Kharkiv Institute for Social Researches
Supported by International Renaissance Foundation
Protecting the right on access to medical care for internally displaced persons in Dnipropetrovsk and Kharkiv Regions
Kharkiv — 2015
УДК 364.444:314.72
Authors: Andrew Chernousov, Leading expert, PhD Svitlana Shcherban, Research Fellow Translated by Andrew Chernousov
The publication was made possible due to financial support of the Public Health Program Initiative of the International Renaissance Foundation. The views expressed in this publication are those of the authors alone and do not necessarily reflect the position of the International Renaissance Foundation.
Protecting the right on access to medical care for internally displaced persons in Dnipropetrovsk and Kharkiv Regions/ A. Chernousov, S. Shcherban — Kharkiv: Kharkiv Institute for Social researches, 2015. — 32 p. The publication is reflecting the report by results of the sociological survey devoted to protection of the right to medical care for internally displaced persons (IDPs) from Antiterrorist operation zone on the example of Dnipropetrovsk and Kharkiv Regions. Report is representing opinions of volunteers, health care employees and IDPs themselves concerning the provision of medical care for them. The publication can be useful for public officials, health care employees, NGO representatives, UN agencies employees and for everyone who is interested in the topic. The survey could not be properly realized without substantial help of volunteers from «Kharkiv Station», Charity Foundation «Gorenie» and Charity Foundation «Dopomoha Dnipra»
© Kharkiv Institute for Social Researches, 2015
List of acronyms:
ATO — Antiterrorist Operation HIV/AIDS — Human Immuno — deficiency Virus / Acquired Immuno — Deficiency Syndrome IDP — internally Displace Person DHC — Department of Health Care HCI — Health Care Institution RSA — Regional State Administration
Contents
5
Introduction
7
Basic medical and social problems for IDPs
11
Arrangement of medical care for IDPs
17
Access to medical care services for mostly vulnerable groups of IDPs
22
Cooperation of state agencies and volunteers concerning provision of medical care to IDPs
25
Probable improvements for provision of healthcare services for IDPs
29
Conclusions
Introduction Last months due to aggression of Russia, Ukraine is almost every day meeting new challenges and problems which are remained without respond or reaction is extremely slow because of lack of experience and scales of the problem. Since March 2014 regions of the East of Ukraine started actively to accept IDPS form temporary occupied territory of the Donetsk and Luhansk regions. According to data of State Service for Emergency Situations of Ukraine, on March 31, 2015 the number of internally displaced persons made 810 000, among them in Dnipropetrovsk and Kharkiv Regions accepted over 240 000 persons1. People were forced to leave, abandoning homes, leaving belongings and clothes and loosing for unidentified period the opportunity to solve their everyday problems. One of the main problems which are challenging moved people from Donbas, is the access to medical care and necessary medicines. This is especially on high agenda for the most vulnerable categories of IDPs such as: pregnant women, children, aged people, wounded and traumatized persons, disabled, mentally ill, people living with HIV/AIDS, hepatitis, TB, diabetes etc. That’s why Kharkiv Institute for Social Researches under financial support of the Public Health Program Initiative of the International Renaissance Foundation conducted sociological survey, directed on studying of the situation with arranging access to medical care for internally displaced persons.
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Indicators for the planned monitoring are: Basic medical and social problems of IDPs
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The most requested types of medical services (consultancy, diagnostics, treatment, ambulance etc.);
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Awareness of IDPs concerning the access to medical care (what? where? when?);
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Timeliness and completeness of medical services;
1
Official web-site of State service for Emergency Situations — http://www.mns.gov.ua/news/34232.html
5
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Medical care for the most vulnerable categories of IDPs (insulin — dependent, wounded and traumatized persons, mentally ill, people living with HIV/AIDS, TB, hepatitis etc.);
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Free of charge medical care;
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Cooperation between public officials and volunteers in the arrangement of medical care provision of IDPs;
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Ways of health care provision improvement for IDPs.
The survey was conducted in Dnipropetrovsk and Kharkiv Regions, which were the first regions to meet enormous number of internally displaced persons and already have experience to solve those problems.
