NEWS FROM UKRAINE - MEDICAL REFORMS BLOCKED, KUSHNER AND RUSSIA – WHY IT MATTERS, SUPPORT FOR UKRAINE HOLDING STRONG, MACRON TELLS IT LIKE IT IS...

03.06.17


UD. 3 June 2017.

By Iryna Terlecky.

Strange twists in the war against corruption and interesting views from the West.

Medical reforms blocked

One of the successes of the reform programme over the last year has been health reform under Ulana Suprun, the Ukrainian-Canadian Acting Health Minister. 

A key achievement was opening up procurement of medicines through the e-procurement Pro-Zorro system. 

This allowed a transparent system of tendering for medical supplies and cut out widespread collusion between bureaucrats and a small group of suppliers which had been a lucrative source of income for corrupt officials. 

According to statistics, around $4 million has already been saved with no reduction in the quantity or quality of supply.

A bigger challenge, however, has been to move away from inefficient funding and treatment mechanisms towards the system used in Canada and the UK, where funding follows the patient. 

The Health Ministry has a three-year healthcare reform plan that would bring Ukraine’s healthcare system more closely in line with European practices by transferring most patient care from hospital treatment to primary care and prevention, increasing the efficiency of healthcare spending, stimulating better practices among doctors and hospitals, and ensuring citizens’ access to a package of primary healthcare services free of charge.

Specific plans for 2017 include establishing contracting mechanisms for primary care in line with the principle “money follows the person,” and turning away from the current inefficient funding mechanism based on the number of hospital beds. 

All public healthcare services will be administered by one institution, the Public Health Centre, which will develop healthcare contracts with hospitals for budget-funded healthcare services - the equivalent of the NHS. 

Additionally, in line with the decentralisation reform being pursued by the current government, hospitals should begin to exercise greater local control over the healthcare systems servicing their communities. 

In 2016, reformers piloted a new system of primary care in Dnipro and Vinnytsia; doctors signed contracts with patients and funding was allocated based on the services provided. 

The pilot was widely seen as a success and further roll-out was planned for 2017.

However, the reform process has not been supported in all quarters: some doctors fear that the loss of hospital beds will result in job losses; there is considerable argument about the standards of treatment and approved medication that should apply; there are no reliable statistics to show that there will be enough trained staff to offer primary care services; and there is likely to be a funding gap. 

All of this resulted in the Ukrainian Parliament voting against putting four critical bills on medical reform onto the agenda. 

Interestingly, the highest support for the bills came from Yatseniuk’s Narodnyi Front party and the Samopomich party. 

Around half the MPs from the Poroshenko bloc voted for the motion to consider the medical reform bills, while all members of the Opposition bloc (ex-Yanukovych supporters) and the Tymoshenko bloc voted against.

Ulana Suprun and her team have been engaged in intensive talks with MPs of all parties, as well as holding meetings across the country and hosting a social media information campaign to allay some of the fears that have been expressed. 

There is renewed hope that the bills will be on the parliamentary agenda in the coming days and that they will be passed into law soon. 

Kushner and Russia – why it matters

Just as President Trump may have been hoping that press focus would turn away from the links between his campaign and Russia, and towards his first overseas visits, the Washington Post broke the story that Trump’s son-in-law, Jared Kushner, asked the Russians for a secret communications channel with the Kremlin.

According to intercepts of Russian communications reviewed by US officials, Russian Ambassador Sergey Kislyak reported to his superiors in Moscow that Kushner, made the proposal during a meeting in December at Trump Tower and suggested using Russian diplomatic facilities in the United States for the communications, in an apparent move to shield their pre-inauguration discussions from monitoring.

Reuters reported that Kushner had at least three previously unreported contacts with Kislyak both during and after the 2016 campaign. 

Then, The New York Times reported that federal investigators are trying to determine why Kushner met with Russian banker Sergey Gorkov shortly after the meeting with Kislyak, reported by the Washington Post.

Various media sources are speculating what this all means.  

The Economist has set out a potential ‘benign’ explanation – which even so has worrying implications. 

