The Cooperation between the World Health Organization and Ukraine by Olia Brutsiak
About the author : Olia Brustiak is a law student at the National University “Odessa Law Academy” in Ukraine. She is one of the few students selected by the Mitacs Globalink program to come to the H-Pod at Université de Montréal for an internship. This article is the result of her great internship work.
Healthcare policy is one of the most important policy orientations for a country, as it has a direct connection and direct effects on the health of each person, regardless of citizenship, nationality and other distinguishing features. Also, it is one of the most expensive branches of policy in each state, according to World Bank data, in 2016 worldwide healthcare expenditure reached 10% of GDP.
Those policies are based on fundamental rights such as the right to health, enshrined in Art.12 of the International Covenant on Economic, Social and Cultural Rights, which includes a wide range of socio-economic factors that create the conditions that allow people to lead healthy lifestyles, as well as the basic components of maintaining health, such as food and diet, living conditions, access to clean drinking water and adequate sanitation, safe and non-harmful working conditions as well as a favorable environment for human health (Committee on Economic, Social and Cultural Rights). This fundamental right is also found in international agreements and regulations, written by non-governmental agencies like the World Health Organization (WHO). WHO aims for the attainment of the highest possible level of health by all people. WHO publishes guidelines, recommendations, official statistics and scientific research. WHO expects that its regulations influence the national legislation of its members. Let us consider this influence on the example of Ukraine.
Ukraine is a state is located in Eastern Europe, with a population of 42 million people (occupied territories of Crimea and Donbas region excluded). Ukrainian GDP in 2017 was 112.2 billion USD, 2.8% of which was spent on healthcare (in 2019 this percentage increased to 3.8%). Ukraine is faced with a number of public health challenges. This includes arecognized tuberculosis epidemic: in 2018 there were 35,000 people registered as suffering from this disease. Furthermore, Ukraine has one of the fastest rates of the spread of HIV/AIDS, and in 2018 there were 144,633 registered HIV-positive patients. In addition, an important influence on the health of Ukrainians are environmental issues, a consequence of the 1986 explosion of the Chernobyl nuclear power plant, one of the biggest in the history of nuclear power. This disaster still influences the health of Ukrainians. After the disaster, there was a rapid increase in cancers (especially thyroid cancer and leukemia); the thyroid gland is one of the organs most at risk of cancer due to its accumulation of iodine-131 and there is an especially high risk for children. According to UNSCEAR, over 6,000 cases of thyroid cancer were recorded among children and adolescents who received radiation during the Chernobyl accident over the 1990-2005 period. Given the low likelihood of sporadic thyroid cancer among children and adolescents, some of these cases are considered to be a direct consequence of radiation exposure. Experts believe that the incidence of thyroid cancer will increase for many years to come. In addition to cancer, following the disaster, the number of pathologies in newborns also increased.
The norms produced by WHO have a substantial influence on the Ukrainian legal instruments in healthcare. The main document is the WHO Constitution, which is the foundation for building a healthcare system in each country. These principles are reflected in Art. 49 of the Constitution of Ukraine (“Everyone has the right to health care, medical assistance, and health insurance”) and the Ukrainian Law “Fundamentals of legislation of Ukraine on health care”. These acts are general and their norms are mandatory for all further acts that are legislated in the healthcare sphere.
In Ukraine, there are also a number of specialized legal acts that have a direct connection with the regulations of WHO. This means that the connection is enshrined by the description of the WHO regulations in the official Ukrainian legislation database (website of the Ukrainian Parliament). Meaning that these documents were used during the creation of Ukrainian legal acts. Thus, WHO documents such as “Good Pharmacy Practice – Standards for Quality Service”, “International Health Regulation”, “WHO Framework Convention on Tobacco Control”, “Charter of Paris Against Cancer”, have connections with a considerable amount of documentation on the national level and are included in national legislation.
Also, WHO acts can have an impact during judicial procedures for resolving disputes. While considering cases, judges often refer to WHO recommendations concerning classifications of diseases, scientific definitions and stages of diseases. Following an analysis of Unified Register of Court Decisions (http://www.reyestr.court.gov.ua/ ), as of July, 15th2019, there were 2,212 references to WHO, including 93 references in Administrative cases, 39 in Civil, 2,068 in Criminal, and 12 in Economic cases.
