a smaller size) are mapped but were not included in the analysis; because they cannot be considered as a “facilty” since they do not have permanent staff. The precinct officers who work there belong to larger subregional departments (Lysychansk, Sievierodonetsk, etc..). MAP 11: Access to justice services across settlements level of trust in the available court in their set- 7% of HHs have had a legal tlement was most commonly reported to be dispute in the 12 months prior to ‘average”’ with a slightly higher proportion of this assessment. 7+93A HHs reporting not trusting the institution (37%) than trusting it (24%). Amongst the HHs who reported having had a legal dispute, 36% reported that the court pro- HOUSEHOLDS’ RELATIONS WITH THE ceedings were “affordable” to them in terms of POLICE total costs (fees, lawyers, etc.). From the facil- ity’s perspective, 3 out 5 courts FKIs reported FIGURE 62: Households’ level of trust in that their facility was charging their users their the police in their settlement usual court fees. 39 No trust 39% + 35+26 Trust 35% of HHs reported having 30% Cannot answer 26% needed free legal aid services at least once in their life 30+70A Similarly to what was observed for courts, HHs Interestingly, almost half (45%) of HHs who were rather circumspect about the police in reportedly needed legal aid reported that it their settlement, as they seemed slightly more was in fact not available to them, while 41% likely to report not trusting their local police indicated it was “fully available”, and 14% “par- (39% of HHs) than trusting them (35%). tially”. However, for HHs who did report using In that regard, 22% of HHs reported knowing this legal aid (30%), 89% considered that the their local police officer, with a slightly higher institution did everything within its power to proportion in the rural areas of Siev. Rural and solve their problem. Finally, none of the courts Siev. Urban (respectively 36% and 38%). or centres for legal aid FKIs reported cases The differences highlighted in Figure 63 below when users tried to bribe the service provider between HHs who had reportedly encountered to avoid detention. Similarly to HHs’ perception a police officer in the 12 months prior to this on police, Figure 61 above shows that HHs’ assessment (20%) and those who did not (the FIGURE 61: Households’ level of trust in other 80%) are relatively important, which the court in their settlement might suggest that the police institution suffers

39 from a deteriorated public perception. Cannot answer 39% + 37+24 For instance, amongst those who did interact No trust 37% with a police officer, 51% considered having Trust 24% been treated fairly, while only 23% reported

38 HEALTHJUSTICE & SECURITY 2 FIGURE 63: Police officers’ attitudes as FACILITY CONDITION facilities had access to drinking water at the poses, while 27% of FKIs reported insufficient reported by HHs time of data collection. numbers of computers, and no FKIs indicated 43+ Overall, as illustrated in Figure 64 below, justice having no computers at all. Further, a quarter Refuse to answer 43% 19+ Additionally, 82% of FKIs reported that their 19% 0 facilities seem to be in satisfactory condition, of FKIs (27%) considered their computers as

+24 facility was equipped with sufficient toilets for

Referred to hierarchy 24% +16+ with relatively few shortages of utilities except being ‘obsolete’, while 45% of FKIs reported 0+23 their staff or users, and all of them reported 16% for water (Figure 65) that “a few of them” were obsolete (and ‘none’ having access to basic handwashing stations. Treated fairly 23% +51+0 was reported by only 18%). 51% FIGURE 64: Estimation of facility condition +9

9% +22+0+7+1 by FKIs and IMPACT enumerators FACILITY EQUIPMENT AND SUPPLIES Likewise, all police stations FKIs reported that Addressed the problem quickly 22% 0+ their facilities were equipped with a landline or 7% Excellent 0% 20+ 0 FIGURE 66: FKIs satisfaction with material a cellular telephone available to call 24/7, while Require payment 1% 20% +45 and technical supply of facilities 40% of courts FKIs reported the same. Did not encounter Did encounter Good 45% +40+ a police officer a police officer 40% 0+36 45% Finally, all police stations FKIs reported that

Satisfactory 36% +40+0 40% 9% their facility had not enough vehicles to enable that they would be treated fairly if they did +18 fast responses to incidents. 18% +0+0 9% 36% encounter an officer. Likewise, 7% of respond- Poor 0% +0 ents who did not see a police officer think that 0% +0 Don’t know/ hard to say 0% 100% of police station they would be required to pay money, although Comp. dissatisfied Dissatisfied Neutral FKIs reported not having enough / don’t know only 1% of respondents who did encounter an FKIs’ estimation IMPACT enumerators’ estimation Satisfied Comp. satisfied vehicles for fast responses officer reported having been required to pay 100+A money. On the other hand, it is interesting With regards to Water, Sanitation and Hygiene Findings suggest that the level of FKIs’ satisfac- to compare those figures with the police sta- (WASH), water shortages appeared to be rela- tion regarding the material and technical supply ACCESSIBILITY FOR PERSONS LIVING tions’ FKIs perspective, as 2 out 3 police FKIs tively common, but not particularly concerning, in their facility was relatively good (see Figure WITH DISABILITIES (PWD) reported that they had never encountered any since 9% of FKIs reported that their facilities 66), despite some relatively low figures regard- cases of people trying to bribe them in order to were experiencing ‘frequent shortages’, and ing IT equipment. In terms of IT equipment, Only 1 facility was reported by IMPACT enu- avoid detention, while one FKI reported this to 18% experiencing “rare shortages”. Further- 73% of FKIs reported that their facilities had a merators to be “accessible” for PwD, whereas happen only very rarely. more, only 36% of FKIs reported that their ‘sufficient number’ of computers for work pur- all other facilities were considered as “not accessible”. Finally, it is quite noticeable that 43% of HHs FIGURE 65: % of FKIs reporting their facilities encountering the following shortages refused to answer to these questions, corrobo- In fact, as highlighted in the Table 16 below, Water shortage 73% 18% 9% rating a certain level of sensitivity regarding the very few facilities have their amenities ade- quately adapted to facilitate the access of PwD relations with the police. Electricity shortage 45% 55% (according to FKIs). In addition, the majority of From the service providers’ point of view, a bit Gas shortage 64% 36% justice FKIs (36%) reported not hiring PwD more than half of FKIs (55%) reported estimat- among their staff members. ing that the population was ‘aware enough’ or Heating shortage 82% 9% about how to report a crime. No Yes, rarely Yes, often Not applicable

