Feasibility Study: Effectiveness of Public Health System (Programmes/Policies) in Combating Severe Population Health Crisis in Ukraine

Ukraine is a middle-income country within the WHO European region which has long faced significant population health crisis exacerbated by growing health inequalities within the country (rural/urban, male/female divide). It is one of the five countries in the region with the lowest life expectancy (11 years less than the EU average) and more than 10 years life expectancy gap between males and females. The health care and public health systems in the country remained virtually unchanged since independence in 1992 becoming completely inadequate to deal with the current challenges of growing epidemics of Non-Communicable Diseases and TB/HIV/AIDs epidemic.

Supported by the people of Ukraine, current government shows serious intentions to reform the country and use evidence in decision-making. Yet, given the dire state of the population health and political and economic difficulties, they are likely to opt out for a quick introduction of ready-made examples from other countries leaving the fundamental analysis of what does/did and does/did not work in a Ukrainian context for the future. Yet, we believe that evaluating past programmes/policies, as well as setting up the stage for the evaluation of future interventions would be crucial in designing reforms ensuring improvement of population health. Past experience of public health programmes/policies in Ukrainian context should not be wasted and in the full-scale study we would like to evalute such programmes/ policies to inform the development of effective PH system and facilitate its implementation.

To do this, we will first undertake a development study. This study will focus on the following things: (i) exploring the evolution of the public health programmes/policies at the national level and mapping their actual implementation across regions and over time, assessing their history, context, design and logic, (ii) assessing the availability and quality of the quantitative and qualitative data, (iii) assessing the potential for additional quantitative and qualitative data collection to enhance the possibilities for the evaluation of future public health programmes/policies, and (iv) reflect on the barriers to use evidence in health-related policy making in Ukraine.

This will allow us to select the programmes/polcies deemed evaluable to narrow down the focus of the full-scale study and refine the methodological approaches, provide recommendations as to the routine data collection to improve its quality, and introduce emerging public health community to the evidence based decision making.

This study is intended to accumulate knowledge to design properly the future full-scale project "Study on the Role of Public Health Programmes/Policies in Combatting Severe Population Health Crisis in Ukraine". Full-scale research project will analyse the relative effectiveness of public health measures in Ukraine over the period from 1990 to 2014, to form the evidence base for the development of an integrated public health system and its successful implementation. The development study is needed due to the scarcity of relevant knowledge on public health in Ukraine and lack of easy access to the necessary data, and thus knowledge on whether the data is suitable for such evaluation. The main objective of the development study is to assess the past programmes/policies in as to their evaluability based on their history, design, context, and implementation and the availability and quality of the data. The research will involve four Work Packages - scoping the data sources, in-depth interviews with key stakeholders and informants, preparation of data and analysing its quality, conducting an iterative research process based upon the Evaluability Assessment approach. It will take place in Canterbury and Kyiv from May 2015 till April 2016 performed by multi-institutional and multi-disciplinary research team led by Stephen Peckham which includes senior researchers with experience in conducting large surveys, qualitative studies, statistical and economic analysis and health systems and health policy research.

Our development study (DS) promotes the EPHO10 "Advancing public health research to inform policy and practice" in three ways: (i) by studying the evolution of the public health system in Ukraine since early 1990s, (ii) by providing information on available data sources and their quality, and (ii) by providing recommendations on the evaluability of past PH programmes/policies. In addition, it contributes to the EPHO1 "Surveillance of population health and wellbeing" by providing recommendations on the quality of routinely collected data, as well as EPHO7 "Assuring a sufficient and competent public health workforce" by providing training opportunities for the emerging public health workforce. There are three major groups of beneficiaries: (B1) major stakeholders - Ministry of Health of Ukraine, World Bank, and WHO Country offices, other international organisations; (B2) local health departments; (B3) health researchers; (B4) emerging public health workforce.
As a result of DS, B1 will have (i) a better understanding on the evolution of public health in Ukraine over the most recent period of its history; (ii) an assessment of the quality of routinely collected data and recommendations on how this data can be improved and extended for future evaluations of their initiatives, and (iii) an overview of barriers and obstacle to using research evidence in policy/decision making. This will allow better understanding of the underlying problems and designing accordingly their initiatives, taking into account potential pitfalls with the implementation, as well as promote use of evidence in policy/decision making. B1, B2, B3 will benefit tremendously from all activities related to the data, which is currently being underutilised and inaccessible. This will enable generation of new knowledge related to population health and evaluate future initiatives. All four groups of beneficiaries (B1, B2, B3, B4) will gain from the Open Workshop which will be held to present the results of the DS findings and provide short training on policy/programme evaluation and evidence-based decision-making.