This article outlines some options and recommendations for local administrations to further optimise the primary healthcare network, as well as the legal documents on which they are based.

Natalia Gusak, Regional Coordinator for Healthcare Reform Support of the U-LEAD with Europe Programme

Victoria Cheban, Legal Adviser of the Chernivtsi LGDC of the U-LEAD with Europe Programme

Since the introduction of the primary healthcare reform in 2017-2018, most local self-government bodies have made the decision to transform healthcare facilities from budgetary institutions into communal non-profit enterprises, becoming their founders. Similar decisions were made by rayon councils. However, to create even more efficient networks and provide better healthcare services to amalgamated hromadas it may be necessary to reformat the primary healthcare network within one rayon or even within one AH.

There may be several situations in this regard:

1. Change of the founder with the transfer of property rights to a legal entity from the rayon council to the AH council.
2. Accession of other settlements to AH, and thus the possibility of transition of rural outpatient clinics from rayon primary healthcare centres to the communal non-profit enterprise of an AH.

1. There are several steps to be taken when transferring property rights to a legal entity:

1) The process begins with the adoption of a decision by the AH council and submission of a proposal to the rayon council, managing the legal entity. At the same time, the rayon council may also initiate the transfer of the respective legal entity.

2) The next step in the process of legal entity transferring should be inventory.

When it comes to the transfer of a communal enterprise or organisation that is a non-budget institution, inventory is not required.

3) The next stage, after the inventory of the assets and liabilities of the legal entity is completed, the AH council considers the renaming of the legal entity (in cases where such renaming is required by the current legislation), and also considers the need to approve the constituent documents of the respective legal entity in a new version and resolves the issue of management of the respective legal entity.

4) The final stage is the introduction of changes to the information on the legal entity in the Unified State Register by the AH council or its authorised body.

5) Just as in the case of autonomisation, in case of the enterprise renaming, the corresponding entry must be recorded in the employment record books of the employees.

6) Since the name of the primary healthcare provider was changed during the change of owner and changes were made to the charter of the enterprise, it is an important step to inform the licensing authority of any changes to the data specified in its documents that were attached to the license application.

7) In order to comply with the contractual relationship with the National Health Service of Ukraine (NHSU) in accordance with clauses 14-16 of the CMU Resolution “Some issues regarding contracts on medical care of the population under the programme of medical guarantees” No. 410, a legal entity has the right to submit to the NHSU, through the system, a proposal to change the contract concluded between them in order and on the terms stipulated by the contract.

2. Accession of other settlements to AH, and hence the possibility of transition of rural outpatient clinics from the rayon primary healthcare centres to the communal non-profit enterprises of an AH.

The sequence of actions will be similar to the transfer of property rights to a legal entity, but with certain peculiarities.

1) The process also begins with the adoption of a decision by the AH council and submission of a proposal to the rayon council or other AH council managing the legal entity.

2) After consenting to the transfer of the relevant affiliate to the communal non-profit enterprise management of another amalgamated hromada, it is also necessary to transfer the property on the balance sheet of the communal non-profit enterprise.

3) The next step in the transfer of property will be its inventory.

4) Then the AH council, that accepted the property, has to make a decision on its disposal.

It is also extremely important in the process of changing the subordination of an outpatient clinic to another legal entity to ensure the labour rights of employees.

The transfer of the employee is subject to the mandatory receipt of his/her consent to such a change in the terms of the employment contract.

Prior to the transfer of an employee from one communal non-profit enterprise to another there is usually a documentary agreement of such procedure between their managers.

A person invited to work in the order of transfer from another enterprise, institution, organisation by agreement between the heads of enterprises, institutions, organisations, cannot be denied the employment contract (part 5 clause 24 of the Code of Labour Laws).

5) As in the previous situations, when a new primary healthcare provider receives new healthcare facilities, an important step is to notify the licensing authority of any changes to the data that were specified in its documents that were attached to the license application.

6) In accordance with clauses 14-16 of the CMU Resolution “Some issues regarding contracts on medical care of the population under the programme of medical guarantees” No. 410, a legal entity has to submit to the NHSU, through the system, a proposal to change the contract concluded between them in order and on the terms stipulated by the contract.

It should also be mentioned that clause 14 of the Model Contract on Medical Care of the Population under the Programme of Medical Guarantees requires the provider to submit in due time complete and reliable information, draft contracts on changes to the contract in the prescribed manner.

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