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The Ukrainian Parliament adopted Draft Law No. 7117 ‘On Improvement of Accessibility and Quality of Health Care Services in Rural Areas’: what changes will it bring?

Today, on November 14, 2017, the Verkhovna Rada of Ukraine adopted in the second reading Draft Law No. 7117 ‘On Improvement of Accessibility and Quality of Health Care Services in Rural Areas’ with 280 People's Deputies having voted ‘For’. As part of the ongoing Healthcare Reform in Ukraine, this Draft Law provides for cooperation with the local authorities in reforming rural medicine and addressing the urgent issues: the rural doctor shortage and poorly equipped outpatient clinics or rural health posts.

The Rural Health Care Today

More than 13 million Ukrainian citizens currently live in rural communities. Most physicians and health care providers are not willing to work in non-urban areas, because the rural medicine in Ukraine is funded far inferior to need while most rural healthcare facilities lack proper infrastructure and are not even equipped with the basic facilities. For instance, 71% of rural healthcare posts across Ukraine have no access to water supply, 75% – to sanitation services, and 82% of rural outpatient clinics have no sanitary units at all.

There are 4 000 outpatient clinics and 12 700 rural health posts in 23 000 villages and urban type settlements across Ukraine. In most cases, the rural doctors redirect their patients to seek a more qualified medical advice or treatment in ‘raion’ or ‘oblast’ [regional or city clinics]. For comparison: worldwide, the primary health-care providers in rural areas work effectively and treat up to 80% of patients at local medical facilities.

What changes will Draft law No. 7117 bring to rural medicine in Ukraine

First and foremost, this Draft Law is intended to create conditions for the improvement of accessibility and quality of health care services in rural areas. Health care facilities should therefore gain autonomy in managerial and financial decision-making to become more independent (the Law of Ukraine ‘On Amendments to Certain Legislative Acts of Ukraine Regarding the Improvement of Laws on Activities of Health Care Institutions’ providing for the implementation of measures to reform the health care system in Ukraine with the aim of establishment of a network of state and community owned health care institutions having sufficient level of autonomy to provide efficient and timely medical care services for the people). Equally important, Draft Law No.7117 in tandem with the package of Draft Laws No. 6327 and No. 6604 (‘Money follows the patient’) provide for changing the model of the rural health care financing to ensure that rural health care facilities receive additional funding for the development of proper infrastructure and rural healthcare providers get competitive salaries.

Moreover, an effective health care infrastructure should be developed and additional ambulance stations and clinics should be constructed in many villages across Ukraine. The public transportation and the patient’s need to travel to a certain location to see a doctor are the issues to be addressed almost everywhere. All the above mentioned problems require resources. And Draft Law No. 7117, submitted to the Ukrainian Parliament for consideration by the President, will provide for UAH 5 billion in funding for the development of health care infrastructure in rural areas over the next two years.

This funding is intended to ensure that rural communities will receive

• additional ambulance stations with the possibility of accommodation of the physician's family,
• motor vehicles for physicians to be able to travel between villages,
• new medical equipment,
• access to high-speed Internet.

Draft Law No. 7117 is part of the current Medical Reform that provides for cooperation with the local authorities in addressing the urgent rural healthcare issues. Many rural communities have already confirmed their willingness to offer doctors accommodation for UAH 1.00 to engage physicians and health care personnel to work in their localities. This means both that the rural doctors will not spend money on rent and make more money than their colleagues in cities.

Our common goal is simple and clear: to create the necessary conditions and ensure that rural doctors provide primary health care services of the same quality as their urban colleagues.