3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
On 19 June, the MoH issued the Order #1431 “On approval of a substantial amendment to the clinical trial protocol and refusal to conduct a clinical trial of medicines intended for the implementation of measures aimed at preventing the occurrence and spread, localization and elimination of coronavirus disease (COVID-19)”. The Order envisages the following: (i) test sites were added for conducting a trial “Multicenter, double-blind, randomized, placebo-controlled study of efficacy and safety of the AMIZON® MAX, capsules 0.5 g, manufactured by Farmak JSC, in combinations with basic therapy, for patients with COVID-19”; (ii) a clinical trial for the PROTEFLAZIDUM was not allowed.
On 07 September, the Government announced that mobile teams have been formed in almost 600 primary care facilities to refer doctors to patients suspected of having COVID-19 to obtain PCR test material. 1051 mobile teams were formed in these institutions.
On 22 October, the Minister of Health announced an MOH plan on healthcare provisions in a case of deterioration of epi-situation in Ukraine:
1st level – 5-7000 confirmed COVID-19 cases per day. The health care system is capable to response effectively;
2nd level – 8-10000 confirmed COVID-19 cases per day. The health care system should deploy up to 30% of the total bed capacity (52,000 beds), including deployment of temporary hospitals;
3rd level – 11-15000 confirmed COVID-19 cases per day. Tight quarantine measures should be applied.
4th level – 15-20000 confirmed COVID-19 cases per day. The MOH will force the activation of medical triage protocols with the priority of providing medical care.
*According to the national legislation (available at https://zakon.rada.gov.ua/laws/show/1645-14/print), the terms “quarantine” and “self-isolation” mean:
quarantine - administrative and health measures used to prevent the spread of highly dangerous infectious diseases;
self-isolation - the presence of a person in respect of whom there are reasonable grounds for the risk of infection or spread of an infectious disease, in the place (premises) determined by him in order to comply with anti-epidemic measures on the basis of the person's obligation.
There are a number of measures put in place to reconfigure service delivery to increase treatment capacity in Ukraine. Specifically, since 12 March 2020, 51 hospitals have been designated as reference hospitals. As of 21 April, the number of first line response hospitals was extended to 246 to ensure access for those requiring hospital care, by October the number increased to 393. An assessment of hospital readiness was conducted with support of the WHO, following the Interim Version of the Hospital Readiness Checklist for COVID-19. In addition, to ensure sufficient bed capacity, the closure and reprofiling of a large number of infectious disease hospitals which was planned prior to COVID-19 outbreak is postponed.
Starting from April 2020 the State Emergency Service has deployed tents near the designated first line response hospitals to provide testing support and triage.
The Ministry of Health has provided health facilities of different levels with a clear algorithm for COVID-19 cases. In addition, infographics have been developed to illustrate the course of action and patient pathways to be followed (see Section 3.2. Managing cases).
Additional credits: Dr Elina Dale; Dr Vitalii Stetsyk; Dr Liudmyla Slobodianyk;Mr Artem Skrypnyk;Ms Olga Demeshko; Ms Anastasiya Brylova; Ms Tetiana Dolhova