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In Ukraine, we are undergoing a complete transformation of our healthcare system. We are moving away from the old Soviet Semashko input-based system to an output based system that is based more on results, and also moving away from inpatient care to basing much more of our system on primary care and a strong public health system, which will guide our policy changes.

And when we were designing this transformation of our healthcare system, we have paid special attention to our vulnerable populations to make sure that we don’t leave anyone outside of the system. And we made several choices that I think are very useful and helping those vulnerable populations to not be left out.

One of them is that we have now provided individual choice for patients. Until now, patients were assigned their physician by the place of registration, or their residency. They were told to go to this clinic, or to this hospital, based on where they lived. We have now freed patients from this requirement, and patients are able to choose their primary care physician from any facility, whether it is public or private, and as long as this facility has signed a contract with the National Health Service of Ukraine. This has been particularly important for vulnerable populations, such as our IDPs in Ukraine.

Since the invasion of Crimea by the Russian military, and the illegal annexation of Crimea by the Russian Federation, and the invasion and occupation of parts of Eastern Ukraine, over 1.5 million IDPs have been forced to flee their homes. Under the ongoing healthcare transformation, they are no longer tied to their place of residency, they are not limited to receive care, where they are registered, leaving their documents and homes behind. They can now choose any of the primary care physicians in their new place of residency. That is something that is important for them, as they are particularly vulnerable, because they are first at risk that they don’t have consistent care, and secondly, they have left their homes. Having permanent access to medical care is essential for them.

A second, but no less important, change that we have put into the new system is integration. In our healthcare transformation, we actually started with primary health care, making it more strong and more robust.  We have created a National Health Service of Ukraine, which is a single purchaser, which uses budgetary funds to pay capitation payments to physicians. Since we started this, which has only been six months, we have had 20 million Ukrainians, or almost every second citizen of Ukraine, sign up with their primary care physicians. Our primary care physicians have increased their salaries by 2-3 times, based on this new capitation payment plan. And now they are stakeholders in the reform, they are interested in pushing the reform forward.

And we have created a secure eHealth system, which is the basis for all of this. The system contains data on all patients, doctors and healthcare providers that have already joined the reform.

What has that done? What it’s done is that it’s freed a lot of the patients from the requirements that they had in the past – whether they had to go to a certain doctor, whether they had to bring in all of their documents. In the eHealth system, there are simple forms that are filled out online, without the presence of a lot of different documents. And also, it has helped us so that we can integrate those patients who are most vulnerable, who are not willing to come in and to show all of their private documents to the government system, to be able to sign up into the eHealth system. The data now belongs to them. This helped us in many different ways, including by increasing the level of trust in the government.

The third thing we have done is that we have made the system inclusive. The National Health Service of Ukraine signs contracts with public institutions, with private institutions, and very uniquely in Ukraine – with NGOs. We have an NGO – the Network of People who live with HIV – that have opened primary care clinics for HIV patients, and for any patients. They provide special services, and their family physicians are specially trained to take care of those patients who have HIV, so that they know what those additional needs are.

Another one of our inclusive changes is we have adolescent-friendly clinics. One of our Ukrainian young people spoke at the opening session – Yana Panfilova. In fact, she was a spokesperson for the youth, she voiced their position, prompted us to pay attention to specific issues. And we did. We have created adolescent-friendly clinics, where people like Yana can come and talk to a doctor, or a pediatrician, can ask about HIV, can ask about sexually-transmitted diseases, about pregnancies, and feel safe, this information is kept private between her and the physician that she is talking to. We have special nursing staff that is also trained there, and we provide free testing for HIV, Hepatitis B, pregnancy tests, and so on in these clinics, and have those adolescents feel confident that the confidentiality of the services is provided for them.

However, our young people are also at risk in other ways, not only through distrust in the system or confidentiality. The OSCE has reported that 23 children have been injured or died in 2018 alone because of the war in eastern Ukraine. Three teenagers were killed on September 30^th in a landmine blast in the Russian-occupied town of Horlivka, which is in eastern Ukraine. UNICEF reports that 220,000 Ukrainian children are under threat from injury or death from landmines.

In 1978, the Alma-Ata Declaration stated that ‘An acceptable level of health for all the people of the world by the year 2000 can be attained through a fuller and better use of the world's resources, a considerable part of which is now spent on armaments and military conflicts’. The current text, the text that we have now accepted at our conference, states that ‘Unless we act immediately, we will continue to lose lives prematurely because of wars, violence, epidemics’ and so on.

What I would like to say today is that abiding by the country's commitments and obligations is the basis for ensuring global order and justice for all.

So, I call on all countries that are represented at our conference today to take this simple but important step. Because for us in Ukraine, the biggest obstacle currently to attaining UHC, based on a robust foundation of primary care, remains Russian military occupation, and the cultural and informational deception it brings.

I have a special T-shirt on today. This is Oleg Sentsov, he is the political prisoner illegally detained in Russia right now. He doesn’t have access to medical care in prison. Ukraine’s Ombudsperson, as well as Ukrainian and international doctors, are denied access to Oleg, which is why we can not assess his actual health status after the 145-day hunger strike. He was awarded the Sakharov Freedom Award yesterday, and he won’t be able to accept it on December 12th, because he is imprisoned illegally in Russia. He was taken out of Crimea and put in a prison after a kangaroo court trial, in which he was sentenced to 20 years of hard labor.

And only after these human rights violations cease happening, when the Russian Federation abides by international law, will we be successful in advancing a global order to such a level that all of us will have equal access to healthcare, there will be peace and prosperity in every one of our countries.

So, the most vulnerable populations need to be helped, whether it’s the HIV patients, whether it’s the youth, whether it’s those who are internally displaced, or whether it’s those who are imprisoned. Let’s pay attention to all of them, and make sure that each of our resolutions takes their needs into account as well.

Thank you!

As delivered on Oct. 26, 2018, at the 2018 Global Conference on Primary Health Care, Astana, Kazakhstan.

Please follow the link to read the full speech in Ukrainian