JUSTICE & SECURITY 39 TABLE 16: % of Justice FKIs reporting prior to data collection. In terms of prepared- The most commonly requested services by 30% FKIs so as to explain these HR gaps. their facilities to be lacking the following ness, only 55% of FKIs reported their facilities NGCA residents were reported to be related These findings are reflected in the similarly inclusive amenities to have a bomb shelter, of whom 67% consid- to legal clarification, as shown on the Figure low proportion of FKIs who considered that the ered the shelter’s safety level to be satisfactory. 68 above. number of requests from the population was Type of missing amenities % of FKIs ‘too high’ (only 9% of FKIs, with 82% report- FIGURE 67: % of FKIs experiencing pres- HUMAN RESOURCES, STAFF TRAINING ing the number of requests to be ‘about right’). Restroom signed with an 55% sure on their facilities due to NGCA resi- Overall, this seems to reflect an acceptable sit- appropriate pictogram dents uation, which is further confirmed by the finding Guiding strip to the entrance 36% reported below: Overall 64% 27% 9% Ramp outside of the building 36% 100+0A 45+55A of FKIs reported that Handrails on stairs inside 36% 55% stress and emotional load were Elevator 27% 100% of 45% of Justice FKIs police station FKIs esti- estimated their managerial common among the staff mem- Information signboards with Sieviero. 100% 27% mated their staff to con- staff to consist “mostly of 55+45A bers information duplicated into Braille sist “mostly of males” or females” (18%), or “without” However, some room for improvement exists Sound beacon at the entrance 27% Lysychansk 33% 67% “with a slighlty higher pro- males (27%) with regard to staff training in relation to the Handrails on stairs outside 27% portion of males” specific case management/ handling of men- Doorplates marked with Rubizhne 50% 25% 25% 18% The gender breakdown of workforce in police tally ill persons and children: contrasting colors and large font Experiencing pressure due to NGCA residents stations is markedly skewed towards male Information signboards with large Experiencing pressure due to NGCA residents 18% Not experiencing pressure due to NGCA residents workers, whereas 80% of courts FKIs reported font and contrasting color NotDo experiencing not know pressure due to NGCA residents that their staff was “mostly female”. FKIs most Lift 18% commonly reported their staff to be either Do not know Other, specify 18% ‘mostly young’ (45% up to 35 years old) or with 67+33A 67+33A Ramp inside of the building 18% Overall, 64% of FKIs reported that their facil- a ‘slightly higher proportion of youth’ (27%); ity was experiencing pressure due to NGCA and facilities had 71 staff on average. 67% of police 67% of police FKIs The facility has all of the listed 0% FKIs reported their staff reported their staff was residents, with all FKIs in Sievierodonetsk indi- Moreover, 82% of KIs reported that their facili- was trained to manage trained to manage cases cated experiencing this pressure, compared IMPACT OF CONFLICT ON FACILITIES ties have IDPs among their staff members, with cases with children involving mentally ill per- with 50% of FKIs in Rubizhne, and fewer in 16 members on average per facility. (and 33% reported sons (and 33% reported During the period 2014-2019, no facilities in Lysychansk. their staff was partially their staff was partially Lysychansk were reportedly damaged as a trained) trained). FIGURE 68: % of FKIs reporting most com- result of shelling. In Rubizhne, 25% of FKIs of FKIs reported that all monly requested administrative services 9% reported their facilities to be damaged and their FTEs were filled at the time GOVERNANCE AND INTERACTION WITH by NGCA residents of assessment USERS reportedly moved to another location, while 50+30+30+30 10+90A 50% 25% as well reported damaged and subse- Legal advice and clarification Although this Figure is very low, only 27% In terms of internal governance, most facilities quently partially recovered buildings. Preparation of applications 30% of FKIs considered that their facility had not were reported to have one or several mecha- No facilities had to stop service delivery due Representing legal interest 30% enough FTEs to manage with their workload. nisms in place to ensure user feedback and to the security situation during the 12 months Dispute resolution 30% Lack of qualified candidates was reported by improve management practices. First, 40%

