Feasibility Study: Effectiveness of Public Health System (Programmes/Policies) in Combating Severe Population Health Crisis in Ukraine

Ukraine is a middle-income country within the WHO European region which has long faced significant population health crisis exacerbated by growing health inequalities within the country (rural/urban, male/female divide). It is one of the five countries in the region with the lowest life expectancy (11 years less than the EU average) and more than 10 years life expectancy gap between males and females. The health care and public health systems in the country remained virtually unchanged since independence in 1992 becoming completely inadequate to deal with the current challenges of growing epidemics of Non-Communicable Diseases and TB/HIV/AIDs epidemic. Supported by the people of Ukraine, current government shows serious intentions to reform the country and use evidence in decision-making. Yet, given the dire state of the population health and political and economic difficulties, they are likely to opt out for a quick introduction of ready-made examples from other countries leaving the fundamental analysis of what does/did and does/did not work in a Ukrainian context for the future. Yet, we believe that evaluating past programmes/policies, as well as setting up the stage for the evaluation of future interventions would be crucial in designing reforms ensuring improvement of population health. Past experience of public health programmes/policies in Ukrainian context should not be wasted and in the full-scale study we would like to evalute such programmes/ policies to inform the development of effective PH system and facilitate its implementation. To do this, we will first undertake a development study. This study will focus on the following things: (i) exploring the evolution of the public health programmes/policies at the national level and mapping their actual implementation across regions and over time, assessing their history, context, design and logic, (ii) assessing the availability and quality of the quantitative and qualitative data, (iii) assessing the potential for additional quantitative and qualitative data collection to enhance the possibilities for the evaluation of future public health programmes/policies, and (iv) reflect on the barriers to use evidence in health-related policy making in Ukraine. This will allow us to select the programmes/polcies deemed evaluable to narrow down the focus of the full-scale study and refine the methodological approaches, provide recommendations as to the routine data collection to improve its quality, and introduce emerging public health community to the evidence based decision making.