Fighting for the future: Experts discuss health care, education and media reforms
Health care reform
The moderator of the discussion, Svitlana Bubenchykova, independent expert, started the conversation with the industry budget for 2021. It amounts to UAH 123 billion, which is 6% more than in 2020. Discussions covered the search for sources and mechanisms for additional funding, the necessary legal framework, the potential of public-private medicine partnerships, public health initiatives and medical education.
Mykhailo Radutskyi, MP, Head of the Parliament Committee on Public Health, Medical Assistance and Medical Insurance, noted that without sufficient funding it makes no sense to talk about health care reform. According to him, the COVID-19 pandemic showed miscalculations and needs for reform.
Suggestions for raising additional funds:
- introduction of separate address excises on strong alcoholic beverages and tobacco products (including electronic);
- provided 25% for health care in the law on legalization of gambling;
- share from the Large-scale Privatization Program;
- Institute of surcharges – a bill is being prepared, which regulates the system of surcharges and co-payments, paid medical services, voluntary contributions and insurance, etc.
According to the people’s deputy, given the global crisis and pandemic with the help of these sources, the required 225 billion UAH in 2021 will not work, but expect 2022.
Elina Dale, Adviser on Health Policy at World Health Organization Representative in Ukraine, noted that in the light of world experience, common taxes should be part of the path to universal health care, and states should find this path. Excise taxes are supported by the WHO. There is also an option of voluntary additional insurance.
“The key lesson for all countries in the world is not to rely on voluntary health insurance to provide financial protection for your population and access to quality services,” she said.
Mykhailo Radutskyi called for tax benefits and an explanation of why such insurance is needed as the only incentive for voluntary health insurance. The speaker also said that the important reform law draft №4142 “On Public Health” is ready for the first reading, designed to rebuild the system. The People’s Deputy noted that he supports the system of additional payment for services, as it works in many countries: the state guarantees high-quality affordable service, but if the patient wants an additional service – he must pay extra.
“The best public-private partnership can be in concessions. When the state remains the owner and thus does not violate the Constitution. When the network does not shrink, does not change the profile, but an investor comes who wants to renovate the hospital, buy additional equipment and thus earn more and fulfill orders of the National Health Insurance Fund and the Ministry of Health, it is the only working mechanism, “said Mykhailo Radutsky.
Relevant relationships in medicine are possible thanks to the updated Law “On Concession”. [Concession – is an agreement on the transfer of natural resources, enterprises, other economic objects belonging to the state or territorial community, for temporary operation to other states, foreign firms, individuals – RPR Coalition].
Andriy Vilensky, Head of the National Health Service of Ukraine, noted that in addition to increasing funding for the Health Guarantee Program, the reform requires changes in the behavior of service providers, teams and patients.
“In the first stages of the reform, we said that institutions should get used to the new form of relations with the National Health Insurance Fund, work with contracts, to the form of payment for work performed. Next we need to talk – primarily in the interests of patients – to use tools to improve the quality of care. We propose to take into account the quality indicators – the coefficient for the next year in the tariff for the payment of services for primary health care. ” An internal discussion is currently underway to calculate it, the speaker said.
The head of the National Health Service of Ukraine (NHSU) added that the process of replenishment / reorganization of institutions that do not meet the requirements for the provision of relevant services is underway. Complaints are actively monitored. “We see 2021 as a year of e-health development, as well as a year of actual monitoring for patients’ rights.”
In addition to specific issues in the field, the speakers spoke about the general vision of the system in Ukraine. In particular, Elina Dale first noted that many countries are reforming the medical sector in the same way. In order to implement the plan, funding is needed first; to this end, the Ministry of Finance, the Ministry of Health and the government must be allies, the quality of services must be improved to encourage voluntary insurance, and the system of taxation and distribution of budget funds must be improved. The speaker called Ukraine’s desire to ensure equal rights for citizens an achievement. According to Elina Dale, the second phase of the reform failed to some extent, in particular due to the pandemic, but the Minister and the system were able to adapt to the changing situation. The expert stressed the importance of considering institutions at all levels as a single system in accordance with the 2030 Strategy, clearly dividing roles between institutions, as well as harmonizing health care reform with decentralization reform.
