Innovating Health-Care Governance in Ukraine: Formal and Informal Practises

  • Tetiana Stepurko
  • Paolo Carlo Belli


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.



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.


  1. Alexander, J. A., Lee, S. Y. D., & Bazzoli, G. J. (2003). Governance forms in health systems and health networks. Health Care Management Review, 28(3), 228–242.CrossRefGoogle Scholar
  2. Balabanova, D., McKee, M., Pomerleau, J., Rose, R., & Haerpfer, C. (2004). Health service utilization in the former Soviet Union: Evidence from eight countries. Health Services Research, 39(6), 1927–1950.CrossRefGoogle Scholar
  3. Danyliv, A., Stepurko, T., Gryga, I., Pavlova, M., & Groot, W. (2012). Is there a place for the patient in the Ukrainian health care system? Patient payment policies and investment priorities in health care in Ukraine. Society and Economy, 34(2), 273–291.CrossRefGoogle Scholar
  4. Fiszbein, A., Ringold, D., & Rogers, F. H. (2011). Making services work: Indicators, assessments, and benchmarking of the quality and governance of public service delivery in the human development sectors. World Bank Policy Research Working Paper Series. Retrieved from
  5. Gryga, I., Stepurko, T., Danyliv, A., Gryga, M., Lynnyk, O., Pavlova, M., et al. (2010). Attitudes towards patient payments in Ukraine: Is there a place for official patient charges. ZeszytyNaukoweOchronyZdrowia. ZdrowiePubliczne I Zarzadzanie, 13(1), 69–78.Google Scholar
  6. Health Index.Ukraine. (2016). Retrieved from
  7. Holt, E. (2013). Ukraine at risk of polio outbreak. The Lancet, 381(9885), 2244.CrossRefGoogle Scholar
  8. Kaufmann, D., & Kraay, A. (2008). Governance indicators: Where are we, where should we be going? The World Bank Research Observer, 23(1), 1–30.CrossRefGoogle Scholar
  9. Kickbusch, I., & Gleicher, D. (2012). Governance for health in the 21st century. Geneva, Switzerland: World Health Organization.Google Scholar
  10. Lekhan, V., Rudiy, V., Shevchenko, M., Nitzan, K. D., & Richardson, E. (2015). Ukraine: Health system review. Health Systems in Transition, 17(2), 1–154.Google Scholar
  11. Luck, J., Peabody, J. W., DeMaria, L. M., Alvarado, C. S., & Menon, R. (2014). Patient and provider perspectives on quality and health system effectiveness in a transition economy: Evidence from Ukraine. Social Science & Medicine, 114, 57–65.CrossRefGoogle Scholar
  12. Mikkelsen-Lopez, I., Wyss, K., & de Savigny, D. (2011). An approach to addressing governance from a health system framework perspective. BMC International Health and Human Rights, 11(1), 13.CrossRefGoogle Scholar
  13. Ministry of Health of Ukraine. (2011). Retrieved from
  14. Morris, J., & Polese, A. (2014). Informal health and education sector payments in Russian and Ukrainian cities: Structuring welfare from below. European Urban and Regional Studies. doi: 10.1177/0969776414522081.
  15. Peabody, J. W., Luck, J., DeMaria, L., & Menon, R. (2014). Quality of care and health status in Ukraine. BMC Health Services Research, 14(1), 446.CrossRefGoogle Scholar
  16. Polese, A., Morris, J., & Kovac, B. (2017). Informality ‘in spite of’ or ‘beyond’ the state: Evidence from Hungary and Romania. European Societies. Forthcoming.Google Scholar
  17. Polese, A., & Stepurko, T. (2016). Society: In connections we trust. Transitions Online, 19(4), 7–10.Google Scholar
  18. Presidential Program of Economic Reforms for 2010–2014. (2010). Retrieved from
  19. Rechel, B., & McKee, M. (2009). Health reform in central and eastern Europe and the former Soviet Union. The Lancet, 374, 1186–1195.CrossRefGoogle Scholar
  20. Rhodes, R. A. (1996). Understanding governance (Vol. 53). Buckingham: Open University Press.Google Scholar
  21. Roiseland, A. (2011). Governance, informal. In B. Badie, D. Berg-Schlosser, & L. Morlino (Eds.), International encyclopedia of political science (Vol. 1, pp. 1018–1020). Thousand Oaks, CA: Sage.Google Scholar
  22. RynekZdrowia. (2016). Minister zdrowia: służbazdrowia to odpowiedzialnośćpaństwa, nie PRL. Retrieved from,164189,14.html
  23. Stepurko, T., Pavlova, M., & Groot, W. (2016). Overall satisfaction of health care users with the quality of and access to health care services: A cross-sectional study in six Central and Eastern European countries. BMC Health Services Research, 16(1), 342.CrossRefGoogle Scholar
  24. Stepurko, T., Pavlova, M., Gryga, I., Murauskiene, L., & Groot, W. (2015). Informal payments for health care services: The case of Lithuania, Poland and Ukraine. Journal of Eurasian Studies, 6(1), 46–58.CrossRefGoogle Scholar
  25. Stepurko, T., Pavlova, M., Levenets, O., Gryga, I., & Groot, W. (2013). Informal patient payments in maternity hospitals in Kiev, Ukraine. The International Journal of Health Planning and Management, 28(2), e169–e187.CrossRefGoogle Scholar
  26. Stepurko, T., Vitiuk, V., Kvit, A., & Kovtonyuk, P. (2014). Medical care on the Euromaidan: Who have saved the lives of the protesters? Social, Health, and Communication Studies Journal, 1(1), 80–104.Google Scholar
  27. Sviatnenko, S., & Vinogradov, A. (2014). Euromaidan values from a comparative perspective. Social, Health, and Communication Studies Journal, 1(1), 41–61.Google Scholar
  28. Tambor, M., Pavlova, M., Rechel, B., Golinowska, S., Sowada, C., & Groot, W. (2014). The inability to pay for health services in central and Eastern Europe: Evidence from six countries. European Journal of Public Health, 24(3), 378–385.CrossRefGoogle Scholar
  29. Toole, M. J. (2016). So close: Remaining challenges to eradicating polio. BMC Medicine, 14(1), 43.CrossRefGoogle Scholar
  30. Ukraine Crisis Media Centre. (2016). Activists, MPs: Patient’s relatives should have access to the Intensive Care and Resuscitation unit. Retrieved from
  31. UNDP. (2015). UNDP and Ukrainian Health Ministry sign an agreement on public procurement through international organizations. Retrieved from
  32. Wanner, C. (2005). Money, morality and new forms of exchange in postsocialist Ukraine. Ethnos, 70(4), 515–537.CrossRefGoogle Scholar
  33. WHO. (2004). Global strategy on diet, physical activity. Retrieved from
  34. WHO. (2013). Global Health Observatory data repository. Retrieved from
  35. WHO. (2016). Ukraine: Data and statistics. Retrieved March 18, 2014, from
  36. Worldwide Governance Indicators. (2014). Rule of law and government effectiveness. Retrieved from

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Tetiana Stepurko
    • 1
  • Paolo Carlo Belli
    • 2
  1. 1.School of Public HealthNational University of “Kyiv-Mohyla Academy”KyivUkraine
  2. 2.World Bank Program, Africa Region, World BankWashington, DCUSA

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