40 HJUSTICEEALTH & SECURITY 2 of courts FKIs (2 out of 5) reported having a GENDER-BASED AND DOMESTIC Despite the apparent lack of preparedness that Finally, findings suggest that HHs were not very performance monitoring system in place for VIOLENCE RESPONSE has been highlighted just above, FKIs were knowledgeable of the evolution of the issue of prosecution, and 80% reported having such a nonetheless generally confident that GBV/ domestic violence in their community, as Figure system for their judges. Secondly, the majority 45% of FKIs estimated DV survivors trusted their facilities’ capacity to 73 below illustrates. receiving “frequent” requests of FKIs (73%) reported their facilities generally protect them and prosecute perpetrators (see FIGURE 73: % of HH reporting about the collect quantitative data on various aspects about DV in the year prior to this Figure 71). 45+55A assessment problem of domestic violence being ag- of the facility and use it in decision-making, gravated in their area compared with the Domestic violence (DV) cases occurred rela- FIGURE 71: FKIs self-estimation on GBV/ which reportedly most commonly happens on a previous year monthly basis (36% of FKIs). Similarly, 82% of tively frequent according to all FKIs, and even DV survivor’s trust in their capacity to 70+19+6+4+2 Hard to say 70% FKIs reported the presence of an internal qual- more so according to police stations’ FKIs protect them and prosecute perpetrators ity assurance mechanism, and almost all FKIs (100% reported “frequent” cases). However, Did not change 19% (82%) reported publishing their annual reports. only 36% of all FKIs’ reported that their staff 27% Aggravated 6% were properly trained to react to GBV or DV Most commonly reported subjects of Became less grave 4% In terms of external governance, just a bit more cases (in accordance with the new law), while 55% interest for trainings/information dis- 18% Refuse to answer 2% than half of FKIs (55%) reported that their facil- 36% estimated that they were only partially semination on GBV/DV, by % of FKIs ities have undergone an external evaluation or trained (and 100% of police stations FKIs HOUSEHOLD PERCEIVED THREATS ON audit in the 12 months prior to the assessment. reported the same). PERSONAL SECURITY A third of FKIs (67%) reported that their facili- Strongly disagree Disagree Neutral As illustrated in Figure 74, the greatest threats ties were engaging users in the cycle of service Agree Strongly agree / don’t know 36% of FKIs estimated that (non-conflict related) that HHs reported were provision. In addition, 73% of FKIs reportedly their staff were only “partially” related to the conservation of individual prop- had an operating feedback mechanism for their trained to react to GBV/ DV cases The number of GBV/DV cases/requests was 36+64A most commonly reported to be “unchanged” in erty. Threats to the physical integrity were users, which most FKIs (75%) estimated the seemingly only perceived secondarily, with majority of users to apply from time to time, Subjects of interest for trainings and/or dis- comparison to the previous year (as per 45% street harassment (reported by 5% of HHs), while 25% reported most users applied these semination in GBV/DV response area were of FKIs). It is important to emphasize, however, murder (5%), kidnapping (4%) and rape (3%). systems ‘frequently’. According to 88% of FKIs, numerous and broad, which, to a certain extent, that the vast majority of HHs were not aware When it comes to perceived threats, there were feedback most commonly concerned personal highlight the lack of consistent and comprehen- of services available for survivors of GBV, as no significant difference between gender, nor queries. Finally, FKIs reported using several sive knowledge on these very topics. demonstrated by Figure 72 just below: between the different assessed areas. channels of communications in the direction of FIGURE 70: Most commonly reported sub- FIGURE 72: % of HHs reporting being their users, as illustrated in Figure 69. jects of interest for trainings/information aware of services available for DV survivors On the other hand and as shown in Figure 75, dissemination on GBV/DV, by % of FKIs 66+13+11+8+7+5+1 the majority of HHs (73%) reported not per- FIGURE 69: Most commonly reported main Hard to say 66% 80+80+40+20+20+20+20 ceiving any conflict-related threats as being of communication channels used by facili- Changes in criminal / and procedure code 80% Healthcare facilities 13% concern for their HHs. However, 22% of HHs ties, by % of FKIs did report concerns about shelling, and another 92+84+76+64+60+ Changes in GBV/ DV legislation 80% Psychosocial support 11% Information sheets 59% Prevention of GBV/ DV 40% Legal aid 11% 12% of HHs reported perceiving shooting as a conflict-related threat. Overall, 90% of HHs Social networks 56% Definition of GBV/ DV 20% None 8% reported feeling safe walking alone in their On the facility website 54% Response to GBV /DV 20% Shelters or safe space 7% community during the day, with no significant Mass media 39% Restraining orders 20% Information support and referral 5% differences between gender (90% of female Home visits 37% Programs for perpetrators 20% Refuse to answer 1% respondents and 91% of male respondents).

JUSTICE & SECURITY 41 FIGURE 74: Most frequently reported FIGURE 75: Most frequently reported non-conflict related threats by HHs conflict related threats KEY FINDINGS 73+ 57 None 73% Overall, findings demonstrate a general low None 57% 22+12+7+7+6 + 15+12+9+7+6+5 Shelling 22% 86+14A 84+16A usage of courts, but also a relatively low trust House is broken into 15% in the police and court system. Nonetheless, Shooting (small arms) 12% of HHs of HHs Petty theft 12% 86% 84% citizens generally appear to feel safe in their Military presence 7% reported road condition reported road condition Damage to personal property 9% everyday life, and conflict-related concerns Absence of bombshelter 7% and traffic-related rea- and traffic-related rea- Tricked into paying money 7% sons* for feeling unsafe sons* for feeling unsafe seem to be secondary, while concerns related Mines 6% Noisy neighbors 6% during the day during the night to the physical infrastructure, such as road The absence of conflict-related threats in HHs’ conditions and notably sidewalks, are seem- Street Harassment 5% The absence of sidewalks were especially everyday life mentioned above is corroborated ingly the main reasons for why HHs in the important reasons in that regard in the periph- by the fact that such threats only account for assessed areas feel unsafe. This Figure drops significantly at night, with eral areas of Siev. Rural and Siev. Urban (with 2% of the reported reasons why HHs felt unsafe significant differences in terms of gender: Only 65% and 63% of HHs, respectively, compared Furthermore, the findings from this section while walking alone in their community during 38% of female respondents reported feeling to 44% of HHs on average), while HHs report- also clearly highlighted a gap in knowledge the day (namely 2% because of shelling, and safe walking alone at night; whereas 68% of ing being concerned about hooligans and and trainings on GBV/DV issues from the none for mined roads), while no HHs reported male respondents did (and 48% of HHs over- people under influence was relatively low in facilities’ perspective, as well as from the these reasons at night. all). Bad encounters (such as people under the same areas, reflecting the differentiated population’s point of view. influence of alcohol or drugs or hooligans) were On the other hand, road conditions and traffic challenges faced by HHs based in an urban or the most commonly reported reasons for feel- in general1 accounted for the main reasons as in a rural settings. ing unsafe at night, and especially so for female to why HHs reported feeling unsafe at day and 1. The aggregation of: Absence of sidewalks, Drunk drivers, respondents (see Figure 76 above). at night: Absence of cross-walks, Fast traffic, Absence of street lighting, Unregulated intersections/traffic FIGURE 76: Most commonly reported reasons for feeling unsafe while walking in the com- munity, by % of HHs reporting feeling unsafe During the night During the day 90 90 +91 +48 0 + 0 90% / 91% + 38% / 68% Feel safe walking 0 0 +0 +0 +55 +46 44+0 + +51

0 55% / 44% + 46% / 51% Stray animals +46 +21 +52+ +23+ 0+45 0+66 21% / 23% Absence of sidewalks 46% / 52% +22 +49

45% / 22% +0 +0 66% / 49% Drunk or drug-addict people +39 +58 +19+0 +47

0+10 39% / 19%

+ 58% / 47% Hooligans +14 +13+ +8+ 0+13 0+18 10% / 8% Drunk drivers 14% / 13% 12+0 +13+0 + 18% / 12% Robbery 13% / 13% +11 +6 13 6+0 + + 0+8 6% / 6% Absence of crosswalks 11% / 13% + +40 +0 +51 40% / 51% Absence of street lighting 8% / 0%

