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Access to Healthcare (Vulnerabilities) Households Reported Accessing Medical Hearing of Shelling (20%)

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Access to Healthcare (Vulnerabilities) Households Reported Accessing Medical Hearing of Shelling (20%) UKRAINE Capacity & Vulnerability Assessment Popasna Raion, Government Controlled Area. July - August 2018 Introduction Methodology Fighting between the Government of Ukraine’s mine presence, creates significant protection The assessment began with a secondary The populations of interest in this study are: (GoU) forces and armed opposition groups risks and causes significant damages to data review in order to identify the main internally displaced persons (IDPs), non- in the territory of Donbas is entering its fifth service infrastructure. In addition, facilities service providers in the raion. REACH used displaced populations and service providers in year. The conflict is concentrated around face challenges regarding insufficient supplies geospatial data from the main mapping Popasna raion. The research used a stratified the contact line separating the government and equipment, budget constraints and limited services in Ukraine to map the settlements in random sample with four strata: rural areas controlled areas (GCA) from non-government qualified staff. Using a network approach2, relation to the provision and access to basic within 5km of the contact line, rural areas controlled areas (NGCA) of Donetsk and this study maps the basic service delivery services.3 The maps were later validated by beyond 5km of the contact line, urban areas Luhansk oblasts. capacities at a facility level and the access to direct observations of REACH enumerators in within 5km of the contact, and urban areas such services at the household level in order the field. beyond 5km of the contact line (Table 1). Popasna raion is located along the contact to identify barriers in service capacity and The primary data collection was conducted The household survey included 798 face-to- line in the GCA of Luhansk oblast. The contact vulnerabilities relating to household access. from 11 July – 21 August 2018, and included face household interviews across the GCA line has isolated much of the population of The basic services assessed in this Capacities key informant interviews (KIIs), community settlements of Popasna raion, designed to be Popasna raion from important urban centres and Vulnerabilities Assessment (CVA) are: key informant interviews (CKIIs), focus statistically representative of households in located in NGCA, reducing the ability to education, healthcare, social, administrative group discussions (FGDs), and household the raion with a 95% confidence interval, and a access basic services. The ongoing fighting services, food markets, non-food item (HH) surveys. KIIs were conducted with 7% margin of error. The confidence level may has disrupted the local economy and service (NFI) market, construction markets, banks, representatives of service providers who be lower or have a wider margin of error for availability in many settlements, forcing a ATMs, post offices and pharmacy stores. were interviewed in Popasna raion to assess smaller subsets of the population. highly vulnerable population to travel longer Service capacities and household access are the impact of the conflict and challenges to Limitations distances to access basic services. As a result, compared to identify resulting vulnerabilities, the service provision. REACH conducted Some key informants (KIs) interviewed were the pressure on service provision in GCA using strata disaggregated by rural and household surveys regarding perceptions of not working for their facility in 2013, and were has increased. The Area-Based Assessment urban areas and their distance to the contact change in service access and usage since unaware of the issues faced at that time, on (ABA) of July 2017, identified that there was line, within 5km (5km) and beyond 5km of 2013. Following field visits, enumerators some occasions making comparisons of an increased pressure on service provision as the contact line (>5km). The study compares participated in FGDs in order to share their the humanitarian situation in 2013 and 2018 a result of the conflict in Popasna.1 This study perceptions of change in service provision and direct observations of the conditions of each a challenge. On questions related to the expands on the previous assessment, further access from 2013 to 2018. The findings will be facility. The data collection for CKIIs used provision of services, some responses may analysing the challenges faced by service used to inform humanitarian and development a purposive sampling method. Pensioners, be slightly under reported as respondents may providers in delivering basic services and the aid providers in their support of basic service strategic professionals and service