First is that the Trump transition team “…was so consumed with angry distrust of and contempt for the government of Mr Obama that they trusted Russian officials working for President Vladimir Putin more than they trusted any part of the American diplomatic or national security apparatus.” 

And second fear echoes continuing concerns about Trump’s motives on Ukraine, that Kusher was charged with exploring “…a grand bargain between America and Russia, perhaps involving Russian forces launching an unsqueamish, iron-fisted assault on Islamist terrorists in Syria, in exchange for Mr Trump granting Mr Putin a free hand in Ukraine and other bits of his backyard.”

We await developments from the Senate Intelligence Committee and the other committees that are investigating Russian interference in the US election and the various ties between President Trump’s team and the Russians. 

Support for Ukraine holding strong

In spite of concerns about the Trump administration and Russia, and new tensions emerging between the US and NATO and the EU, the statement issued at the end of the G7 meeting in Taormina reiterated continuing strong support for Ukraine. 

This was by no means a foregone conclusion, given that US Secretary of State Rex Tillerson had previously questioned why American voters should care about Ukraine. 

At the April meeting of G7 Foreign Ministers, French Foreign Minister Jean-Marc Ayrault said Tillerson had openly questioned why “American taxpayers” should be concerned about Ukraine. 

Ayrault told reporters that he had replied: “It is in the interests of the U.S. taxpayers to have a Europe that is secure and is strong politically and economically ... You don’t want a weak Europe, broken into bits and feeble.”

Amongst a host of other issues, G7 leaders reiterated support for Ukraine’s territorial integrity, stressed Russia’s responsibility for the conflict and raised the possibility of additional sanctions. 

The final communique stated:

“We stress the responsibility of the Russian Federation for the conflict and underline the role it needs to play to restore peace and stability. 

“We reiterate our condemnation of the illegal annexation of the Crimean peninsula, reaffirm our policy of non-recognition, and fully support Ukraine’s independence, territorial integrity and sovereignty. 

“We recall that the duration of sanctions is clearly linked to Russia’s complete implementation of its commitments in the Minsk Agreements and respect for Ukraine’s sovereignty. 

“Sanctions can be rolled back when Russia meets its commitments. 

“However, we also stand ready to take further restrictive measures in order to increase costs on Russia should its actions so require.”

Macron tells it like it is

Eyes turned to France, with President Putin’s first official visit. 

He drew the anger of Ukrainians everywhere by referring to Queen of France (1051-1065) Anna Yaroslavna – daughter of Yaroslav the Wise from whom all French Kings are descended – as Russian. 

Commenting on the ratification by the Dutch Senate of the Ukraine-EU Association Agreement, President Poroshenko said that Ukraine was being reunited with Europe. 

“It is a reunion, because historically we were part of it ... since the times of the ancient Ukrainian Prince Yaroslav the Wise and his daughter Anna who was born in Kyiv and whom just yesterday Putin tried to ‘kidnap’ in the eyes of all Europe for the sake of Russian history.” 

At their joint press conference, Macron was asked why he had denied access to some Russian news outlets at his campaign headquarters. 

With Putin standing next to him, he openly accused RT and Sputnik of lying and spreading misinformation. 

“…Russia Today and Sputnik have not behaved as media outlets and journalists but behaved as organs of influence, propaganda, and false propaganda.”

Macron and Putin also agreed on the need to restart dialogue on the war in Ukraine.

And finally…

With the Dutch Senate the last hurdle to ratification of the EU-Ukraine Association Agreement, the way has been cleared for the Agreement to come into effect, with its expected benefits for Ukraine’s trade with the EU and prospective further assistance on reform. 

However, despite all the assurances of Western support, the war in Eastern Ukraine continues. 

There is no reduction in the number of ceasefire violations, but there has been an alarming increase in attacks on civilian targets – though thankfully with no significant death toll in the last week. 

The last week has also seen celebrations all over the world, in the now traditional ‘Vyshyvanka day’. 

It has been widely reported that the turnout for the Vyshyvanka march in London was higher than in Kyiv and other Ukrainian cities. If true, that says a great deal about the Ukrainian diaspora in this country, and even more about Ukrainians in Ukraine…

 


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