If our hromada had not been investing in healthcare, we would not be able to counteract the epidemic now. Interview with Yuriy Bova, head of Trostianetska hromada
Yuriy Bova, head of the Trostianetska AH of the Sumy Oblast is convinced that if the hromada’s investments in the healthcare sector had not been exceptional, it would have been impossible to counter the epidemic now
By Dmytro Synyak
Yuriy Bova is a rather prominent figure in local self-government of Ukraine. His Trostyanetska AH is exemplary in many spheres, which has been repeatedly noted by various government officials and experts. Mr Bova has always considered it an honour to raise the hromada’s medical sector, despite being accused by political competitors of “over-paying doctors and hospitals”. But now it suddenly turned out that this attention was not excessive. Thanks to this, the Trostyanets Rayon Hospital was able to very quickly get ready to counteract a dangerous infection.
Is the healthcare sector of the Trostianetska AH ready to struggle with the epidemic?
- We are very fortunate to have begun reforming our healthcare sector two years ago by taking ownership and maintenance over the rayon hospital. We also managed to set in order the unbalanced budget of the hospital, which was not enough to cover even the most urgent needs. However, we still have to add hromada funds to the state money, since medical subventions are not enough even to cover doctors’ salaries. This year, the amount of these additional payments from the local budget reaches UAH 6 million.
Have you optimised your hospital staff? In some rayon hospitals, hromada audits have sometimes revealed harmonists and whole units of lift operators.
- It was the first thing we’ve done. Prior to the hromada amalgamation, the Trostyanets Rayon Hospital had nearly 500 staff members. We cut about 100 of them. These were mostly technicians: security guards, drivers, repairmen, etc. We practically didn't downsize doctors. With staff optimisation, we have saved at least UAH 15 million a year. But there will be no further downsizing. After all, our hospital has 7 departments and serves 37 thousand people, working around the clock. Our hospital needs about UAH 3 million to pay for heating services. But in the neighbouring rayon such a medical institution needs UAH 7 million! Because they did not do the thermal modernisation we did, and there they heat with gas, not firewood like we do. Honestly, we hoped that the reform of the secondary healthcare link would continue this year, and that Trostyanets hospital would start making money on its own, receiving funds from the National Health Service for each patient. Then we wouldn't have to spend those UAH 6 million, but we have what we have.
What is the overall budget of your hospital?
- About UAH 43 million. The U-LEAD Programme, which analysed the activities of our healthcare facilities, estimated that if we had not optimised hospital costs, our expenditures would have now reached UAH 60 million, and this burden would be mainly put on the local budget. I also hope that the second phase of the healthcare reform will not be hindered by the coronavirus epidemic. Even though people are now trying not to have appointments with doctors, our hospital can already switch to a new “Money follows the patient” system. All our departments have already signed relevant agreements with the National Health Service and are absolutely ready to compete for their right to existence.
What do you mean by “absolutely ready”?
- For example, the hospital maternity department has been well repaired, in strict accordance with all standards. And in less than three months, over 60 women gave birth to their babies there. There should be about 300 of them in the year, twice as many as before the renovation. Meanwhile, 250 expectant mothers are enough to maintain the department. That is, I can say that we are confident about our future. Women come to us to give birth even from Kharkiv and Sumy, because the conditions are very good, and everything is free of charge. We also repaired and renovated the therapeutic, gynecological, radiological departments and laboratory for which we purchased a lot of modern equipment. I think in two or three more years of such work, and our hospital will become one of the best in Ukraine.
Let’s get closer to the «virus topic». Is your hospital supplied with ALV (artificial lungs ventilation) machines?
- Yes, we have five stationary machines and one mobile machine. However, it is not enough, of course, and we have already ordered three more ALV machines. The hospital has enough space for these machines. Besides, we have totally preserved the infrastructure of the infectious department of the hospital, that is located in a separate building, consists of separate boxes and can accommodate 30 people at the same time.
Do you have enough qualified staff to fight the probable epidemic?
- I believe that the biggest achievement of our hromada in healthcare is that we managed to keep our medical staff. Before hromada was amalgamated, the doctors would not get their salaries 4-5 months in a row, they felt apathy, if we waited a bit longer – they all would leave their jobs. And now they are our main support in the fight with coronavirus. Thanks to the participation in various webinars and on-line meetings, our doctors now have a clear understanding what they must do in case of COVID-19, they have enough protective costumes, masks, etc. A high level of preparedness of our hromada towards the probable epidemics was recently acknowledged by a special oblast commission headed by Roman Hryshchenko, who is the head of oblast administration.
