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 Running hot water is not guaranteed and the hospital, serving about
2,800 people in Staiky and other villages, has not been refurbished
since Soviet times.
There is also little hope of a change for the better among medical
staff who rely on charitable donations, often from local
businessmen, to buy even basic medicines and the petrol needed to
visit patients in remote areas.
A reform drive launched by the Western-leaning government installed
after a pro-Moscow president, Viktor Yanukovich, was overthrown in a
popular uprising last year has become mired in bureaucratic inertia,
arguments and allegations of corruption.
"I don't know who is writing and carrying out reforms at the top or
if they have ever been to a village and seen how people live and
with what medical services," said family doctor Nadiya Martynenko in
Staiky, a cluster of dilapidated one-story houses on the River
Dnieper, an hour's drive from the capital Kiev.
She said state funds cover only the electricity and meager staff
salaries, and that over the past decade "they've cut everything they
could and even what they shouldn't ... it's very precarious."
Staiky is far from unique. Soviet-era hospitals across the country
of 42 million are crumbling, underpayment of medical staff continues
to foster a system of bribe-taking and Ukraine's poor vaccination
rate has placed it on a blacklist alongside some of the world's
poorest countries, including South Sudan.
Corruption has plagued Ukraine since the country gained independence
from the Soviet Union in 1991. But under Yanukovich, it became much
worse.
Health Minister Alexander Kvitashvili, one of several foreigners
appointed to ministerial positions in the hope that their outsider
status and international experience would help Ukraine make good on
reform promises, hoped to recreate successful reforms carried out in
his native Georgia.
A year after his appointment, the health bill outlining reforms is
stuck in parliament.
"It's frustrating. There are vested interests - they're everywhere
... Working with the parliament we differ on what a basic
understanding of reform is," Kvitashvili told Reuters.
Without a complete reboot, "financially the system will collapse in
about a year, if not faster, because there is no way Ukraine can
increase spending to a sustainable level," he said.
DEMOCRACY STRUGGLING
The stalled health bill is one of many examples of the slow progress
Ukraine is making in reforming its economy, prompting Western
backers to question Kiev's commitment to ending crooked practices
that pushed the country to the brink of bankruptcy.
Squabbles in parliament have held up other bills. Some of these are
required for the disbursement of funds under a $40-billion
international bailout program, and Kiev's Western backers warn that
its attempt to rebuild itself on transparent, democratic lines is
under threat.
Ukraine's progress has also been hampered by a conflict in the east
of the country between government forces and pro-Russian separatists
and a deterioration in relations with Russia, which annexed the
Crimea region in 2014.
The health ministry's reforms were finalised in April and brought to
parliament for approval in July but discussions have dragged on,
Kvitashvili said. As he did so, he turned off his cellphone, its
ringtone set to the theme tune from TV series Game of Thrones, in
which rival clans battle for influence.
Part of the plan focuses on separating the procurement and delivery
of health services, a system which until now has allowed most
contracts to be brokered in backroom deals with little external
oversight.
According to a report by the Anticorruption Action Center, a
Ukrainian civil society organization, only six out of 6,500
authorized pharmaceutical companies took part in the procurement of
HIV drugs in Ukraine in 2013, sharing among themselves a market
worth $30.9 million.
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The salaries of doctors are too low to eradicate the use of bribes
between patient and practitioner, which means many of the health
industry's financial dealings are done in the shadows.
"You can see head doctors driving Porsches and having Vertu phones,
but the hospitals are in an abysmal condition," Kvitashvili said.
The "informal" part of the healthcare economy amounts to about $7
billion per year - more than triple the size of the state's annual
expenditure on health, he estimated.
Frustration over the lack of progress prompted Kvitashvili to tender
his resignation in the summer, only to have it rejected by
parliament.
Some commentators have said he lacks the know-how to navigate the
web of allegiances that continues to bind Ukraine's ruling class
despite avowed attempts to move on from the political cronyism of
the past.
"I believe he wants reforms, but he doesn't totally understand the
reality of Ukraine - that if someone promises their support it
doesn't mean they won't try and trip you up," doctor and healthcare
commentator Evgeny Komarovsky said
Alexandra Ustinova, from the Anticorruption Action Center, also said
there was a conflict of interests in some of the appointments at the
ministry, such as bringing in a lawyer who used to work for a
pharmaceutical company owned by a member of parliament from
President Petro Poroshenko's party.
"CATASTROPHE"
Giovanna Barberis, the Ukraine representative of the United Nations
International Children's Emergency Fund (UNICEF), said "the
obstacles (to reforms) are huge and sometimes it looks pretty grim
because the pace is extremely slow."
The start of an immunization campaign following an outbreak of polio
on Sept. 1 was delayed by several weeks, prompting Ellyn Ogden,
worldwide polio coordinator for the United States Agency for
International Development (USAID), to criticize the "highest levels
of government" for an inadequate response.
She said "no other country in the world is in such a dire situation
or shows such disregard for protecting children against childhood
diseases."
The Global Polio Eradication Initiative, which is spearheaded by the
World Health Organization, said: "For some time, Ukraine has been a
catastrophe waiting to happen."
Ukraine did not buy drugs, medicines or vaccines for most of this
year as the health ministry sought to approve a temporary
procurement system via international organizations to bypass the
compromised system that Kvitashvili hopes to reform.
The temporary system was finalised in late October, and Ukraine
plans to buy around $100 million of vaccines and medicines, but
severe shortages remain.
"There are no anti-diphtheria vaccines in the country," healthcare
commentator Komarovsky said.
Meanwhile the more drastic reform bill is languishing in parliament
and Kvitashvili says his resignation is still on the table.
"Well my letter is still there. I did not withdraw it. We will see
how the Parliament will act," he said by email.
(Editing by Timothy Heritage)
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