Originally published in Kyiv Post on December 28, 2018.
Tetiana began every day with fear for her son: "In the morning, I heard the clock ticking and I understood I was running out of time.” Suffering from a rare disease that affects his appearance, physical abilities and body functions, every morning his health deteriorated because the medicine he desperately needed was unavailable in Ukraine.
Tymofiy, the father of a three-year-old boy with respiratory and hearing impairments, had no choice but to seek care outside Ukraine to ensure his child’s safety and well-being.
Olga, a former tuberculosis patient, struggled to meet the high costs of treatment, the direct costs of medicine and the precious time she spent away from family and work while seeking care.
People in Ukraine have long suffered from uncertain access to medicine and treatment options, largely due to inadequate transparency and corruption within the Government. Continued efforts to combat these malpractices have resulted in important gains in the availability of healthcare services, leading to improvements in the health and well-being of Ukrainians.
I am a deputy director at the United Nations Development Programme (UNDP) and mother to a beautiful one-year-old boy myself. Ensuring adequate care for my child drives home the challenges that UNDP is working hard to address in Ukraine by procuring medicine and medical products on behalf of the Ministry of Health since 2015.
UNDP adheres to the principle of ‘Leave No One Behind’. This maxim strikes home when considering the health and well-being of our children, a new generation that is entitled to a high-quality and happy life in this beautiful country.
I have followed up with Ukrainian patients and parents who have underscored the transformative changes that Ukraine is seeing in health reform. The situation in Ukraine is improving; medicines are becoming more accessible. UNDP-administered programmes have saved the Government of Ukraine approximately one billion hryvnias. These dramatic savings have enabled increases in availability of life-saving medicine for Ukrainian patients.
The prices of most medicines have dropped significantly due to increased competition, transparent procedures, and the purchase of over 70 percent of medicines directly from manufacturers. This was hard to imagine four years ago, when 95 percent of medicines were bought from local distributors, dramatically increasing their prices and subsequently decreasing their availability. According to Sergey Dmitriev, a leading advocate on HIV and hepatitis, international procurement enabled Ukraine to secure remarkably low prices (some of the lowest in the world) for the treatment of hepatitis C.
Many monopolies have dissolved as new generics entered the Ukrainian market through international procurement conducted by UNDP and other international organizations. Currently, three to five times more medicine can be purchased than was possible before. A range of newly registered companies are gaining trust in the Ukrainian market, and these companies are looking forward to the simplification of regulations and to greater ease in conducting business.
These achievements are the result of collective efforts by the Government, civil society, the private sector and the citizens of Ukraine. Ukrainian parents did not sit idly by in the face of a dire situation; they mobilized to raise awareness and make a difference. Tetiana, by speaking publicly about the barriers to accessing treatments for rare diseases, inspired the creation of a civil society organization that lobbies for faster and easier registration of medicines. Consequently, the Government drafted the first law in Ukraine on rare diseases and began allocating money for their treatment. Tymofiy has been tirelessly working with other parents to fully integrate children with hearing impairments into society and to promote childhood vaccination. Olga, inspired by her personal plight, became an activist to support others who have had to deal with tuberculosis.
In 2015, patient organizations (led by Deputy Minister of Health Olga Stefanyshyna) and anti-corruption activists were heard: the Parliament of Ukraine modified national legislation and temporarily transferred the procurement of essential medicines and medical devices to international organizations, including UNDP, until a transparent national procurement agency is in place and fully operational. Ukraine recently extended the legislation for another year. Also, the Ministry of Health announced that the long-awaited health reform has passed its first stage; under the Ministry’s leadership, a new national medicine procurement agency is being established.
The advocacy efforts of people like Tetiana, Tymofiy and Olga and the tireless efforts of the Ministry of Health have paved the way for several successes in health care reform. Ulana Suprun, acting Minister of Health, was recently nominated as the main reformer of the country.
As a result of these efforts, access to medicine in Ukraine has widened, completely reshaping the healthcare landscape. We are proud of how far we have come together. Despite many challenges ahead, the people of Ukraine — civil society representatives, civil servants and the general public — are determined to ensure high standards of care and increased quality of life for themselves and their fellow citizens.
Patience and persistence are essential. Major change does not occur overnight; major change takes years of work, learning from mistakes and the long-term engagement of everyone.