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6
Survey composed of: Face-to-face interviewing of internally displaced persons who applied for medical care to state health care institutions. Sample is targeted, directed selection at points of provision of volunteer help, N=100;
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Expert interviews with volunteers providing help to internally displaced persons. Sample among available experts, N=30;
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Expert interviews with employees of health care institutions, public health care institutions, who met IDPs in their work. Sample among available experts, N=20;
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Document — responds analysis of the Ministry of Health Care of Ukraine, Dnipropetrovsk Regional State Administration, Kharkiv Regional State Administration which were about provision of health care to internally displaced persons in the mentioned regions.
Protecting the right on access to medical care for internally displaced persons in Dnipropetrovsk and Kharkiv Regions
Basic medical and social problems for IDPs There is an important factor which is influencing the health problems, impeding the process of applying for health care and receiving care services and also slowing process of treatment and recovery is availability of other social day-to-day problems. Among them are unemployment (45 %); homelessness (33 %), lack of warm clothes (25 %), lack of food (15 %); problems with receiving of social benefits (19 %) etc. (Table 1). Table 1. Most disturbing problems for IDPs Problems
% responds
Unemployment
45
Access to health care
36
Searching for living rooms
33
Warm clothes
25
Legal aid
21
Receiving of social benefits (pensions, child social payments etc.)
19
Lack of food
15
Receiving of social payments for IDPs
15
Receiving of psychological aid
7
Transfer to other place/city
5
Registration as an internally displaced person (getting a certificate)
5
Making the child to kindergarten
4
There is no seriously disturbing problem
4
Getting of specialized or higher education by the respondent or his/her child
2
7
Actualities of those needs were confirmed by IDPs responds on financial status of their families. Thus, 24 % of interviewed people admitted that they barely make ends meet and sometimes they are lacking money for food. Another 63 % have indicated, that they have enough for food but for purchasing clothes and footwear is not enough. That is why every fourth IDP has actual problem in obtaining of warm clothes. Only 13 % of interviewed IDPs responded, that they have enough money for living, but they cannot afford valuables (furniture, refrigerator etc.). There are no internally displaced persons who have no financial problems at all (Drawing 1). Drawing 1. Evaluation of financial status of IDPs ( % to responds) Enough for food but for purchasing clothes and footwear is not enough
63
Barely make ends meet and sometimes they are lacking money for food
24
Have enough money for living, but they cannot afford valuables
13
No financial problems at all
0
NO financial problems except for purchasing major valuables (vehicles, houses)
0
According to volunteers’ responds since last month IDPs’ problems have been changed. In summer 2014 people were leaving unsafe regions of Donbas spontaneously, grabbing only necessary documents. As a result they needed even basic household items such as dishes, linen etc. For the time being internally displaced persons making their decision to move more thoroughly, making prepared with minimal set of items and belongings for long-term living outside their homes. Besides this, there is an increased number of IDPs who are staying at the Ukrainian government controlled territory more than 6 months and are more accustomed: they have homes, found a job, made children to kindergartens etc. Their problems are concentrated on improving of living conditions and asking for washing machines, refrigerators and TVs at points of humanitarian aid distribution.
8
Protecting the right on access to medical care for internally displaced persons in Dnipropetrovsk and Kharkiv Regions
According to volunteers’ and medical sta opinion, a lot of IDPs could not clearly realize that they need a psychological support. This is meant to be the second row problem and solution could be postponed on later stages. According to survey results only 7 % of respondents said that they are really worried about their psychological rehabilitation.
We meet severe psychological conditions of the people. For the moment we see dominating states state of hopelessness and anger. We’re considering these as psycho disturbances. Bu t it is a depressive state, people are distrusted in better future. We see a lot of post traumatic stress disorders, psycho-emotional disorders, which must receive respond, otherwise this could impact the general health condition of people. Quotation from the interview with the employee of Department of Health Care
Concerning direct needs of medical care, the main problem is primary diagnostics and treatment (61 % of responds), in 19 % of cases there were needed only primary consultation and another 19 % needed stationary treatment (Drawing 2).
9
Drawing 2. Types of medical care needed by respondents/their parents (% to answers) 70
61
60 50 40
12 6
6
Registration at HCI
19
20
Ambulance
19
30
Medicines
Stationary treatment
Consultation
Diagnostics & treatment
10
The biggest number of applications for medical care was on treatment of colds and (36 %) chronicle diseases (28 %) (Table 2). Every tenth interviewed person applied for help needed for pregnant ladies and newly born child. Responds in the category “Other care� were mostly related to receiving of dental care, less to eye specialist.
