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The Importance of Community Consultations for Generating Evidence for Health Reform in Ukraine
Abstract and Figures
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.
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... За даними Світового банку, Україна стикається з кількома проблемами, включаючи диспропорції в регіональному економічному та демографічному зростанні, а також фрагментовану систему фінансування регіонального розвитку. Крім того, дослідження показали, що консультації з громадою є ефективним способом зрозуміти потреби та досвід населення в Україні у сфері охорони здоров'я, який може інформувати про політику, пов'язану з економічним добробутом і зростанням [52]. ...
Мета роботи: полягає у висвітлені поглядів щодо наслідків впровадження деяких стратегем воєнної, економічної та політичної підтримки України до 2025 року підкріплених результатами експертного опитування. Акцент у статті здійснений на аналізі аргументів та контраргументів відповідних проаналізованих позицій фахівців. Метод дослідження: основними методами досліджень є методи: аналізу; синтезу; порівняння; формалізації та оцінювання матеріалу. Результати дослідження: висвітлення деяких актуальних науково-практичних стратегем відновлення України за рахунок воєнної, економічної та політичної підтримки її підтримки до 2025 року; розгляд можливих результатів їх імплементації з двох позицій (аргументи "за" та "проти"); отримання наукового обґрунтування можливої ефективності цих стратегем до 2025 року, з урахування результатів відповідного експертного опитування. Теоретична цінність дослідження: полягає у донесені до широкого кола науковців специфіки імплементації наявних стратегем воєнної, економічної та політичної підтримки, як частини Плану післявоєнного відновлення України – можливих позитивних та негативних наслідків впливу на економіку країни. Тип статті: теоретичний, описовий, практичний.
... Though much of intersectional exploration takes place at what Chan (2017) calls the macro-system level, there have been many calls to drive this analysis down to the micro, in terms of peoples' lives (for example, Hankivsky et al., 2017), to what Patil (2013) terms 'domestic intersectionality' and Avraamidou (2016) as life-history interactions. At this micro-level, intersectional analysis reveals complicated identity negotiations of being, for example, young, a woman, student, daughter, scientist, as well as how these identities interact, nest, and shift (Wells et al., 2015). ...
This paper studies intersectional multiplicity by encompassing the ways individuals shape relationships between social structures and their science identity. We discuss the science lives of two sixteen-year-old British South-Asian Muslim women studying in a single-sex independent school in London, both of whom aspire to science careers. Adapting McCall’s ‘intracategorical complexity’ in favouring a case study approach, we present the multiplicity of our participants’ relationships with exclusion and inequality, discrimination and privilege within their lived social settings, and how these relationships shape their identities and ambitions to become scientists. Our findings reveal that despite their similarities in their societally ascribed intersectional makeup, Ayesha and Hanya differ in viewing their intersections as challenges and/or opportunities. They both portray agentic control towards ‘going against the grain’ as future women scientists by negotiating their intersections as they develop their science identity.
... [1][2][3][4][5] Community consultations are one of the effective vehicles to educate policymakers and health-care professionals regarding important areas of perceived health-care needs for developing effective programs or policies. [6] Generating evidence requires a complex undertaking that calls for proven procedures and protocols and cross-disciplinary, cross-cultural expertise. An exchange of versions and views as part of the review process makes it easier to deal with regional variance, idiosyncratic interpretations, and inevitable oversights. ...
Background: Preventive dental visits help in the prior detection and treatment of oral diseases; therefore, to improve oral health outcomes, an opposite knowledge of the way the individuals use health services and the factors apocalyptic of this behavior is essential. Aim: To quantify oral health-care-seeking behavior and influencing factors in the field practice area. Materials and Methods: A cross-sectional study was done in the field practice area among WHO indexed age groups using a pretested and validated questionnaire in August 2017. A stratified random sampling technique was used resulting in a sample size of 200 to assess oral health-care-seeking behavior and influencing factors in this population. Obtained data were analyzed using SPSS version 20. Descriptive statistics, Chi-square test, and binomial logistic regression analysis were used to summarize the results, whereP ≤ 0.05 was considered as statistically significant. Results: The results of this study evinced a female preponderance of 64% with less proportionate (26%) of the study population seeking oral health services, out of which private dental clinic occupied the first choice in using dental services (17%). A carious tooth without pain was the most common dental problem irrespective of age (47.5%). Females were 0.392 times more likely to attend dental visits when compared to males (P = 0.003), while considering social class, people belonging to the upper-middle class were 0.24 times more likely to avail dental services when compared to lower social class (P = 0.015). Conclusion: This study revealed lower rates of dental services sought among the field practice area where most of them availed private clinics compared to government clinics.
