Reform of Ukraine’s civilian healthcare system is underway following the adoption of a new law. Military medicine, despite the unique experience gained during ATO, also requires further dynamic transformation.
A correspondent from the newspaper 'Народна армія' (People’s Army) spoke with Mariana Bezuhla, medical planning and reform coordinator at the Ministry of Defence Reform Project Office, about what changes we can expect to see in the medical support system with the reform of the Armed Forces of Ukraine.
Mariana Bezugla
Studied medicine in Ukraine and Poland; basics of information support in the UK. Background: general physician, trusted physician, junior researcher. Background in medical support of medical information systems and development of local medical care protocols.Mobilized, served as an attending physician in a medical company until seconded to engage in international cooperation in medical area at the General Staff of Armed Forces of Ukraine.
— What part of the current system of military medicine needs urgent reform?
— The most valuable and problematic, when it comes to managing and especially during reform, resource is personnel. If you want to improve the system you need new people who will set new rules. Bureaucracy-heavy segments have the biggest need of the reform: medical supplies, patient records, etc
For example, a soldier wounded in the area of the ATO is given medical care at different levels: immediately after injury, during evacuation, in a medical facility close to the front line, in a hospital in a safe zone. At every stage there should be information about his injury and treatment. At the same time, it’s important that the time needed to stabilize a patient’s condition isn’t wasted filling out extra paperwork.
With the help of volunteers (for which we are extremely grateful), Armed Forces of Ukraine are introducing a system of electronic medical records that will optimize this process.
The order of the Ministry of Defense “On delivery of software, telecommunications and server equipment, automated workspaces and documentation of the e-Health complex” by the end of March 2018 has been signed. It was developed jointly by the Main Military Medical Directorate and Reforms Project Office of the Ministry of Defence. The expert support of partners from the United States also ensured systematic development of this branch according to NATO principles and standards.
Corruption and reputational risks must be removed from the system of medical supplies, and it must become transparent and operational, with understandable record-keeping and control.
The system of military medical education and training is getting a lot of public attention. These changes require constant focus and step-by-step work. You shouldn’t expect an immediate effect, but it is critically important to the development of high-quality medical care, especially to reduce injury-related deaths.
At the heart of this reform is the newly created 205th Tactical Medicine Training Centre, whose team has proven capable of bottom-up reform.
— In your opinion, what should Ukrainian military medicine of tomorrow look like?
— Further progress requires not only personnel changes but also a change in management philosophy. The military medicine department has been reorganized into a unified “medical command” to utilize the full capacity of the military system to advance reform.
This means dissolving the two previous management structures that existed in parallel and had a convoluted division of responsibilities and authority. A new Main Military Medical Directorate has been formed, the appointment process was quite tough, and the functions and responsibilities were written out in as much detail as possible.
The main goal of creating the new structure is to set up an effective system of medical support that meets the needs of Armed Forces of Ukraine and NATO standards.
The Main Military Medical Directorate is subordinated to the Minister of Defense. On issues related to planning, use and management of the resources of the AFU’s medical service and training, the Main Directorate is subordinated to the head of the General Staff – the Commander-in-Chief of the Armed Forces of Ukraine. This does not mean dual subordination, but a division of responsibilities given the functioning of the Armed Forces (The minister handles policy, while the chief of the General Staff is responsible for the direct use of forces).
Military medicine should work for troops at garrisons and in combat zones. Our goal is to create a system where both aspects are covered 100%.
— How much time is needed to fully upgrade Ukrainian military medicine?
— Although most strategic programs have specific timeframes, you can’t focus on dates. We believe a goal has been reached once a certain stage has gone from planning to implementation and is functioning. We only report on results.
As for costs, the redistribution of available resources, on the contrary, will free up funds and increase economic efficiency. Sometimes you need to get rid of the old to create a platform to build something new. This is a painful process for specialists with an orthodox mindset. Sometimes it can also be painful for “consumers”: the results do not appear lightning fast.
We try to use the foreign experience as much as possible when planning the reform of domestic military medicine.
Of course, we have many own workouts, which we want to complement with the best from our western partners. The current quality of the medical services of the armed forces of the U.S., Canada, UK, Germany and other countries was also achieved in stages. The same way that the ATO was an impetus for creative changes, the experience of our foreign partners also shows that warfare forces systems to look for better ways. When developing the new principles and training programs, we rely to experiences of the U.S. and Canada and our own modifications.
— Will the reform of the civilian and military sectors be combined?
— A country is a social and economic organism, and the functioning of one “organ” depends on the work of another. Military medicine cannot remain outside the changes in the healthcare system, and today unified medical space of Defence forces and civilian sector is being formed.
A Coordination Centre has been created in the Cabinet of Ministers of Ukraine for this purpose. It unites the medical services of defence and law enforcement structures and representatives of the Ministry of Health in interdepartmental expert boards in six areas. The aim is to create unified medical space where military and civilian medicine “speak the same language”, use unified standards of treatment and supplies, and work together in operations.
In 2018 interdepartmental cooperation will result in new norms and medical standards, amendments to orders that haven’t changed since Soviet times, and so on.
