UD. 12 November 2016.  

By Iryna Terlecky.

Important steps forward on reform but no peace in sight.

Radical healthcare reforms

Since the collapse of the Soviet Union, Ukraine’s health care system has been characterised by inadequate government funding, which has left doctors without a living wage and fuelled widespread corruption, where bureaucrats have embezzled resources and only those who can afford to pay or bribe their way through the system receive the treatment they need.  

Acting Health Minister, American-Ukrainian Ulana Suprun, who has already made her mark with measures which have unblocked imports of medications, an overhaul of emergency services and a nationwide child vaccination campaign, has driven approval by the Cabinet of Ministers to a National Health Reform Strategy – a series of new measures set to come into force in January 2017. 

These are designed to eliminate the corruption of intermediaries and introduce direct payments to doctors depending on the type of services provided and the number of patients treated.

Doctors will be paid through a new state medical insurance body, modelled on the United Kingdom’s National Health Service. 

A family doctor will receive an average of Hr 210 or $8 for every patient per year on top of their salary, while hospitals will be given more financial freedom to use unused funds to purchase medication or new equipment.

According to the National Health Reform Strategy, the new health insurance will be funded by the state and will be provided regardless of an individual’s place of residence or financial status, which means that those internally displaced because of the war in Eastern Ukraine will automatically receive cover.

The insurance will also cover patients with tuberculosis, HIV/AIDS, drug addiction and hepatitis. 

This in itself is a major step forwards given that those with HIV/AIDS and addiction problems have consistently found it most difficult if not impossible to receive the treatment they need.

Stimulating competition is seen as a cornerstone of the new strategy.  Starting in early 2017, all patients will be able to choose amongst a list of primary care doctors with whom they will be required to sign a contract. 

Officials say that stimulating competition between individual care providers will drastically improve the quality of medical services and allow doctors to earn higher salaries as well as additional bonuses for the services provided.

In addition, Ukraine’s regions will receive tertiary-care facilities to provide intensive care treatment and emergency services, with the aim of ensuring that patients are no more than an hour away from such a facility. 

Visa-free travel to the EU

The prospect of visa-free travel for Ukrainians and Georgians to the European Union has been blocked by an internal EU dispute, fuelled by the rise of ultra right-wing parties in several European countries. 

The anti-immigration stance of these parties led to France and Germany, amongst others, to require stronger controls which would allow the visa exemption to be stopped in certain circumstances.

Agreement on a mechanism for suspending such visa waivers in emergencies ends mounting embarrassment for some EU leaders who felt the EU was reneging on pledges to ex-Soviet states it has promised to help as they try to move out from Moscow’s sphere of influence. 

The prospect of easier travel to Western Europe has been used by governments in both Kyiv and Tbilisi to win popular backing for painful, EU-sponsored reforms. 

But EU leaders backtracked about opening doors to Ukrainians after the public backlash which followed last year’s refugee crisis.

Diplomats and lawmakers finally struck a deal on 8 December to end the dispute. 

Late-night talks resulted in the European Parliament conceding that governments can reimpose visa requirements quickly, and without the EU Parliament’s approval.

“Europe is delivering,” the conservative leader in the EU legislature, Manfred Weber, tweeted after the deal.

The deal will now allow the European Commission or a majority of EU states to suspend swiftly a country’s visa exemption for nine months if there is a sharp rise in its citizens overstaying their permitted time in the EU, making multiple asylum requests or creating other problems for the Europeans.

The EU would be able to extend the suspension period for a further 18 months in some cases, but through a more complex procedure that would also give a say to the European Parliament.

President Poroshenko said that the deal was ‘encouraging news’, but it is worth noting that the UK is not a party to the deal and will continue to impose its own visa requirements on Ukrainians – a process which is not likely to become easier as the country moves closer to Brexit.

