Feasibility Study Effectiveness of Public Health System (Programmes/Policies) in Combating Severe Population Health Crisis in Ukraine
Implementation: Centre for Health Services Studies at the University of Kent and Kyiv Economic Institute at the Kyiv School of Economics
Funding: the Department for International Development/UK Medical Research Council/ «Wellcome Trust»/ Economic and Social Research Council
Principal research question: To what extent is it possible (and practically feasible) to evaluate Ukraine`s national and local public health programmes/policies, and how should this be done
Duration: 1 year
Total amount requested from this funding scheme: ~100K GBP
Ukraine faces the double burden of high rates of communicable diseases and rapidly escalating non-communicable diseases. The healthcare system in the country has remained virtually unchanged for years since independence in 1992 and the existing components of the Public Health system have never even been comprehensively studied.
“Public Health - the science and art of preventing disease, prolonging life and promoting health through the organized efforts of society”.(Sir Donald Acheson, 1988)
The weakness of the PH system is one of the major health system issues in Ukraine, as it prevents the country from dealing with the high prevalence of NCDs and simultaneous epidemics of communicable diseases (TB and HIV/AIDS). There is much fragmentation, with competing structures and overlapping and competing lines of authority and accountability at all levels - national, regional (oblast), districts (rayons) and municipalities. Combined with the deficit of financial resources and modern PH expertise, the PH system is not strong enough to address the population health crisis comprehensively.
Following the change of government in 2014 and activation of civil society (which monitors developments in political and socio-economic spheres to help prevent corruption), Ukraine now has a window of opportunity to consider Public Health policy and system reform.
We believe that analysing past programmes/policies and existing data is crucial to better inform ‘whole system’ development. Our development study will provide in-country evidence to enable an analysis of past programmes/policies, and to provide recommendations for strengthening the PH system so that it can better achieve population health goals.
Our key research questions are:
- What are the existing elements (i.e. programmes/policies) of the PH system and how have they evolved from early 1990s?
- Does the obtained information allow for the identification of the theory of change underlying each programme/policy – the aims, objectives, outcomes/targets and mechanisms by which outcomes are expected to be achieved (using 2-3 cases)?
- What routinely collected data is available on (i) implementation of these programmes/policies (e.g. process or output data), (ii) outcomes expected from these programmes/policies, (iii) other related outcomes?
- What does existing data tell us about need and its distribution across different population groups (to identify vulnerable groups in addition to rural population and middle-age males) - in relation to the disease burden; and to what extent is that data valid and reliable?
- Do the quality and scope of existing data and the contextual setting allow for the identification of the impact of PH programmes/policies on population health in general and separately for vulnerable population groups?
- What is the potential for additional quantitative and qualitative data collection to support future evaluation of the programmes/policies?
- What are the barriers and obstacles to using evidence in population health related policy making in Ukraine?
Within the project we will implement three Work Packages:
- Scoping the data
- In-depth interviews with key stakeholders and informants
- Preparing data and analysing its quality
- Conducting Evaluability Assessment
First work package within our project foresees collection of the health and public health related data at rayon level from the Oblast Centres for Medical Statistics and transferring this data into electronic form suitable for analysis. We would like to make this data available to the public and expert community via Atlas of Economic and Social Development. The Atlas will depict Health Statistics on Regional, Rajon and City levels, Programmes and Policies in Health Care since 2000 (and 1990 for 3 pilot regions), Major indicators of Reforms Success and Implementation of Reform by Oblasts
Expected Research Impact:
- The proposed study will complement the wider initiative led by the World Bank, WHO and the Ministry of Health to reform the healthcare and PH systems in Ukraine.
- Will create publicly available Atlas of Economic and Social Development, an easy to use instrument to monitor developments in health of population as well as changes of the Health Care and Public Health Systems
- Will be complementary to the efforts of our research partner, team led by Olena Hankivsky, to study the impact of health care reform on population health inequalities
- The academic publication describing the workings of the PH components at national and local levels and information on available data sources and their quality, published online will stimulate further interest in health research both inside Ukraine and internationally.
- Will provide an educational opportunity for the emerging PH specialists’ community on resources for health research and evidence-based policy making in Ukraine.
The research team is multi-institutional and multi-disciplinary and includes senior researchers with experience in health systems and policy research, conducting and analysing large surveys, leading qualitative studies, statistical and economic analysis.
Stephen Peckham, Director of the Centre for Health Services Studies at the University of Kent
David Hunter, Director of the Centre for Public Policy & Health and Deputy Director of the Centre for Translational Research in Public Health at Durham University
Erica Gadsby, Research Fellow of the Centre For Health Services Studies at the University of Kent
Olena Hankivsky, Visiting Professor at the London School of Hygiene and Tropical Medicine, Director of the Institute for Intersectionality Research and Policy at Simon Fraser University
Tatiana Andreeva, independent researcher, expert in Public Heath
Olena Nizalova, Associate Professor at Kyiv School of Economics, Research Fellow in Health Economics at the Centre for Health Services Studies and Personal Social Services Research Unit at the University of Kent
Hanna Vakhitova, Assistant Professor, Senior Economist at the Kyiv Economic Institute at Kyiv School of Economics
Nataliia Shapoval, Research Associate and Policy Projects Manager at the Kyiv Economic Institute at Kyiv School of Economics, Managing Editor at VoxUkraine
Vadym Bizyaev, Analyst at the Kyiv Economic Institute at Kyiv School of Economics
Kateryna Ruskykh, Research Associate at the Kyiv Economic Institute at Kyiv School of Economics
Oleksandra Bertliy, Leading research fellow/Project coordinator at the Institute for Economic Research and Policy Consulting
We will be glad to answer any additional questions or provide more information if necessary. Please do not hesitate to contact project’s Principal Investigator Professor Olena Nizalova via email at email@example.com or Project Coordinator Nataliya Shapoval at firstname.lastname@example.org or via phone at +380664911672.
 Ukraine lacks expertise not only in public health system’s research, but experiences overall shortage of public health specialists. The only School of Public Health that exists in the country de facto prepares only specialists in healthcare management.The only School of Public Health which existed in Ukraine from
 By public health system we mean the whole array of preventive (as opposed to curative) programmes and policies at both local and national level.
 This question is one of the key questions within the Essential Public Health Operation (EPHO) “Advancing public health research to inform policy and practice” identified within the European Action Plan for Strengthening Public Health Capacities and Services (EAP) of the policy framework for Europe Health 2020 http://www.euro.who.int/en/health-topics/health-policy/health-2020-the-european-policy-for-health-and-well-being/about-health-2020 .