‘Eliminating the MSEC will not help Ukraine. In a poor society guided by survival values, disability has become a kind of perverse privilege.’ Pavlo Kovtoniuk

Following high-profile scandals, the government decided to abolish the Medical and Social Expert Commission (MSEC), a move that was long overdue and of utmost urgency. The reasons for this decision have been accumulating for years, highlighting the shortcomings of the existing system, which lacks flexibility, humanity and is often criticised for its complexity and formalism. All of this has created an atmosphere where, instead of effectively supporting people with disabilities, the state has often lost touch with their real needs. The liquidation of the MSEC marks the beginning of a new chapter, as the state authorities realise that modernisation of this system requires not just cosmetic changes but a deep reorganisation.

Pavlo Kovtoniuk, former Deputy Minister of Health and co-founder of the Ukrainian Healthcare Centre , emphasises that the MSEC system is not only outdated, but also deeply flawed in its essence, as it turns disability into a formality that limits people rather than helps them. He sees the problem of the MSEC not as a separate element, but as a symptom of the general state of the social assistance system, which has long ceased to be humane. Against the backdrop of the war and the need to help veterans and people with disabilities, this reform has become particularly relevant and urgent.

MSEC as a system devoid of humanity: key issues

“The MSEC is not a disease, but a symptom.

…I will not speak from the position of an expert in the MSEC (I am not, and this is an advantage in this case), but from the position of a person who has changed complex state systems and a person who has been through the MSEC himself.

The disability system reform is one of the most overdue. What is happening there is horrifying and shameful. This system is devoid of dignity, humanity is the exception, not the rule. It is built that way. I am horrified to think that thousands of veterans will soon be going through this system en masse (this is also happening now, but on a small scale).

Today we have a public scandal that has drawn attention to it again. There are three narratives in the media space:

All the MSECs should be closed immediately,

all heads of the MSECs should be immediately dismissed,

the process of determining disability should be digitised immediately.

We need to accept that it will not work immediately. But we need to start now in order to have at least some results before the possible demobilisation,’ Kovtoniuk said.

According to him, the MSEC operates on the basis of strictly defined formal requirements. Disability here is reduced to a set of signs on which a person can qualify for assistance, and this creates significant disadvantages. Kovtoniuk notes that instead of supporting and helping to restore physical functions, the system is focused on fulfilling a number of formalities: having a certain diagnosis, being in the relevant registers, performing certain rituals – from hospital treatment to submitting numerous extracts. A person is forced to prove their limitations rather than restore their functions.

This situation leads to an absurd result: it is more profitable for a person not to restore functions, but to remain in a state that confirms his or her diagnosis. Thus, the MSEC does not fulfil its function of helping a person integrate into social and economic life, but rather records his or her limitations. This approach contradicts the idea of dignity that the support system for people with disabilities should provide.

Distorted perceptions of disability: disability as a source of benefit

The MSEC system is not only incapable of supporting people, but also shapes false values. Kovtoniuk points out that the disability system has become a means of solving the financial problems of many citizens. In Ukraine, disability is often perceived not as a physical limitation that requires support, but as a reason to receive certain material benefits, especially among public sector employees and pensioners. In a society where people strive to survive at any cost, disability becomes a kind of social privilege. For example, many people obtain this status for the sake of financial payments and additional benefits, rather than for rehabilitation or restoration of functions.

“The logic of the system is becoming inverted. A whole stratum of people (with low income, and sometimes not very low income) consider disability to be a means of solving their financial issues, and not payments to be a means of solving their disability issues.

It has become a culture to register a disability as a source of income – it is widespread, particularly in the public sector, where disability has a significant impact on salaries and pensions. This is where prosecutors come in. But it’s not just prosecutors.

Working in the public sector or being an old-age pensioner creates ideal conditions for this game. Since earnings have little to do with a person and are not related to work, the only question is how to ‘make’ yourself disabled, i.e., to collect the necessary set of documents required by the MSEC.

Your physical functions may not be particularly limited, but this is not required. You need to have superpowers to accumulate the right hospital discharges, extracts from dispensary records, undergo the ritual of being dug up in hospital, etc.

In a poor society guided by survival values, disability has become a kind of perverse privilege. I can assure you that some of those prosecutors, if not all of them, believed that they were legally entitled to their pensions. Moreover, many of them also had formal grounds for them,” Kovtoniuk said.

This situation is deeply rooted in the system, and the fight against it requires radical changes. According to Kovtoniuk, this phenomenon is not the exception, but rather the rule. Even in the public sector, disability sometimes has a significant impact on salaries and pensions. This results in a culture where disability is seen as a source of income, rather than a temporary or permanent limitation that needs to be addressed. This is not because of the shortcomings of people, but because of the flaws in the system that encourages them to do so.

Deformation of social assistance: disability as a status that defines poverty

Kovtoniuk emphasises that the system of assistance is built on the principle of equating disability with poverty, which is a deeply flawed approach. The state provides the same set of services and benefits without taking into account the real needs of each individual. As a result, people with disabilities are forced to either settle for limited standards of support or look for other ways to get help. This results in people who, for example, need assistance with mobility, being forced to either apply for a pension or refuse any support. In such circumstances, disability is effectively cemented as a status associated with material deprivation, and the state does nothing to break this link.

The role of the state and the need for a new system

Instead of just providing financial support to people with disabilities, the state should be involved in returning these people to active life. This is only possible if the entire system is reorganised based on the individual needs and capabilities of each citizen. In particular, Kovtoniuk believes that the medical component of disability should be redefined, and the International Classification of Functioning (ICF) should be the basis for it. This system allows determining a person’s real functional limitations and setting individual goals for recovery.

At the same time, social assistance should be flexible and focused on rehabilitation. This means abandoning benefits and subsidies as the main instrument of support and moving to individual assistance, including financing, regulation and service delivery. For example, if a person is able to work but has limited mobility, they should be assisted with space adaptation or other specific services. If a person is temporarily unable to work, they should receive a pension until they recover.

Proposal for a new structure: replacing MSEC and LCC

For a full-fledged reform, Pavlo Kovtoniuk proposes replacing the MSEC and the LCC with two new structures.

“It is very important: the type of assistance should be chosen separately from the determination of physical limitations and should be done by other people based on an analysis of needs and capabilities.

To implement this approach, two new structures are needed to replace the MCC and MSEC. The first would be based on the existing network of rehabilitation care and family medicine to identify limitations (the ICF or a similar tool could be used) and work on recovery.

The second is a completely new type of organisation that deals with individual social assistance (in particular, integrating various services and services).

This will be the place where MSECs should be closed. As well as digitalisation and dismissals. These are important elements of the reform, but in no way substitutes for it (although this is also a likely scenario, unfortunately),” the expert said.

According to Kovtoniuk, changes in the MSEC system cannot be quick, they will take several years, but their importance cannot be overestimated. Only a deep and systemic reform can change the situation when disability ceases to be a formality and a means of financial manipulation. The liquidation of the MSEC and the creation of new structures aimed at assistance and rehabilitation will allow people with disabilities to return to a full life.

Kovtoniuk emphasises that dismissal of managers or digitalisation of the old system cannot replace the reforms, because without systemic changes we will only get a new MSEC with a different name.