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The Ministry of Health of Ukraine buries Ukrainians' hopes for a healthy future!

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To the all interested parties

Prime Minister of Ukraine

Secretariat of the Cabinet of Ministers of Ukraine

Ministry of Health

CCM Ukraine

State Institution "Center for Public Health of the Ministry of Health of Ukraine"

Ukrainian Red Cross Society

The Global Fund to Fight AIDS, Tuberculosis and Malaria:

- Board of Directors

-Office of the Inspector General

- Senior Fund Portfolio Manager Eastern Europe and Central Asia Team

PricewaterhouseCoopers

Global TB Caucus

STOP-TB Partnership

To representations of international organizations in Ukraine:

International Committee of the Red Kross, Mission in Ukraine

United Nations Organisation, United Nations Development Program

Joint United Nations Program on HIV/AIDS

World Health Organisation

United Nations Children’s Fund

International Monetary Fund

World Bank

Delegation of the European Union

Council of Europe Office

To embassies of the countries in Ukraine- donors of the Global Fund

The United States  of America

The Federal Republic of Germany

The United Kingdom of Great Britain and Northern Ireland

The French Republic

Japan

The  Republic of Korea

The Kingdom of Sweden

The Kingdom of Norway

The Swiss Confederation

Canada

The Kingdom of Denmark

The People’s Republic of China

The Kingdom of the Netherlands

The Kingdom of Saudi Arabia

To the representations of the foreign Mass-media organizations in Ukraine

The Ministry of Health of Ukraine buries Ukrainians' hopes for a healthy future!

"The Ukrainians Against Tuberculosis" on the occasion of the World TB Day that is marked on 24 March held a direct action in front of the building of the Ministry of Health of Ukraine where they put forward their demands for the Ministry of Health of Ukraine and the Cabinet of Ministers of Ukraine.

The action's participants also presented a Declaration of united efforts and commitment to the cause of fighting the TB epidemic in Ukraine in order for it to be signed.

 

Dear colleagues!

On 24 March, the entire world marks the World Day of Tuberculosis, a disease that every day takes thousands of lives worldwide. The Cabinet of Ministers of Ukraine and the Ministry of Health of Ukraine also marked this day, joyfully reporting about a decrease in the incidence of the traditional TB form by another fraction of a percent.

At the same time, Ukraine's high officials forget to say that the incidence of especially dangerous TB forms, extensively drug-resistant and multidrug-resistant TB, is growing rapidly in Ukraine.

In fact, Ukraine ranks second in the world in the prevalence of XDR-TB and is one of the countries with the highest prevalence of MDR-TB.

Every day 11 untreated Ukrainians die of TB. The senior officials of the Cabinet of Ministry of Ukraine and the Ministry of Health of Ukraine bear personal responsibility for these deaths of Ukrainian people.

According to the WHO's estimates (2017), the average estimated TB incidence in children is 37.4 per 100,000, i.e. 2,500 children have TB, which is 4.5 times the official figure. It should be noted (for comparison) that in economically well-developed countries, TB cases in children in the indigenous population are isolated at all [Tuberculosis surveillance and monitoring in Europe, WHO. 2017. 162 p.]

For the third year running, Ukraine has tried unsuccessfully to overcome TB without having a national programme for TB control that's provided for by Ukraine's legislation.

The previous TB control programme, the State Targeted Social Programme for TB Control for 2012-2016, expired back in 2016.

Yet, the Ministry of Health of Ukraine since the end of 2016 has been unable to develop and ensure adoption of a new state targeted social programme for TB control for forthcoming years.

For more than two years the country lived without a state road map for overcoming the TB epidemic, with Ukraine's regions dealing with the disease in ways they determined based on their understanding of the problem.

Amid the growing epidemic of XDR-TB, the country needs a clear, professional and, most importantly, high-quality road map for fighting TB in the form of a national programme for TB control.

But the quality of the programme developed by the Ministry of Health of Ukraine and submitted by the Cabinet of Ministers of Ukraine to the Ukrainian Parliament is unprecedentedly low. And now the developers of the programme intend to shift responsibility for adoption of the law with the low-quality programme to the Verkhovna Rada of Ukraine.

The National Programme for TB Control proposed by the Cabinet of Ministers of Ukraine in 2019 should have been launched in 2018. So its adoption as a law of Ukraine in 2019 in the proposed form, with activities and financing provided for for 2018, makes no sense.

Besides, the proposed Programme is grounded on TB incidence statistics for 2016, i.e. figures dating back three years, which is not acceptable for such a document.

Also, there's distortion of statistical data that form the basis for financial and programmatic calculations underlying the proposed draft National Programme.

The imperfection of the programme unprecedented in all the years the TB epidemic has existed in Ukraine and lack of political will are indicated, first and foremost, by the content of the section that was groundlessly titled "Decisive political measures and support systems (systemic support and service provision reform)".

The fact that expenditures related to the National Programme must be protected items of the State Budget of Ukraine isn't taken into account.

The Programme doesn't provide for fulfilment of the promise made by the MoH of Ukraine and the Government to let TB establishments use funds saved on shortening of their bed capacity to ensure effective infection control, do repairs, raise salaries and improve treatment and laboratory facilities and equipment.

There's no detailed strategy for infection control developed in implementation of the LAW OF UKRAINE "On Ensuring Sanitary and Epidemiological Well-Being of the Population".

