Eduard Vitonshynsky is a 28-year-old father and has leukaemia. After several chemotherapy treatments, he needed a transplant, which he couldn’t get in Ukraine due to a lack of competent and affordable hospital services. His father Igor had to pay US$100,000 out of his own pocket to pay for all of Eduard’s treatments. “After he was diagnosed, we were referred to a private hospital. But we had no information. Now all my money is gone, I sold everything that I had,” he told Equal Times last September. The family’s hopes then lay in a programme funded by the Ukrainian government, which funds exceptional care, particularly last resort, including surgeries abroad.

For close to a year, bureaucratic and financial barriers have placed families, for whom weeks can mean the difference between life and death, in limbo. In autumn 2018, several families spent weeks camped in front of the Ministry of Health in Kiev, their colourful tents covered with photos of their sick children. Igor was among them. “We’ve been everywhere to ask for help but we haven’t gotten any answers.

They keep us waiting but in the meantime our loved ones are going to die. It’s like they wanted to get rid of us,” he says to agreement from a group of about ten others. At the end of 2018, some patients, including Eduard, finally obtained their visas and cheques to receive operations in Turkey. But many had already run out of time.

Due to lack of investment and chronic corruption, the Ukrainian healthcare system has deteriorated considerably since the country achieved its independence. For many Ukrainians – especially those with modest incomes – the best option is simply not to get sick. The country has no universal healthcare system. In Soviet times, everyone had access to free healthcare; and though this right remains guaranteed by law, in practice, patients and their families have to increasingly pay out of pocket for their healthcare and medicine. The gap between those who can afford to pay either a bribe or a private doctor, and those who can’t, continues to widen.

Life expectancy in Ukraine is falling

This lack of effective healthcare coverage is compounded by the low pay that Ukrainian doctors (between US$140 and US$280 a month, depending on their area of specialisation) and other healthcare workers receive. This contributes to the haemorrhaging of human resources into the private sector, and especially abroad.

“Around 70 per cent of jobs in the hospital sector in Kiev have not been filled. Young people are completing their education and moving en masse to Poland, the United States and elsewhere,” says Larysa Vyacheslavina Kanarovska of the Independent Medical Workers Union of Kiev. “This lack of practitioners is a disaster for our country. Wages are low and sometimes go entirely unpaid. Medical workers are under massive pressure and constantly lack resources. Patients who could receive treatment are dying every day and doctors are desperate because they have peoples’ lives in their hands and there’s nothing they can do.”

While Ukraine’s life expectancy resembled that of western Europe in the 1960s, the gap between the two has now widened to more than 10 years. Average male life expectancy in Ukraine has fallen to 67, while it approaches 80 in most European countries. Systemic failures and low wages for caregivers have led to endemic corruption, resulting in a multi-tiered system that excludes many citizens from care. In the absence of sustained prevention policies, the number of people with Aids and tuberculosis has skyrocketed in recent years. For fear of the bill they may receive, many patients wait until they are in critical condition before finally going to a doctor.

According to one study, 80 per cent of patients are unable to afford the medicine that would allow them to pursue their treatment, while pharmaceutical companies avoid the Ukrainian market due to corruption.

For physician and MP Olga Bogomolets, who formerly chaired the parliamentary committee on health issues, Ukraine is in a very critical situation – and things are likely to get even worse. “Today, 99 per cent of the population is simply surviving. The middle class is leaving the country. They are the country’s lifeblood and they are no longer paying taxes here, while the poorest and most vulnerable have stayed behind. We have nearly a million people suffering from cancer, with close to 100,000 new cases every year, and this trend will continue to increase,” she told Equal Times in an interview in September.

“How can you pay for treatment, for cardiovascular diseases for example, which is the leading cause of death in the country, when you only earn €40 a month in retirement and the state only covers 27 per cent?” Bogomolets, a candidate in the 2019 presidential election to be held on 31 March, proposes to an increase in healthcare spending to nearly 5 per cent of GDP (compared to 2.9 per cent today).

A divisive healthcare reform

When President Petro Porochenko took office in 2014 following the Ukrainian revolution, his government set about implementing a healthcare reform, which received broad support in parliament and took effect in April 2018. The reform calls for a “change of mentality” aimed at fighting corruption and improving pay for doctors. From now on, every Ukrainian will have to choose a ‘family doctor’, who will see up to 2,000 patients and be paid by the state for services provided. According to proponents of the reform, including the IMF and the World Bank, the idea is to have the money follow the patient rather than going through healthcare institutions.

But this reform has proven divisive in Ukraine. For some, like the patients’ rights advocacy association Patients of Ukraine, it represents step in the right direction.

“For the first time in 20 years, we have a minister who has the intention and the opportunity to introduce reforms and we support her project. It seems more logical to us to provide funding according to treatment rather than [the number of] hospital beds. In addition, follow-up by a family doctor allows for more prevention, because the mindset people have now is that you only go to the doctor when things are serious,” explains Olga Brychko, head of communication for the association.

According to the Ministry, within the first few months of the reform’s implementation, 40 per cent of citizens had already completed their attending physician statements. At the medical and health assistance centre in the Pechersk district of central Kiev, a nurse shows Equal Times the cardboard boxes filled with the forms that the centre continues to receive. “We have around 3 kilos here. So far it’s working well but we also have to be proactive and encourage people to sign up. Sometimes we go out on the streets to ask people to think about signing up, especially elderly people,” she says.

Doctors, on the other hand, have been less receptive to the reform. “The problem is that people are not used to going to the doctor regularly,” explains Dr Tatiana Musina, who describes the hoops that she and her colleagues in the public sector have to jump through to meet their quotas. Their salaries now depend on it. “Since July, my workload has increased but my salary has been reduced by two-thirds,” she says. A general practitioner specialising in paediatrics, Musina until recently earned around 10,500 hryvnias (US $375).

“The implementation of this reform was ill-conceived and requires too much effort on the part of physicians. A lot of other things should have been addressed first. I think this reform was designed to further break the public sector by discouraging doctors and driving them into the private sector.” This is precisely what happened to Dr Musina, who finally decided to take a position at a private clinic.

Healthcare workers unions denounce the cuts in hospital staff and ambulance workers. When the reform was drafted, their proposals on working conditions were not included, nor were proposals relating to the creation of genuine social protection, with a system of compulsory and universal insurance coverage.

A heightened political battle

Since its inception, the healthcare reform has been a source of heightened political tensions. The reform was initially proposed by Health Minister Ulana Suprun, an American-born radiologist of Ukrainian origin, now under attack from all sides. In early February, legal action brought by an opposition deputy threatened to strip the minister of her functions, alleging that the conditions of her appointment were irregular.

For some, her reform doesn’t go far enough and isn’t up to the challenges of social justice; for others, she is masking a liberal agenda aimed at setting up costly ‘American style’ healthcare system with unequal access. Supporters of the minister believe that these attacks come from those resisting change, especially considering that the current system has allowed the misappropriation of funds to take place for years.

With the ongoing war against separatists in Ukraine’s east and an economic crisis that continues to seriously affect the country’s public finances, the task of healthcare reform remains daunting. Due to go to the polls at the end of March for its presidential elections and in November for its legislative elections, the country is embarking on a political campaign in which the social protection and health of Ukrainians often do not rank at the top of candidates’ priorities. Before things really change in Ukraine, many families, like the Vitonshynsky family, will still have to spend their savings trying to keep their loved ones healthy.