V.V.Kostiuk,
Head of Healthcare Department Popilnia State Administration

The implementation of the EU Project „Financing and management in Ukraine’s healthcare» in the pilot Popilnia region in Zhytomir oblast

The Popilnia region is primarily agricultural one, with its population nearing 36,000. The share of children and invalids is 21.2%, individuals of employable age amount to 48.5%, and pensioners total 31.1%. The region’s feldsher and feldsher/obstetritian points provide services to 43.7% of its population.

The region’s network of medical treatment & prevention facilities included the central regional hospital with 13 beds, the village hospital for 25 beds, 8 village ambulatories, 10 feldsher/obstetritian points and 20 feldsher points. The level of hospital bed coverage is 44.4 per 10,000 population, the level of hospitalization is 44.4 per 10,000 population; the doctor to population ratio is 19.7 for 10,000 population, the mid-level medical personnel to population ratio is 68.3 per 10,000. 17.4% of the region’s population are members of the „Hospital cash fund”.

To implement in the region the cooperation agreement between the EU project and Zhytomir oblast administration, and following the plan for training the region’s healthcare workers for operation on the basis of the new business –legal status and the new model of financing, a series of seminars, training modules and discussion clubs were conducted with participation of medical workers, Chairs of village councils, EU countries’ experts, officials of the region’s executive government bodies, the treasury and financial agencies. The issue of implementation of the EU project has been continually covered by the region and oblast mass media.

The following are the results achieved for the time being:

• The statute was approved for the region’s healthcare department within the Popilnia region state administration, and the department itself was established with the three staff selected on the competitive basis (department head, leading specialist and economist/accountant), the department’s statutory documents were approved, the funding was allocated and the office space provided at the region state administration;
• The session of the regional council passed a decision to approve the statute of the Communal enterprise „Popilnia central regional hospital” and the appointed director of this enterprise which passed state registration;
• The rubber stamps were made for the established health department and the Communal enterprise;
• The regional Council (“Rada”) passed a decision „On making amendments to the budget”;
• There were conducted sessions of the village Radas and passed was the decision „On providing funding, personnel and property for the regional Communal enterprise”;
• The total of 27 workplaces was set up with necessary equipment and computers provided. The computer training class was organized. The medical personnel (family doctors, statisticians, medical registration officers, bookkeepers, employees of the healthcare department, admissions’ department and the in-patient department) were trained to use computers and computer programs installed;
• An agreement was signed between the region’s healthcare department (Customer) and the Communal enterprise «The Popilnia central regional hospital» (Provider of healthcare services)

The basis for this contractual arrangement is the agreement between the Customer and the Provider on the plan for provision of medical assistance (its structure and volume) with a focus on the most rational and effective ways of meeting the patients’ needs.

The system of contractual arrangements allows to:

• Improve the effectiveness of the Provider’s work;
• Improve the planning of healthcare development;
• Improve the management system for provision of medical assistance;
• Improve quality of medical services.

As of the 1st of June 2005 the financing of the medical facility will be carried out by means of a global budget, which would allow the manager greater autonomy in using the funds, without dividing the latter based on the codes of economic classification.

At this stage there are a series of problems that need be addressed:

• At the local level– optimization, provision of telephones to family doctors, reduction in energy consumption (possible lease-out of offices), preservation and modernization of the material-technical base, etc.;
• At the higher level – improvements to the price-setting system, identifying medical services that need be paid for and establishing an official list of prices; creating the system of medical standards.

The structure of the medical facility is expected to be changed in the future (specifically – it will be used to set up the primary medical-sanitary assistance center with the view to dividing the primary and secondary levels of healthcare).

It shall also be necessary to improve the operation of the automated information systems and to step up the efforts aimed to form the public opinion on the vision of the end result – creation of the healthcare system model focused on the patient’s interests first of all.