10
Protecting the right on access to medical care for internally displaced persons in Dnipropetrovsk and Kharkiv Regions
Table 2. Reasons of application for medical care of respondents/ relatives Reason
% to responds
Colds
36
Chronicle diseases
28
Other (dentist, oculist)
12
Pregnancy, newly born child
10
Vaccination
9
Disablement
8
Deterioration of mental health
7
Receiving of insulin
2
Wounds, trauma, concussion
2
According to physicians, among chronicle diseases are prevailing cardiovascular diseases. A lot of IDPs applied with complaints on hypertonic crisis. There are also applications with arthritis, diabetes, diseases of the nervous system and cancer problems.
Arrangement of medical care for IDPs According to oďŹƒcial position of public authorities internally displaced persons are enjoying all opportunities on receiving medical care including receiving medicines free of charge or on preferential terms, as other permanent residents of the territory they moved to. Providing of medicines is realized in accordance to Ukrainian legislation and within limits of approved budgetary and costs statements of health care institution for the current year.
11
In real life this means, that public institutions of health care were forced to provide medicines for IDPs using their own budgetary fund, which was elaborated for the poorest part of the population. Medicines which must be distributed free of charge according to legislation (these are mainly such diseases as TB, hepatitis, HIV/AIDS, diabetes etc.), from those reserves which are made for local residents of those regions where IDPs moved to. We also have to take into account that even the latter are not always have sufficient amounts of medicines.
We are using the money which are allocating for every budget year. This is so-called «emergency store», which was used in case we met patient who could not afford himself to purchase medicines. We could not afford to leave him/her without medical care, so that’s why we’re using the store. But this store is not endless. And we’re using the store for needs of IDPs. Quotation from the interview with the medical employee
So the basic problem, which became even more apparent in war conflict time, is the urgent need of reforms in medical sphere of Ukraine. Health care is only virtually is free of charge, but de-facto all citizens are paying for everything starting from fees for fluorography image and to payments for child birth procedures. Besides unsanctioned collection
12
Protecting the right on access to medical care for internally displaced persons in Dnipropetrovsk and Kharkiv Regions
of money, internally displaces persons, like other citizens of Ukraine, facing problems of queues, tightened bureaucracy, outdated diagnostic and treatment equipment.
We’ve applied to clinics and hospitals than and they redirected us from one office to another. We could not accept you, you have to visit this and that office and collect different certificates. And we had to pay everywhere. IN one office we’re asked to give money for paper for receipt, in other office we’re asked to make “donation”, or to pay for massage… But I’m not complaining... they did help me and attitude was friendly. But I’m absolutely conscious, it’s not because we’re IDPs, this concerns everybody. We had this situation in Donetsk as well. Quotation from the interview with IDP
According volunteers’ opinion, constant violations of patient’s rights are existing not only because the majority of HCIs work in such a way, but also because people themselves are poor aware of their rights and ways of their protection.
Mothers, who have disabled children, they need anticonvulsant medicines, which must be provided free of charge. So the district therapist is trying to avoid providing medical services and asking to get new patience card or take another primary consultation. She could not bring the baby to therapist, she is laying. For instance, she has no wheelchair or what else. And she could not realize the she must go to physician in charge in write a complaint. And even if she asks something she could not properly understand what was the respond. Quotation from the interview with volunteer
A lot of people could not merely identify such situations as violations of their rights, another part of citizens consider complaints procedures as purposeless and that could not help to solve the
13
problem and are ignoring them. But most frequently payment for health care by IDPs means for them strict restrictions in purchasing food and other primary items, which seriously impact the recovery process. That is why they have to fight for their rights or refuse health care services at all.
