Hundreds of thousands of seriously ill Ukrainians are at risk if Ukraine doesn’t start its 2020 procurement of drugs and medical supplies as soon as possible.
Medical Procurement of Ukraine, the state company created for this purpose, was supposed to start buying supplies this year, but it can’t act until the Ministry of Health gives it the go-ahead. This is a problem because Medical Procurement of Ukraine is in charge of almost half of Ukraine’s medical procurement portfolio.
The longer this delay goes on, the later Ukraine will get critical drugs and the greater the risk that people with HIV, cancer and other diseases will have their treatment interrupted.
“If the Ministry of Health does not start the procurement cycle through Medical Procurement of Ukraine soon, we will have a catastrophe towards the end of the year,” said Sergey Dmitriev, head of policy at Ukrainian patient nonprofit CO 100% Life, which supports people with HIV.
The delay has also slowed Ukraine’s ability to get enough material for its COVID-19 response, leading to a shortage of personal protective equipment (PPE) in the country in the early days of the epidemic. Over 788 medical workers became infected with the novel coronavirus, nearly a fifth of the national total as of April 16, partly due to the lack of equipment.
Multiple officials laid the blame at the feet of former Health Minister Ilya Yemets, who allegedly held up the state company’s work for the three and a half weeks he was in office.
But even now, two weeks after he was fired, Medical Procurement’s work is largely at a standstill with Ukraine already lagging behind schedule to start buying drugs for 2020. The ministry only authorized the state company’s very first procurement for the year this week – an order of 90,000 units of protective gear.
The Ministry of Health took the Kyiv Post’s questions on the subject but was not able to provide answers by press time, despite multiple reminders.
Slow start
Starting in 2015, Ukraine ceded responsibility for important medical procurements to international organizations, as part of far-reaching medical reforms.
This was done for two reasons. One was an effort to avoid corruption by health officials with ties to pharmaceutical companies. The other was because international organizations have an easier time dealing with suppliers.
That approach saved millions of dollars. But there was a backlash from some domestic pharmaceutical companies, which said it gave foreign companies an unfair advantage.
Medical Procurement of Ukraine was designed to be the international organizations’ successor. Last year, the state company held several pilot purchases of drugs, getting them 38% cheaper than the expected value set by the state. The firm was ready to start working this year.
“We were and are ready to start purchases,” the Medical Procurement press service told the Kyiv Post. “We are constantly monitoring the market, we are constantly in touch with businesses.” The company also tracks hospitals’ needs.
Former Health Minister Zoryana Skaletska signed an order in late February granting the company responsibility for 14 out of 38 different medical acquisition categories, according to the state company’s press service.
These categories include treatment for serious conditions like cancer, multiple sclerosis and AIDS, which need the most complex and expensive procurements.
Some nonprofits that have been assisting with medical procurement disagreed with this decision. Inna Ivanenko, director of the Patients of Ukraine organization, said that it would have made more sense to give the company a more gradual start – like buying drugs that were previously handled by nonprofits. This would let the nonprofits step in in case of problems.
Timofiy Badikov, the director of NGO Platform for Health and former deputy head of the Public Council at the Ministry of Health, agreed that it would have been safer to do another trial year before entrusting the firm with nationwide purchases.
However, he added that NGOs involved in drug procurement may be unwilling to give up their sphere of influence.
Still, other insiders, including CO 100% Life’s Dmitriev, gave the state company high marks. “They have a good team, good specialists,” he said. “If the current team were to go, those who replaced them would not be able to do procurements.”
Former health minister to blame
The Cabinet of Ministers approved a resolution to start buying personal protective equipment and tests in February through international organizations.
“On the first day of his work, former Minister Ilya Yemets had to sign an agreement and launch a procurement process,” said Olga Stefanishyna, a former deputy minister under ex-Minister of Health Ulana Suprun and a current lawmaker for the Voice party. “We would already have everything we needed today to protect our doctors.”
Volodymyr Kurpita, the former head of the Health Ministry’s Center for Public Health, said that Ukraine lost three weeks under Yemets, which impacted its response to the epidemic.
Many experts agree with him. While the ministry says hospitals with COVID-19 patients are provided with 20 days of supplies, over half of medical facilities have supplies for up to 10 days and some, for less than a week. Some hospitals have less than a quarter of required personnel active partly due to the equipment shortage. Primary care doctors have told the Kyiv Post that ambulances have asked them for protective equipment to drive patients, lacking their own.
Ukraine was forced to rely on NGOs and big business donors to equip their doctors, hospitals and paramedics with sufficient protective equipment in the first few weeks of quarantine.
But it wasn’t just the epidemic. Ukraine still hasn’t started buying 2020 treatments for cancer, cardiovascular diseases, tuberculosis, AIDS, strokes and other conditions.
Medical Procurement Director Arsen Zhumadilov publicly stated that Yemets blocked all acquisitions and tried to install his “trusted person” at the state company before he would let it do its job.
The candidate, Volodymyr Hryshkovets, had no experience working in a medical procurement agency. Speaking with Radio Free Europe/Radio Liberty, Hryshkovets admitted that he never sought the role and did not know why the health minister proposed him. Hryshkovets was convicted in 2019 for stealing merchandise from a supermarket in Zhytomyr, a city roughly 140 kilometers to the west of Kyiv.
“You tied it to the appointment of your protégé,” Zhumadilov wrote on Facebook, addressing Yemets. “You are now responsible for this.”
Zhumadilov was called in by the National Police to give a statement on suspicions that he wasted or embezzled state funds, which may have been retribution for his allegations against Yemets. The case has not progressed since then, according to the state company’s press service.
Reached by phone, Yemets spokesman Sergey Nahoryansky repeatedly dodged the Kyiv Post’s question about whether the former health minister was responsible. He said he had no information to confirm or deny Zhumadilov’s accusation and said that this subject is no longer worth discussing.
“This is all in the past and is no longer relevant,” Nahoryansky said.
Yemets was fired on March 30, not long after Zhumadilov made his accusations, for failing to deal with the pandemic. He was replaced by Maksym Stepanov.
While top officials had no confidence in Yemets’ capabilities, replacing two health ministers in one month during a pandemic has not helped Ukraine move any faster.
In the meantime, Medical Procurement of Ukraine has still not been given the green light to start purchasing medical supplies, with the exception of the 90,000 PPE units. The PPE request is its own separate order, which does not provide general procurement authorization.
Waiting for green light
To move forward, the Cabinet of Ministers needs to approve a list of drugs to be bought, according to Stefanishyna. The Health Ministry also needs to sign an order clarifying how procurements will be done. The ministry also has to sign off to allow international organizations to procure their half of the medicine for 2020.
The ministry also has yet to appoint a deputy minister to oversee procurement. Stefanishyna said that no special task force on procurement is working right now.
But even if Ukraine were to start procuring drugs right now, it would take three to six months – sometimes more – for the supplies to be delivered the country. Months-long queues resulting from the pandemic could make the wait time even longer.
Worse yet, patients with serious illnesses are already at a higher risk, as coronavirus will stretch the national health care system to its breaking point.
“The most problematic situation will start in October,” said CO 100% Life’s Dmitriev, when over 100,000 HIV patients could be left without antiretroviral drugs. “I can only imagine what’s happening in other areas.”
