Healthcare is widely acknowledged as one of the key battlegrounds in the fight to end endemic corruption in Ukraine’s state institutions, but the sector is proving highly reform-resistant. As if to illustrate the point, the start of 2017 witnessed a concerted publicity campaign designed to discredit the Health Ministry’s latest anti-corruption initiatives. In the first few weeks of January, numerous political figures issued statements accusing the ministry’s reform efforts of putting patient lives at risk, while members of the Ukrainian parliament’s Healthcare Committee tried – and failed – to oust the acting minister. Meanwhile, numerous mainstream media platforms ran with a slurry of negative stories about the healthcare situation in the country. Many of these information attacks directly targeted the Acting Health Minister herself, US-born doctor of Ukrainian descent Ulana Suprun. Accusations levelled against Dr. Suprun everything from concealing international medical procurement details to faking her own medical qualifications.
When she sat down with Business Ukraine magazine in early February in a cozy café close to Kyiv’s government quarter, Dr. Suprun seemed unfazed by the ongoing campaign to blacken her reputation. Quite the opposite, in fact. She sees the personal nature of the efforts to discredit her as tacit acknowledgement that her reform efforts are moving in the right direction. “I’m experiencing a lot personal attacks rather than criticism of the work we are actually doing. I see these personal attacks as an indication that our opponents do not have any ammunition to use, because what we are doing is the right thing to do.”
Confronting the corrupt old system
The 53-year-old radiologist from New York says her skin is more than thick enough to shrug off the recent smear campaigns against her, but she recognizes that she is now engaged in a head-on confrontation with powerful forces who stand to suffer substantial losses if her reform drive proves successful. The initial salvos of this fight for the future of Ukrainian healthcare have given Dr. Suprun an indication of what to expect in the months ahead. “Just as there is a hybrid war in east Ukraine, there is a kind of hybrid war taking place here too,” she says. Whom does she regarded as her opponents in this conflict? “We’re up against representatives of the corrupt system that has been in place for years, the old system that used the healthcare industry for its own advantage instead of the benefit of the Ukrainian people.”
Many of Dr. Suprun’s most prominent critics are indeed politicians tied to the former government of Viktor Yanukovych, together with healthcare professionals who have built lucrative careers within the existing system. These associations create huge question marks over the credibility of their criticisms, but the anti-reform forces opposing Dr. Suprun also have the weight of Ukraine’s oligarch-owned mass media behind them. An early January survey conducted by the Anti-Corruption Action Center into Ukrainian TV reporting on healthcare reforms identified 82% of coverage as negative in character. Dr. Suprun is well aware of the problem. “It is difficult to create a good communications strategy when you don’t have access to the mass media such as national TV channels,” she says. “The owners of the television stations are not proponents of the reforms we are conducting. This is a real problem as around half of all Ukrainians continue to get their news from TV sources.” This communications challenge is significantly complicating Dr. Suprun’s reform efforts, which focus on greater transparency in the procurement of medical supplies and a more market-based approach to the government funding of medical services. She aims to counter the lack of TV exposure by boosting the Ministry’s social media presence and reaching out to regional audiences during weekly trips to oblast centers around Ukraine. Social advertising campaigns are also in the pipeline.
Clear consensus for change
While she must contend with hostility from much of the Ukrainian media along with sections of the medical industry and parliament, Dr. Suprun feels she has all the backing she needs to succeed. Crucially, both President Poroshenko and Prime Minister Groysman publicly rallied to her side during the spate of early 2017 attacks. She sees no reason for this support to weaken, as long as the reforms she pursues are reasonable and demonstrably bring about positive change. ““Everyone accepts the general idea that Ukraine’s medical system needs to change,” she says. This is something of an understatement. The quality of Ukraine’s healthcare services is currently dire, a fact reflected in abysmal life expectancy figures and a plummeting population. Ukrainian males can expect to live for around a decade less than their counterparts elsewhere in Europe, while the entire healthcare system is riddled with everyday corruption.
This state of affairs is particularly galling given that Ukraine has long been a focus of healthcare excellence. Thousands of international students continue to enroll at Ukrainian medical universities every year, while the country’s medical tourism industry is fast emerging as one of the most competitive in the region. Dr. Suprun believes this disconnect between Ukraine’s potential and current healthcare realities is eminently fixable. She rejects notions that there is simply not enough money, pointing instead to the debilitating effects of endemic corruption. “Everybody working in the healthcare industry would get paid decent wages and everybody would receive decent treatment if we used the available resources and funding in an effective and honest manner. At present, we do not use the money honestly. There is a lot more funding available than you might imagine. This financing does not currently go where it needs to go. If we can focus that financing on our real needs, there is more than enough.”