The Onyshchenko tapes

On 6 December, exiled Ukrainian member of Parliament Oleksandr Onyshchenko released the first of a series of audio recordings he claims prove President Petro Poroshenko and his inner circle are corrupt.

Onyshchenko was a member of an offshoot party from former President Yanukovych’s party of the Regions, who was charged by The National Anti-Corruption Bureau with stealing Hr 1.6 billion ($64 million) from state-owned gas producer Ukrgazvydobuvannya. He denies the charge but fled Ukraine before he was stripped of his parliamentary immunity in July.

In the recording, Onyshchenko and fellow party member Oles Dovhiy, described as representing Poroshenko, discuss the possibility of Onyshchenko reaching a plea bargain with Ukrainian authorities. 

Onyshchenko told that the plea bargain would be reached in exchange for him writing off Poroshenko’s alleged $50 million debt to him. 

Onyshchenko claims that the meeting between them took place on 6 September in London and was recorded on audio and video by British detectives. 

He also claims that another negotiator from Poroshenko demanded $2 million to be paid to Poroshenko for the plea bargain to be allowed.

Onyshchenko said on 1 December that he had given U.S. authorities evidence of the alleged corruption of Poroshenko and his inner circle, including audio recordings, text messages and documents. 

On the same day, the Security Service of Ukraine started a treason case against Onyshchenko.

Onyshchenko has said he had been an intermediary in Poroshenko’s alleged efforts to bribe members of parliament and to organize a smear campaign against ex-Prime Minister Arseniy Yatsenyuk before Yatsenyuk quit in April. 

He has also accused Poroshenko of extorting money from businesses and politicians, raiding companies and trying to monopolize the media by negotiating to buy television channels. 

Other accusations include alleged payments to Onyshchenko to bribe local electors to vote for candidates allied to the President.

Ukraine’s Prosecutor General’s office has filed a formal case against Onyshchenko and urged him to provide all the documents and evidence which he is systematically releasing to the press, and also to return to Ukraine to be questioned in person. However, this is unlikely to happen. 

With President Poroshenko’s approval ratings plummeting, and increasing popular discontent with progress on combatting corruption, the accusations are likely to dominate the news and have the potential to reduce still further the confidence of Western partners.

High tech shelter for Chornobyl reactor

On 29 November, officials from all over the world gathered about a football field away from the Chornobyl site to celebrate the final placement of a massive, high-tech shelter over reactor 4, which exploded in April 1986.

The original structure encasing reactor 4 was hastily built and risked corrosion and leaking that could lead to renewed contamination of water or air at any time. 

By the late 1990s, parts of the structure risked “imminent collapse” according to the European Bank for Reconstruction and Development (EBRD), which has funded the new high-tech shelter that will encase the original one. 

Emergency repairs were made, but it wasn’t until 2004 that the site received the necessary equipment to do biomedical screening and conduct construction activities in a way that would minimize harm to workers. 

To make matters worse, according to the EBRD, radioactive water was present in the shelter basement and concerns were growing that the contaminated water would leak into the nearby Dnipro Basin. 

In 2010, an automated monitoring system was added to monitor the water situation.

Experts are confident that the radioactive water will dry out, and the double walls of the shelter are guaranteed to prevent any radiological releases for the next 100 years. 

Besides also keeping out any rain or snow and providing a barrier against extreme hot or cold, the external cladding will be able to withstand a class 3 tornado or a 6.0 magnitude earthquake. 

The structure’s internal wall is smooth to “minimize the risk of dust deposition and accumulation,” according to the EBRD, and it’s made of corrosion-resistant, fire-resistant, and non-magnetic steel.

As we go to press…

President Poroshenko has announced that the death toll from the Russian war in Eastern Ukraine has topped 10,000, with OSCE monitors recording flare-ups of shooting each day. 

While moves are being revived for prisoner exchanges between the Ukrainian government and Russian-backed separatists, the situation remains fragile and uncertain, with the risks for civilians showing no signs of lessening.


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