Yuriy Bova inspects Trostyanetska local hospital
Does hromada help entrepreneurs, who found themselves in a tough situation due to quarantine?
- It is the other way around: the entrepreneurs help us, understanding how important it is at the moment to make the healthcare function properly to be able to counteract the epidemic. The local council allocated over 800 thousand hryvnas to buy the AVS machines (its price – around 500 thousand hryvnas), masks and disinfection supply. The entrepreneurs of our hromada added 200 thousand hryvnas to buy придбання infusion pumps, distillers and other supply. However, most of them never had any doubts that the expenditures on medical reform are extremely necessary. For example, in 2018 our hromada collected nearly 800 thousand hryvnas to buy modern biochemical blood analyzer for our laboratory, that analyses over 130 parameters, besides does it much cheaper than the old equipment. Thanks to this, the cost of the blood analysis dropped sufficiently. The rayon charity fund “Dobrota”, that functions in hromada, collected 1,5 million hryvnas last year, that were spent on the needs of our hospital and this year this charity fund bought for the hospital various equipment for around 300 thousand hryvnas. Also, we receive help from foreign donors. For example, those who were born in our hromada but live in Germany now, sent 30 thousand euros as financial aid to our hospital last year.
How much money was spent by hromada, during the two years of its existence, to support healthcare?
- Two years ago on repair and supply with the necessary equipment for the therapeutic department we invested around 2 million hryvnas. The major repair of gynecologist department and maternity unit was done last year and cost 6,6 million hryvnas. However, around 1 million hryvnas for these purposes we received from the national budget. Every year Trostyanetska city council allocated funds for medical staff salaries. Last year 5 million hryvnas, two years ago – 3 million hryvnas. Also, to cope with this issue we receive help from rayon council and neighboring Boromlyanska AH. However, the most falls on the budget of Trostyanetska AH. Only in 2019 on the hospital in total was allocated 15 million hryvnas, half of our development budget. We bought the ultrasound machine, x-ray machine…It is hard to remember everything now! We hope, that a new formulated approach, that soon should be used to finance the secondary healthcare will allow to double salaries to our doctors. This would strengthen the healthcare system. How many times for the last years was the salary raised to educators? And how many times to doctors? Now, the educators stay at home and doctors are risking their lives every day, saving us.
However, there is another reality: very often the doctors, who receive low salaries drive expensive cars and wear on their necks heavy golden chains. In what “public and free of charge” hospital can you have a “free of charge” operation done? You have to pay for everything! A former minister of healthcare Pavlo Kovtoniuk claimed, that half of the Ukrainian healthcare budget – in shadow.
- Yes, it is also true, but I can assure you that it this situation has nothing to do with our hospital. We had to bid a farewell to a few doctors, but we insisted on the rule: no bribes from patients. Everything is free of charge, including baby delivery. The cost of medical services must be reimbursed soon by the National Healthcare Agency. Soon, when everyone will see that the best doctor has more patients and, consequently, more money, the whole healthcare system will start functioning differently.
Has the oblast supported you to counteract the epidemic?
- Yesterday the oblast council adopted a decision to allocate 28 million hryvnas to fight coronavirus, however, it is still unknown on what purposes the funds will be spent. Probably, the half of this amount will be spent on ALV machines, however, it is still not clear what hospitals will get them. After negotiations with the head of Sumy oblast administration, one of the pharmaceutical enterprises in the oblast allocated to all medical facilities the medication for a few million hryvnas. Our hospital also received some of that medication. I hope, that the oblast will continue to help us.
However, you would not call your situation critical?
- We managed to buy the necessary amount of the protective masks, disinfection supply, hand sanitizers, etc., however, it is hard to predict for how long it all will last due to the rapid development of epidemic. Coronavirus will force the country turn its face to doctors and to the whole healthcare system. Besides, what we had to buy in the emergency regime and for the reserved funds, should have had already been at the hospitals. And now all these is a huge deficit. The suppliers, who work exclusively in the prepay format, say, that they will not be able to provide the order sooner than in 2-3 weeks.
What would happen now, if hromada would not start working on the healthcare system recovery?
- We would not have had any doctors left. One of the rayon administration heads confessed at the meeting with people: “If not for the Trostyanetska city council, there would be no hospital in rayon. Rayon did not have enough funds to pay salary to medical staff for a long time now. No one talked about developing hospital back then, of course”.
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