... Needs for changes in the Ukrainian health care system A measure for a collapse in the Ukrainian health system is the epidemiological situation of the country's population, as well as changes that have occurred in its health status since the end of the Soviet era [14,16,17]. The Health for All database [18] reveals that mortality due to cardiovascular diseases in 1990 amounted to 589.03 deaths per 100,000 inhabitants in Ukraine. ...
Background: Ukraine, one of the largest states formed on the rubble of the Soviet Union, is widely perceived as a country that has lost its opportunities. Being devastated by corruption, it shows incapable to modernize and enter the economic path of sustainable growth. Similarly in the health care system no deeper reform efforts have been
taken in the entire post-soviet period, leaving the system in bonds of ineffective solutions taken out of the Soviet era.
Main body: The recent geopolitical and economic crisis seem to favor the introduction of radical solutions that might lead to a rapid change in the organizational paradigm of the economic system, as well as in health care in Ukraine. In this paper we aim to highlight the key features of the ongoing health reform in Ukraine, identify basic challenges for it, and assess rationality and feasibility of the reform. We found that the projected scope and schedule of changes in the
Ukrainian health system give promising prognosis regarding its final effect.
Conclusions: The final success of health reform in Ukraine is dependent on a number of factors, including the financial foundation arising of economic stability of the country, balance assurance between public and private spending for health and ability to eliminate the long-lasting practices, particularly when they are connected
with activities of lobbying groups occupying particular positions in the health system. A consequence of actions taken by the political decision-makers in the longer perspective are also to highly determine the reform’s chances for success.
... Given an intersec- tional approach, involving trans youth of color as part of an advocacy movement remains vital both to adhering to the core constructs of intersectionality and to reify the narratives and experiences of trans youth of color. This direction is increasingly consistent with consulting and collaborating with the communities standing at the fringes of marginality (Campbell, 2016;Hankivsky, Vorobyova, Salnykova, & Rouhani, 2017) to properly attain the relationship between policy-based problems and experiences of oppression. ...
The sociopolitical context surrounding the 2016 United States presidential election and the subsequent entrenchment of a Trump presidential administration have engendered radical changes within the social, political, and cultural protections and ramifications for transgender communities. More compounded by the linkages across multiple dimensions of social identity, trans youth of color uniquely navigate communities, resources, and contexts resulting in the complexities of oppression and resilience. Considering developmental stages of youth in association with cultural implications and resources, families as individuals and groups operate as substantial forms of allyship and solidarity. Pervasive issues relating to harassment, discrimination, incivility, and violence have historically marred the lives of trans youth of color. This article (a) illustrates the multitude of issues facing trans youth of color resulting from the 2016 election; (b) integrates families with ally development; (c) explicates the utility of approaches grounded in intersectionality theory; (d) applies salient arguments to a case example; and (e) discusses implications for research, practice, and policy.
Background
Knowledge management (KM) emerged as a strategy to promote evidence-informed decision-making. This scoping review aims to map existing KM tools and mechanisms used to promote evidence-informed health decision-making in the WHO European Region and identify knowledge gaps.
Methods
Following the Joanna Briggs Institute (JBI) guidance for conducting scoping reviews, we searched Medline, PubMed, EMBASE, the Cochrane library, and Open Grey. We conducted a descriptive analysis of the general characteristics of the included papers and conducted narrative analysis of the included studies and categorized studies according to KM type and phase.
