Noncommunicable diseases and Injuries in CIS Challenges of chronic diseases in Ukraine

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Noncommunicable diseases and Injuries in CIS
Challenges of chronic diseasesin Ukraine

• Igor Oliynyk MD, MScPH
• Financing Sustainable Healthcare in Europe
• 11-12 March 2008
• Lake Bled

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Lessons learnt

• Major NCD are responsible for 85 of deaths and
  70 of the disease burden in the European Region
• In CEE the age profile of chronic disease
  morbidity and mortality is dramatically younger
  than in the EU countries
• Traditional approaches to chronic diseases led to
  an enormous increase in costs for the society,
  but to very modest outcomes
• Disease-care approaches in CIS
• BUT
• 70 of chronic diseases are avoidable, so there
  is a solution(WHO)
• CINDI 4 major chronic diseases 4 lifestyle
  factors 4 integrated approaches- 4 major
  strategies 4 major social determinants
• Reorienting the health system integration of
  prevention into primary care (Canada)
• Moving towards chronic care models
• Quantifiable indicators help track a results

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Meeting the challenge of NCDI in the CIS
Countries30-31 October 2007 Moscow, Russian
Federation

• WHO EURO and WB ECA
• Rationale
• EECA have shorter and/or declining LE - 11 years
  difference in LE between EECA (67.2) and EU
  (78.4)
• Greater burden of diseases that is primarily
  attributable to NCDI (16 times more death than
  all communicable diseases, maternal and perinatal
  diseases)
• CVD accountable for 60 of death
• 70-80 of HC expenditures allocated for chronic
  conditions
• Economic implications for the societies
• 50 of deaths in working males in Russia may be
  attributable to hazardous drinking
• EBM and effective interventions exist
• Urgent call for action

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Meeting the challenge of NCDI in the CIS
Countries30-31 October 2007 Moscow, Russian
Federation

• Increased awareness of the problem and leadership
  at highest political level are essential
• Responsibilities of Govt. at all levels
• Multi-sectoral approach
• Prevention throughout life
• Health services should fit the purpose,
  responding to the present situation
• Empowerment
• Reinforcing values and healthy behaviours
• Strategic information
• Support to regional response
• Info and recourses
• Involvement of private sector
• International community role

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Meeting the challenge of NCDI in the CIS
Countries 30-31 October 2007 Moscow, Russian
Federation

• Next steps
• Establish an international alliance to support
  CIS countries in meeting the challenge of NCDI
• Develop an operational plan
• Mobilize technical and financial resources

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The World Bank ECAwww.worldbank.org/eca

• NHP strategy should reflect growing differences
  between countries and sub-regions.
• Results-based approach (quantifiable)
• HIV/TB and MDG targets
• Nutritional MDG targets in CA and Caucasus
• Premature death and disabilities from NCD reduced
  by 20
• Improved governance (reduction informal payments
  and transparent drugs procurement)
• Inequalities to access necessary services reduced
  by 25
• HC infrastructure, continuum of care and Q. and
  cost-effectiveness of services
• Increased patients satisfaction with services by
  25
• Countries - risk pooling arrangements
• Develop plan for demographic transition
• Improved understanding among decision makers
  about PH and cross-sectoral dimension of health
  determinants

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Challenges of chronic diseasesin Ukraine
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Ukraine background information

• Second largest in Europe
• Favorable geographic position
• Independent since 1991
• Severe transition crisis

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Health care systemSemashko model

• Line-items budgeted
• Tax-based approach
• 80 regional budget 20 central budget
• 60 - public sources 40 OOPs
• Public Health Expenditures 3.7 of GDP
• Essential package of services
• VHI 1.5

• Vertical
• Centralized planning
• Supply-oriented
• Little distinction between primary and secondary
  levels
• Politically abused (6 Ministers within 4 years)
• unequal

Health expenditure per capita and public
expenditure share Ukraine vs comparator
countries/regions, 2004 (Source World
Development indicators)
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Health status of Ukrainians

• Ukraines early transition period experienced a
  rise in mortality rates, especially for adult
  males.
• Non-communicable diseases are the dominant cause
  of the disease burden in Ukraine.
• There is also evidence that the prevalence of
  infectious diseases in particular tuberculosis
  (TB) and HIV/AIDShas been increasing.

The deterioration in health status among
middle-aged groups may exert significant fiscal
pressures on the long-term care system in the
future.
Note Since 2005 the registration of deaths is
classified according to ICD-10 codes. Source
State Statistics Committee Ukraine
(http//www.ukrstat.gov.ua/ ).
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Ukraine has not just significantly lower healthy
life expectancy, but also the highest percentage
of lifespan lived with illness and disability
Life Expectancy at Birth in 2005, Ukraine
Compared Internationally
Note Data for Ukraine are for 2005 data for
comparators are for 2004. Sources World
Development Indicators Ministry of Health of
Ukraine.
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Emerging Infectious DiseasesHIV epidemic
impact and forecast in Ukraine
Forecasted number of HIV-infected by 2014
Forecasted share of AIDS deaths among all deaths
population 15 49
Forecasted number of AIDS orphans by 2014
Life Expectancy reduce by 2014 4 years for
males (from 65.6 to 61.6) 5 years for females
(from 75.8 to 71.0) HIV epidemic will
accelerates demographic crisis By 2014
additional decrease by 500,000 Macroeconomic
Impact 6 reduction GDP 2 reduction in labor
force 8 reduction in total welfare
Source The World Bank and International HIV/AIDS
Alliance, 2006
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Ukraine demographic changes
Total population Ukraine, 2006-2050 forecast
Age-sex pyramid (population tree), 2006 and 2050
forecast
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Public Expenditures Review (Health)

• Local governments has very little control over
  the resources
• Health norms issued by the MoH generate severe
  rigidities in the delivery of services
• Most of such budgets being consumed in recurrent
  spending as opposed to increasing the share of
  quality-enhancing expenditures
• There is a constitutional prohibition to closing
  health care facilities
• In general, Ukraine has a greater number of
  health system inputs than do EU-10 countries and
  other EU countries
• The prominence of specialized medical care vs
  primary care
• Most public health spending is concentrated in
  hospitals and specialized health facilities as
  opposed to primary health care
• The poorest quintile is the least likely to use
  outpatient, inpatient, and preventive services.

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Addressing the challenges

• Governmental Initiatives/Programmes
• Health of the Nations 2002-2011
• Presidential Program Ten Steps Towards People
• New Government Program Ukrainian Breakthrough
• International Organizations (WB, EC, WHO, CIDA)
• Civil Society (low involvement)
• Private Sector (V. Pinchuk Foundation, Ukraine
  3000, Ukraine's Development)