My Mom is disabled person. She needs surgery and aſter surgery care. When we were told prices we realized that it is too expensive for us. Rental fees, foods, transportation… money is needed everywhere and we’re lacking them. We have to postpone the surgery, but it is the issue of time and situation would not change for the better. Quotation from the interview with IDP
— We’ve paid 10 UAH for every exercise for eyes to develop ability of eye muscles. We needed to do several times. — And how many times you’ve done this? — 6 or 7 times. — And what? Did you pay every time? — Yes, we did every time. We were told that we have to pay. They said that we have the same system like in your Donetsk. — How substantial is this amount for you? — Of course it is substantial, even for на 100 % substantial, because you have to choose: to buy something to eat or make diagnostics for you child. Quotation from the interview with IDP
Concerning payments for medical services, the vast majority of respondents indicated, that health care services were free of charge (77 %), but alongside with is that meant purchasing medicines and other treatment supplies. According to IDPs responds, making all necessary tests and diagnostics as usually were for fees, in case if they applied to private HCI, where public HCI readdressed them if they could not fulfill some procedures. Concerning surgeries, IDPS
14
Protecting the right on access to medical care for internally displaced persons in Dnipropetrovsk and Kharkiv Regions
frequently had to pay all medical supplies, which were used at surgery process. Another 13 % of respondents, admitted that they paid directly for medical services to the physician or nurse. Every tenth IDP paid for health care services to public HCI (Drawing 3). The payment varied from 150 to 1200 UAH (the most frequent fee is 500 UAH). Concerning fees directly to physician or nurse, it made from 7 to 2000 UAH (the most frequent fee is 50 UAH). Drawing 3. Distribution of IDPs’ responds on the question «Did you/your relatives paid for the last medical service at public HCI?» ( % to responds)
10
13
77
Yes, to HCI Yes, to physician/nurse No, medical aid was free
Generally, the majority of IDPs are satisfied with the quality of provided medical care (81 %). Unsatisfied IDPs made only 7 % (Drawing 4). In the course of interview respondents, in spite of financial problems in payments for medical services, admitted kind and empathically attitude from the side of medical employees to them as IDPs, indicating attention and humaneness.
I’m so grateful to physicians, they were so sensitive, kind and they really accepted me well. Therapist, I would say by God, just like my relative. She called me “sister”, and I cried, and she reassured me. I’m so grateful! Quotation from the interview with IDP
15
We always respected people especially physician for their ability to communicate,because they do not owe us nothing. And made tension for people in the clinic, and they will not get any additional salary for this. We were grateful said “hello”. Good people always understand each other. Quotation from the interview with IDP
Drawing 4. Satisfaction of quality of received medical care at public HCI (% to responds)
12 81 7
Fully or rather satisfied Hard to say Fully or rather unsatisfied
If we summarize all problems in receiving of medical aid at public HCI, 45 % of responds of IDPs admitted that they had no problems at all. The biggest problem as indicated earlier, is high value of medical aid (27 %). Lack of information about medical services was indicated as barrier to get necessary medical aid (17 %). Only 5 % of responds admitted negative attitude of medical staff to the respondent as to internally displaced person (Drawing 5).
Yes, we did met such a problem. We were told that we’re reckless and we used to live on bulks of money, and now we’ve arrived and requiring new homes, jobs and you don’t want to pay, but you’ll have to like others! Quotation from the interview with IDP
16
Protecting the right on access to medical care for internally displaced persons in Dnipropetrovsk and Kharkiv Regions
Drawing 5. Problems for IDPs when they were trying to get medical aid at public HCI (% to responds)
There were any problems
45
Medical care was too expensive to the respondent
27
Lack of accessible information about ways of obtaining medical care
17
Negative attitude of medical staff to IDPs
5
Absence of necessary diagnostics and treatment equipment
4
Poor transportation with HCI
4
Lack of needed specialists
3
Low qualified medical care
2
Neglect of medical care
2
Access to medical care services for mostly vulnerable groups of IDPs According to official statistics of the Health c are Department of the Kharkiv Regional State Administration on February 2, 2015 among 123 693 of registered IDPs there are: children — 13 582; aged people — 80 174; disabled — 5718. Number of people applied for medical care is 46 402 (Table 3).
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Table 3. IDPs categories, who applied for medical care to HCI (absolute numbers) Among 46 402 IDPs, applied for medical care:
Number
Adults
31931
Children
14471
Cancer patients
2102
Pregnant ladies
1359
Mentally ill
596
Wounded
525
Insulin dependant
338
People living with HIV/AIDS
187
TB patients
168
Visits to doctors
35 918
Treated in hospitals
10 484
Information on general numbers of IDPs of dierent categories was not provided by the Department of the Dnipropetrovsk Regional State Administration. According to volunteers’ opinion, there are a lot vulnerable persons among IDPs, who needs urgent medical care which could not be postponed. Mainly this concerns TB patients, people living with HIV/ AIDS, hepatitis, insulin dependent, cancer patients, mentally ill and wounded IDPs. The biggest problem, according to opinion of both volunteers and physicians, is that treatment and recovery process of indicated diseases
18
Protecting the right on access to medical care for internally displaced persons in Dnipropetrovsk and Kharkiv Regions
is rather expensive and even local inhabitants frequently could not receive sufficient treatment. It is especially urgent for hepatitis, cancer patients and those with war wounds.