Results
Out of 9541 citations identified, we included 141 studies. The KM tools mostly assessed are evidence networks, surveillance tools, observatories, data platforms and registries, with most examining KM tools in high-income countries of the WHO European region. Findings suggest that KM tools can identify health problems, inform health planning and resource allocation, increase the use of evidence by policymakers and stimulate policy discussion.
Conclusion
Policymakers and funding agencies are called to support capacity-building activities, and future studies to strengthen KM in the WHO European region particularly in Eastern Europe and Central Asia. An updated over-arching strategy to coordinate KM activities in the WHO European region will be useful in these efforts.
As the Ukrainian health care system undergoes reform, severe treatment gaps persist for those in need of mental health treatment. This study expands the limited knowledge of factors underlying treatment-seeking behavior. We sought to understand: What encourages or deters Ukrainians from seeking mental health treatment? In addition, among those who chose to seek treatment, what influences the type of treatment sought (conventional or alternative)? Alternative treatment is defined as treatment or counseling provided by spiritual advisers or healers, and conventional treatment is defined as formal treatment or counseling provided by mental health professionals or other health professionals. Using the 2002 Ukrainian version of the World Mental Health Composite International Diagnostic Interview—the only dataset of its kind available for a country that emerged from the former Soviet Union—this study explores the predictors of treatment-seeking behavior for mental health services. Results indicate that Ukrainians diagnosed with depressive, anxiety, or substance use related disorders are more likely to seek treatment, while those diagnosed with Intermittent Explosive Disorder are not. Current physical health issues are also associated with an increased likelihood of seeking treatment. Among treatment-seekers, individuals with stronger religious beliefs are more likely to seek alternatives than conventional forms of treatment. These findings contribute to the small body of research addressing treatment-seeking behavior and can further inform underlying patterns in treatment gaps in Ukraine.
South Africa’s interventions to address complex social challenges rely on coordination across several sectors and between different levels of government and society. Improved alignment, planning and coordination are needed when addressing the causal factors of these social challenges. These causal factors include the environments in which people live and their behaviours. Furthermore, emphasis is placed on the recurring engagement of civil society, especially of marginalized stakeholders, as participants in the efforts to address the challenges. The study draws from the promise shown by stakeholder networks, termed Innovation Platforms, in other Sub-Saharan Africa countries to address such complex social challenges. The study aimed to improve the understanding of how a stakeholder network’s engagement practices impact the effectiveness of the network. To this end, a conceptual framework and management tool for stakeholder engagement in IPs is proposed. The study followed the conceptual framework analysis procedure to develop, evaluate and refine the conceptual framework. The article describes the core research outcomes of the framework development approach, starting with a systematized literature review to identify core concepts, followed by interviews with experts and a case study to refine the framework content. The case study applied the framework to develop recommendations for improved engagement in a stakeholder network which has been established around the challenge of vagrancy in Stellenbosch, South Africa. The result of the approach is a multidimensional framework for conceptualizing stakeholder engagement practices in a variety of contexts. The focus of the framework content remains on the practices of engagement which enable effective and fruitful stakeholder interactions within and around a network. The study delivered valuable insights into the nature of some development initiatives in South Africa and the impact of stakeholder engagement on them.
Based on the experience of many countries in Europe and the advice of experts, this guide outlines some of the steps prison systems should take to reduce the public health risks from compulsory detention in often unhealthy situations, to care for prisoners in need and to promote the health of prisoners and staff. This especially requires that everyone working in prisons understand well how imprisonment affects health and the health needs of prisoners and that evidence-based prison health services can be provided for everyone needing treatment, care and prevention in prison. Other essential elements are being aware of and accepting internationally recommended standards for prison health; providing professional care with the same adherence to professional ethics as in other health services; and, while seeing individual needs as the central feature of the care provided, promoting a whole-prison approach to the care and promoting the health and well-being of those in custody.
