Ukraine's health record looking dismal, says Canadian consultant (12/01/96)

Ukraine's health record looking dismal, says Canadian consultant

by Christopher Guly

OTTAWA - Reforming Ukraine's health sector is perhaps one of the most difficult challenges facing the country, said Vancouver-based health-care consultant Myroslaw Kohut.

Mr. Kohut, who has prepared reports on Ukraine's social sectors for the World Bank, said that decentralization of authority, hyperinflation and high unemployment have not only had a negative impact on the country's economic health, but have placed the health of Ukrainians at great risk.

"Not only is basic hygiene not up to common Western standards, but the level of disease is rising," said Mr. Kohut, who was recently in Ottawa to attend a special forum organized by the Canadian Society for International Health (CSIH) on health reform projects in Ukraine.

"Cholera [which produces severe diarrhea] is up, and so is the incidence of diphtheria [a contagious disease that leads to inflammation of the heart and nervous system]," he added.

In fact, the Department of Foreign Affairs' travel advisory service warns visitors to Ukraine of an arms' length list of health precautions to be aware of in advance of arriving in the country.

Ironically, pre-independent Ukraine once supplied 90 percent of the Soviet Union's pharmaceutical supplies, noted Mr. Kohut, who serves as a member of CSIH's board of directors. Now, Ukrainians must bargain for their own supplies in a global currency market and, as a result, everything from anesthetics to inhalers are in short supply.

Money, not technology, is ultimately the reason.

"Wealth is the best predictor of health," said Mr. Kohut. "If wealth decreases, health may be affected negatively in turn."

According to a 1994 World Bank Development Report, Ukraine reported a gross national product (GNP) per capita ratio of about $2,200 U.S. - compared with the United States at about $26,000 and Canada at about $20,000. GNP is defined as the total value of all goods and services produced by firms within a country. It is measured as the gross domestic product (the value of output of all goods and services produced inside a country) plus foreign income, minus income earned during the same period by foreign investors within the country.

But Ukraine's health risks extend beyond their depleting financial reserves.

Over the past four years, Mr. Kohut said he has dealt with five different Ukrainian health ministers, including the incumbent, Andriy Serdiuk. The revolving-door approach to filling the post, coupled with the Ukrainian government's decision to decentralize authority for health issues to the regional or oblast levels, has diminished the quality of accountability, said Mr. Kohut. "There are stories where doctors charge women $100 (U.S.) to deliver their babies. Well, that's almost like the mafia asking for payment for protection."

Furthermore, Ukrainian health care workers are among those who must either wait months on end, if ever, to get paid to do their jobs. Though official Ukrainian unemployment figures suggest an unbelievably low jobless rate of between 30,000 and 40,000, Mr. Kohut believes the figures are as high as half the country's working population.

"The government gets around this by listing people on extended leave. Yet, in March 1995, there were reports that there was $500 million in unpaid wages in Ukraine. Faced with no salaries, many Ukrainians have been forced to return to growing their own food. For example, Mr. Kohut said recent statistics show that half of Ukraine's potato crop comes from Ukrainians' backyards.

Perhaps, therein lies a consolation. "At least they're cutting down on fatty foods and eating a little healthier," he said.