| Health care system in Ukraine |
| The proportion of GDP spent on health in Ukraine remained almost unchanged in the 1990s and is among the lowest in the European region. It was 3.5% of GDP in 1998. In the same year inpatient care accounted for 67.9% of total healthcare expenditure. Changes in health care organisation since 1991 have been described as 'inconsistent and fragmentary'17 and reforms are hindered by a lack of national strategy. |
| Undergraduate medical and nursing education makes no provision for palliative care. Health care educational reform, particularly designed to produce more 'holistically' oriented nurses, will provide opportunities for palliative care development. There are no trained palliative care specialists and no palliative care handbook written in the Ukrainian language. |
| Communication remains a problem in the area of cancer and palliative care. One respondent describes the difficulties: |
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'[There is] insufficient communication with cancer patients. Unfortunately, [the] Soviet doctrine that cancer patients must not be informed about diagnosis and prognosis has not changed yet in Ukraine … Stalin considered people as a small detail of the state machine. Unfortunately that principle is still alive … Government is simply not interested in health care, especially in problems of fatal diseases. On the other hand, we have a public health system. As the result of this situation a "vicious circle" has been formed. "Abandon all hope, ye who enter here", the words from Dante's Inferno, surely capture the emotions of considerable parts of our patients … psycho-oncology is "terra incognita" in our country'18. |
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| Two key activists in the development of palliative care in the Ukraine provide a summary of the current situation: |
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'One of the biggest obstacles for developing a hospice system in Ukraine is the low level of public and even medical professional's awareness of palliative care. There is not much information about hospices. In general, the public knows nothing about hospice, or doesn't believe hospices could be implemented. |
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There are others who admit to supporting hospice principles. But even among oncologists there are many who define "palliative care" as "non-radical treatment". They do not know about pain control and oral forms of opioids. Psychological, social, cultural concerns are usually disregarded. Bereavement support services are completely absent. |
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The ongoing economic crisis presents a major problem in hospice development, especially if it is done through government authorities. It seems reasonable that we begin developing initiatives which use non-government organizations and health professionals' associations. To do so may prevent funding problems, at least initially.19 |
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| Health care expenditure (US$) per capita, Commonwealth of Independent States and Mongolia |
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| Source: WHO Regional Office for European Health for All database and HiTs |
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