This report, composed of 9 chapters, presents findings from the 2009/2010 survey of the Health Behaviour in School-aged Children (HBSC) study. This study examined demographic and social influences on the health of young people (aged 11, 13 and 15 years) in 43 countries and regions in the WHO European Region and North America. The children included in the study described their social context (relations with family, peers and school), physical health and satisfaction with life, health behaviours (eating patterns, tooth brushing and physical activity) and risk behaviours (use of tobacco, alcohol and cannabis, sexual behaviour, fighting and bullying). Statistical analyses identified meaningful differences in the prevalence of health and social indicators by gender, age group and levels of family affluence. The aim was to provide a rigorous, systematic statistical base for describing cross-national patterns, in terms of the magnitude and direction of differences between subgroups, thus contributing to a better understanding of the social determinants of health and well-being among young people, and providing the means to help protect and promote their health.
The pace of health reforms in Tajikistan has been slow and in many aspects the health system is still shaped by the countrys Soviet legacy. The country has the lowest total health expenditure per capita in the WHO European Region, much of it financed privately through out-of-pocket payments. Public financing depends principally on regional and local authorities, thus compounding regional inequalities across the country. The high share of private out-of-pocket payments undermines a range of health system goals, including financial protection, equity, efficiency and quality. The efficiency of the health system is also undermined by outdated provider payment mechanisms and lack of pooling of funds. Quality of care is another major concern, due to factors such as insufficient training, lack of evidence-based clinical guidelines, underuse of generic drugs, poor infrastructure and equipment (particularly at the regional level) and perverse financial incentives for physicians in the form of out-of-pocket payments. Health reforms have aimed to strengthen primary health care, but it still suffers from underinvestment and low prestige. A basic benefit package and capitation-based financing of primary health care have been introduced as pilots but have not yet been rolled out to the rest of the country. The National Health Strategy envisages substantial reforms in health financing, including nationwide introduction of capitation-based payments for primary health care and more than doubling public expenditure on health by 2020; it remains to be seen whether this will be achieved.
This analysis of the Ukrainian health system reviews recent developmentsin organization and governance, health financing, health care provision,health reforms and health system performance. Since the country gainedindependence from the Soviet Union in 1991, successive governments havesought to overcome funding shortfalls and modernize the health care systemto meet the needs of the population’s health. However, no fundamental reformof the system has yet been implemented and consequently it has preserved themain features characteristic of the Semashko model; there is a particularly highproportion of total health expenditure paid out of pocket (42.3% in 2012), andincentives within the system do not focus on quality or outcomes.The most recent health reform programme began in 2010 and sought tostrengthen primary and emergency care, rationalize hospitals and changethe model of health care financing from one based on inputs to one basedon outputs. Fundamental issues that hampered reform efforts in the pastre-emerged, but conflict and political instability have proved the greatestbarriers to reform implementation and the programme was abandoned in 2014.More recently, the focus has been on more pressing humanitarian concernsarising from the conflict in the east of Ukraine. It is hoped that greater political,social and economic stability in the future will provide a better environmentfor the introduction of deep reforms to address shortcomings in the Ukrainian health system.
This article presents an overview of disability rights issues in the context of state socialism in the former Soviet Union, especially the Russian and Ukrainian Soviet Socialist Republics. The Soviet state’s governmentality of disability, and the little-known history of Soviet-era disability rights movements, produced important legacies that shape disability policy and discourses, rights movements, and experiences of disability in the region today. By focusing on Soviet approaches to housing, education, rehabilitation, and work vis-à-vis people with disabilities, and documenting the varied responses of disability communities, this article contributes a missing Soviet chapter to the new disability history. This approach encourages readers to reconsider some assumptions about the evolution of disability rights outside the West. Especially, I interweave discussions of Soviet-era state policy with descriptions of people’s personal experiences to emphasize the ways that people with disabilities in the former Soviet Union have been active agents--if not organized advocates--across the 20th century.
This article describes the care structure set up progressively, over the past 25 years, in the psychiatric ward of Lille-Est hospital. This is an innovative project which conforms to the logic of WHO recommendations (declaration and plan of action on mental health "Facing the challenges, building solutions", January 2005). The essential priority is to avoid resorting to traditional hospitalisation by integrating the entire health apparatus into the city, via a network involving all interested partners: users, careers, families and elected representatives. The ambition of this neighbourhood service is to ensure the adaptation and non-exclusion of persons requiring mental health care and to fight against stigmatisation and discrimination.