Policy responses for Ukraine - HSRM


Policy responses for Ukraine

5. Governance

5.1 Governance

The GOVERNANCE of the health system with regard to COVID-19 relates to pandemic response plans and the steering of the health system to ensure its continued functioning. It includes emergency response mechanisms, as well as how information is being communicated, and the regulation of health service provision to patients affected by the virus.

Ukraine did not have a specific pandemic response plan in place before the outbreak started (first case detected on 06 March 2020). The Government and Ministry of Health issued  Order #185 dated 24.01.2020, which set up the Ministry of Health Emergency Operation Committee and provided technical guidance to the healthcare system. On 3 February, 2020 the national action plan to prevent the spreading of COVID-19 in Ukraine (hereafter – COVID-19 NAP) and the Cabinet Operational Emergency Committee were approved by the Cabinet of Ministers of Ukraine. The Cabinet Operational Emergency Committee is headed by the Prime Minister while the Chief State Sanitary Doctor of Ukraine and the Deputy Minister of Health had been tasked to coordinate the COVID-response of the Ministry of Health. Further, to ensure better intersectoral coordination and conducting a comprehensive analysis of the ability of the health system to effectively respond to COVID-19, on 25 April the Government established the intersectoral working group (WG) chaired by the Minister of Health. Members of the WG are senior representatives from the ministries of Finance, Internal Affairs, Digital Transformation, State Border Service, Government Commissioner for Gender Policy, Presidential Office, National Security and Defense Council, Security Service, State Criminal Enforcement Service.

The COVID-19 NAP is multisectoral and activated key stakeholders (Ministries, other state authorities and regional governments) to prepare for COVID-19.  It details the development and approval of regional response plans; designated points of entry to be activated in case of declaring emergency situations; development of operational plans (medical examination, isolation, transportation to the hospital, notification etc.) at airports, harbours, ground transport pathways on the border; designation of core hospitals at each region for COVID-19 treatment; scenarios for hospital repurposing; essential supplies calculation needs and distribution; and regular updating of guidelines for detection, surveillance, triage, case management, treatment, and IPC.    

On 17 March 2020 the Parliament adopted the Law “On Amendments to Some Legislative Acts of Ukraine aimed at preventing the occurrence and spread of coronavirus disease (COVID-19)”.  The Law introduces fines for violating restriction measures and lifts some tax requirements in order to provide financial relief for businesses, workers, and pensioners hurt by the economic slowdown. The fines for violating the restrictions range from 17,000 to 34,000 UAH (637-1,274 USD) for individuals and from 34,000 to 170,000 UAH (1,274-6,373 USD) for officials. Violation of the health standards and rules for prevention of infectious diseases will be punished by fines ranging from 17,000 UAH to 51,000 UAH (637-1,912 USD) or imprisonment up to three years. If a violation leads to the death of a person or other serious consequences, imprisonment from five up to eight years is possible.
The law also allows people to work remotely or go on vacation and provides additional allowances for medical staff and other employees involved in the COVID-19 response. Moreover, operational procurement of necessary goods, work and services are shortened to one day. Furthermore, the law bans forced expulsion from homes in case of non-payment during the restrictions and 30 days after its end. The measures are in power for three months after the publication of the law.

Besides that, on 20 March 2020 the Government approved the list of essential pharmaceuticals and medical equipment (including PPE) required for COVID response, which are exempted from import duties and value added tax. Furthermore, fast-track procedures for the regulation and licensing of medical devices has been introduced by the Cabinet of Ministers Decree #226 as of 20 March 2020 for medical products (devices) essential for the COVID-19 response. 

