KYIV, Ukraine — Ukraine has been struggling to modernize and break free of Soviet policies that once had dictated much of the laws and public service systems in the country. Remnants of Soviet rule can be seen in the state-run healthcare system, which has experienced little productive change since Ukraine’s independence in 1991. One of the biggest issues facing the amelioration of healthcare in Ukraine is the endemic, widespread use of drugs and alcohol that the state system has failed to properly combat.
Healthcare in Ukraine
Healthcare in Ukraine has been neglected in many ways. Up to 92 percent of citizens are concerned about seeking medical help due to a fear of the exorbitant costs. The medical help they do receive is outdated and inefficient. Compared with other Communist countries post-Soviet rule, mortality rates in Ukraine have only improved 8 percent; whereas, countries such as Romania and Latvia have improved 42 percent.
More broadly, healthcare in Ukraine has long since been hindered by a lack of resources available for those administering and receiving care. Inadequate funding and an unwillingness seen in politicians and policymakers undermine the government’s efforts to develop prevention and treatment programs for addicts. Oftentimes initiatives put out by the Ministry of Health either fail to come to fruition or are not implemented to their fullest potential.
The Extent of Substance Abuse
Since independence, drug use has grown and begun to reach across several age demographics. Most drug users are aged 20-30. However, as of 2005, more than 60 percent of drug users were teenagers with 13 percent between the ages of 11 and 14. At least 30 percent of citizens reported that they knew someone who participated in drug use. Cannabinoids and opioids remain the drugs of choice for most users. Alcohol use is more common than drug use due to cultural and social norms that have normalized and in some cases encouraged drinking. In 2005, it was estimated that alcohol accounted for about 9 percent of the disease burden in Ukraine.
Two factors that have greatly influenced the perpetuation of substance abuse are societal expectations and stigmas surrounded addiction and insufficient prevention, treatment and awareness policies within systems of healthcare in Ukraine. Soviet rule not only impacted the overarching, governing systems of the nation but it also created social implications and assumptions surrounding healthcare that have proven detrimental to the population’s dependence on illicit substances.
A general disregard for and isolation of addicted persons has led to a public mentality that is driven by the criminalization of substance abuse rather than the treatment of such. Persistent drug and alcohol users are seen as an enemy of the public. They detract from the good of the social collective and, therefore, are not treated fairly by the healthcare system.
The Growing HIV/AIDS Epidemic
A derivative of the substance abuse problem facing Ukraine is the country’s increasing rates of HIV/AIDS that affects nearly 1 in 5 drug users in Ukraine. Ukraine has the second-highest number of people living with HIV/AIDS in Eastern Europe and Central Asia. While strides have been made to reduce this number the increasing rate of new cases has proven difficult to overcome. There have been decreases in the number of people reporting infection, but this doesn’t necessarily mean fewer people live with the disease. It does imply a lack of awareness and treatment policies put forth by the Ministry of Health.
Improvements in the Healthcare System
The government of Ukraine has recognized the severity of the substance abuse epidemic. Despite the insufficiencies of healthcare in Ukraine, the Ministry of Health has implemented an increasing number of prevention and treatment programs. Ukraine has agreed to implement UNAIDS’ HIV/AIDS treatment that takes a 90-90-90 approach. Its procedure for fighting the disease and its growth is based on the percentages of people who are currently undergoing treatment, aware of their status and living virally suppressed.
Opiate substitution therapy was legalized in 2004 for addicted drug users, which has widened the possibilities for better drug treatment in the future. Additionally, the Ukrainian Ministry of Health has invested in the betterment of its people through the general implementations of a five-pillar system to reform the current healthcare system. This initiative is based on benefits, funding and creating basic standards.
Ukraine has come a long way since the inadequate institutions that once debilitated its healthcare systems. Although there are places for advancement, the foundations are in place for the country and the government to set the standard for awareness and treatment programs to help those who struggle with substance abuse. Healthcare in Ukraine has the potential to help people who have been previously neglected. The government’s initial dedication to ending the criminalization of addiction will hopefully create a national environment in which addicts no longer face the stigmas they have in the past.
– Jessica Ball