Female Male

42 HEALTHJUSTICE & SECURITY 2 Facilities, however, were reported to offer a large array of services.

SOCIAL USAGE AND USER SATISFACTION MAP 11: Available facilities providing social services per area SERVICES The relatively low number of facilities has to be put into perspective with the correspondingly This section presents findings on social ser- very low proportion of HHs who reported using vices, from the users as well as from the these services (3%). The most frequently facility perspective. Due to the low number accessed services were facilities to support of HHs using social services (61, or 3% of all families, children and youth, pensioners and/ HHs), findings from the HH survey should be or for IDPs. Amongst these 61 HHs, 74% considered as being indicative only, in addition reported to be either ‘completely’ or ‘rather’ to the findings from FKI interviews (17 social satisfied with these services. services FKIs in total), which are indicate throughout the report. FIGURE 77: HHs’ satisfaction towards social services AVAILABLE SOCIAL SERVICE FACILITIES 43% At the time of assessment, there were no 4% social service centres in Siev. Rural and 13% 31% Urban areas. Map 12 clearly indicates that 9% most of the FKIs and HHs where thus going to other areas, most commonly to Popasna Comp. dissatisfied Rather dissatisfied Neutral / don’t know and Sievierodonetsk (and to a lesser extent to Rather satisfied Comp. satisfied Kreminna). Due to its low number of facilities, Lysychansk did not seem to exert a strong The main reason for dissatisfaction was attraction over its surrounding areas. reportedly related to the quality of staff. TABLE 16: Number of available facilities FIGURE 78: Top reported reasons for per area disatisfaction among dissatisfied HHs 35+25+24+21+18+14+12+7+7 Quality of social service staff 35% No toilets for visitors 25% Sieviero. Rubizhne Lines 24% Lysychansk Procedure 21% Center for family and youth 1 1 Distance to the facility 18% Center for the social rehabilitation of children 1 1 1 Price for services 14% Children’s service 1 Corruption 12% Facility is not accessible for PwD 7% Employment center 2 Uncomfortable waiting room 7% Department of Social protection of population 1 1 3 Territorial center 1 2 1 MAP 12: Network map: access to social services facilities across settlements FACILITY CONDITION AND EQUIPMENT reported being satisfied and dissatisfied. According to FKIs, the supplies that facilities Most facilities were reported to be in “satisfac- were the most lacking of were computers (75% tory” condition, as demonstrated below: of FKIs) in the first place, followed by furniture FIGURE 79: Overall condition of the facil- (63%) and office space (63%). However, it ity according to FKIs (red) and IMPACT should be noted that only 24% of FKIs specif- Enumerators (beige) ically reported ‘not having enough’ computers 0+

6+ for work purposes. Fourteen percent (14%) of Excellent 0% 6% 0 all FKIs considered that their computers were +29

Good 29% +24+ “not obsolete”, while 47% reported that “a few 24% 0+53 of them” were and 18% reported that almost

53% +59+0 Satisfactory 59% all their computers were obsolete. The major- +12 ity of FKIs reported that their facilities were 12% +12+0 Poor 12% equipped with a sufficient number of toilets and +6

+ basic handwashing facilities (71% and 94% of Don’t know/ hard to say 6% 0% FKIs, respectively). However, a considerable FIGURE 80: FKIs satisfaction with material proportion of FKIs (41%) reported that their and technical supply of facilities facility did not have access to drinking water. In addition, all facilities in Lysychansk were 6% 24% reportedly facing frequent water shortages 41% in the three months prior to this assessment,

24% while no other social service FKIs in any of 6% the other assessed areas reported that their

Comp. dissatisfied Dissatisfied Neutral facility experienced water shortages. Finally, / don’t know Satisfied Comp. satisfied Figure 81 below shows that facilities generally did not experience frequent shortages of basic FKIs’ satisfaction regarding the material and utilities, such as electricity, heating or gas, but technical supply of facilities varied consid- rather on an occasional basis, as reported by erably, and almost equal proportions of FKIs FKIs. FIGURE 81: % of FKIs reporting their facilities encountering the following shortages

Water shortage 82% 18%

Electricity shortage 59% 29% 12%

Gas shortage 47% 53%

Heating shortage 76% 12% 12% No Yes, rarely Yes, often Not applicable

44 HSOCIALEALTH SERVICES 2 IMPACT OF CONFLICT ON FACILITIES ACCESSIBILITY FOR PERSONS WITH HUMAN RESOURCES A considerable proportion of FKIs indicated DISABILITIES No FKIs from facilities in Lysychansk or the need to have more capacity building/ Rubizhne reported their facilities having Only 59% of facilities were reported by trainings for the facility staff on decentralized been damaged as a result of shelling during IMPACT enumerators to be “partially acces- service provision, since 24% of FKIs con- the period 2014-2019, while 11% of FKIs in sible” for PwD, and 41% as “not accessible”. 95+5A 86+14A sidered this proposition as being ‘extremely Sievierodonetsk did report damage to their Additionally, very few facilities had their ameni- relevant’ and 47% as ‘rather relevant’, which 94% of FKIs esti- 88% of FKIs esti- indicates a potential area of improvement, and facilities. It is also noteworthy that no facili- ties adequately adapted to facilitate the access mated their staff to consist mated their managerial staff which would also address the primary reason ties had to stop service delivery due to the of PwD, as indicated in Table 17: “mostly of female” (and to consist “mostly of female” security situation during the 12 months prior 6% “no male”) or “without males” of users’ satisfaction, the quality of social ser- TABLE 17: % of Social services FKIs vice staff. to this assessment. In terms of preparedness, reporting their facilities to be lacking the 35% of FKIs reported that their facilities have The gender breakdown of workforce in social following inclusive amenities INTERNAL AND EXTERNAL GOVERNANCE a bomb shelter, of whom 67% reported con- services facilities is markedly skewed towards sidering that the shelter’s safety level was female workers. According to 74% of FKIs, the In terms of external governance, most FKIs Type of missing amenities % of FKIs ‘satisfactory’. Most FKIs agreed that NGCA majority of staff at their facilities was “mostly (53%) reported to be ‘rather satisfied’ or ‘sat- middle aged” (between the age of 36 and 55), isfied’ with the current coordination of social residents were causing pressure on their facil- Restroom signed with an 65% ity, however, there were some differences in appropriate pictogram and facilities reportedly had 45 staff on average. service provision by the state. reporting on this between areas, as reporting Information signboards with FIGURE 83: Levels of FKIs’ satisfaction 65% ranged from 67% of FKIs in Sievierodonetsk information duplicated into braile 59% of FKIs reported that regarding state current coordination: to 33% of FKIs in Lysychansk. Guiding strip to the entrance 65% all their FTEs were filled at the 18% 29% time of assessment FIGURE 82: % FKIs experiencing pressure Ramp inside of the building 59% 60+40A 24% on their facilities due to NGCA residents Stairs outside equipped with Low salaries and the lack of qualified can- 24% 53% 6% handrails on both sides didates (both 71%), and to a lower extent Sieviero. 67% 33% Lift 53% expected budget cuts (14%) were reported Comp. dissatisfied Rather dissatisfied Neutral / do not use Sound beacon at the entrance 47% by FKIs so as to explain these HR gaps. Con- Rather satisfied Comp. satisfied sequently, 59% of FKIs considered that their Rubizhne 40% 20% Elevator 47% 40% facility had not enough FTEs to match their FIGURE 84: Most commonly reported Ramp outside of the building 41% workload. This may partly explain why 41% of stages of state coordination that require Lysychansk 33% 33% 33% Doorplates marked with contrasting FKIs considered that the number of users was improvements, by % of FKIs.” 41% 88 colors and large font ‘too high’ (and 59% “enough”). Unfortunately, Financing 88% Yes Information signboards with large this may also impact the overall staff well-be- + 35+35+24+18+12+6 ExperiencingPartially pressure due to NGCA residents 35% Informing people font and contrasting color 35% NotNo experiencing pressure due to NGCA residents ing, as the indicator below suggests: Organisation 35% Do Don'tnot know know/ refuse to answer/ hard to say Nevertheless, the majority of FKIs (65%) Planning 24% 82% of FKIs reported that reported that their facilities hosted PwD among stress and emotional load were Reporting 18% their staff members, with 2 persons on aver- common among the staff mem- Other, specify 12% age per facility. 82+18A bers Monitoring & Evaluation 6%

