Centre for Health Services Studies

Excellence in Health Research

This is a joint project with the Kyiv Economics Institute at the Kyiv School of Economics www.kse.org.ua  It is a 12-month development study to assess the feasibility of implementing a full-scale evaluation of the Public Health programmes and policies in Ukraine over the period 1990-2014.

Ukraine has long faced a significant health crisis exacerbated by growing health inequalities.  It is one of five countries in the World Health Organisation European region with life expectancy 11 years lower than EU average and a 10 year gap between males and females.

Since independence in 1992 Ukraine’s health care and public health systems have become inadequate to deal with growing epidemics of non-communicable diseases and TB/HIV/AIDs.  The Ukraine government has stated its commitment to reform and to evidence-based decision-making.  However, the dire state of population health and economic and political difficulties make it likely to opt instead for rapid implementation of ready-made examples from other countries.  This allows for no fundamental analysis of what does/did and does not/did not work in the Ukrainian context.

This 12-month development study funded by the Medical Research Council will examine how Ukraine’s national public health programmes and policies evolved from 1990-2014, mapping their implementation across regions and over time.  Professor of Health Economics, Olena Nizalova leads the CHSS team which also includes Prof Stephen Peckham and Dr Erica Gadsby.

Start date: 15/06/2015 End date: 31/12/2016

Funder: Medical Research Council

Funding: £100,590


Project Publications:

Working Paper 1: Importance of Process and Impact Evaluation of Public Health Programmes/Policies Overall and Especially in Financially Deprived Settings (David J Hunter, Stephen Peckham, Erica W Gadsby)
This paper sets the scene for subsequent papers by discussing the importance of research evidence in public health policy and practice, and the role it plays, alongside other influences, in decision-making processes.  The paper outlines the meaning and challenges of ‘evidence-informed public health’, and discusses the role of governments (and others) in developing public health policies and programmes based on good evidence.  It then explores the UK experience of supporting evidence for public health policy, and looks at the way in which public health research has developed there, before discussing the need for greater commitment to, and investment in, research and knowledge exchange in Ukraine.

Working Paper 2: Current Population Health Needs and Their Regional Distribution in Ukraine (Olena Nizalova,Nataliia Shapoval, Olga Nikolaieva)
This working paper describes briefly the situation in Ukraine in terms of population health over the past decade, starting from the analysis of the national level data on mortality and comparison of its levels and the last decade’s dynamics to that in the UK, Estonia, and Russia. Further comparison is made between avoidable/non-avoidable mortality as a more appropriate measure of the effectiveness of the Public Health system. To complete the description of the situation with population health, we analyse the available information on morbidity across various conditions linked to high mortality.

Working Paper 3: Public health programmes and policies in Ukraine: development, design and implementation (Erica Gadsby, Stephen Peckham, Anna Kvit, Kateryna Ruskykh)
This working paper describes our analysis of the evaluability (in principle) of public health programmes/policies in Ukraine. To do this, we analysed programme and policy documents, and our telephone survey and in-depth interviews, to explore the logic models of programmes/policies and to describe their (intended and actual) implementation. We sought to identify and explain programme aims, objectives, outcomes/targets and mechanisms by which outcomes are expected to be achieved. The following sections include some general conclusions resulting from our analysis of a range of programmes/policies, and give explicit examples of specific programmes/policies where relevant.

Working Paper 4: Existing Elements of Public Health System in Ukraine: Current State and Historical Developments (Erica Gadsby, Olena Nizalova, Olga Nikolaieva, Nataliia Shapoval, Oleksandra Betliy, Anastasiya Salnykova)
This working paper describes the historical developments and current state of the various elements that might together make up the public health function in Ukraine. To do this, we have drawn on the structure used by the European Observatory on Health Systems and Policies in their analyses of health systems in Europe (Rechel and McKee 2014), and the World Health Organization’s self-assessment tool for the evaluation of the essential public health operations in the WHO European region (WHO, 2015). We focus on a number of essential public health operations, as identified by the WHO Regional Office for Europe that guide our assessment of public health capacities and services. They are key issues for health policy-making, and look across the whole political and administrative spectrum, rather than focusing on the activities of specific institutions. For each key issue described in this working paper, we define the issue, briefly discuss the international context, and describe the situation in Ukraine, with reference to policies and regulations, organization and infrastructure, and operations and activities specific to the issue. The first key issue we address relates to the surveillance of population health and wellbeing. We then go on to explore issues of health protection, including emergency response, occupational health, environmental health and food safety. Next, we explore disease prevention and early detection of disease by examining screening in Ukraine. We then examine health promotion in the Ukrainian context, including action to address non-communicable diseases and social determinants of health. Finally, we look at the organization and financing of public health, and the state of the public health workforce in Ukraine.

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Last Updated: 20/03/2019