Strategy for the development of palliative care in Ukraine for 2015-2025

General part

Ensuring the realization of the rights and freedoms of a person and a citizen, defined by the Constitution of Ukraine , as well as the implementation of the Sustainable Development Strategy "Ukraine - 2020" regarding the implementation of European standards of living in Ukraine, the Strategy of the State Policy on Drugs for the period until 2020, requires recognizing the rights of seriously ill patients and creating conditions for achieving the maximum quality of life for palliative patients of all age categories.

In 2014, the World Health Organization (WHO) defined palliative care as an approach that improves the quality of life of patients (children and adults) and their families who face problems related to a life-threatening illness , by preventing and alleviating suffering through early detection, careful assessment and treatment of pain and other physical symptoms, and providing psychosocial and spiritual support. The provision of palliative care is based on the principle of respect for human dignity and is aimed at providing practical support to the families of palliative patients.

It is the duty of the state to ensure access to palliative care for all patients, regardless of age, nosological category of the disease, social status, nationality, religious and political beliefs, place of stay, etc. Given the aging of the population and high demographic mortality rates, since about 700,000 people die annually in Ukraine, including more than 100,000 from cancer, there is a growing need for the organization and provision of quality palliative care. The number of people in need of palliative care is more than 600,000 patients annually, plus members of their families who need accompaniment and support. That is, annually, more than 1.5 million people need palliative care.

In recent years, some progress has been achieved in the field of palliative care, in particular, the Law of Ukraine "On Amendments to the Fundamentals of the Health Care Legislation of Ukraine on Improving the Provision of Medical Care" was adopted in terms of the definition of palliative care as a type of medical care and the organizational principles of its provision , Laws of Ukraine "On the approval of the State-wide program for combating oncological diseases for the period until 2016", "On the approval of the State-wide target social program for combating tuberculosis for 2012-2016" "On the approval of the State-wide target social program for combating HIV infection/AIDS for 2014-2018", which contain issues of the development of palliative care.

Awareness of the tasks of palliative care has increased somewhat, specialists have appeared who are experts in palliative care and have studied the experience of other countries, a number of regulatory and legal acts of the Ministry of Health and the Ministry of Social Policy have been adopted and are being implemented.

To date, 2 centers, 7 hospices and more than 60 independent palliative care departments have been created in Ukraine, which provides access to 1,500 inpatient palliative beds, with the need for 3,500 beds recommended by the World Health Organization. There are only 7 mobile services providing palliative care at home for adults and children. According to experts, the need for palliative care in Ukraine is met by only 15%.

At the same time, there is a low level of awareness of various strata of the population, state authorities and local governments regarding palliative care, insufficient regulatory and legal regulation in the field of palliative care, lack of a systematic approach to the organization of its provision, interdepartmental cooperation and an integrated approach in this area with taking into account the patient-oriented approach.

This Strategy defines the purpose, tasks, primary priorities and indicators of the formation and development of palliative care in Ukraine and corresponds to the state guarantees taken in accordance with the Convention on the Protection of Human Rights and Fundamental Freedoms , the Convention on the Rights of the Child, and the directions of development defined in the Resolution of the Sixty-seventh Session of the World Health Assembly (2014) "Strengthening the palliative care system as a component of comprehensive treatment in the patient care system."

Principles of Strategy implementation

The strategy is based on the following principles:

• patient-oriented approach;
• legality, respect for human rights, humanity and respect for human dignity;
• openness, honesty and coordination of the palliative care system;
• strengthening of supporting systems of health care, social policy, and others;
• permanent scientific and operational research;
• availability of medicines to ensure high quality of life of palliative patients;public participation in the creation and functioning of the palliative care system;
• fulfillment of international obligations.

The purpose and tasks of implementing the Strategy

The goal of the Strategy is to create a system of palliative care and ensure guaranteed access to it for patients of all age categories, regardless of their location.

Tasks of Strategy :