Cancer treatment is complicated because it requires a lot of money. They ask you at the very beginning whether you have sufficient amount of money? We have no free oncology therapy. And moreover we have wounded patients. Wounded means these are untreated trauma or concussions or fragments. And even in this case treatment is more accessible through ambulance, aſter surgery recovery will cost over 400-500 UAH per day. Of course patients do not have such money. Quotation from the interview with volunteer
I have oncology disease. I had a block of chemotherapy and now every 3-4 months I have to take another chemotherapy blocks. One medicine — alkeran — costs 600 UAH, if you buy at unofficial supplier. The therapist said that they don’t have it and we have to find ourselves. Then another medicines — mirin — which is even more expensive. 2100 UAH for unit. This is only for one moth. I was given them in Donetsk. I also had an opportunity here, but the specialist told me that I Have to visit my treatment doctor. And treatment doctor is in Donetsk… of course he has enough of his own patients and told me that I took it for two years and there is a risk for me. They gathered a koncilium and one of doctors told me that I don’t even look like ill person. I said nothing. I did not receive any medicines and I’m still waiting. Quotation from the interview with IDP
Treatment of such patients is frequently oſten complicated with the fact that moved persons do not have proper medical documentation (anamnesis) with indication of particular diagnosis and presubscribed medicines.
19
Not all patients are aware of what type of insulin they need, so this information is known to treatment doctor. But he is there and medical documentation is also there and they did not take them from there. So we could not help such person because we don’t know what to purchase. Quotation from the interview with volunteer
The survey has shown another significant problem with provision of medical care to mentally ill persons. It is connected primary with the fact, that on the territory of occupied parts of Donbas such patients for some time did not receive any treatment. During last months sta of psychiatric hospitals was cut and patients were staying there without any treatment, until they were evacuated. If such mentally disabled person was evacuated on the Ukrainian government controlled territory there might be some problems connected with his custody person, because none could be forcibly put in psychiatric hospital without consent. Aer leaving the ATO zone, such patients are in a heightened state of psycho-emotional irritation and refusing to visit psychiatric hospital.
20
Protecting the right on access to medical care for internally displaced persons in Dnipropetrovsk and Kharkiv Regions
Such person could not rent an apartment, make social benefits as well. We could not accommodate them. There is no social work in this direction from the part of the responsible agencies. Quotation from the interview with volunteer
It is also worthy to admit the problem tuberculosis which is on the very high agenda for several reasons: ✚
Huge latency of patients, especially among IDPs who could not be registered and could stay in public places with contagious type of TB;
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Absence of mandatory primary medical survey of newly arrived displaced persons as a preventive measure to counteract to spread of disease;
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Ignorance of many people of danger of contamination when they contacted unknown people while staying at cellars and bomb shelters etc.
We had a story with TB. We provided treatment to one IDP with his chronicle disease, which was non-contagious. We’ve brought him to the physician, treated him, he was served by many people. People helped with clothes and footwear, brought food, brought him to the hospital. I was taken him from the hospital to another clinic. They’ve started with fluorography image. And they have revealed tuberculosis which required emergency treatment. They are arriving, finding jobs, visiting volunteer centers and could not make a medical survey at all. But they are arriving from regions with distributed bronchopulmonary diseases, where a lot of coal miners. They must do fluorography image at least… Quotation from the interview with volunteer
21
Cooperation of state agencies and volunteers concerning provision of medical care to IDPs According to respond on our informational request from the Department of Health Care of the Kharkiv Regional State Administration they provide a list of non-governmental organizations and volunteer initiatives which have partnership relations in the sphere of providing of medical care to IDPs. So, at February 16, 2015 there were: ✚ ✚ ✚ ✚ ✚ ✚ ✚ ✚ ✚
22
Regional organization of Red Cross — Ukraine; Regional organization of medical employees trade union of Ukraine; Civil society organization «Kharkiv Foundation of psychological researches»; Kharkiv medical community; International Charity Foundation «There is a hope»; Charity Foundation «Parus»; Help Army Group; Kharkiv Regional Department of All — Ukrainian Network of PLHIV/AIDS; Volunteer Initiative «Kharkiv station».
