1London School of Hygiene and Tropical Medicine, London, UK
2School of Public Policy, Simon Fraser University, Vancouver, BC, Canada
3Institute for Intersectionality Research and Policy, Simon Fraser University, Vancouver, BC, Canada
4Institute of Population Health, University of Ottawa, Ottawa, ON, Canada
Background The paper presents the results of community consultations about the health needs and healthcare experiences of the population of Ukraine. The objective of community consultations is to engage a community in which a research project is studying, and to gauge feedback, criticism and suggestions. It is designed to seek advice or information from participants directly affected by the study subject of interest. The purpose of this study was to collect first-hand perceptions about daily life, health concerns and experiences with the healthcare system. This study provides policy-makers with additional evidence to ensure that health reforms would include a focus not only on health system changes but also social determinants of health (SDH).
Methods The data collection consisted of the 21 community consultations conducted in 2012 in eleven regions of Ukraine in a mix of urban and rural settings. The qualitative data was coded in MAXQDA 11 software and thematic analysis was used as a method of summarizing and interpreting the results.
Results The key findings of this study point out the importance of the SDH in the lives of Ukrainians and how the residents of Ukraine perceive that health inequities and premature mortality are shaped by the circumstances of their daily lives, such as: political and economic instability, environmental pollution, low wages, poor diet, insufficient physical activity, and unsatisfactory state of public services. Study participants repeatedly discussed these conditions as the reasons for the perceived health crisis in Ukraine. The dilapidated state of the healthcare system was discussed as well; high out-of-pocket (OOP) payments and lack of trust in doctors appeared as significant barriers in accessing healthcare services. Additionally, the consultations highlighted the economic and health gaps between residents of rural and urban areas, naming rural populations among the most vulnerable social groups in Ukraine.
Conclusion The study concludes that any meaningful reforms of the health sector in Ukraine must include a broad range of factors, including the healthcare system but importantly, must extend to SDH approach and include the prioritization of health promotion, limiting alcohol and tobacco availability and enforcing environmental protection.
Antoun J, Phillips F, Johnson T. Post-Soviet transition: improving health services delivery and management. Mt Sinai J Med. 2011;8:436-448. doi:10.1002/msj.20261
Bazylevych MY, Hresanova E. Introduction: health and care work in postsocialist Eastern Europe and the former Soviet Union. Anthropology of East Europe Review. 2011;29:1-7.
Footman K, Bayard R, Mills A, Richardson E, McKee M. Public satisfaction as a measure of health system performance: a study of nine countries in the former Soviet Union. Health Policy. 2013;112:62-69. doi:10.1016/j.healthpol.2013.03.004
Peabody JW, Luck J, DeMaria L, Menon R. Quality of care and health status in Ukraine. BMC Health Serv Res. 2014;14:446. doi:10.1186/1472-6963-14-446
Tambor M, Pavlova M, Golinowska S, et al. The inability to pay for health services in Central and Eastern Europe: evidence from six countries. Eur J Public Health. 2013;24:378-385. doi:10.1093/eurpub/ckt118
Haerpfer C, Wallace CP. Health problems and the transition from communism in the former soviet union: towards an explanation. Perspectives on European Politics and Society. 2013;14(4):460-479.
Meslé F, Vallin J. Mortality and Causes of Death in 20th-Century Ukraine. Heidelberg: Springer; 2012.
Murphy A, Levchuk N, Stickley A, Roberts B, McKee M. A country divided? Regional variation in mortality in Ukraine. Int J Public Health. 2013;58(6):837-844.
Stickley A, Koyanagi A, Roberts B, et al. Loneliness: its correlates and association with health behaviours and outcomes in nine countries of the former Soviet Union. PLoS One. 2013;8(7):e67978. doi:10.1371/journal.pone.0067978
Hinote B, Cockerham W, Abbott P. Post communism and female tobacco consumption. Eur Asia Stud. 2009;61(9):1543-1555.
Hinote B, Cockerham, W, Abbott P. The specter of post-communism: women and alcohol in eight post-Soviet states. Soc Sci Med. 2009;68(7):1254-62.
Cockerham W, Hinote B, Abbott P, Haerpfer C. Health lifestyles in Ukraine. Sozial and Preventiv Medizin. 2005;50:264-271.
Roberts B, Abbott P, Mckee M. Changes in the levels of psychological distress in eight countries of the former Soviet Union. J Public Health Med. 2012;11(3):141-152.
Roberts B, Abbott P, Mckee M. Levels and Determinants of Psychological Distress in Eight Countries of the Former Soviet Union. J Public Health Med. 2010;9:17-26.
Cockerham W, Hinote B, Abbott P. Psychological distress, gender, and health lifestyles in Belarus, Kazakhstan, Russia, and Ukraine. Soc Sci Med. 2006;63: 2381-2394. doi:10.1016/j.socscimed.2006.06.001.
Tarantino L, Chankova S, Rosenfeld J, Routh S, Preble E. Ukraine Health System Assessment 2011. Bethesda, MD: Abt Associates Inc, Health Systems 20/20 Project; 2011.
Bazylevych M. Who is responsible for our health? Changing concepts of state and the individual in post-socialist Ukraine. Anthropology of East Europe Review. 2009;27:65-76.
Polischuk M. Challenges of the System Transformation (Vyklyky Transformatsiyi Systemy – in Ukrainian). Report of the Minister of Health of Ukraine. National University of Kyiv-Mohyla Academy; 2005.
