Health care reforms slipped into critical condition on July 2 when Health Minister Alexander Kvitashvili resigned amid criticism over his work performance.
Facing accusations by the President Petro Poroshenko’s parliamentary faction, the lead party in the ruling coalition, for stalling changes, the legislature’s health committee decided to put his dismissal to a vote on July 2.
Instead, the former Georgian health minister quit, saying he did not wish to “get on the nerves” of lawmakers and wanted ensure the adoption of his team’s bills to improve health care.
“I didn’t overestimate myself – I underestimated the barriers,” Kvitashvili said during a press briefing on July 2.
He said he hoped the reforms would go on without him, and promised to provide any assistance and advice his successor might require.
Kvitashvili drew the most stinging criticism for delays in drug procurement: He had said that new national tenders to buy drugs for the state health system would start in April, but they are yet to be held.
Another pledge, to have international non-profit organizations purchase medicine for the state, has not started yet. The main law was passed, but not the requisite supporting secondary legislation crucial for implementation.
“The Health Ministry is frozen,” resisting and delaying taking action, head of the Patients of Ukraine charity foundation Dmytro Sherembey said at a press conference on April 29. Another critic, Vitaliy Shabunin of the Anti-Corruption Action Center, said that “the Health Ministry is dragging its feet on drugs procurement,” and Kvitashvili’s resignation “is long overdue” because of the absence of reform.
Slow-moving bureaucracy beyond the control of Kvitashvili was to blame, the health ministry said. Procedural regulations for the international procurement system are still circulating for approval in various agencies and ministries, Deputy Health Minister Ihor Perehinets told the Kyiv Post. He said he expects all the final approvals to come in the next three weeks.
“In the current circumstances the process is going as well as it can,” he added.
Another key component – the list of drugs to be purchased – should be drawn up by the end of this week, Perehinets said. Bids will be accepted in two weeks.
Officials say they’ve established clear rules and procedures for holding them, and they are encouraging all potential suppliers to apply, promising a fair and transparent process in which all bids will be properly considered.
Specialists from the European Commission will start working with the ministry on a new tender procedure in September.
Most of the work done to date to change the healthcare system has been preparatory since it hasn’t been reformed since 1991. The work is still essential if comprehensive reform is to proceed, Perehinets said.
That is the reason for the lack of visible results and delays, but now “there has been sufficient progress, and there are prerequisites for conducting serious and dramatic changes in the near future,” the deputy minister said.
Part of the problem is that system has to keep providing essential medicine and services, while at the same time undergoing a complete overhaul.
Another complaint about the ministry concerns drugs for HIV-positive patients that were ordered in 2014 but have not yet been fully supplied. According to Shabunin and patients’ organizations, this could soon leave 30,000 HIV-positive patients without drugs vital for their treatment.
Fiolis, a pharmaceuticals company earlier known as Vektor Pharma, was contracted to purchase the drugs and received the full payment of Hr 52 million ($3.3 million) from the ministry in December 2014. The company then had 180 days to fulfill the order, but failed to do so, blaming currency restrictions and a hike in the exchange rate. It is now suing the ministry, asking for an additional Hr 10 million to cover losses from the 40 percent devaluation of the hryvnia since December.
Fiolis has so far transferred only Hr 10 million to the Indian producer, Ranbaxy Laboratories Limited.
“This is a total disaster that Ukraine has not experienced since 2003, when the first HIV/AIDS treatment programs were starting,” said Volodymyr Zhovtiak, chairman of All-Ukrainian Network of People Living with HIV/AIDS.
Patients are at risk of not receiving treatment if the situation isn’t resolved by the end of July, said Zhovtiak.
However, Perehinets says the situation is now under control. Fiolis will now continue paying in installment, while Ranbaxy also agreed to somewhat reduce its prices to decrease Fiolis’s exchange-rate-related losses. One of the three drugs has already been supplied in full, although patients claim this is not enough for uninterrupted treatment. The next delivery is expected in ten days, as Fiolis paid the maker another $285,000 on June 30.
“All regions are provided with drugs at least until the end of July – there will be no treatment interruption,” Perehinets said.“People
will not be left without treatment” later either.
The ministry’s back-up plan includes the redistribution of existing stocks of drugs to the regions, obtaining drugs from the prison healthcare system, and getting emergency supplies from the Global Fund. The U.S. government has also agreed to give an additional $7 million for urgent procurement.
Kyiv Post staff writer Olena Gordiienko can be reached at [email protected].
