SDC strives to establish accessible and affordable public health care in Ukraine. It is a difficult and challenging task to implement and it is too early yet to consider whether this objective has been met. Some decades ago, the Ukrainian health system was established to serve the curative needs of the population. This resulted in an oversized tertiary health care sector. Subsequently, there have been permanent difficulties in ensuring public funding for socially desirable goods and services and a lack of local budget funding for the provision of social services, it has become difficult to ensure sustainable delivery of primary health care. In certain cases, the unavailability of medical specialists in the regions denied the rural inhabitants regular access to medical facilities. However, in the majority of cases the issue was the price of medical services and medicine. On average, Ukrainian households spend about 15% of their annual budget on health services (unofficial payments are not counted). One quarter of all Ukrainians consider that medical costs are too high, and this impedes them from referring to medical establishments even when it is necessary.

In the last five years SDC targeted a build up of its technical assistance programme to Ukraine in order to account for systemic malfunctions. The delivery of perinatal equipment (intensive care units for neonatal departments of regional children’s clinics) allowed the starting of a dialogue with local authorities on the quality of medical services (the use of telemedicine and evidence-base knowledge) and public health management issues (equipment management and the cost efficiency of medical interventions). This has served as a basis to consolidate all past Swiss assistance to Ukraine and improve the management capacities of medical specialists in order to ensure that the received equipment will be used by the Ukrainian partners in the most productive way. This is not an appropriate time to speak about the direct contribution of Swiss assistance to better perinatal health. Nevertheless, it has already become obvious that there has been a visible lowering of child mortality in the partner hospitals in SDC pilot regions.

Social mobilisation and partnership have a tremendous potential for integrating Ukrainian society around common needs and problems. The consequences on the state budget of fiscal decentralisation and cross- subsidisation of local social programmes have been devastating. The social sector (water supply infrastructure, health, social assistance and care) appears to have been the most badly affected. It is frequently referred to as requiring immediate support, Consequently, local administrations across the country have shown an interest in learning the practices of Crimea, Chernobyl, Ivano- Frankivsk and other settlements in order to replicate their experience with regard to basic social services provision.

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