In addition to top-level political backing, Dr. Suprun also enjoys considerable support from the international community. For example, UNDP, UNICEF and Crown Agents all play key roles in the international medicine procurement initiative that has caused such consternation among critics of the current Ukrainian healthcare reform agenda. All sides see this international involvement as a temporary measure until Dr. Suprun and her team can oversee the creation of a Ukrainian state body capable of handling procurement issues effectively, but given the scale of corruption in the sphere of medicine purchases, this international involvement has been vital.
From Maidan to the east Ukraine frontlines
Another key support base for Dr. Suprun’s reform agenda is Ukraine’s civil society. Since the Euromaidan Revolution, Ukraine’s NGO sector has played a remarkably prominent role in the country’s reform efforts. Civil society actors have repeatedly managed to push through initiatives and overcome the inertia of Ukraine’s often cumbersome and obstructionist state apparatus. “What has really impressed me is the support we are receiving for our reforms from civil society,” she reflects. “Many of the people we encounter in different civil society positions are the same people who were active on Maidan (during the 2013-14 Euromaidan Revolution – Ed.). They understand that what we are trying to do at the Health Ministry is a continuation of the demands voiced on Maidan. At present, the system exists to perpetuate the system. Financing goes to healthcare institutions and not to patients. We want to change the system so that the patient is the center of attention.”
The idea that Dr. Suprun’s reforms are a continuation of the Euromaidan Revolution has proved popular, earning her public sympathy and high-profile endorsements from some of the country’s most credible reformers. Her cause has also benefitted from the fact that some of Dr. Suprun’s biggest critics are notorious for their connections to fugitive former Ukrainian President Viktor Yanukovych and Russian President Vladimir Putin. Many otherwise uninformed observers have assumed that with enemies like these, she must be doing something right.
For Dr. Suprun herself, the Maidan connection is particularly meaningful. Brought up in a Ukrainian-American family and married to a fellow member of the Ukrainian Diaspora, Dr. Suprun made her first trip to Ukraine in the 1970s and has been a regular visitor ever since. She and her husband long dreamed of moving permanently to Ukraine, only to have their plans put on hold for a variety of family reasons. Eventually, in autumn 2013 they prepared to make the switch to Kyiv. As they relaxed in London during a stop-off on the way to Ukraine, the Euromaidan Revolution erupted. “We arrived in Kyiv on the morning after the Berkut (riot police) attack on the students and went straight to Maidan,” she recalls. Dr. Suprun was soon active providing medical services for protesters.
Her experience during the winter of civil unrest in Kyiv – including the death of a protester who she was unable to save due to lack of medical kit – was to prove the catalyst for a larger role in east Ukraine as the Russian hybrid invasion unfolded in the spring and summer of 2014. Dr. Suprun initially ran an initiative that helped provide first aid supplies and training for poorly equipped Ukrainian frontline troops. As she become increasingly familiar with the shortcomings at the front and the deaths of soldiers due to insufficient medical equipment and training, her involvement expanded to include working with casualties beyond the battlefield. She helped doctors to acquire the skills needed to treat wounded soldiers in hospital, and was behind efforts to establish a school of rehabilitation medicine.
This systematic approach, along with the many lives her efforts helped to save, brought Dr. Suprun to the attention of the Ukrainian authorities, leading to her current appointment. Can she now replicate her frontline reform successes on the national stage? After just over half a year at the Ministry of Health, she remains optimistic, but also stresses the need for realistic expectations and a long-term vision. “The problem with reforms in Ukraine is that everyone tends to look at small pieces of the puzzle and not the bigger picture. Reform is doable, as long as you have a clear concept in place. You also need patience. It is not realistic to expect everything to change overnight. In reality, it is going to take years.”
The hunger for immediate results is one of the core problems facing Ukraine’s current crop of reformers. They are trying to change a deeply flawed system that is also deeply entrenched, yet they must demonstrate rapid results in order to generate popular support for what are often painful transitions. With many of the country’s most powerful vested interests lining up to block Dr. Suprun’s ambitious healthcare reform agenda, much may now depend on her ability to maintain the support of the country’s political leaders, civil society, and international partners in the months ahead.