Jarno Habicht is head of the World Health Organization’s (WHO) country office in Ukraine and is deeply familiar with the healthcare challenges faced in Europe, including those of eastern Europeans.
Habicht graduated from the medical faculty of the University of Tartu and holds a doctoral degree in public health. He has worked in Estonia’s public sector institutions and been with WHO since 2003. Before becoming Ukraine’s WHO representative, Habicht led WHO offices in Moldova and later in Central Asian states.
Closely acquainted with Ukraine’s healthcare decentralization reforms, and the country’s healthcare challenges, Habicht has personally visited many frontline areas and has even taken part in WHO discussions from bomb shelters during shelling.
Kyiv Post spoke to Habicht at Ukraine’s National Center for Radiation Medicine, which has worked in collaboration with WHO for many years and is developing strategies for responding to nuclear threats from the Russian Federation. For decades, the center has cared for the liquidators of the Chornobyl nuclear disaster.
We spoke with Habicht not only about healthcare reform in Ukraine, but the consequences that the on-going war will likely have on the health of Ukrainians and how those consequences might be overcome.
I’d like start from the beginning in terms of the role of WHO in the reform of Ukraine’s healthcare system. Have you seen progress? What has been done and what is still to do?
Firstly, it’s a pleasure talking to you and representing the World Health Organization. I look back on the reforms that began in 2016-2017 and, you know, Ukraine has got many elements right. This includes how to go about establishing a national health service, health financing arrangements, data systems, e-health, and primary care. So, from our point of view, the reforms have allowed the Ukrainian heath system to respond to the shocks of 2020 [COVID-19 pandemic] and 2022, during the full-scale invasion. What has happened since then and over the last three years means that much more needs to be done. We are seeing greater needs relating to mental health, trauma, surgery, rehabilitation, etc.
But still, the Ukrainian healthcare system has been trying to adapt to wartime?
Yes. In hospitals, much more emphasis has been placed on addressing antimicrobial resistance, how medicines and antibiotics are used, as well as surgery. So, the reforms are going in the right direction, but much more needs to be done. Our role is to be here, to support Ukraine to move forward, and to provide expertise. It’s important that, during wartime, reforms are continuing, and Ukrainians have [access to] all types of medical help and that the healthcare system is working.
A lot of Ukrainians in Europe, especially refugees, and also many Americans and Europeans for that matter, have said that the Ukrainian health system seems better to what they are used to. Why do you think that is?
Firstly, the world moves forward, and life is changing. Ukrainians deserve a better healthcare system and you can see the difference now between Kyiv, Lviv, other big cities and what we have in rural areas. So, I think reforms are concentrating on primary care. Also, Ukraine has a very large hospital network. In wartime, the effort of consolidating hospitals is important, and I’m encouraged by how the reforms are continuing.
When you ask me why Ukrainians are so disgraced by healthcare systems in the EU or US, you have to look to specifics. Take dental care, for example. Yes, a lot of Ukrainian refugees are returning home to have cheap and qualified dental care. It’s very costly in EU countries, but it’s also costly to people living in the EU. In many countries, dental care is not part of the [state] benefit package and can cause financial hardship. The other important aspect is culture and language. We see a trend of people often returning to their native country because it’s easier to get care there easily. So, you see, there are various reasons why.
It`s very good that Ukrainians can compare healthcare in other countries to that in Ukraine, and now they can draw their own conclusions about what they want to see from the reforms.
If it’s even possible, are there any positive outcomes from the full-scale invasion for Ukrainian medicine and healthcare?
We have many challenges. We’ve experienced over 2,300 attacks on healthcare, especially on facilities, and we’ve lost many healthcare workers during the on-ongoing war. A lot of healthcare personnel have moved from pre-frontline areas to the western regions of Ukraine, resulting in regional disbalance.
What is important is the Ukrainian healthcare system’s resilience, and it continues to provide services. In many spheres we see developments. For example, mental health services are now more widely available than in 2022.
Still, we need more – we’ve only just started.
More mental health workers? Yes, we do. We have trained over 100,000 mental health workers on MHGap [standards and practices in primary care], and the leadership of the First Lady All Ukrainian Mental Health Program in this area is important. Another area is rehabilitation. Now, as people have many different needs, we need to ensure that specialists are available and therapists are trained, ensuring that we have competent centers in various cities like Dnipro, Poltava, and Vinnytsia.
We need rehabilitation services not only in the west of Ukraine but also in Sumy and Zaporizhzhia. This area is developing fast to address the needs of veterans and trauma, but equally for those who suffer strokes and many other conditions, where rehabilitation supports people to be as active as possible in everyday life.
Besides trauma, other areas developing fast are emergency evacuations and saving lives. But all of the healthcare system is developing. We have new public health laws, including new laws on medicines, so parliament is taking steps to improve that. It’s not only about what happens in primary clinics but about the whole system moving forward. Efforts from healthcare workers on the front line, to the politicians and leaders, have ensured resilience in recent years.
Tell me about today. You presented new equipment for radiation measurement in the National Radiation Medicine Center. What is the importance of such scientific-medical facilities for Ukraine and what can they do?
Today, we are handing over equipment, including dosimeters, to the center. We have been collaborating over the last two decades. During the on-going war, many humanitarian organizations brought a lot of dosimeters here. So, we’re making sure that it’s a training center and that all personnel know how to use all kinds of equipment.
We gave more than 100 such centers equipment to work with. Since Feb. 24, 2022, centers like this have been working widely on chemical and radiological threads. This center has been a critical place of knowledge since the Chornobyl catastrophe, which happened 39 years ago. So, it offers research potential, but we need the younger generation to come to study. The training this week includes colleagues from Rivne, Khmelnitsky and Zaporizhzhia, who have come here to study.
What changes in the Ukrainian healthcare system do you expect to see after the war has ended?
Lately, many people have been thinking about the day after and what the future will bring. And I expect we’ll have more diseases. Currently, we have a lot of people who don’t care about their health because of war. They delay care, especially for chronic diseases, while many people can’t afford the care they need.
We have seen a demographic shift because 6.5 million Ukrainians who are not in Ukraine are mostly younger people. So, we will see more chronic diseases after the war. Another problem is that immunization coverage is decreasing. That means that we are more prone to diseases like diphtheria and measles, and overall vaccine-preventable diseases that we can avoid. However, the main problem is inequality between regions.
When I visit pre-frontline cities like Sumy, Zaporizhzhia, Kharkiv, etc., I see less healthcare workers there than in the western regions. So, we have to be sure that after the war ends, when people return to the cities, healthcare workers will too. It’s something we saw during the liberation of Kyiv region in April 2022, including in Bucha and Irpin. We need healthcare workers and services where people live, and this would also increase trust and provide additional security.
We’ll see challenges, but I believe, together, it is possible to address them. And finally, there will be fiscal pressures. The resources in the public sector are limited, but we need to ensure continuous financial resources for healthcare, as people already pay a lot out of their own pocket, and there is a need to ensure access to affordable and quality healthcare for Ukrainians.