Decentralization has given local governments new powers and resources to improve the quality of service delivery on the ground. Healthcare has become one of the priority areas being actively developed in municipalities since the start of the reform.

Keretsky Village Council in Zakarpattia region is one of those municipalities that took responsibility for the healthcare development and actively began to improve this sector. Experts from the Regional Office of U-LEAD with Europe in Zakarpattia Oblast played a major role in this process, and from the first days of the municipality’s creation advised it on various issues. With the support of U-LEAD, the municipality established a Primary Healthcare Center, which gave an impetus to the healthcare development.

The municipality’s leadership immediately decided on medicine development on the territory of Keretsky village council and improvement of the service delivery. Therefore, the municipality was selected to participate in the initiative of the U-LEAD with Europe for the formation of a capable primary healthcare network. During April-November 2021, specialists from the municipality underwent comprehensive training and developed their plan for the development of primary healthcare institutions.

“The training from U-LEAD was very timely for our municipality, as we were just launching a primary healthcare network analysis and not fully understood where we should go next. Professional experts worked with us, continuously provided their help and conducted a series of consultations. We took all our first steps together with U-LEAD experts, which gave us confidence and inspired us to work even harder,” shares Mykhailo Vasylenko, Head of the Primary Healthcare Center of Keretsky Village Council.

According to Mykhailo Vasylenko, an important role in the process of creating a capable network of primary healthcare is played by the cooperation of local authorities and municipality residents. The leadership of Keretsky municipality adhered to this formula and was interested in such cooperation.

Before creating the Center, the municipality conducted a detailed analysis of its capacities and resources in order to understand whether they would be able to maintain the primary healthcare sector, which at that time required significant financial infusions.

Mykhailo Vasylenko developed a quality strategy for the development of primary healthcare for several years, which allows to implement changes gradually, understanding all the advantages and risks. In June 2021, the official registration of the Communal Non-Profit Enterprise “Primary Healthcare Center of Keretsky Village Council” took place.

Deputies understood the importance of such steps for the further development of Keretsky municipality, so they immediately supported the proposal of the chairman and the initiative group. This was the first step towards the development of rural medicine in the municipality.

Registration of a legal entity was only the first step, it was important to have time to go through all the procedures and conclude a contract with the National Health Service of Ukraine. The leadership of the municipality and the newly created institution perfectly understood this, so they worked in tandem to make all decisions as quickly as possible and ensure everything necessary for signing contracts.

“We understood that a team should work on signing the contract with National Health Service of Ukraine. At that time, I managed to select excellent staff to rely upon to solve many issues. A lot of work was done in the shortest possible time. The most important thing is that we made it and showed the first team result thanks to coordinated work and step-by-step planning of our actions. It was possible to systematize a huge amount of data that was collected practically from scratch. The U-LEAD experts helped a lot, guiding us and communicating all the important information. We are glad that we received a license on time and signed a contract with the National Health Service regarding the primary healthcare activities and vaccination,” notes Mykhailo Vasylenko.

Previously, all medical facilities on the territory of Keretsky village council were subordinated to two structures, since the municipality was formed on the border of two rayons, which created a number of difficulties. Accordingly, the municipality built the entire network from the very beginning, forming its structure as carefully as possible. A lot of work was done with doctors who at that time worked in medical institutions to establish a high-quality work team.

“I would like to emphasize the professionalism of the management of the Primary Healthcare Center. It was the professional and responsible approach that allowed the institution to develop and receive funding from the National Health Service even in wartime. The speed of decision-making and clear actions made it possible to obtain high indicators on declarations exactly when the National Health Service was fixing the amount of payments. It would seem that the institution was just lucky and they “jumped into the last train” before the war, but, knowing the internal processes, they had already bought a ticket in advance,” says Pavlo Ryabokon, Decentralization and Local Self-Government Advisor of the Regional Office of U-LEAD with Europe in Zakarpattia Oblast.

There are 45 employees working in the Primary Healthcare Center of Keretsky village council, who serve more than 15,000 people.

There are four outpatient clinics in the municipality. Since the establishment of the new institution, the municipality managed to update the material and technical basis of the clinics at the expense of the funds from local and state budgets, as well as international and Ukrainian organizations.

Thanks to the successful coordination of work, the management of the Center was able to attract about UAH 2 million of additional resources for the development of healthcare institutions.

Inpatient units with new, modern equipment and medicines operate in each outpatient clinic. Currently, work is actively underway to create appropriate conditions for the operation of telemedicine offices, which will be a real breakthrough for local institutions. Appropriate equipment has already been purchased, and doctors have received certificates allowing them to work with it.

After the full-scale invasion of the Russian Federation, the municipality accepted many internally displaced persons. By mid-March, more than 2,500 displaced people lived there.

“It was a new challenge for us, as the population increased dramatically, which could provoke an increase in disease rate. We were preparing for this, looking for additional resources to provide everything necessary for our new patients, since some of them had serious illnesses. We managed to attract a lot of humanitarian aid from Ukrainian and international organizations, which became a useful experience for all of us,” says Pavlo Ryabokon.

Over the past few months, medical facilities have been undergoing cosmetic repairs and fitting out new offices. Special attention is paid to the conversion of the heating system in medical institutions and their preparation for the new heating season. The leadership of the municipality understands all the new challenges and tries to get ready now to avoid crisis situations.

“We are happy to follow the good results shown by Keretsky municipality in providing quality medical services. Since the municipality’s creation, the management has declared access to quality healthcare as one of the priority areas of work. Our team of U-LEAD experts joined this process and provided appropriate support in establishing the Primary Healthcare Center. We held a number of meetings, provided consultations, and helped calculate the feasibility of establishing such an institution. It is nice that our joint work gave such a positive result. It is important that in Keretsky municipality they do not stop at what they have achieved, but work on further improvement of the medical service delivery and attract new resources for the development of this sector,” – sums up Mykola Siusko, Head of U-LEAD’s Regional Office in Zakarpattia Oblast.

Keretsky municipality is not going to rest on its laurels, but is already making new plans for the near future. Such an example of the development of rural medicine is indicative and should inspire other municipalities not to hesitate, but take responsibility for the development of healthcare facilities into their own hands.