On 1 April 2020, the Parliament has passed Law № 3268 (http://w1.c1.rada.gov.ua/pls/zweb2/webproc4_1?pf3511=68473). The law permits using unregistered medicines for the duration of the pandemic, recommended by official (inter)national regulatory authorities such as the FDA in the US, the Medicines Agency in the EU, and the MHRA in the UK, for the treatment of Covid-19 in the respective country. In addition, authorized medicinal products may be used during this period for indications that are not specified in the instructions for medical use in the presence of proven efficacy of coronavirus treatment or if they are recommended by the official authorities of those countries. Furthermore, the new act enables faster processes for authorization and clinical trials for COVID-19 related medicinal products. These exceptions are in force until 1 July 2020. This should be used to update the development of national treatment guidance, which envisage the use of chloroquine, lopinavir/ritonavir, oseltamivir, tocilizumab and remdesivir as treatment options for moderate and severe COVID-19 cases. The Ministry of Health expressed interest in joining the WHO-led Solidarity Trial, which aims at speeding up research on COVID-19 treatment options.
On 06 May the Parliament adopted two laws:
1) The Bill # 3380 “On amendments to certain laws of Ukraine aiming to strengthen the capacity of the healthcare system of Ukraine in combatting the outbreak of COVID-19” aimed at:
- increasing payments to medical personnel on sick leave (including self-isolation) due to COVID-19 from 50% to 100% of monthly average wage;
- mandatory testing for persons with COVID-19 symptoms or for those who have been in contact with confirmed COVID-19 cases, and for medical personnel treating COVID-19 patients, and for National Police and National Guard personnel involved in implementation of COVID-related measures;
- the Cabinet of Ministers to instruct the Ministry of Health to adopt and timely amend instructions and protocols for medical personnel when hospitalizing and treating COVID-19 patients; to elaborate protocols in case of influx of COVID-19 patients and overload of healthcare system; to align protocols with recommendations issued by WHO and Centers for Disease Control and Prevention (US Public Health Service); to ensure availability of PPE in medical facilities.
The law aims at providing increased payments for medical personnel, hospitalized or self-isolated due to COVID (currently, such medical workers receive 50% of monthly salary). It will also launch widespread testing in order to prevent the dissemination of COVID.

2) The Bill # 3376-1 “On amendments to the article 39 of the Law of Ukraine “On protection of population from infectious diseases” (on additional guarantees for medical and other personnel involved in protection of population from infectious diseases)” on the following:
- medical personnel, for whom COVID-19 infection resulted in disability, is to receive no less 300 minimum subsistence wage (630,600 UAH);
- families of medical personnel who died as a result of COVID-19 contamination, are to receive 750 minimum wages (1,576,500 UAH);
- families of medical personnel, who died as a result of COVID-19 contamination, are entitled to same rights and privileges as families of military personnel, who died while serving.

On 17 September the Parliament amended the Law “On Medicines” on the implementation of the electronic retail trade for medicines. The Government temporarily allowed the sale of drugs via Internet during the pandemic.

On 17 November, the Parliament amended the Code on Administrative Offenses in regards to fines for non-compliance with the mask regime in public places for citizens in 170-255 UAH. Police and State Labor inspectors are thus allowed to impose fines at the scene.

Additional credits: Dr Elina Dale; Dr Vitalii Stetsyk; Dr Liudmyla Slobodianyk;Mr Artem Skrypnyk;Ms Olga Demeshko; Ms Anastasiya Brylova; Ms Tetiana Dolhova

On 25 May, the WHO Country Office together with MOH and UPHC launched the monitoring of the regional COVID-19 response through the PHRM tool (Public Health Response Monitor) to improve understanding of the response modalities in Ukraine and facilitate a coordinated response between the central authorities and regional (oblast) governments.

On May 27, 2020, the Government:
- approved the Economic Stimulus Program for overcoming the consequences of the COVID-19 pandemic. The Program takes into account initiatives in the following areas: access to finance, access to markets, deregulation, modernization and development, access to infrastructure. An important part of the Program will be the systematic and thorough support of domestic producers;
- supported the initiative of the MoH and expanded the list of healthcare facilities designated for COVID-19 from 339 to 449;
- extended the ban on export of anti-epidemic products until July 1, 2020.

On 19 June, the Parliament adopted amendments to the Law concerning treatment of COVID-19 on the extension of validity regarding the threat of increasing incidence of coronavirus disease (COVID-19).
On 1st July, The Cabinet of Ministers proposed to strengthen the administrative responsibility of the owners of public institutions and organizations. The Cabinet of Ministers proposed to the Verkhovna Rada (the Parliament) a draft law on fines for both individuals and legal entities.
The Government lifted some restrictions that had previously been applied to overall Ukraine:
- on holding mass events with more than 10 participants – the number of participants can be more than 10 people with a limitation of 1 participant per 5 square meters; participants should keep the 1.5 m distancing;
- on the operation of catering services (restaurants, cafes, etc.), shopping and entertainment centers, accommodation services (hotels, hostels), entertainment establishments, fitness centers, etc.
The Government also established changes in the working hours of executive authorities, government authorities, administrative service centers, social protection institutions, and units of the Pension Fund of Ukraine. Other businesses are also encouraged to change their work schedules to avoid the concentration of passengers in public transport.

With introduction of epidemiological zoning strategy in July, the Government delegated to the regional authorities the right to make a decision on intensification of anti-epidemic measures through the regional commission on technogenic and environmental safety and emergencies considering epidemiological criteria (see details in the section 1.3.).  

Additional credits: Dr Elina Dale; Dr Vitalii Stetsyk; Dr Liudmyla Slobodianyk;Mr Artem Skrypnyk;Ms Olga Demeshko; Ms Anastasiya Brylova; Ms Tetiana Dolhova