This deep embedding of WHO norms in the Ukrainian legal system began only recently, in 1991 when Ukraine achieved independence from the Soviet Union. But the history of cooperation between Ukraine and WHO is much deeper and began with the establishment of WHO in 1948. We can chart the history of this cooperation:
● 1948 – Ukraine becomes a member-state of WHO through an agreement signed on July 22nd, 1946,
● April 3rd,1948 – Ukraine joins the Statute of WHO,
● 1950-1991 – the period of inactive membership of Ukraine (as it was part of the USSR),
● 1992 – renewal of membership of WHO with the independence of Ukraine,
● 1994 – establishment of the WHO Country Office in Kyiv,
● 2016 – new period of cooperation between Ukraine and WHO, beginning of the reform of the healthcare system in Ukraine.
Until 1991, Ukraine’s membership in WHO was inactive for several reasons. First of all, Ukraine was part of the Soviet Union – a centralized country – so it could not act on its own behalf. While legally, after the amending of the Soviet Union Constitution, the Ukrainian Soviet Socialist Republic had the right to enter into a direct relationship with WHO, in practice, if it was not useful for the center, no relationship was created. Secondly, the Soviet Union had a particular healthcare system, built by Dr. Mykola Semashko, which was based on the following principles:
● centralized state subsidies for public health measures;
● free, affordable and equal medical care to all people with the principle of local provision;
● creation of the state system of sanitary institutions;
● common approaches in statistics and accounting for general population morbidity;
● implementation of information supporting of professional medical activities;
● systematic targeted training of medical personnel;
● development of medical self-government;
● setting up activities aimed at the prevention of diseases;
● public involvement in healthcare.
These principles were useful at the beginning of Soviet Union history. It was considered a big achievement that levels of health in the Soviet Union reached those of Western countries: according to the Great Soviet Encyclopedia, the average life expectancy in the country increased by 26 years over 1926–1972. Also, the USSR experiment in the field of public health had an impact on the formulation of healthcare in many countries: not only were the principles of Soviet health care used by other socialist countries, but the USSR actively participated as a founding member in the activities of the World Health Organization (WHO). However, by the end of the 60’s and the beginning of the 70’s, Semashko’s system started to become obsolete, as it caused the following problems:
- long queues in hospitals (people spent more time in the line than with doctor);
- free healthcare was a fiction – in reality, gifts and so-called “charitable” payments were used to receive standard health assistance. There was a stereotype among the people: “if you are ill – you need money… If your illness is serious – you need a lot of money”;
- hospitals and medical equipment were very outdated, and the government, instead of replacing them, compensated by increasing of number of medical personnel (and as a consequence the medical profession lost its prestige) and beds. According to the data in 1975 there were 24,250 medical institutions in the Soviet Union (in the Ukrainian Soviet Republic 4,122), 3 million beds (578,300 in the Ukrainian Soviet Republic) and 853,200 doctors and 2.5 million middle level medical personnel in the Soviet Union (157,100 doctors and 484,500 middle level medical personnel in the Ukrainian Soviet Republic).
After the collapse of the Soviet Union in 1991, Ukraine inherited its healthcare system, with all its advantages and disadvantages. After almost 25 years of independence, the health system was one of the most scandal-ridden (at the beginning of 2013, the country was shaken by scandal related to deaths following vaccinations of children) and was profitable for people who lead it. A criminal case against one of the previous Ministers of Health of Ukraine was launched in 2014 relating to the misappropriation of state money (about 342 million UAH), which the government had allocated for the purchase of medicines. The healthcare system was subject to a “cosmetic” reforms. Finally, Ukraine started cooperating with WHO independently and in a stable manner. All the main acts of WHO, such as Good Pharmacy Practice – Standards for Quality Service (1996), Charter of Paris Against Cancer (2000), WHO Framework Convention on Tobacco Control (2003), International Health Regulations (2005), were implemented in Ukrainian legislation. Also, every 2 years, Ukraine signs the Agreement on cooperation between the Ministry of Health of Ukraine and the Regional Office for Europe of the World Health Organization. Usually, this agreement consists of 2 parts: the first one highlights the priority directions of activity and development for a country’s healthcare system, the second one contains the information about the budget for performing these tasks. The Regional Office produces data and statistics on Ukraine (as well as for each of the 53 countries in the European region) as well as a publication on each country (Ukraine’s first publication was in 2005 “Highlights of health in Ukraine”).
