Attachments
Summary
The Decentralization Reform and Healthcare Reform have been initiated in Ukraine in 2014/2018 and have been rolled out simultaneously over the past few years. The reform implementation has had a systemic impact on the access of the conflict-affected population to essential healthcare services in the Donetsk and Lugansk Oblasts. Given that these two oblasts have been facing the challenges of
conflict impact since 2015 and still remain accountable for the service delivery in the areas under the active conflict, the roll-out of reforms has been an additional factor of stressful transformation on the system and communities. The decentralization reform could have varying levels of success in achieving its intended effects on the healthcare system, such as equity in population health outcomes, health system efficiency, and health system resilience, including how community engagement influences these effects. It is important to understand the challenges of the process to optimize the positive and minimize the negative impacts of reforms on accessing the essential healthcare services by the conflict-affected population.
The difficulties faced by healthcare facilities and local authorities are the consequence of the natural process of change. In order to eliminate the negative consequences, it is extremely important to have a prompt response from both the legislative and executive branches of power. Taking into consideration the aforementioned, the need to refine the legislation by amending the existing statutes and regulations as well as the creation and adoption of additional statutes and regulations (1) are clear. It is also important to understand that the quality and accessibility of healthcare services in each community should be addressed separately. Demographic, environmental, infrastructural (and other) indicators must be taken into account together with the immediate needs of the population in order to ensure the effective work of the community healthcare system. Therefore, each community needs to be conscious and careful with the strategic planning of health programmes. The involvement of public activists and active participation of the population is a necessary component for creating accessible and effective healthcare for the population of the local community (2). It is important for healthcare managers to be aware of their role in planning healthcare programmes and to build the right dialogue with local health authorities (3). The role of humanitarian organisations should be focused on close cooperation with healthcare facilities and directly building the economic and human resource capacity of communities (4).