Stepurko T, Pavlova M, Levenets O, Gryg I, Groot W. Informal patient payments in maternity hospitals in Kiev, Ukraine. Int J Health Plann Manage. 2013;28(2):e169-e187. doi:10.1002/hpm.2155
Abbott P, Sapsford R. Life-satisfaction in post-Soviet Ukraine. J Happiness Stud. 2006;7(2):251-287.
Murphy A, Roberts B, McGowan C, et al. One for all: Workplace social context and drinking among railway workers in Ukraine. Glob Public Health. 2015;10(3):391-409. doi:10.1080/17441692.2014.979856
Abbott P, Wallace C. Talking about health and well-being in post-Soviet Ukraine and Russia. Journal of Communist Studies and Transition Politics.2007;23(2):181-202. doi:10.1080/13523270701317455
Jeffries I. The Countries of the Former Soviet Union at the Turn of the Twenty-first Century: The Baltic and European States in Transition. London: Routledge; 2004.
Yanitsky O. Sustainability and risk: the case of Russia. Innovation. 2000;13:265-277.
World Health Organization (WHO). Closing the Gap in a Generation. Health Equity through Action on the Social Determinants of Health. Geneva: WHO; 2008.
Dickert N, Sugarman J. Ethical goals of community consultation in research. Am J Public Health. 2005;95(7:1123-1127
World Health Organization (WHO). The World Health Report 1996. Fighting disease. Fostering development. Geneva: WHO; 1996. http://www.who.int/whr/1996/en/. Accessed March 14, 2015.
Lekhan V, Rudiy V, Nolte E. Health care systems in transition: Ukraine. Copenhagen: WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies; 2004.
Mackenbach JP, Murphy A, McKee M. Ukraine: not only a matter of geopolitics. Lancet. 2014. pii: S0140-6736(14)60425-6. doi:10.1016/S0140-6736(14)60425-6
Salo ІА, Shvab ОV, Yeresko NМ, et al. Ukraine: Monitoring the Implementation of UNGASS Goals on Sexual and Reproductive Health: Analytical Survey. Kyiv: Engineering Ltd; 2010.
Venkatesan C, Abraham, KK. ‘If We Involve, Will They Contribute?’: Involvement of People Living with HIV in Policy and Program Decision-Making. A Qualitative Situation Assessment of Greater Involvement of People Living with and Affected by HIV/AIDS (GIPA) in Five Indian States. India: Indian Network for People Living with HIV/AIDS; 2010.
World Bank. An Avoidable Tragedy: Combating Ukraine’s Health Crisis. Lessons from Europe. Kiev: World Bank; 2009.
Hankivsky O, Vorobyova A. 2014. Health care delivery system: Ukraine. In: The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society. Wiley Blackwell; 2014:889-894.
O’Mara-Eves A, Brunton G, McDaid D, et al. Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis (Public Health Res). Southampton (UK): NIHR Journals Library; 2013.
Arora NK, McHorney CA. Patient preferences for medical decision making: Who really wants to participate? Med Care. 2000;38:335-341.
Gilmore AB, McKee M, Rose R. Determinants of and inequalities in self-perceived health in Ukraine. Soc Sci Med 2002;55:2177-2188.
Bakirov V, Danilenko I, Kizilova K, Kuzina I. General condition and social determinants of health of the population of Ukraine. In: Brigadin P, ed. Health of Populations and Social Transformations in the Post-Soviet States. Minsk; 2013:325-351.
Kizilov A, Malikova N, Rapoport A, Tereschenko E. Health care system of Ukraine: main tendencies of development. In: Brigadin P, ed. Health of Populations and Social Transformations in the Post-Soviet States. Minsk: 2013:306-325.
Balabanova D, Bayard R, Richardson E, McKee M, Haerpfer C. Health care reform in the former Soviet Union: beyond the transition. BMCHealth Serv Res. 2012;47:840-864. doi:10.1111/j.1475-6773.2011.01323
Danyliv A, Stepurko T, Gryga I, Pavlova M, Groot W. Is there a place for the patient in the Ukrainian health care system? Patient payment policies and investment priorities in health care in Ukraine. Society and Economy. 2012;34: 273-291.
Stepurko T, Pavlova M, Gryga I, Groot W. Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments. BMC Health Serv Res. 2010;10:273. doi:10.1186/1472-6963-10-273
Luck J, Peabody JW, DeMaria LM, Alvarado CS, Menon R. Patient and provider perspectives on quality and health system effectiveness in a transition economy: evidence from Ukraine. Soc Sci Med. 2014;114:57-65. doi:10.1016/j.socscimed.2014.05.034.
Currie C, Zanotti C, Morgan A, et al. Social determinants of health and well-being among young people. health behaviour in school-aged children (HBSC) study: international report from the 2009/2010 survey. Copenhagen: WHO Regional Office for Europe; 2012.
Mishler W, Rose R. Trust, distrust and skepticism: popular evaluations of civil and political institutions in post-communist societies. J Polit. 1997;59:418-451.
Pehlivanova P. The decline of trust in post-communist societies: the case of Bulgaria and Russia. Contemporary Issues. 2009;2:32-47.
World Health Organization (WHO). Health 2020: A European Policy Framework and Strategy for the 21st century. Copenhagen: WHO; 2013.