SOCIAL SERVICES 45 Considering all state coordination domains, INTERACTION WITH USERS GENDER-BASED AND DOMESTIC KEY FINDINGS AND SUGGESTED FKIs most commonly reported that the financ- VIOLENCE RESPONSE More than half of FKIs (59%) reported that their RECOMMENDATIONS ing domain required improvements (Figure facilities were engaging users in the cycle of 84). Furthermore, a bit less than half of FKIs Almost half of FKIs (41%) reported that their service provision. Amongst these FKIs, 100% Findings showed that, overall, only a low (47%) reported that their facilities have under- facility has effectively registered possible/ reportedly did so in the needs assessment/ proportion of the population makes use gone an external evaluation or audit in the 12 actual cases of domestic or GBV among their planning stage, and 40% in the monitoring of social services. However, most of the months prior to the assessment, while 41% staff or users, and subsequently informed and evaluation, implementation and reporting users appeared to be satisfied of these reported that there had not been an external the police or the adequate social affair ser- stages. It is noteworthy that all FKIs reported services. evaluation or audit (and 12% reportedly did not vices. Most of these cases (as per 72% of having an operating feedback mechanism for know). Additionally, 71% of assessed facilities FKIs) were registered in facilities depending their users, to which most users reportedly Only the three most central areas of this were reported to have established collabora- on the “Department of Social Protection of apply ‘frequently’ (reported by 47% of FKIs), target area (Sievierodonetsk, Rubizhne tion with other institutions, to further streamline Population”, and in “Centers for the social 24% ‘occasionally’ or ‘rarely’, and 6% ‘never’. and Lysychansk) had facilities providing referrals between institutions. rehabilitation of children” (25% of FKIs). Most of the provided user feedback were social services. Moreover, a considera- reportedly personal queries (76%) and com- ble proportion of the population seems to In terms of internal governance, findings indi- 76% of FKIs reported that their plaints (14%). access social services in the neighbouring cate that most social service facilities have facility had effective SOPs to react to cases of domestic violence or area of Popasna, which could indicate a one or several mechanisms in place to ensure According to FKIs, the most popular modes GBV. 6% have partial SOPs gap in service provision in the Sieviero- feedback is taken into account and improve 76+24A donetsk target area. of engaging with users were via personal management practices. To this end, almost all interviews (60% of FKIs), followed by team dis- FKIs reported collecting quantitative data on cussions (50%) and phone interviews (30%). various aspects of the facility and using this 76% of FKIs reported that their facility disseminated informa- data in decision-making, of whom 35% of FKIs Finally, FKIs reported using many different tion on GBV/ DV issues. 6% do it reported their of facilities collecting data on channels of information for their users: 76+24A partially. a quarterly basis, 6% reported this happens monthly or semi-annually, and 24% indicated Of the 24% of FKIs reporting not effectively that their facilities only collected data “if neces- FIGURE 85: Most commonly used commu- registering possible and/or actual cases of nication channels according to FKIs

sary”. In the same vein, virtually all FKIs (94%) 100+88+88+82+76+71+53+53 DV/GBV, 75% reported the main element that reported the existence of an internal quality Via partner organizations 100% their facilities were lacking to react adequately assurance mechanism within their facilities. In the facility itself 88% to cases of GBV/DV was an issued order on a Most FKIs (76%) reported their facilities gen- On the facility website 88% GBV case and 50% of FKIs were lacking a reg- istration journal. Additionally, another reported erally publish their annual reports. Those who Information sheets 82% did not publish indicated that the main reason element was a lack of staff awareness around Social networks 76% behind not publishing was either because the legal framework governing GBV survivor’s they did not have the habit to publish annual Mass media 71% rights, as per 25% of these FKIs. reports, or because of confidentiality concerns Home-visits 53% (reported by 2 FKIs each). Finally, 82% of FKIs Message Boards 53% reported using case management practices in their day-to-day operations.