Protecting the right on access to medical care for internally displaced persons in Dnipropetrovsk and Kharkiv Regions
Information about cooperation with institutes of civil society by the Department of Health Care of the Dnipropetrovsk Regional State Administration was not provided. Alongside with this in the course of interview with the employee of the Department there was mentioned cooperation with the Charity Foundation «Dopomoha Dnipra». We should notice that volunteers’ responds concerning cooperation with public agencies has their peculiarities in every region. Thus, according to volunteers’ responds, in Dnipropetrovsk region there is a systematic cooperation with HCI directly. Every day the Department of Health Care sends the representative to the centre of humanitarian aid to IDPs and receives a list of medical needs of IDPs and is trying to find resources using own money and charity funding.
Department has a data base with names of all IDPs, who need medical care. Every day we’re collecting this list and transfer it to centres of medical and sanitary help. These centres in turn on the next day must get in touch with every person and agree on the plan of providing of health care services. As a result by the end of the day we have reaction on every person in the list request — whether problem was solved or not. Quotation from the interview with employee of the DHC
23
Concerning Kharkiv Region, according to volunteers respond, they are mainly initiators of providing solutions of medical problems of IDPs.
As I can see public bodies just could not manage the problem, but sometimes they even do not want to do something. So they have no opportunity to accommodate people and the say: we can’t accommodate you. Maybe they just need to try… they can’t give money for medicines and they will tell — we have no money. So this is how it works. Of course they are inviting us on different meetings, councils. But we’re visiting only those where we can impact the situation. So we do this selectively. Of course I have phone numbers of Department Chief, but I can’t call him for every minor problem. Quotation from the interview with volunteer
Alongside with this, volunteers from both regions confirmed that frequently for provision of health care in particular situation they apply not to the DHC, but directly to chiefs of HCI and solving problem “at the place”. Medical staff themselves is extremely rare could initiate contacts, but they could say about their problems at HCI.
The biggest problem for IDPs is the same as for the rest of population: our hospitals have no medicines and supplies. We have no good, contemporary medicines in sufficient amounts. Our emergency units asking to supply saline, glucose which are very elementary supplies. These things must be in place every single moment. Quotation from the interview with volunteer
Besides the above mentioned, part of medical staff of public health care institutions and clinics are actively volunteering in providing care for IDPs, i.e. providing consultancy, advise concerning changing this or that types of treatment and finding cheaper analogues.
24
Protecting the right on access to medical care for internally displaced persons in Dnipropetrovsk and Kharkiv Regions
There is also a situation when physicians are IDPs themselves and they are actively participating in providing care in spite of the fact that they already have a job at HCI at the Ukrainian government controlled territory.
Probable improvements for provision of healthcare services for IDPs
Another important task of the research was to identify ways of probable improvements of health care provision to internally displaced persons. The position of IDPs themselves was frequently about expanding the number of state programs in the sphere of provision of such aid (41 % responds). Another 15 % of responds were about necessity to make information about health care more accessible (Drawing 6). «Coordinate volunteers’ work and state agencies» and «increase the number of employees, responsible for medical care provision for IDPs» these alternatives collected 12% each. It is important to admit, that in 22 % of cases IDPs were doubt to answer, reasoning this that they did not think over how the situation could be improved. 18 % of respondents indicated that nothing needs to be changed. Almost all of them were fully satisfied or satisfied with provided health care.
25
Drawing 6. Probable ways of improvement of public health care provision according to IDPS opinion (у % to responds) Increase the number of state programs of health care provision
41
Hard to say
22
Do nothing
18
Make more accessible information of health care
15
Coordinate the volunteers’ work and state agencies
12
Increase the number of responsible staff
12
Develop working mechanism of on-line/ phone consultancies
7
Interviewed volunteers and employees of the health care system are mainly shared the opinion of IDPs and indicating that one significant problem is lacking sufficient efforts from the state and lacking of special programs for IDPs, mainly in the sphere of funding of public health care system.
We would strongly recommend central state agencies pay their attention to the problem, because needed resources for treating IDPs are lacking, we must have support from the national budget of Ukraine. Doing this we could overcome all existing problems. ІQuotation from the interview with employee of Department of Health Care
26
Protecting the right on access to medical care for internally displaced persons in Dnipropetrovsk and Kharkiv Regions
We’re catastrophically lacking money. Medicines are extremely expensive especially now. We could not supply medicines for all. Of course we’re not alone with the problem. Army needs help, and the majority of the population is beyond the poverty line. But when you meet the family with ill child, you have to find money to help. We’re trying our best but reserves are almost empty. Quotation from the interview with volunteer
Together with this, volunteers also emphasized the problem of coordination of actions of all stakeholders in providing health care services to IDPs. We frequently see that medical staff and public officials, who are providing help to IDPs, have no idea about volunteer initiatives in the region.
