Adequate funding and laws are lacking
Contrary to expectations, the All-Ukrainian Congress of the State Sanitary and Epidemiological Service, held the week before last, passed in a surprisingly calm manner. Notably, everybody expected the country’s top health officers to heatedly discuss and draw conclusions from the recent infectious outbreaks in Boleslavchyk and Sukhodolsk. Undoubtedly, conclusions had been drawn, as befits any meeting of such level. However, they concerned primarily the specifics of the functioning of the Sanitary and Epidemiological Service rather than the visible results of its activity (or lack thereof).
It transpired, for example, that the money issue tops the list of the health officers’ primary concerns. Back in 2000, then First Deputy Health Minister cum Surgeon General Olha Bobyliova was very critical of the innovations relating to the distribution of funds. They obliged the sanitary and epidemiological institutions to transfer to the state budget their proceeds from off-hour services and expert examinations. It was predicted at the time that the service’s operation on a self-supporting basis would not end well, as it would not be able to support its extensive network of laboratories and research facilities. Thus experts suggested the service follow in the footsteps of the agrochemical sector. When faced with a similar situation, its management simply separated cash flows, transferring proceeds from off-hour services to the state budget and keeping receipts for expert examinations to themselves.
However, at that time the Sanitary and Epidemiological Service did not succeed in lobbying its interests. But despite cadre changes the health officers have not lost heart. The current Chief Sanitary Physician Olha Lapushenko also believes that supervision and expert examinations should be separated. Meanwhile, chief sanitary physicians should be granted the status of state functionaries, because today they in fact are hostages of the customer. “The situation is paradoxical,” says Ms. Lapushenko, “chiefs of sanitary services first sign the expert conclusion and then themselves check those conclusions.” What is more, according to Ms. Lapushenko, because of the lack of funds the expert analysis results are not always objective. Moreover, today efforts must be confined to increasing the professional level of employees of regional services.
Can we blame the Sanitary and Epidemiological Service for the high incidence of infectious disease in Ukraine? Its employees think not. Let us start from Sukhodolsk. A local health officer pledged amid an outbreak of viral hepatitis that he had refused to sign the water rationing schedule proposed by the utility service representatives, since out of professional considerations he could not sign a document that ran counter to all state standards. As for Boleslavchyk, the sanitary and epidemiological service also had no influence over the contamination of water and the ensuing mass toxicodermia, much like over other incidents caused by the antiquated sewage system.
Earlier, speaking in an interview with The Day, Deputy Surgeon General Serhiy Berezhnov complained about the helplessness of the Sanitary and Epidemiological Service during the traditional summer outbreaks. Since the human factor causes 90% of all cases of infectious disease, how can one possibly make sure that everybody washes his hands and follows the rules of preparing food in hot weather? Moreover, Mr. Berezhnov believes that too much uproar is traditionally raised in Ukraine over cases of infectious diseases. “People develop diseases all the time and everywhere. Perhaps the medicine has managed to fully eradicate smallpox alone. And the fact that last year the World Health Organization proclaimed Ukraine a country free from poliomyelitis is a major victory, which, however, is not discussed as much as the outbreaks.”
There is no denying that Ukraine has made some progress in fighting infections. To illustrate, the list of diseases against which we have vaccinations has been expanded, with 95% of the population vaccinated against the most common diseases, which complies with WHO standards. Moreover, statistics suggest that in recent years the incidence of infectious diseases in Ukrainians has dropped by 20%. In particular, incidence of dysentery is down by 43%, acute enteric infections by 35%, viral hepatitis by 10%, and measles by 39%. Health officers attribute the high incidence of HIV/AIDS and tuberculosis to poverty, which is also confirmed by WHO experts. In its 2002 report on the health of the residents of the CIS and Western Europe, the WHO pointed to poverty as the root cause of the high incidence of infectious disease, regardless of whether poverty is determined according to the level of income, living conditions, or educational background.
On the other hand, one can clearly see some shortcomings in the work of the Ukrainian Sanitary and Epidemiological Service. To illustrate, while it is commonly believed that many infectious outbreaks are caused by environmentally hazardous industries, the Russian sanitation service has initiated environmental insurance and regularly performs sanitary and epidemiological monitoring. It is noteworthy that in Ukraine no sanitation and epidemiological standards have been developed for incinerator plants (many of which, incidentally, are under construction throughout Ukraine). Moreover, there is a lack of sanitation laws for filling stations, mini-plants, and high-rise buildings. Put simply, there is a lack of concentration on the potential risks and a thought-out strategy for the work of the Sanitary and Epidemiological Service. However, we have reasons to view the future with optimism. The State Sanitary and Epidemiological Service has been recently granted the status of a government body, which opens big prospects for it. A status change envisions a great degree of independence and its active involvement in the budgetary process. Apparently, the ice has been broken.