Ukraine pays the compulsory membership fee (in 2019 it was 29 million USD) and it participates in the WHO General Assembly. From the WHO side, Ukraine can receive humanitarian and financial help when it is needed, also WHO actively works on the International program for overcoming the consequences of the Chernobyl disaster (with experimental projects on the subjects of hematology, the thyroid gland, oral hygiene, etc.).
A new period in the history of cooperation between Ukraine and WHO started in 2014. At the end of 2013 and the beginning of 2014, the corrupt regime of President Yanukovych and his supporters was overthrown. Since the beginning of the conflict on Ukrainian territory, WHO has provided 300,000 doses of vaccines with anti-paroxetine toxoid for people injured during the armed conflict in the East of Ukraine. In addition, WHO helped Ukraine to stop its poliomyelitis epidemic.
From 2016, the period of close cooperation between Ukraine and WHO began and it is connected with the appointment of Uliana Suprun to the chair of acting Minister of Health of Ukraine. In 2016, a total reform of the Ukrainian healthcare system began. The Ministry started the first stage of the project on the prevention of non-infectious diseases in cooperation with Regional Office. A number of courses were held on providing emergency medical healthcare, prevention of tuberculosis, etc. Also, the Ministry, in cooperation with Regional office, started the program “Не винна вагітність” (“Pregnancy without wine”) and actively works to reduce alcohol intake during pregnancy.
WHO is not only the main advisor in the total transformation of healthcare, but is also a big partner of Ukraine in the international arena.
On May 21st, 2019 in the framework of the general discussion on World Health Assembly, the head of the delegation of Ukraine to the 72nd Chief of the Secretariat of the World Health Organization, the Acting Minister of Health of Ukraine Dr. Suprun, made a speech. She emphasized that healthcare transformations are a benchmark for changes in her country, and reported that over the past 2.5 years the path to universal coverage of medical services and the implementation of the goals of sustainable development in Ukraine had radically changed due to the profound transformation of the principles of healthcare financing and the creation of the National Health Service of Ukraine. It was emphasized that these achievements took place in difficult conditions caused by Russian aggression against Ukraine. Recalling the more than 13,000 deaths as a result of the Russian liberation war, more than 1.5 million people forced to leave their homes, 70 political prisoners and 24 prisoners of war (Ukrainian seamen retained by the Kremlin), the acting Minister of Foreign Affairs called on the member-states of WHO and other international organizations to limit their cooperation with the Russian Federation.
Suprun asked that the sanctions regime against the Russian Federation (RF) be preserved and extended, until the withdrawal of its armed units from the temporarily occupied territories of Ukraine and the release of all Ukrainian prisoners of war and political prisoners.
On May 22nd, 2017, the Ukrainian delegation protested against the nomination of Veronika Scvortsova (the representative of Russian delegation in the General Assembly of WHO) to the Presidential chair of the General Assembly of WHO explaining that as “the representative of the Russian Federation, whose country is waging war against Ukraine, has no moral right to lead the Assembly of an organization aimed at preserving the life and implementation of the standards captured by the Oath of Hippocrates“.
These facts mean that WHO is, first of all, the organization that supports the development of public health in Ukraine, and that it is also an important international actor that can affect the political situation in Ukraine.
WHO actively supports the reform of the Ukrainian healthcare system. It periodically evaluates each stage of the reform, gives recommendations, actively cooperates in the prevention of tuberculosis, measles, cancer and HIV/AIDS. Meanwhile, Ukraine uses the recommendation of the WHO in the promotion of a healthy and active lifestyle.
This content has been updated on 10 June 2020 at 15 h 17 min.