Considering the rotten state of medicine in Ukraine, you’d think Ulana Suprun’s plan to finally tackle the bureaucracy and corruption that has long crippled the country’s health care system would be widely celebrated. After all, it’s an issue that affects every Ukrainian — and the American-born health minister was eager to accept the challenge.
But just one day after her ministry officially launched its reform campaign in April, Suprun’s reward from Parliament was a resounding call for her dismissal. Then again, Ukraine isn’t a place that always welcomes an enterprising spirit, especially when it messes with vested interests.
While the country has been on a reform drive since a street revolution toppled a corrupt regime in 2014, hard-charging reformers like Suprun are meeting fierce resistance from a decades-old system built on graft, political stasis and entrenched habits. Take Ukraine’s health care system: Nominally socialized, physicians are paid pittances and rely on kickbacks for even basic services. “I don’t know a single person in my circle who’s gone to a doctor and had some kind of procedure, or received a checkup, for free,” says Olga Demeshko, a health care analyst and deputy director of Patients of Ukraine, a charitable foundation in Kiev. Pharmaceutical companies, meanwhile, have traditionally reaped windfalls from inflated drug prices.
She’s the only minister who came not to steal or to collect profits, but to actually change something.
Olga Demeshko, deputy director, Patients of Ukraine
Suprun, 55, is trying to change all that. Since becoming Ukraine’s health minister in July 2016, she has led the most ambitious and meaningful effort yet to overhaul the country’s health care system. Aimed at building transparency as well as securing fairer access for patients and more competitive salaries for doctors, her approach is angering anyone who’s profiting off the current setup — from doctors pocketing wads of cash to pharma firms and their political allies in government. But that doesn’t concern Suprun: “One of the things that I’m admired for in Ukraine is that I’m honest,” she told the BBC in April, “and I tell the truth, and I call things by their names.”
Born in Detroit to Ukrainian immigrants, Suprun was raised with a keen sense of cultural awareness. Educated at Wayne and Michigan State universities, the trained radiologist spent most of her career in New York City specializing in women’s medical imaging. Suprun and her husband, a Canadian of Ukrainian descent, eventually felt the tug of their homeland and moved to Kiev at what would prove to be a pivotal moment: The day they arrived in late 2013, a group of protesters downtown was viciously beaten by police, a prelude to the bloody revolution that would oust then-President Viktor Yanukovych several months later.
That revolt fueled Ukrainians’ hopes that their lives would soon change for the better. Instead, they found themselves mired in a war against Russian-backed separatists sent by Moscow to destabilize the country. Suprun, having volunteered her medical services in Kiev during the revolution, redirected her efforts toward helping Ukraine’s under-equipped military as it struggled against the insurgency. To date, her nongovernmental organization, Patriot Defence, has trained more than 28,000 soldiers in tactical medicine and distributed more than 20,000 first-aid kits to troops since fighting broke out in mid-2014.
After accepting the top post at the Ministry of Health, Suprun, who has taken Ukrainian citizenship, brought the same boot-strapping spirit to the corridors of power. Her first move was ensuring that reform of the procurement process, long a hotbed of theft and wasteful government spending, was continuing apace. Next came an even bigger challenge: reconfiguring the byzantine system of state-provided health care, in which allocated funds were spent on facilities regardless of performance. With doctors taking home an average of $140 per month, they had little incentive to critique the system or do much about it.
Now, under a widely publicized campaign that has earned Suprun respect at home and abroad, citizens are free to choose their physicians rather than being tied to the local clinics in their district. Doctors and clinics, for their part, will receive payments according to the number of people they treat. According to Oleksandr Yabchanka, an adviser to Suprun, it’s all bound by a simple, market-oriented rule: “The money follows the patient.” And Ukrainians seem to be responding: Since April, some 17 million people — more than one-third of the population — have sought out their own personal doctor, and a recent poll found that 82 percent are satisfied with their choice.
Suprun’s supporters say that her brand of sober-minded policymaking is the result of canvassing the country, accompanied by a team of well-educated optimists, and collecting opinions from both specialists and ordinary Ukrainians. “She’s the only minister who came not to steal or to collect profits, but to actually change something,” says Demeshko.
With some in Parliament seeking to relieve Suprun of her position, it’s clear not everyone feels the same way. Corrupt or not, her critics argue that Suprun — the consummate outsider, a label she embraces — simply doesn’t understand the system she’s trying to reform. Some believe Ukraine can’t support the financial burden of her reforms. Others go even further: The head of the parliamentary health committee, herself a well-known Ukrainian doctor, blames Suprun’s policies for allegedly dooming countless citizens to death. At the very least, detractors say, her plans are poorly understood by medical professionals who’ve worked in the system for years. “Clear communication is being replaced by propaganda,” says Kostyantin Naduty, who runs an advocacy group for Ukrainian doctors.
With parliamentary and presidential polls both due next year, Suprun is faced with a finite window to see her reforms through before electioneering distracts the population. That’s why she has little patience for those who find fault without offering constructive criticism. Nor, apparently, is she deterred by the thought she might lose her job. “What would give me pause is if the Ukrainian people came out and said, ‘This isn’t what we want,’” Suprun said in the BBC interview. “That’s not we heard.”
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