Ukraine’s healthcare system – resilience under fire
As the Ukrainian population takes shelter and strengthens its resistance to the Russian invasion, Ukrainian Health Minister Viktor Lyashko has pushed for “business as usual” within the health system, but many resourcefulness and support are needed in an environment where stocks of medical supplies are already depleted. running out of.
Just two weeks ago, the Ukrainian parliament was evaluating the final stages of the modernization of the state-guaranteed National Health Service of Ukraine (NSZU) under a newly increased budget, including the guaranteed minimum wage for staff medical and improved specialist care. The World Health Organization (WHO) had been closely backing those plans as the country emerged from the Covid-19 pandemic. All of these plans, however, were derailed by the sudden invasion of Russia a few days later, and martial law took hold.
First steps under martial law
In the face of the sudden crisis, which was first exacerbated by cyberattacks on government communications, the Ministry of Health (MoH) still managed to launch the first emergency appeals for volunteer staff, blood donations and international aid. He also canceled elective hospital procedures to make way for emergencies. This was followed by more practical steps, the first being a simplification of funding mechanisms to ensure continued support for medical facilities under martial law. In addition, the Ministry of Health has advised hospitals to negotiate direct supply contracts with manufacturers of medicines, diagnostics and dressings, bypassing the usual tender procedures.
Community pharmacists – ingenuity under pressure
While community pharmacists were urged from the outset to keep all outlets open to the public, this has only been possible in some locations. There was a predictable spike in demand for medicines and first aid items from the first day of the invasion, as documented by Ukrainian analysts Pharmexa, followed by a rapid dwindling of available stocks of essential medicines , which have become increasingly difficult to piece together as transport links have been disrupted and orders have become more difficult.
At this point, the Professional Pharmacy Association of Ukraine (APAU) has issued an urgent appeal to suppliers to allow deferred payments and simplified contracts, especially for the replenishment of local stocks of painkillers, antipyretics, hemostats and dressings. In Kyiv, local pharmacies advertised a phone-order program for home delivery of drugs from stock in condemned premises. The Department of Health has also returned to allowing paper prescriptions for reimbursed drugs for outpatients with chronic conditions.
Such measures, however, could only be short-term solutions, with reports already of looting of pharmacies and destruction of hospital facilities. The WHO has now called for the opening of a humanitarian corridor to bring medical supplies to the most troubled areas. While hope remains for the government to struggle towards a period of stability and rebuilding of services, it is hard to imagine how desperate the situation can become if fighting continues long term in large parts of the country. .
The taint of Russian trade – this is only the beginning
Russia’s position is comparatively more complex than Ukraine’s, and the Russian government will have to deal with a blemished international reputation that will likely take a long time to recover from. While direct sanctions on medicines are not on the international agenda and should remain so, the many punitive measures that have already been imposed will nevertheless have detrimental effects on access to healthcare and medicines in Russia. .
The Association of Russian Pharmaceutical Manufacturers (ARPM) warned that European suppliers had already started to block the transport of pharmaceutical raw materials to Russian sites and that subsequent supply contracts were almost impossible to obtain. Several sanctioned financiers such as Sberbank and the Russian Direct Investment Fund (RDIF) have been major sponsors of the pharmaceutical industry, with the RDIF notably sponsoring exports of the much-publicized Sputnik V Covid-19 vaccine. At the same time, the economic effects of the falling ruble are already being felt, and there is a high likelihood of drug withdrawals and shortages as manufacturing and import costs become unsustainable.
In addition to measures such as import substitution strategies, the Russian government has also looked at more creative angles to try to circumvent the effects of sanctions, such as expanding compulsory licensing authorizations and channeling supplies through other members of the Eurasian Economic Union (Belarus, Kazakhstan, Kyrgyzstan and Armenia). However, such moves are unlikely to mitigate the major economic blow to Russia’s trade position, which is also likely to send shockwaves through neighboring Eurasian markets, many of which trade closely with Russia while trying to to maintain a political distance. The damage to Russia’s economy and trade is likely only beginning, and the longer the conflict persists, the harder it will be for the country to recover.
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