Andrii Skipalsky, Head of the Board, NGO “Life”, noted that the mentioned bill №4142 is the highest priority and should be considered as a basic law for building the public health system. The speaker outlined the public’s attitude to the reform and drew attention to the problem of prevention: “Politically, everything is very right. Structurally – you need to invest a lot in the prevention and prevention of disease, maintaining duration and increasing quality of life. How to do it is a big challenge, and it should be part of the reform. “
What to do next: the Public Health System Act, the Biosafety and Biosecurity Act, the Blood Safety System, the implementation of the Tobacco Directive.
Olena Kucheruk, Public Health Program Expert, International Renaissance Foundation, singled out the launch of a public health system made possible by the reform. She emphasized:
- It is important to maintain system networking, especially in a decentralized environment.
- Prevention of non-communicable diseases should be one of the key priorities.
- As part of the public health system, it is important to carry out epidemiological surveillance.
The speaker stressed that over the past 5-10 years, views, prejudices and myths against vaccination and immunoprophylaxis have become popular. They can stand in the way of victory in a pandemic. According to Olena Kucheruk, the role of governments and the responsibility of the media are important in counteracting these views.
Tetyana Yurochko, Professor at the School of Public Health at National University of Kyiv-Mohyla, said that a breakthrough and a challenge in building a public health system is the introduction of this specialty in educational institutions.
“International standards of training, the establishment of criteria for evaluating graduates of programs – is a way to ensure the quality of these personnel,” – said the speaker.
To this end, an English-language master’s program in global health is currently being developed, which aims to raise European standards, ensure the exchange of speakers and teachers during the educational process, and establish a process of joint research. Tetyana Yurochko noted that the demand for quality managers of the healthcare system is growing, so educational institutions should establish cooperation with the Ministry of Health, the Ministry of Education and Science and medical institutions.
The moderator Mykola Skyba, expert of the Education and Skills of the Future programme at the Ukrainian Institute for the Future, noted the key topics of discussion: harmonization of legislation with the challenges of time, quality of pedagogical education, and linkages between the labor market and education.
Volodymyr Bakhrushyn, Independent Expert, Doctor of Physics and Mathematics, professor , noted that changes in the education system should be coordinated with economic strategy and international standards. The expert noted that in recent years the key problems of education could not be solved, but significant steps have been taken in this direction. In particular, the adoption of the law “On complete general secondary education”. In order to train modern professionals, the system must modernize the content of education, strengthen material and financial support, links with business, the labor market and other sectors of the economy. Currently, there is no common systemic vision among educators.
Andiy Vitrenko, Deputy Minister of Education and Science of Ukraine, noted that the ministry’s team is not going to stop any reforms. He recalled 5 key priorities: preschool, New Ukrainian School, vocational education, higher education and adult education, Ukraine’s involvement in the Euro-Atlantic scientific environment. The speaker added to them the granting of greater autonomy to institutions and work with children from the temporarily occupied territories, as well as the willingness to cooperate for the development of the national education system.
Serhiy Babak, MP, Head of the Parliament Committee on Education, Science and Innovations, said that the amendments to the law on higher education and the renewal of the law on general secondary education laid the foundation for qualitative changes in the two parts. The speaker stressed the need for continuity of both the education of the citizen and the reform of its system. Innovations in this direction are already included in the legislation, such as formulas for financing higher education institutions, KPI for heads of higher education institutions, introduction of indicative cost of education, etc. Promising draft laws in the parliament – on vocational education, on vocational education; working groups are working to develop initiatives for preschool and adult education. According to the people’s deputy, the parliament should not slow down, and the government should increase the pace in order to pilot new high schools from 2024.
Iryna Zhdanova, Executive Director of the Open Policy Foundation, praised the progress in reforming the education system. She noted that the results of the reform can be measured in a few years. The speaker compared the reform of education in Ukraine with a startup in terms of experiments, examinations and testing of ideas and stressed that stories of success and mistakes are important.