The requirement is ignored that patients must be provided, at the expense of the State Budget, with symptomatic drugs to get protection from irreversible adverse reactions affecting their liver, hearing, eyesight, nervous system etc. that could result from administration of toxic TB drugs in "the patient-oriented approach".

The WHO's recommendations regarding the TB-diabetes comorbidity aren't taken into account.

The role and place are ignored of the Red Cross of Ukraine whose nurses have professionally provided care for patients with TB, including at their homes, and which remains a powerful partner of the state even in the absence of budget funding.

The need to reform the state policy on TB control based on a multidepartmental and multisectoral approach is ignored.

There's no strategy for reducing TB incidence and mortality among children.

Introduction isn't provided for of an effective system for TB detection, prevention and treatment of active military men who defend Ukraine's independence in the eastern part of the country and those who left military service, as well as internally displaced persons.

Also, decisive political measures should have drawn public attention, at least tangentially, to the need:

- to increase expenditure on public health to 5% of GDP, as required by the WHO;

- to introduce obligatory state medical insurance of the entire population of Ukraine.

For the first time in the history of drawing up of such programmes, the MoH's almost three-year-long work is no more than a declaration of intentions.

The draft national programme is full of manifestative and declarative phrases (such as "comprehensive coverage", "rational use", "successful external control", "proper access", "of the entire set of services... in full", "optimisation ... of the effect of programmes" etc.) that aren't concretised into criteria and indicators.

But if calls and intentions don't have clear indicators and criteria, they can never be realised.

Specialists of our non-governmental organisations carried out a detailed analysis on each item and task of the National Programme developed by the MoH of Ukraine.

Proposals and remarks to the effect that the presented programme as it is today must not be adopted were sent to the MoH of Ukraine, the Cabinet of Ministers of Ukraine, the relevant Committee of the Verkhovna Rada of Ukraine, the heads of the parliamentary parties and factions, people's deputies of Ukraine.

We should state that a programme for TB control as a road map for the country must exist and must be a high-quality one. That's why our non-governmental organisations specialising in TB require that the MoH and the Cabinet of Ministers of Ukraine urgently correct the programme and submit its corrected, quality version to the state's supreme body, the Verkhovna Rada of Ukraine, for adoption as a law of Ukraine.

The World and All-Ukrainian TB Day were marked by public organisations, patient organisations, physicians, the Free Trade Union of Ukraine's Medical Workers and ordinary people who aren't indifferent to the threat of TB with the public action "The Ministry of Health buries Ukrainians' hopes for a healthy future!"

This direct action was held on 22 March 2019 near the central entrance to the building of the Ministry of Health of Ukraine.

The action included a performance that symbolically and vividly illustrated the future of Ukrainians with TB that's prepared for them by the Ministry of Health of Ukraine.

There was symbolic honouring of the memory of a Ukrainian who died through the fault of the MoH of Ukraine.

A wheel stretcher was set up in front of the building of the MoH of Ukraine with a mannequin of a person who died of TB and a coffin was placed for him to be buried in. There was symbolic honouring of the memory of the Ukrainian who died through the fault of the MoH of Ukraine. A wreath reading "From the MoH of Ukraine. From Ulana Suprun" was laid at the coffin and a banner was set up saying "How many more mourning coffins will we see with Minister Ulana Suprun?"

During the ceremony, Chopin's Funeral March and Beethoven's Symphony No. 7 "The Allegretto" played.

The event was opened by Vitalii Rudenko, chairman of the Board of "The Ukrainians Against TB" Charitable Organisation, who offered to honour with a minute's silence the memory of our compatriots who die today of tuberculosis, and the memory of hundreds of thousands of Ukrainians who have already died through lack of political will and effective measures on the part of government officials since 2005, when the TB epidemic began. During the minute's silence, tocsin ringing sounded.

Vitalii Rudenko emphasised:

"Ukraine is rapidly losing human potential, including due to the inefficient policy in the area of public health.

Let's together look at the real results of the work of the Ministry of Health of Ukraine in the area of TB control in Ukraine, not at the declared ones.

In the peaceful part of Ukraine, 11 our compatriots die each day of tuberculosis! And this is just the official statistics. According to expert estimates, the figure is much higher.

Here's the symbol of a human, with a tag and number 11, the diagnosis is "died of TB". Who's guilty of everyday peaceful deaths of our people?

Look at this building and officials responsible for implementation of the state policy in the area of public health who are looking at us from its windows. And at the Cabinet of Ministers of Ukraine that's situated just across the road from them.

These officials should kneel down every day to all those who died of TB, their families and relatives.

Or they should file a letter of resignation and get out of their rooms and give an opportunity to those who can make real steps in fighting with TB".

A symptom of the disease called indifference was that no official of the Ministry came out to the public for a dialogue.

Ukraine's non-governmental organisations specialising in TB and patient organisations continue to fight for the health of our compatriots. Being aware that Ukraine with its TB is becoming toxic to European countries and those of the democratic world, we call on the international community to react to the inefficiency and low effectiveness of the work of the Ministry of Health of Ukraine which is not a proper response to the present-day TB threat challenges.

Co-head of "Stop TB Together" Coalition of Organisations, member of the National Journalist Association Igor Gorbasenko

Chairman of the board of "The Ukrainians Against TB" Charitable Organisation Vitalii Rudenko

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