Public health activists say that the lives of thousands of Ukrainians are at risk because officials within the Health Ministry are blocking reforms in drug procurement that would make medicines cheaper and more widely available.
Health activists and corruption watchdogs have for years accused health ministry officials of holding rigged bids that benefited a small circle of companies, often owned by the same person. As a result, medicine of poor quality would often be purchased at inflated prices, causing drug shortages for HIV/AIDS or tuberculosis patients as budgeted funds get depleted.
This is a long-running war in Ukraine, but recent battles have been won.
One achievement in particular is that drug procurement for the seriously ill will be handed over to international organizations UNICEF, the United Nations Development Program and Crown Agents, thanks to a bill passed in March. The international organizations will be entrusted with a total of twelve state programs worth about Hr 2.2 billion ($96 million), according to Deputy Health Minister Ihor Perehinets.
A request for comment on this report sent to Crown Agents was not immediately answered, nor was a request sent to the Health Ministry. The Health Ministry on Nov. 5 announced it would be signing the agreement on Nov. 6, though activists fear this may still be too late.
President Petro Poroshenko applauded the move to involve international agencies in the drug procurement process, as it would deprive vested interests, including entrenched domestic companies and their allies in government, the chance to rip off the country’s most vulnerable citizens – those suffering from HIV/AIDS, cancer, tuberculosis and other serious illnesses.
But the dug-in companies and their alleged partners in government are being accused of sabotaging change in how medicine is purchased for what is supposed to be a free, state-run healthcare system.
Those who “for many years have ‘absorbed’ the money of taxpayers in these drug procurement schemes, who helped and continue to help medicines with questionable quality and a massive price tag ‘win’ in national tenders – that’s who stands to gain from this. And that’s why there are delays,” said Nina Astaforova-Yatsenko, head of the Children with Hemophilia organization.
Drug procurement in Ukraine has long been known more as a mafia syndicate than a proper industry, with staged tenders between companies all owned by the same individual, over-inflated prices and cartel agreements.
A report by the Anti-Corruption Action Center in 2013 revealed that there was no competition whatsoever in drug procurement tenders; instead, the entire industry was under the control of a “pharmaceutical mafia” comprised of a select group of companies – some with ties to Ukraine’s parliament.
The result is seriously ill patients getting low-quality medications at exorbitant prices.
Astaforova-Yatsenko has taken part in recent protests to force the Health Ministry and Cabinet of Ministers to make sure the law passed by parliament in March is implemented in order to change this. The law was submitted and approved in record time, and many expected the rest of the process to go just as quickly.
But several resolutions setting out the proper procedure still require signatures, and the Health Ministry has yet to sign the biggest of three international contracts, with Crown Agents.
“The agreement with Crown Agents is still not signed, and all cancer patients – both children and adults – depend on this agreement,” said Olga Stefanyshyna of the Patients of Ukraine advocacy group. “They should’ve already started delivering the medications in early September.”
Iryna Lytovchenko of the PILLs charity organization, which raises money for children suffering from cancer, painted a grim picture of what would happen if the agreement were not signed.
“It is this organization (Crown Agents) that provides medications for cancer patients, and this is the lion’s share of funds allocated by the government for drug purchases,” Lytovchenko said.
If the necessary medications are not delivered this year and a tender is not held, not only will the budget funds for these medications simply “disappear,” she said, but “all cancer patients will be left without the required medications for all of 2016.”
On Oct. 28, Health Minister Alexander Kvitashvili said the agreement with Crown Agents would be signed by the end of the week, or at the very latest, early next week, in early November.
Yet that deadline has passed, and still the contract has not been signed.
Scarier still than the prospect of cancer-stricken children being left without vital medications is the prospect that certain individuals in the government intentionally created such a situation – but that is precisely what experts from the Anti-Corruption Action Center claim.
Alexander Ustinova of the Anti-Corruption Action Center singled out two individuals closely involved in the procurement process who she says have thrown a wrench in procurement reforms: First Deputy Minister of Health Alexandra Pavlenko and Hlib Zagory, the director of Darnitsa pharmaceuticals.
Zagory is a member of the Petro Poroshenko Bloc in parliament, and Pavlenko, a lawyer, has represented Zagory’s interests in at least one court case.
Pavlenko has denied making efforts to stop procurement reforms in comments to the Kyiv Post and said she was never an ally of Zagory. Zagory’s spokesmen have yet to respond to a written request for comment on the matter.
All experts interviewed by the Kyiv Post agreed that even if the necessary documents are signed in the near future, the process switching drug purchasing duties to international organizations may have already been derailed.
A mere two months remain for international organizations to secure and deliver all the required medications – and that may not be enough time.
Astaforova-Yatsenko told the Kyiv Post she fears the international groups could be discredited if they fail to deliver the required medicine by the deadline, thus forever killing the idea of making the transition to using them.
Ustinova of the Anti-Corruption Action Center expressed the same concern.
“I’m very worried that they (enemies of reform) will do all that they can to ensure that these international organizations can’t supply the medications by the deadline. The less time these organizations have, the less flexible they are,” she told the Kyiv Post.
Dmytro Sherembey, the chairman of advocacy group Patients of Ukraine, agreed with this assessment.
“The question is really how quickly our government will transfer the funds for the medications,” he said, pinning all the blame for delays on the Ukrainian side.
“First and foremost, this is because some officials are incompetent and because the corrupt schemers don’t want to let international organizations into the market,” Sherembey said. “Because they know that everything will now have to be open and transparent.”
Olga Stefanyshyna, also of Patients of Ukraine, said that vested interests, such as people who earn money on state procurement and don’t want to lose that cash cow, have more to gain from derailing the reforms. She said that up to “40% of the state budget was actually stolen (through drug procurement schemes) last year.”
Thus, entrenched interests stand to lose at least Hr 2 billion ($86 million) and “they will clearly be very upset,” she said.
Giovanna Barberis, UNICEF representative in Ukraine, said in a statement sent to the Kyiv Post that while Ukraine had signed a memorandum of understanding with the organization, “the procurement process can only be finalized once the Ukrainian legislative framework would enable the Ministry of Health to make a payment in a foreign currency as per international standards.”
Staff writer Allison Quinn can be reached at [email protected]