• Increasing public awareness of palliative care issues;
• Providing a patient-oriented approach in palliative care;
• Implementation of normative and legal regulation of the field of palliative care;
• Conducting a national assessment of needs for palliative care for patients of different age categories according to their places of stay, as well as for medicines, primarily for pain relief;
• Provision of planned calculations for the creation of a network of special palliative care facilities for the period 2015-2025. Expansion of the network of inpatient facilities of the "Hospice" type and centers/departments for the provision of palliative care, including for children, in accordance with the recommendations of the World Health Organization. as well as networks of mobile services for providing palliative care at home, nursing care services, day palliative care services of other organizational forms;
• Providing funding for palliative care from various sources. Developing and ensuring the functioning of regional, district, city programs for the development of palliative care with the involvement of sustainable funding;
• Development and approval, in accordance with WHO principles, of standards and clinical protocols for providing palliative care to patients of all age categories; standards of social services;
• Ensuring an integrated approach and establishing an order of interaction between various departments involved in the provision of palliative care in order to achieve the maximum quality of life of palliative patients and their relatives;
• Ensuring the availability and accessibility of a wide range of painkillers (syrups, plasters, tablet forms, sprays, etc.) for patients of different age categories in Ukraine;
• Creation of a system of state support for manufacturers of drugs and pharmacies that conduct activities related to the circulation of narcotic, psychotropic substances and precursors, with the aim of expanding their assortment and availability;
• Development of human resources for the operation of stationary and mobile palliative care services for patients of all age categories;
• Creation of a system of pre- and post-graduate education for medical, social, pedagogical workers on issues of palliative care and treatment of chronic pain syndrome;
• Carrying out scientific research on the issue of providing palliative care;
• Creation of a monitoring system for compliance with the rights of palliative patients and their protection;
• Creating an effective mechanism for involving volunteers and the public in providing palliative care to patients and their families;
• Conducting information campaigns, charity and art actions to draw public attention to the needs of palliative patients and support the activities of palliative care facilities and institutions

Subjects of Strategy formation and implementation

The Ministry of Health, the Ministry of Social Policy, the Ministry of Education, the Ministry of Internal Affairs, the State Medical Service, local state administrations and local self-government bodies (with consent), health care institutions, public, professional, religious associations, scientific institutions, charitable foundations, etc.

Monitoring and evaluation

Areas in which the results of the Strategy are evaluated:

• Conducting an assessment of palliative care needs every three years to determine the level of satisfaction of needs and the necessary review of measures for the quality functioning of the palliative care system;
• Regulatory and legal regulation of palliative care provision and access to pain relief for patients of different age categories, regardless of their location;
• Funding of palliative care from various funding sources;
• Conformity of existing services (stationary and mobile) for different age categories to defined national needs, taking into account regional specifics;
• Implementation of educational programs before and after diploma education for medical and social workers, pedagogical workers, psychologists, volunteers, clergy;
• Provision of services (stationary and mobile) with a sufficient number of medical personnel with an appropriate load calculation, as well as social workers, teachers, psychologists, and clergy.

According to quantitative indicators:

• the number of approved relevant legal acts regulating the field of palliative care and meeting the standards of the World Health Organization and other international organizations;
• the number of inpatient palliative care beds for adults and children in accordance with the identified needs;
• number of mobile palliative care services for adults and children in accordance with identified needs;
• the number of day centers for adults and children in accordance with the identified needs;
• increasing accessibility to palliative care – accounting for the difference between demand and actually provided palliative care services;
• the number of opioids dispensed under hospital and pharmacy prescriptions, including discounted ones;
• the number of received opioids in the territory of the administrative unit (region, city, district);
• the number of pharmacies in the region/city that have a license to carry out activities related to the circulation of narcotic, psychotropic substances and precursors;
• the determined volume of quotas, in dynamics, for Ukraine in accordance with the data provided by the international drug control committee.

According to qualitative indicators:

• monitoring and assessing the quality of palliative care among patients and their family members using a standardized study;
• mortality in a hospital bed;
• study of compliance of prescriptions for pain treatment with approved clinical protocols with the participation of independent experts;
• availability/staffing of positions of psychologists and social workers in centers (departments). Involvement of priests.

Stages and expected results

The stages of implementation of the Strategy are determined by the plan of measures for its implementation, which is approved by the Cabinet of Ministers of Ukraine.

Implementation of the Strategy will contribute to the implementation of a unified state policy on the development of palliative care, which will ensure:

• creation of an accessible and effective system of providing palliative care based on the application of the best world practices, international standards and approaches, scientific developments of domestic and foreign specialists, in order to ensure the appropriate quality of life of palliative patients and their family members;
• creation of an optimal network of institutions and services providing palliative care, of various forms of ownership and subordination and organizational forms;
• assistance and support to families who find themselves in difficult life circumstances;
• coordination of the provision of palliative care by institutions and institutions of health care, social protection of various levels and various departments, as well as non-state forms of ownership;
• creation of a system of interaction of institutions and institutions of health care and social protection of the population;
• creation of a comprehensive system of pre- and post-graduate training of specialists involved in the provision of palliative care;
• creation of a system of motivation and encouragement to attract staff who provide palliative care;
• ensuring broad participation of charitable, public, religious and other non-governmental organizations and associations of citizens in issues of providing and developing palliative care;
• creation of targeted financial programs at different levels of financing palliative care and improvement of efficiency, rational and targeted use of budget funds;
• creation of mechanisms for attracting extrabudgetary funds to the palliative care system.

As a result of the implementation of the Strategy, optimal conditions will be created for the legal, economic and organizational support for the provision of palliative care, which will contribute to the accessibility of palliative patients and their family members to quality palliative care.

Implementation of the Strategy is carried out at the expense of state and local budgets and other sources.