Working together to build a strong public health system for Ukraine

WHO is supporting public health in Ukraine by conducting a series of activities to strengthen the organizational cohesion of key institutions and to ensure collaboration across the country’s public health systems. On 20–21 March 2019, WHO facilitated a meeting with key stakeholders to clarify roles and responsibilities across 3 organizational levels of the public health system:

• the Ministry of Health;
• the Public Health Centre of the Ministry of Health; and
• the newly established regional public health centres.

Participants, along with international health partners including representatives from the Norwegian Institute of Public Health, discussed the implementation of the following national public health priorities:

• improvement of the immunization programme;
• prevention and management of noncommunicable diseases;
• blood donation;
• emergency preparedness and response;
• biosafety; and
• development of the regional public health centres.

The meeting aimed to identify areas where the roles and responsibilities of the main public health actors in the country can be further clarified, while also identifying opportunities for cooperation across all organizational levels. It took a systems-thinking approach so that participants could tackle public health as a system rather than an issue viewed from the perspective of one entity/institution.

The sessions were designed to enable actors within the public health system to express their specific needs for support from each other and to define their roles and responsibilities to improve the functioning of the whole public health system.

Focus on organizational development

Since the beginning of Ukraine’s health system reform in 2015, WHO and health partners have been focusing on the organizational development of the public health system. Within the context of the decentralization of public health services, clear understanding of the functions, roles and responsibilities of all players is key to the success of building strong health systems.

In March 2019, the Public Health Centre of the Ministry of Health completed a rapid assessment of the 11 core functions and attributes defined by the International Association of National Public Health Institutes (IANPHI). These functions help countries to organize and conduct their public health services.

WHO facilitated the assessment with the participation of the representatives of the Norwegian Institute of Public Health, who shared their own experience of implementing the core functions. The assessment provided insight into the Public Health Centre’s current levels of delivery in relation to its mandate and core public health functions. It revealed the following main issues:

• the development of the regional public health centres is crucial to the success of the public health system as a whole;
• no one in the system has been mandated to carry out key coordinating functions; and
• the operationalization of some key functions are hindered by a lack of legislation (due to a delay in development).

WHO and the Centers for Disease Control and Prevention of the United States of America also conducted a joint visit in February 2019 to support the Public Health Centre in conducting an assessment of its organizational maturity across various areas of work. For each of the areas, the assessment team defined practical actions to reach a further state of maturity. The topics reviewed included:

• corporate and operational planning;
• leadership and governance;
• health and safety;
• laboratory safety;
• laboratory reference and diagnostic services (including quality improvement); and
• internal and external communications.

Further work of the Public Health Centre will focus on applying the newly developed European Competencies for Public Health Workforce Framework (Eco-PHWF) to define actions in support of staff development.

The WHO-initiated Coalition of Partners to Strengthen Public Health Services in the European Region (CoP-PHS) developed the Eco-PHWF under the leadership of Maastricht University (the Netherlands) and the Association of Schools of Public Health in the European Region. Ukraine is represented as a Member State in the CoP-PHS.

Reinforced with European best practices and international technical expertise, the Public Health Centre is using this momentum to update its structure and to develop a human resources development plan and an action plan for implementing its core functions.

Strong international partnerships to support health reform

WHO conducted these activities with the support of a variety of partner initiatives, including:

• the Serving People, Improving Health Project funded by the World Bank;
• the Contribution for Activities towards Universal Health Coverage funded by the Government of Japan;
• the European Union–Luxembourg–WHO Universal Health Coverage Partnership; and
• the Policy Dialogue for Better Health Governance project funded by the Swiss Agency for Development and Cooperation.