- During the war, distance learning was the most effective means of providing access to education for students from the temporarily occupied territories. The speaker welcomes the changes in the regulatory framework.
- The quality of content and methods, love and enthusiasm of teachers are the main indicators for determining the effectiveness of distance, non-distance and blended learning. The speaker praised the association of educators in the regions who support the reforms, despite the significant number of conservative educators who see only shortcomings in the reform.
- A positive factor is more involvement of parents in the educational process. This created an opportunity for a better examination of the process. The expert supported the thesis voiced by the majority of speakers about the importance of involving all stakeholders, including parents, in the process of creating a quality education system.
The biggest challenges, including secondary education, remain online management, technical support and teachers’ willingness to change. The main problem of the reforms, according to the speaker, is the “bricks of distrust” and narratives of disunity in society.
Svitlana Suprun, Civic Education Expert at Pact/ENGAGE, noted that during the 4 years of the MES project, it was open to international cooperation, study of world experience and implementation of best practices.
The speaker praised the introduction of a remote online school as a quick response to the closure of schools in a pandemic. Then the community began to develop online courses in various areas to make the school and teachers better prepared for the lockdown. However, in this process, according to the expert, the Ministry of Education and Science and the government should work better. It is about waiting for a single online platform, which as of September 1 has not been created. Currently, this platform is created and filled with content – said Andiy Vitrenko.
Svitlana Suprun stressed the importance of monitoring the impact of the reform on the education system and communicating the results of such observations with citizens.
Under the chairmanship of moderator Andrii Kulakov, programme director at the Internews-Ukraine, experts discussed the state of harmonization of Ukrainian legislation with the international one, assessed the progress of the reform, and outlined the next desired steps of the authorities. The key issues are the financing of the Public Broadcaster, the regulation of online media, control over the transparency of funding, the fight against misinformation and media literacy of the population.
Mykyta Poturaev, MP, Head of the Parliament Committee on Humanitarian and Information Policy, called the prepared text of the draft law “On Media” a positive development after numerous discussions. The negative point is the opposite. The People’s Deputy hopes that the bill will be submitted to the Verkhovna Rada in late 2020 or early 2021.
The speaker reminded of a package of adopted bills in support of creative industries in the context of the corona crisis.
In addition, according to the People’s Deputy, the Committee on Humanitarian and Information Policy is completing work on an updated version of the law “On Outdoor Advertising”. It was prepared by the last parliament, now industry representatives are supplementing it. The committee plans to develop a new version of the law “On Advertising”.
Nikita Poturaev summed up that these initiatives are aimed at overcoming key market challenges – the difficult conditions of the pandemic, the outflow of advertising money abroad, the expansion of the Ukrainian market with Russian content and more. An important point for the future is to counteract misinformation, as the topic is also relevant in Europe.
Taras Shevchenko, Deputy Minister of Culture and Information Policy of Ukraine, added that the adoption of the draft law “On Media” is mandatory under the Association Agreement with the EU (implementation of the EU Directive on audiovisual media services).
Among the completed processes – ratification by Ukraine of the Council of Europe Convention on Access to Official Documents (Tromo Convention); it will enter into force on 1 December for all signatory countries. In this process, “failed” by the previous government, civil society took an active part – said the speaker.
“I am glad that we are talking not only about events in the media and information sphere that concern Ukraine, but also about those events that concern the Council of Europe, when Ukraine is on a positive agenda in European countries and international organizations. Not only when we are reminded of unfulfilled duties, but when we directly have leadership positions,” Taras Shevchenko explained.
The speaker reminded that before the conference in Toronto, civil society prepared a document “Principles of Toronto” as a guarantee of the irreversibility of the course of reforms. According to the Deputy Minister, media reform has not rolled back. However, discussions on increasing the independence and financial transparency of the Ukrainian media, a transparent model of financing the Public Broadcaster, and regulating the Internet remain relevant. The priority for the next year for the Ministry of Culture is to increase the level of media literacy and critical thinking of citizens through educational programs.
