Abstract
In the light of the serious health problems in Ukraine and uncertainties of post-communist transformations and healthcare system reforms, this chapter considers how Ukrainian health care facilities are actually governed. The chapter draws on about 150 face-to-face interviews with physicians, nurses and administrators of both healthcare facilities and regional healthcare departments. The analysis focuses on the actual governance of priorities, human resources, professional performance, and medical technology. It shows that in the context of stagnation of national policy reforms and lack of funding, health facilities are run in Soviet style by powerful chief doctors, while simultaneously informal practices develop to keep the facility operations. The informal governance mechanisms that proved to be barely penetrable to formal regulation allowed healthcare organisations to survive through societal turmoil and disorientation. But through relying on extraction of profits for those on top of the healthcare organisations these mechanisms threaten accessibility and responsiveness of healthcare provision.
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Acknowledgements
This research was undertaken with support from the World Bank. The content of the publication is the sole responsibility of the authors and in no way represents the views of the World Bank. We would like to acknowledge the great contribution of the organisations that implemented the study: FISCO ID (Yuriy Dzhygyr, Kateryna Maynzyuk) and Kyiv International Institute of Sociology (team of researchers and interviewers under the supervision of Artem Myroshnychenko). We are grateful to medical doctors, nurses, health-care managers, and decision makers who agreed to participate in our study. We appreciate the support of our colleagues and research team who facilitated conducting this research and without whose participation this research would have been impossible.
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Stepurko, T., Belli, P.C. (2018). Innovating Health-Care Governance in Ukraine: Formal and Informal Practises. In: Zvonareva, O., Popova, E., Horstman, K. (eds) Health, Technologies, and Politics in Post-Soviet Settings. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-64149-2_8
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DOI: https://doi.org/10.1007/978-3-319-64149-2_8
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