46 HSOCIALEALTH SERVICES 2 TABLE 18: “% of HHs reporting the follow- FIGURE 86: HHs’ satisfaction towards Moreover, the unavailability of cash and long OTHER SERVICES ing financial services to be available in available financial services queues to access cash were the second most their settlement: commonly reported main sources of dissatis- 34% 49% faction as reported by 16% and 14% of HHs, Type of financial service FINANCE % of HHs 7% respectively. available 8% Bank office 89% This section presents various findings on the 3% From the FKIs’ perspective and in terms of ATM 87% gender, all FKIs agreed that an almost even financial services available to HHs in the tar- Comp. dissatisfied Rather dissatisfied Neutral Payment of utility bills 86% / do not use distribution of customers were applying for geted areas; as well as HHs’ perspective and Rather satisfied Comp. satisfied satisfaction towards them. Only three financial Post office or postman providing loans, and that less than a fourth of customers 70% were late for repaying their loans, with a higher service FKIs agreed to be interviewed for all financial services The most commonly reported main reason for proportion of males. assessed areas. Withdraw cash from the cashier 63% HHs’ dissatisfaction in the three central areas All FKIs concurred that internet banking was of Lysychansk, Rubizhne and Sievierodonetsk Money transfers 62% popular amongst their customers, and that was the price of commission for withdraw- AVAILABLE FACILITIES AND TYPE OF Mobile bank 46% their facilities have self-serving machines. als (respectively 60%, 62% and 75% of HHs SERVICES PROVIDED Other payments 44% reported this reason). This was much less of a Additionally, all three FKIs reported users Loans to individuals 42% concern for HHs in Siev. Rural and Siev. Urban accessing their facilities are facing long As mentioned above, the IMPACT enumera- Getting state social benefits 38% (9% and 17%, respectively), who instead more queues “occasionally”. tors team only interviewed one facility in each Loans to legal entities 27% commonly reported the distance to the bank of the three more central areas of Lysychansk, office (77% and 57%) and to ATM (65% and Finally, all FKIs reported to have feedback Rubizhne and Sievierodonetsk; and none in the There were, however, noticeable differences 51%) as their primary reason of dissatisfac- mechanisms for their users, but on the con- more peripheral areas of Siev. Rural and Siev. in terms of available services between the tion, alongside the cost of transport (12% and trary, none reported having effective SOPs to Urban. Amongst those facilities, however, it is above-mentioned central and more peripheral 10% respectively). These reported reasons for react in cases of DV/ GBV in their facility. interesting to note that all FKIs reported that areas of Siev. Rural and Siev. Urban, which dissatisfaction in Siev. Rural and Siev. Urban their facility provided the entirety of the list of are to be correlated with the absence of facili- might be explained by the absence of facilities basic financial services, such as money trans- ties there. The aggregated sum of all reported in these areas and the few financial services fers, insurance, mortgage, loan credit services, available services by HHs in their areas shows available to the population. etc.. Likewise, they unanimously reported that well that the two latter areas are relatively MARKETS the most commonly accessed services were uncovered. FIGURE 87: Top reported reasons for dis- FIGURE 88: HHs’ reported satisfaction services related to pensions and social bene- satisfaction among dissatisfied HHs towards their available food market fits, followed by “access to ATM ”, and “direct Overall, HHs reported being satisfied with the 56+26+18+16+13+7 2% 28% cash withdrawals from the cashiers”. financial services available in their settlement, Price of commission for withdrawal 56% 34% with 83% on average reporting being either Distance to bank office 26% 30% As indicated in Table 18, HHs similarly reported rather satisfied’ or ‘completely satisfied’. How- Distance to ATM 18% having access to a vast array of financial ser- ever, HHs in Siev. Rural and Siev. Urban were No cash available 16% 6% vices in their area: significantly less satisfied than the average, Lines 13% with 52% and 68% of HHs reporting the same, Comp. dissatisfied Rather dissatisfied Neutral Cash limit for withdrawals 7% / do not use respectively. Rather satisfied Comp. satisfied

Most HHs reported being satisfied with their Findings for Non-Food Item (NFI) markets available food market. Amongst the 36% of were remarkably similar to those related TRANSPORTS FIGURE 92: Top reported reasons for dis- dissatisfied HHs, the primary reason for their to food markets, with 32% of HHs having satisfaction among dissatisfied HHs: FIGURE 91: HHs’ satisfaction towards 60+56+52+36+22+10 dissatisfaction with food markets was, by far, reported being dissatisfied with NFI markets, transport services: Poor service 60% the price of goods available in the markets (as most commonly mentioning the price of goods 16% Overcrowded transports 56% per 94% of dissatisfied HHs), followed by the (as per 91% of HHs dissatisfied with NFI mar- 34% Irregularity of service 52% quality of goods, which was reported by 43% kets), followed by quality of goods (33%) and 29% of dissatisfied HHs. The range and variety range/ variety of goods (15%) as main reasons Low quality of roads 36% High prices of goods available was mostly reported as a for dissatisfaction. Similar to food markets, 12% 9% 22% reason for HH dissatisfaction in the areas of but in even greater proportion, 68% of HHs Ineffective routes 10% Siev. Rural and Siev. Urban (22% and 20% of in Siev. Rural reported going to another set- Comp. dissatisfied Dissatisfied Neutral / don’t know HHs respectively, in comparison with 9% on tlement for their NFI market, and 35% of HHs Satisfied Comp. satisfied (respectively 43% and 48% of HHs). In terms average). Similarly, “distance to food market” in Siev. Urban reportedly travelled to another Findings have indicated that Siev Urban of spending, HHs appeared to generally spend was almost exclusively reported as a reason settlement to access NFI markets. However, and Siev. Rural areas are not completely more money on private transportation (373 for HH dissatisfaction in Siev. Rural (22% of across the other assessed locations, there self-sufficient areas in terms of services, and UAH/month on average) than on public trans- dissatisfied HHs, compared to 4% on aver- were almost no HHs reporting similar travels considerable proportions of HHs reported port (190UAH/month on average). Finally, a age), which has to be read in line with the fact to access NFIs. needing to travel to other settlements either relatively high proportion of HHs reported get- that 38% of HHs there reported accessing a at least once a day or on a weekly basis ting subsidies (39%) for transport. market located elsewhere than in their current When it comes to e-commerce, close to half settlement (and 17% in Siev. Urban, in com- of all HHs (41%) of reported never having FIGURE 93: Frequency with which HHs reported needing to travel to other settlements parison with almost no HHs reporting this in ordered goods or services online. in the year prior to data collection, and average of reported monthly HH expenditure on the other areas). Additionally, the absence private transportation (red) and public transportation (black) of food markets within the settlement of res- FIGURE 90: Frequency with which HHs idence was reported by 20% of dissatisfied reported ordering goods or services Siev. 2% 7% 13% 32% 14% 32% 394UAH/ 157UAH

