The project has the following components: institutional and legal support of the MoH to ensure favorable conditions for implementation of social medical insurance; development and implementation of two pilot projects to exemplify the effectiveness and efficiency of EU best practices in social health insurance; organization of trainings for current and future administrators (managers) of health care institutions; and formation of positive public perception of the reform through wide-raging information campaign in the media.

During its implementation, the project will make use of the positive experience in reforming medical care and health insurance systems that exists in European countries, particularly Germany, Czech Republic, Poland, and Estonia, where similar technical assistance projects in reforming their health care systems have been implemented with success. The project team is set-up by experts from Finland, Greece, Germany, Poland, Estonia and Romania, etc. and its Steering Committee has members coming from various Ukrainian ministries, Oblast and Rayon authorities, international organizations, such as WHO and the World Bank as well as from health care institutions in the pilot sites.

The project achievements during 2004 can be summarized as follows: The project WG has submitted to the Committee on Social Policy and Labour Issues of Verhovna Rada detailed comments on the Draft Law on MHI; the List of affordable health care services ("minimum package") has been reviewed in detail with the aim to support the development of a unified methodological approach of costing of health care services.

Based on the assessment of IT procurement needs for the pilot work at Oblast and Rayon level and the tasks to be carried out at MoH the tendering process has been completed and the installation of HW & SW to support the introduction of a modern financial and management system in the provision of health care services is under way. The drafting of a Strategic Plan to cover the future IT system the main elements of such a plan have been put forward for discussion and analysis by the WG on IT issues.

The approved set of documents by the pilot authorities in Kharkiv and Zhetomyr includes among others the establishment of the Rayon Health Care Department (RHCD), which will act as purchaser of health care services, the Contract for the provision of services, the Statute of the Central Rayon Hospital which provides that the CRH will be operating under the legal status of a communal non-profit enterprise, and the transfer of property and funds from the ambulatory facilities at village level to the Rayon level in order to be managed by the RHCD.

The training activities were carried out according to the training methodology, the training plan and the approved Train the Trainers (TTT) Curriculum. All seminars and workshops as well as one TTT course (Health Sector Development) had a two days duration and took place in the premises of the Kiev Medical Academy of Post-Graduate Education (KMAPO) in line with the signed co-operation agreement. This educational center has also provided for the licensing of all TTT courses that have been incorporated in its teaching program. An evaluation of all training events based on the analysis of the evaluation forms filled in by aprox. 200 participants has shown positive results as health care administrators and medical staff have received through the project up-dated and in-depth knowledge on the areas of health sector development, financing and management.

The approved communication strategy that is directed towards representatives of the government and other state authorities, the healthcare workers, the mass media and the general public is the basis for all PR activities carried out so far by the project. The results of the survey on expectations of population from the health reform were taken into account to develop the first two-months information campaign. Several press-conferences, TV and Radio broadcasting of interviews of MoH officials and international experts, 10 articles in magazines, the publication in 5.000 copies of the brochure on "The Regulatory framework for introduction of Mandatory Health Insurance in Ukraine, meetings of the national press club as well as of the press clubs in Kharkiv and Zhetomyr are among the main activities of the project in this area. The project website is updated on monthly basis ( and the press monitoring activity is continous.

The main activities of the project in 2005 & 2006 include further legal support for the implementation of mandatory social health insurance in Ukraine as well as the development of certain organizational and operational aspects of the future HIF. Aiming at a unified methodological approach on costing of medical services - and its implementation on pilot level - and determining the services that are to be provided by primary, secondary and tertiary care - and their introduction on pilot level - will undoubtedly result to finalize the "minimum package" that a future health insurance system shall cover.

The measures taken so far include the creation of RHCD, the revision of the hospitals legal status to become communal non-profit making enterprises, the introduction of contracts between RHCD and these enterprises based on a minimum package of services, performance criteria, management decisions based on cost accounting, and a comprehensive registration of all patients. The above measures are pre-requisites for the full implementation of a compulsory health insurance system. The ultimate aim is to force health authorities to purchase affordable services and leave the providers the freedom to adapt their capacities and utilise their resources freely to meet their contractual requirements. This will encourage the shift of resources away from the maintenance of excess capacities towards the actual treatment of patients.

The project will support both the health authorities and the providers in the pilot sites to meet their "new" obligations through continuous advice and improvement of their negotiating and monitoring skills. The negotiated agreements will initially be based on historical costs. However, the purchaser will be able to calculate the costs which should ideally be associated with executing the agreed services based upon evidence based medicine and will consistently apply pressure on the providers to reduce their prices towards this ideal.

Finally, both the purchaser and the provider will be equipped with IT systems to be able to carry out their functions effectively by recording and reporting of all required information and monitoring the utilisation of their resources in relation to the extent to which they have fulfilled their contractual obligations. They must furthermore have an overview of their expenses and be able to identify, design and monitor the effects of cost-saving initiatives. Pilot staff will be trained in using the new hardware and software to be purchased under the project.

The aim of the training activities is to create a hard core of staff that are familiar with the current developments in management and financing of health care services and through the 7 remaining TTT courses be in a position to undertake trainer's function in the case of "roll-out" of best practice. Staff of the pilot sites, in particular hospital administrative staff, RHCD and Oblast Health care authorities staff will increase their practical skills and knowledge in health financing and management during 5 two-days courses. On-going two days workshops will deal with specific issues related to the legal and public communication tasks. The evaluation results of all training activities shall at the end be incorporated into the strategic plan for a national policy health personnel development.

A second information campaign with more emphasis in promoting the pilot tasks will be organized and carried out while the monthly update of the project website and the publication of articles will continue. It will be of high importance that the approved "minimum package" is communicated to the public so that they are aware of what they can expect and what their rights are. Therefore, the progress made in defining and costing the list of affordable medical services shall be communicated to the pilot authorities on Rayon and Oblast level as well as to the members of VR.

The project objectives are fully in line with the key priorities of the Ukrainian Government, in particular the introduction of mandatory health insurance with the provision of a guaranteed package of medical services, the establishment of quality indicators at the health care facilities level.

We look forward to receiving your feedback to all 6 issues of the newspaper that are due to be published in 2005/2006 and have you also as active contributers to the preparation of all related material.