Head of the Azov Patronage Service on the transfer of control over the structure that will replace the MSEC to the NHSU
The system of medical and social expert commissions (MSECs), which has been crucial in determining disability and providing social protection for thousands of Ukrainians over the years, has been at the centre of numerous scandals and criticisms. Lack of transparency, numerous cases of bureaucratic delays, difficult access to services for citizens and repeated allegations of corruption have led to a rethinking of the work of the MSEC and the need for reform. In this regard, it was decided to transfer the functions of the MSEC to the National Health Service of Ukraine (NHSU), which will be responsible for determining disability and ensuring fair access to these services. However, this decision has caused a lot of controversy and doubt among experts and the public.
Olena Tolkachova, Head of the Azov Patronage Service, expressed her vision of the deep management problems in the National Health Service of Ukraine and the risks of transferring control over the new disability determination system.
According to Olena Tolkachova, there are currently many problems in the healthcare sector in Ukraine, and the inefficiency of the National Health Service of Ukraine (NHSU) in fulfilling its main tasks is causing increasing concern among experts, doctors and the public. Of particular concern is the decision to entrust the NHSU with control over a newly created structure that is supposed to replace the MSECs (medical and social expert commissions) responsible for determining disability. Such a move seems questionable, especially after the inefficient use of the UAH 16 billion remaining in the accounts in 2023, which was not spent on the treatment and rehabilitation of Ukrainian citizens, including military personnel and war victims.
This fact was evidence of the NHSU’s managerial failure, as well as its inability to effectively manage the funds allocated for healthcare and ensure the proper quality of medical services.
Lack of control and bureaucracy in the management of medical institutions
The head of the Azov Patronage Service notes that one of the main problems of the NHSU is the lack of proper control and monitoring of the activities of state-funded healthcare institutions. Today, the organisation lacks an effective management system that would allow for clear control over the use of funds and ensure an adequate level of medical services.
Healthcare facilities funded through the NHSU are often left without proper supervision. This reduces the quality of medical services they provide. The lack of clear control over their activities leads to situations where patients receive inadequate or ineffective treatment.
The head of the Azov Patronage Service is particularly concerned about the fact that the NHSU has returned to the budget funds that were intended for treatment and rehabilitation, including for servicemen who were wounded during the war. This issue is extremely sensitive, as the need for treatment and support for the wounded is extremely high in times of war, and every inefficiently spent or unused resource has a real impact on people’s health and lives. The NHSU management has not only demonstrated an inability to manage these funds effectively, but has also threatened the very idea of providing quality treatment to citizens at a time when such assistance is vital.
“The ineffective work of the National Health Service of Ukraine (NHSU) is a growing concern among experts, doctors and the public. One of the most alarming signals was the return to the budget of UAH 16 billion in 2023, funds that were to be used for the treatment and rehabilitation of citizens, including military personnel and those wounded in the war. This situation has become a clear example of how ineffective management and lack of professional skills of the leadership can jeopardise the health of the nation and the stability of society.
The NHSU has been headed by Natalia Husak for a long time, who continues to hold the position despite systemic failures in the administration of funds and control over the quality of healthcare services. The inefficiency of her management has led to the fact that the funds allocated for healthcare have not been used, and this is happening in a time of war when the need for treatment and rehabilitation of wounded soldiers and injured civilians is extremely acute,’ says Olena Tolkacheva.
According to her, if the NHSU cannot ensure proper control over the current treatment and rehabilitation programmes, it is hard to imagine that the organisation will be able to manage the newly created disability system. The decision to transfer this responsibility to the NHSU will require significant internal changes in the structure of the service itself, including personnel decisions and the introduction of effective control mechanisms, which will avoid the problems that have already arisen in current programmes.
On the other hand, the bureaucratic delays inherent in the NHSU’s management structure create additional obstacles to quality patient care and timely use of budget funds. In such an atmosphere, the functioning of the new disability system under the control of the NHS is likely to lead to the same problems that have already become typical for the service.
The problem of competence in the NHS leadership
Another serious problem faced by the NHSU is the lack of professional competence and managerial experience among its team members, according to Olena Tolkacheva. The lack of managerial experience in healthcare makes it difficult to carry out complex reforms such as replacing the MSEC system. Establishing a transparent and fair disability determination process requires not only technical knowledge, but also a deep understanding of the medical and social needs of people with physical and psychological injuries who seek support on a daily basis. The lack of professional training and relevant education among NHS managers is a serious obstacle to implementing effective solutions and necessary changes in this area.
In wartime, when Ukraine needs strong and reliable healthcare services, the inefficiency of the NHSU in managing resources becomes particularly acute. The poor quality of medical services provided under its control not only endangers the lives of those injured at the front and civilians, but also affects the overall combat capability of the Armed Forces of Ukraine. Due to the lack of proper rehabilitation and treatment, many soldiers are unable to return to service, and those who continue to fight often do not receive sufficient support to restore their physical and psychological condition.
“The main reason for this situation is managerial ignorance and lack of specialised medical education among the NHS leadership. Administrators who do not have the necessary knowledge and skills to manage a complex healthcare system are leading the healthcare reform to a fiasco. Despite the great opportunities presented by the reform, the lack of proper management and planning makes it inefficient and vulnerable to corruption risks and bureaucratic delays.
If the situation does not change, Ukraine could face a serious demographic crisis. Lack of access to quality healthcare services will lead to an increase in mortality, disability among wounded soldiers and civilians, and a general deterioration in the nation’s health. In wartime, this is even more critical: a decline in the quality of medical care negatively affects the combat capability of the Ukrainian defence forces,” Tolkacheva said.
Implications for Ukrainian society
Olena Tolkacheva believes that the growing number of veterans who do not receive proper medical care will lead to an increase in disability among the population and create an additional burden on social systems. In the long run, this could turn into a serious social crisis, where most citizens will need constant assistance, and the state budget will not be able to provide the necessary support. In a time of war, when society needs to be as united and strong as possible, such a burden on social structures can have catastrophic consequences.
‘Large-scale disability among wounded soldiers who cannot return to service or fully rehabilitate due to poor medical care threatens to create an additional burden on the social security system. In the long run, this will lead to a social crisis, where a large part of the population will need constant help and support.
The lack of decisive action to change the leadership of the NHSU and appoint competent professionals with specialised education threatens to deteriorate not only the quality of medical services, but also the overall security of the country. Therefore, immediate personnel changes and a complete review of approaches to managing Ukraine’s healthcare system are needed to avoid catastrophic consequences for the nation’s health and the combat capability of our defenders.
It is a paradoxical fact that the NHSU has planned to spend UAH 159 billion in 2024, which is 11.2% more than last year’s budget. The main increase in funds is aimed at rehabilitation services, especially for the military and war victims, where the amount of funding has increased to UAH 5.5 billion, compared to UAH 3.1 billion in 2023. This means that civilian medicine is allocating as much as 3.46% for the health of the military during the war – it looks like a mockery,’ said the Head of the Azov Patronage Service.