HHs in Siev. Rural, in comparison to 1% on online 58+13+14+12+2 average. Never 59% Rubizhne 3% 9% 13% 27% 19% 28% Very rarely 13% 257UAH/ 194UAH FIGURE 89: HHs’ satisfaction towards A few times a year 14% their available non-food market Every month 12% Lysychansk 4%7% 13% 28% 12% 36% 341UAH/ 208UAH 9% 28% Every week 2% 31% 26% Siev. Urban 13% 31% 30% 13% 5% 8% 349UAH/ 219UAH

6% Siev. Rural 18% 30% 26% 11% 6% 9% 407UAH/ 189UAH

Comp. dissatisfied Dissatisfied Neutral / do not use Satisfied Comp. satisfied At least once a day At least once a week At least once a month Several times a year At least once a year Never

48 HMARKETSEALTH & TRANSPORT 2 STATE EMERGENCY EQUIPMENT AND SUPPLY INTERACTION WITH USERS AND HUMAN RESSOURCES LEVELS OF PUBLIC AWARENESS SESU FKIs almost unanimously agreed that In terms of gender and age of staff mem- SERVICE OF UKRAINE improving the facilities’ material and technical The majority of facilities were reported to not bers, all FKIs reported that their staff was This section covers SESU services from the supplies would improve their capacity to carry publish their reports to the public (4 out of 7); mostly male, particularly the managerial staff perspective of service providers, provided out their three distinct mandates of emergency however, all facilities were reported to have (four FKIs reported “mostly males”, three “no by seven FKIs. Only the central areas of prevention, emergency response and (reha- a feedback mechanism for their users, most females”). According to five out of seven FKIs, Lysychansk (4 facilities), Rubizhne (1) and bilitation)/ reduction of emergency situations’ notably for personal queries (5/7). The most the staff was “mostly middle aged”. Sievierodonetsk (2) had SESU facilities, each consequences. Improving information man- commonly used communication channels for of which was represented by one FKI. agement and available software would also SESU facilities to disseminate information to Facilities were relatively large in size, with improve their capability, as well as improving the population were mass media (5/7), via reportedly 112 staff members on average per AVAILABLE SERVICES the facilities’ staff qualifications, which was information provision at the facility itself (5/7), facility, not including volunteers. reported to a slightly lesser extent. information sheets (4/7), social networks (3/7) All facilities were reported to cover the majority and via their website (3/7). Incidentally, only FKIs reported that all their FTEs of functions normally attributed to such cen- Nonetheless, most FKIs reported being satis- one FKI reported “very rare cases” of people were filled at the time of assesse- tres, such as conducting rescue operations fied with the material and technical supply of trying to bribe the service provider. According 0/7 ment and emergency medical care, evacuation of their facility, with only one FKI in Lysychansk to FKIs, levels of public awareness of how to population, minimization and elimination of reporting being completely dissatisfied. respond in cases of emergency were average, In none of the facilities, all FTEs were occu- risks. with three FKIs reporting that the public was pied, which was reportedly primarily the case FIGURE 94: FKIs satisfaction with material not sufficiently aware of how to respond in case because of a lack of qualified candidate and FACILITY CONDITION AND IMPACT OF and technical supply of facilities of emergency; while three others reported the expected budget cuts. CONFLICT public being ‘‘aware enough” and only one 43% considered the public to be “fully aware”. FKIs reported that stress and emo- Overall, four FKIs considered their facility to be 29% in ‘good’ condition’, while the other three FKIs 4/7 tional load were common among the indicated ‘satisfactory’ conditions. In the same In terms of citizens’ safety, four out of seven staff members 14% vein, no facilities were reported to experience 14% FKIs reported that the current conditions of It is noticeable that a relatively high number gas, heating or water shortages, and only one apartment buildings regarding fire safety was of facilities (4 out 7 facilities) reported having facility reported rarely experiencing electricity Comp. dissatisfied Dissatisfied Neutral “poor”, while only one FKI reported current recruited IDP among their staff, with a rela- shortages. In terms of preparedness, five out Satisfied Comp. satisfied / do not use conditions to be “satisfactory”. Three out of tively high proportion of IDPs per facility as seven facilities were reported to have a bomb seven FKIs reported not checking emergency well (31 IDP members on average, and espe- shelter, which were reportedly in ‘satisfactory In terms of specific equipment, all facilities preparedness of public buildings (schools, cially so for Sievierodonetsk facilities (2 out 2 conditions’ according to most FKIs. Three out were reported to have a landline available hospitals, administrative buildings, etc..), while facilities with 61 IDPs on average)). In terms of four facilities in Lysychansk were reportedly 24/7, but two out of seven FKIs reported not two reported checking on an annual basis and of trainings, the staff was commonly reported damaged because of shelling, one of which having enough vehicles for their operations. one reportedly checked semi-annually. Finally, to be well-trained to deal with cases involving had reportedly been damaged and only par- Moreover, three out of seven FKIs reported the majority of FKIs (4/7) estimated the current mentally ill persons, as reported by four out of tially rebuilt. None of the FKIs from the other having insufficient computers for work pur- conditions of public buildings in terms of fire seven FKIs. One FKI reported the staff at their areas reported their facilities had been dam- poses. safety to be ‘poor’, while two others reported facility to mostly be only partially trained. aged. estimating the current conditions to be ‘good’.