Inna Hrebeniuk, Member of the Board of the National Public Broadcasting Company of Ukraine (UA:PBC), emphasized that the reform of the public service broadcaster cannot be avoided when reforming the media sphere.
“Although 3 years have passed since the creation of the public broadcaster, in reality we are still struggling for the government and society to understand its importance, mission and values,” the speaker said.
Inna Grebenyuk says that this is a fundamental issue that does not need to be proved, because the public broadcaster is an indicator of the country’s democracy.
In 2020, the issue became more acute. In a pandemic, public service broadcasters have done a good job, research shows. However, a study by the European Language Union showed that the Ukrainian public broadcaster is the only one whose funding has been reduced, not increased.
Among the plans are to raise the bar of professionalism, build a more stable financing model, elect a new supervisory board with a balanced representation.
Natalia Lyhachova, Chairwoman of the Detector Media, voiced the key principles and desirable next steps of the government:
- Ensuring in 2021 full, statutory funding of the public broadcaster and work on a bill on a new model of its financing.
- Absolute transparency and public discussion of plans for cooperation with Euronews in Ukraine. The expert reminded that such an experience was negative: Ukraine paid its debt for a long time and could not fulfill its obligations. In addition, the owner of the TV channel is currently a private person.
- Work on bills that would prevent large-scale misinformation, fakes and manipulations in the traditional and online media of Ukraine.
- Adoption in the first reading, revision to the second reading of the bill “On Media”.
- Financial transparency, balanced regulation of online media, introduction of media literacy – the first steps to combat misinformation now.
“We need to talk about extending some regulation to online content. I absolutely agree with the proposals contained in the bill “On Media”. But we must act very carefully. I would go for the introduction of voluntary registration of online resources, – said Natalia Lyhachova. – By strengthening media literacy programs, we can at least show our audience: these online media are registered and take responsibility, but these are not registered. Why? They do not want to be responsible for their content because they are manipulating. That is, there will be a mechanism that will allow us to work more effectively with the adult audience. “
Regarding media literacy, the head of the NGO “Detector Media” stressed that the state should become a lobbyist for children and adolescents, and donors and NGOs – with adults.
Ihor Rozkladai, Deputy Director, Chief Expert on Media Law at the Centre for Democracy and Rule of Law, singled out the goals for 2021:
- Development of amendments to the law “On access to information” (it celebrates its 10th anniversary in 2021) and its harmonization with the law “On personal data protection”.
- Transparent election of a new composition of the Supervisory Board and the Board of the Public Broadcaster.
- The adoption of the law “On Media”, its history has lasted for eight years; fulfill Ukraine’s overdue commitments to the EU.
The expert called the following areas work for the future:
- Transparency of media funding.
- Adequate mechanisms for cooperation with international players (Facebook, YouTube and others).
- Creating Ukrainian content for children, which is lacking on all platforms. Media literacy work should start with children. “It’s a long-term area where both the state and civil society should unite, because otherwise why are we changing the law.”
- Countering misinformation. Passing a law or going the other way is a matter for discussion.
It was Natalia Ligachova and Ihor Rozkladay who wrote the sectoral analytical brief for the Ukraine Reform Conference 2020 in Vilnius.
The Forum is organized by the RPR Coalition in partnership with the Embassy of the Republic of Lithuania. The Forum is supported by the Ministry of Foreign Affairs of the Republic of Lithuania, the European Union, the EU Project Pravo-Justice, «Civil Society for Enhanced Democracy and Human Rights in Ukraine» project implemented by UNDP Ukraine under financial support of the Ministry of Foreign Affairs of Denmark, and the Embassy of Canada in Ukraine. The Forum is organized within the framework of the project “Core Support of the Reanimation Package of Reforms Coalition” carried out by the RPR Coalition and is made possible by the generous support of the American people through The United States Agency for International Development (USAID) within the Ukraine Civil Society Sectoral Support Activity, implemented by The Initiative Center to Support Social Action “Ednannia” in partnership with the Ukrainian Center for Independent Political Research and the Centre for Democracy and Rule of Law.