providers have believed it would increase their likelihood barriers experienced by households when delivery. were interviewed: three in rural and five of receiving assistance, especially at a facility accessing basic services. The study found that in urban settlements. CKIs reported on level regarding the availability of equipment. incidents of shelling, as well as military and Table 1. Household (HH) survey sample the community’s access to services and To mitigate this potential bias, REACH Primary data collection methods Stratum 1 Stratum 2 Sample size the shelling occurrence. Using a network enumerators explained to respondents before Urban** 5km 206 approach, REACH also mapped changes of data collection that the research would not Household Surveys 798 Urban >5km 202 households’ access to services, comparing directly lead to humanitarian assistance. perceptions of access in 2013 and 2018 to In addition, responses regarding security Key Informant Interviews 168* Rural 5km 186 identify extra burdens on service providers. incidents and shortages might be under Community Key Informant Interviews 268 Rural >5km 204 For a more extended methodology see Annex reported due to the normalization of issues as **Note: settlements in Ukraine are officially classified as “village,” “urban- A. a result of the protracted nature of the conflict. Focus Group Discussions 38 type village,” or “city.” This assessment classifies villages as rural and *Some key informants were interviewed regarding multiple facilities urban-type villages/cities as urban. 1 Map 1. Assessed Settlements in Popasna Raion Lyman Luhanska oblast Shypylivka Lysychansk Sievierodonetsk Metolkine NGCA Bilohorivka Donetska Lysychanskyi oblast Russian Voronove Federation Zolotarivka Maloriazantseve Siversk Topolivka Borivske Verkhnokamianka Vovchoiarivka Bila Hora Myrna Ustynivka Loskutivka Dolyna Bobrove Rai-Oleksandrivka Toshkivka Mykolaivka Hirske Nyzhnie Vrubivka Novoivanivka 7+14+13+8+6+9 Nyrkove Shchastia Novotoshkivske Zolote Orikhove Soledar Viktorivka Komyshuvakha Oleksandropillia Katerynivka Popasna Marinka Urban settlements Druzhba Pervomaisk Karlivka Rural settlements Assessed settlements Bakhmut Novozvanivka No data Kadiivka Main roads 9+15+13+9+5+7 Railroad Troitske Checkpoints Luhansk Kostiantynivka Contact Line (OCHA, as of August 2018) 5km area from the contact line Alchevsk Popasna raion Km 0 4.59 Svitlodarsk 2 W Population The Popasna raion population demographics Figure 1. Population geographic distribution Map 2. Population density (Figures 2 and 3) show a distribution with a higher proportion of people over 46 years old than under 30.4 As illustrated in Map 2, the Shypylivka population is concentrated in urban areas Bilohorivka Sievierodonetsk within 5km of the contact line, mainly in the Lysychanskyi cities of Popasna, Zolote and Hirske. Eighty Maloriazantseve Zolotarivka percent (80%) of the population lives within To polivka Lysychansk Siversk Verkhnokamianka 5km of the contact line, and 20% live beyond 78+11+9+2+A Bila Hora 75+ Urban 5km 4% 78%2% Vovchoiarivka 5km of the contact line. Myrna Loskutivka Urban >5km 11% Dolyna Ustynivka The majority of households (75%) had between Rai-Oleksandrivka Pidlisne Toshkivka Nyzhnie 61-75 Rural >5km 14% 10%8% Mykolaivka Hirske one or two members. Households with one Novoivanivka member were more commonly reported as Rural 5km 2% Nyrkove Vrubivka living within 5km of the contact line, mostly in Novotoshkivske 46-60 15% 9% Viktorivka Komyshuvakha Orikhove urban areas (44%). Overall, 33% of the heads Figure 2. Population demographics (>5km) Soledar Zolote Oleksandropillia ? of household were widowed. The majority of 7+14+13+8+6+9 2+10+11+7+6+7 Katerynivka 31-457% 75+8% 7% 2% Popasna households within 5km of the contact line were Druzhba Pervomaisk headed by females (63%), in contrast to 37% 14% 61-75 10% Bakhmut Vyskryva headed by males. This difference could be due 16-3013% 46-607% 7% 11% Novozvanivka to the higher life expectancy of women, and 75+8% 31-454% 2% 7% Kadiivka Reported population in assessed settlements (persons) that vulnerable individuals were found to be Troitske 0-156% 16-308% 8% 6% ral more likely to stay in their settlements despite urban ru less than 1000 5 9% 0-15 7% being close to the conflict. 61-75 14% 10% 1001 - 5000 Alchevsk Female Male Km more than 5001 The city of Popasna is the largest settlement, 0 4.59 Svitlodarsk followed by the cities of Hirske and Zolote. 46-60 15% 9% Both Popasna and Zolote are located within Figure 3. Population demographics (5km) Largest settlements in the assessed area Inaccessible settlements due to restrictions on 5km of the contact line, making the area within 9+15+13+9+5+7 1+11+9+6+7+8 movement 31-45 8% 7% 5km of the contact line an important hub of 9% 75+ 1% 1. Popasna 6. Vrubivka 1. Novooleksandrivka service delivery and livelihood opportunities. 15% 61-75 11% 2. Zolote
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