SESU 49 GOVERNANCE compared 31% on average (and 53% in Lysy- FIGURE 95: Users’ satisfaction with water UTILITIES chansk). In fact, it is in Lysychansk were HHs provision All facilities were reported to have an internal most commonly expressed their concerns about The following graphs show HHs’ satisfaction of WATER quality assurance mechanism (e.g internal a “regular breakdown” of the sewage manage- M&E); four FKIs reported that their facilities col- basic public utilities. Significant discrepancies 5% 15% ment service (as per 76% of dissatisfied HHs). 21% lect data on a monthly basis, while two reported or noticeable outliers were identified between geographical areas for the below utilities and 42% this happens quarterly, and one reported data Water: 37% of Lysychansk and 32% of Siev. services: is only collected on an annual basis. In addi- Urban HHs were reportedly “completely dis- 17% tion, only one FKI reported collecting geodata satisfied” with water provision, compared to Roads: HHs were almost unanimous in their and using it in decision-making. However, five 17% on average. Furthermore, 66% of HHs in Comp. dissatisfied Dissatisfied Neutral reported reasons for dissatisfaction, as 97% / don’t know out seven facilities reported collecting data on Lysychansk reported being either ‘completely’ Satisfied Comp. satisfied considered the roads in their area being in / not connected the timing of incidents and using it accordingly. or ‘rather’ dissatisfied, confirming the severe “bad condition” In terms of external governance, four out of WASH conditions that have been highlighted by Top three most reported reasons for users’ seven facilities had experienced an external all FKIs throughout this survey. dissatisfaction regarding water Telephone network: only 8% of HHs are evaluation over the year prior to this assess- Too expensive 66% reportedly connected to a telephone or land- ment. This widely reported dissatisfaction seems to be Regular shortage 47% line. due in part to regular water shortages (reported Poor quality of water 35% Interestingly, the majority of FKIs (4 out of 7) by 90% of HHs in Lysychansk and 83% in Siev. Internet: 55% of HHs in Siev. Rural, and 43% concurred on the fact that the decentralization Urban, compared to 47% on average). Finally, it Methodological note: the black line represents the in Siev Urban, reported not being connected to reform will improve the effectiveness of the has to be highlighted that 53% of HHs in Siev. weighted average of users’ satisfaction. All graphs in facility, and two FKIs reported expecting that internet, compared to 31% of HHs on average the following page follows the same schematic layout: Rural reported not being connected to central average dissatisfaction + top three reasons of dissat- the reform will not affect their facility. water supply. Mobile network: 54% of HHs in Siev. Rural isfaction GENDER-BASED AND DOMESTIC and 44% of HHs in Siev. Urban reported being TABLE 19: Most commonly reported top three reasons of dissatisfaction, by % of dissatisfied VIOLENCE RESPONSE either “dissatisfied” or “completely dissatisfied” with their mobile network, compared to 30% on HHs per area Only in 3 out of 4 facilities reportedly had staff average. This is most notably due to a poorer members being sufficiently trained to react in signal (89% of dissatisfied HHs reported this Overall Lysychansk Rubizhne Sieviero. Siev. Rural Siev. Urban cases of GBV/DV, in line with the new legis- reason in Siev. Rural and Siev. Urban, in com- Too Regular Regular Too expensive Too expensive Poor quality of lation in Ukraine, and one FKI reported their parison to 67% on average) expensive shortages shortages (71%) (82%) water (75%) facility had “partially trained” staff. In that (66%) (90%) (83%) regard, potential subjects of interest for train- Waste management and sewage services: Regular Too expensive Regular ings and/or dissemination in the GBV/ DV 69% of HHs in Siev. Rural and 48% in Siev. Poor quality of Too expensive Poor quality shortages (51%) shortages water (20%) (40%) water (78%) response area were numerous and broad Urban reported that waste management (47%) (31%) (almost all suggestions were reported by all services were unavailable in their area, com- FKIs) which, to a certain extent, appears to pared to only 12% on average. Similarly, 92% Low water Regular Poor quality Poor quality of Low water Too expensive highlight the lack of consistent and compre- of Siev. Rural and 67% of Siev. Urban HHs pressure shortages water (35%) water (45%) pressure (17%) (54%) hensive knowledge on GBV/DV related topics. reported sewage services being unavailable, (24%) (40%)

50 HEALTH UTILITIES 2 HEATING MOBILE NETWORK ELECTRICITY 46% 42% 23% 10% 5% 16% 25% 26% 44% 20% 23% 7% 5% 6%

Neutral RECREATION & LEISURE Comp. dissatisfied Dissatisfied Comp. dissatisfied Dissatisfied Neutral Comp. dissatisfied Dissatisfied Neutral / don’t know / don’t know / don’t know Satisfied Comp. satisfied / not connected Satisfied Comp. satisfied 49% Satisfied Comp. satisfied Too expensive 76% Poor signal 67% 18% Too expensive 74% Not adapted to temperature 56% Regular outages 62% 16% Regular shortages 7% 38% Pricing is not clear Too expensive 42% Low output 17% 10% 24% GAS PROVISION WASTE MANAGEMENT ROADS Comp. dissatisfied Dissatisfied Neutral 20% 43% / don’t know 34% 8% Satisfied Comp. satisfied 13% 4% 23% 44% Limited choice or absence 7% 29% 93% 15% Too expensive 20% 40% Unsatisfactory quality 6% 5% 5% 16% Neutral Comp. dissatisfied Dissatisfied Neutral Comp. dissatisfied Dissatisfied Neutral / don’t know Comp. dissatisfied Dissatisfied / don’t know / don’t know Comp. satisfied Satisfied Comp. satisfied Satisfied / not connected Satisfied Comp. satisfied / not available ENVIRONMENTAL CONCERNS Too expensive 82% Infrequent collection 87% Bad condition 97% Low quality of gas 42% Too expensive 20% Unsafe for pedestrians 33% TABLE 20: Top three environmental con- Low gas pressure 21% Absence of waste sorting options 19% No lanes for public transport 7% cerns per areas according to HHs: INTERNET NETWORK SEWAGE MANAGEMENT 19% 33% TOTAL Lysychansk Rubizhne Sieviero. Siev. Rural Siev. Urban 33% 30% 40% 8% Air polllution Air pollution Air pollution Air pollution Spontaneous Spontaneous 7% 21% (31%) (34%) (41%) (30%) landfills (20%) landfills (25%) 2% 7% Water Water Waste Water Neutral Deforestation Comp. dissatisfied Dissatisfied Neutral Comp. dissatisfied Dissatisfied pollution pollution production Water (15%) pollution / don’t know / don’t know (19%) Satisfied Comp. satisfied Satisfied Comp. satisfied (23%) (33%) (25%) (22%) / not connected / not available Regular outages 68% Regular breakdown 62% Spontaneous Spontaneous Water pollution Water pollution Deforestation Deforestation Low quality Low quality 48% 58% landfills (19%) landfills (29%) (20%) (16%) (14%) (14%) Too expensive 35% Too expensive 34%

UTILITIES 51