Enabling all children and pregnant women in Ukraine, including in situations of humanitarian crisis, to utilize improved quality and affordable mother and child health care services
Although total public and private health spending exceeds the global average for Ukraine’s income level, health outcomes remain weak in the country. Public health spending has averaged 4 per cent of GDP in recent years. Legislation and policy are also lagging in Ukraine which, for example, is one of the last countries in Europe with no universal law on salt iodization.
The challenging financial and policy environment contributes to poor quality of care, inadequate infrastructure, especially in rural areas, and the widespread practice of unofficial fees for services. In Ukraine, households contribute almost half of total health expenditure through out-of-pocket payments. This rate is among the highest rates in Europe.
In 2018, non-communicable diseases made up the heaviest disease burden in Ukraine: human immunodeficiency virus (HIV) and tuberculosis are the most serious diseases in Ukraine. The country has one of the highest HIV rates in the Europe and Central Asia, and tuberculosis continues to be the main cause of death among persons living with HIV.
Immunization coverage remains alarmingly low. In 2018, Ukraine suffered the largest measles outbreak in Europe with 47,000 cases that year, including 16 deaths (10 adults and 6 children). At the end of November 2018, immunization coverage was 76 per cent for the first measles, mumps and rubella (MMR) vaccination at 12 months; and 78 per cent for the second MMR vaccination at six years of age: both of these are substantially lower than the WHO-recommended figures of 95 per cent nationwide coverage. Meanwhile vaccination rates are under 55 per cent for vaccinations from diphtheria, tetanus and pertussis; hepatitis B and polio. The polio figure means Ukraine is at high risk of polio outbreak. Data from a 2018 National Health Index survey suggested that while support to vaccination remained at 75 per cent among parents with children under the age of 18, but 11 per cent of parents had negative attitudes to immunization.
Conflict-affected areas are particularly hard hit. Frequent water shortages, coupled with Ukraine's low immunization rates, also increase the risk of communicable diseases. This is concerning in a situation of high mobility and scanty healthcare services. Two-thirds of health facilities in areas closest to the ‘contact line’ have been damaged, hindering the population’s access to healthcare.
UNICEF Ukraine is working to enable all children and pregnant women in Ukraine, including in situations of humanitarian crisis, to utilize improved quality and affordable mother and child health care services. It will do this by ensuring that by 2022 selected oblasts, including conflict-affected districts, have increased capacity to provide quality integrated maternal and child health interventions, including immunization and nutrition services.
Maternal and child health
UNICEF is providing support for maternal and child health services, in particular related to immunization, early childhood development and nutrition, by developing the capacity of health workers and managers, and making targeted interventions for most vulnerable mothers and children in conflict-affected areas. It is supporting the Government to increase routine immunization coverage, helping to procure vaccines internationally, to install large cold chain units, to build the technical capacity of the Public Health Centre, and to facilitate the distribution process. In addition, UNICEF is seeking to strengthen the understanding of health professionals, parents and caregivers on importance of early childhood development.
HIV and AIDS
UNICEF is providing technical support to the Ministry of Health and the Public Health Centre to provide quality HIV and AIDS services and improve the policy environment to better combat the epidemic. Capacity development and targeted interventions, including in conflict-affected areas, are benefiting groups particularly at risk of HIV, such as pregnant and lactating mothers and adolescents.
Health care reform
UNICEF is supporting the Ministry of Health to implement health care reform, through creating an effective dialogue platform for health care reform. It is also advocating for maternal and child health issues to be covered in the primary health care service package. UNICEF is also advocating with key stakeholders, such as the Ministry of Health, the Public Health Centre, the Ministry of Agrarian Affairs, salt traders, producers, and food retailers, and members of the scientific community for a universal salt iodization law. UNICEF is advocating and supporting the introduction of salt iodization into the legislation in order to prevent iodine deficiency among children and other population groups.