We have no proper coordination. If the IDP is brought to the hospital on an ambulance vehicle and he/she needs to find solution for other basic problems, physicians have no idea what to do. They have neither phone numbers nor addresses. Quotation from the interview with volunteer
27
Information campaign on arrangements of the medical care, according to volunteers’ opinion is poor. Most frequently people get information on ways how to deal with health care problems at volunteer points. And if the person does not visit such points, they could postpone it for months without any treatment.
If the IDPs just caught cold it is not such a big problem. At least person could treat himself, or visit the nearest hospital, or call an ambulance if the situation is getting worse. And what if hypertonic crisis, hepatitis or tuberculosis? There is a disease and treatment is needed but the person has no idea where to go. Or decided that he/she has no right, because knows that such health care is provided only for locals. Do you understand? I.e. there is no clear information where to go and what to do?
Quotation from the interview with volunteer
28
Protecting the right on access to medical care for internally displaced persons in Dnipropetrovsk and Kharkiv Regions
Conclusions Among basis health care problems for IDPs we can indicate the following: Lack or absent funding which is allocated on provision of health care for internally displaced persons. For the current moment allocated fund for IDPS are transferred from local budgets, which were designated exclusively for local inhabitants. Especially hard this problem impact those categories of patients, who are entitled by law for receiving free medicines (TB, hepatitis, HIV/AIDS, diabetes etc). The government should develop dedicated funding program of IDPs health care provision with respect peculiarities of treatment for different categories. ✚
✚ The lack of an established primary medical examination of all displaced persons at non-occupied territory of Ukraine, because on the one hand, there is no timely medical care to those who need it, and the other does not implemented preventive measures to prevent socially dangerous diseases (tuberculosis, lice, etc.). This review should be organized by public health care institutions in places of arrival of settlers in other areas (train stations, bus stations) and humanitarian aid (volunteer, community centers). ✚ Inadequate access to information for internally displaced persons on where and how to seek medical care; as their right to free healthcare and more. There is also need for immediate implementation of clear informing of IDPs about where and how to obtain outpatient and inpatient care, get registered in accordance with needs of healthcare institutions; provide addresses and contacts of these institutions in all areas. ✚ The limited financial resources of IDPs for purchasing even a minimum set of medicines in case of colds, the need for sedatives, and especially for chronic diseases — hypertension, rheumatism, asthma and more. In times of financial crisis, war, insufficient funding and health care reform is necessary to use certain temporary measures, including the provision of special discounts on medications or vouchers to a certain amount for their purchase.
29
Difficulties in obtaining medical treatment for those who need constant medication and qualified medical support — diabetics, HIV/ AIDS, tuberculosis, hepatitis, drug addicts, mentally ill and others. For most of these people because of the limited information and lack of medical records of most problems becomes even registration at relevant health care institution, leading to inability to obtain medicines and expert advice. To solve this problem, it is important to clearly inform customers of the organization and repeated passage of diagnosis & treatment.
✚
Post traumatic stress disorder which was called by shelling fire, moving, new conditions of life of many IDPs and mass children neurosis needing immediate attention of psychologists. And almost no systematic involvement of students of psychological faculties to provide psychological services to internally displaced persons. On the one hand, it would seriously dumped volunteers and health care workers. On the other hand, students could obtain diverse practice and improve their skills.
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Internally displaced persons have accompanying social and domestic problems, such as lack of housing, with proper heating, warm clothing, oſten food; inability to find a job; receive social benefits; update documents and more. This can complicate treatment processes and health care, as well as slow down the process of treatment and recovery of the patient. The situation could be improved by elaborating the coordination efforts of local health care departments, social security offices, departments of emergency services, services for children with community and volunteers’ initiatives for complex decision basic needs of IDPs on food, shelter, warm clothes, health care, etc.
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Protecting the right on access to medical care for internally displaced persons in Dnipropetrovsk and Kharkiv Regions
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Protecting the right on access to medical care for internally displaced persons in Dnipropetrovsk and Kharkiv Regions