The health care reform has affected and Zaporizhia ambulance
Its nuances we’re talking with Director of the KU “territorial medical Association “Regional center of emergency medical aid and catastrophe medicine” of Zaporizhzhya regional Council Konstantin Malashenko
– Konstantin, as far as I know, last year the ambulance service in the country with the help of volunteers the study was conducted. What are its results?
– When Mose is a group of experts in the emergency ambulance. The study was conducted on money of the world Bank. Volunteers (not having enough experience in the service and skills) has been tasked to control the exit of cars, and find certain flaws and deficiencies in the work of the divisions.
They checked the quality of the rolling stock (53% in Ukraine does not match, we have up to 70% able to leave, and 30% definitely need to change), the duration of assistance, composition of teams, work administration, dispatching. And gave his opinion about what to reform, to make it better.
The results were then discussed in the Ministry of health. From my point of view, the case is sound, changes are needed. But the analysis should be a consequence. Should be created the program, which is then approved in the Cabinet and give funding.
The pilot project in the Zaporozhye region did not get
But since money is the solution to all problems no, after researching the idea of a pilot project. The experts recommended to invest money where the worst of the situation. 1 billion will give the five regions to improve them to world standards.
In 2019, the development of emergency medical care will be implemented in Vinnytsia, Donetsk, Odessa, Poltava, Ternopil regions and in Kyiv.
In pilot areas the project will:
- training of teams to the level of world standards for the provision of emergency medical care;
- the increase in salary for professionals who have been trained in modern methods of life saving;
- new modern vehicles are equipped with the necessary equipment;
- modern dispatching services.
The remaining area will be deprived of the whole of 2019. It can be critical to the system.
All that is costly, the Ministry of health shifted to local budgets
So, if earlier in the amount of grants is included in salary centers of the emergency ambulance, the cost of energy and capital investment for the purchase of necessary, but now the funds to purchase equipment not included.
In 2013, the entire Ukraine has been purchased 1,100 machines. 74 came to Zaporozhye region. We then changed all that didn’t go to junk.
Thanks to the regional authorities, in 2016-2017 purchased 30 machines. If not for this technique and now would drive a UAZ and Gazelle.
19 cars were given in our locations in the villages. We are trying to improve their performance. Earlier in rural areas, the points were “courtiers” in CRB – gasoline was not, medicine was not, now funding for salaries, fuel, transport, from the regional budget. Local authorities are asking only to give premises that meet the requirements.
I note that in the last few years have seen this trend all that expensive, the health Ministry is trying to hang on to local budgets. So, from the state budget funded only the salaries of employees, utilities shoved to the regional budget.
The result of two years of reform consists of the following: a large part of the cost of ambulance service fell on the shoulders of the regional Council, who bravely up to 70% of the humanitarian budget is spent on medicine.
Young professionals are almost there
Another problem is the wage-levelling. Paramedic, medic, driver have the same salary. All surcharges to a minimum. The amounts are different, but the output situation one. The doctor is minimal, so young professionals in the ambulance are almost there.
If someone comes to work a little experience I will put on some mileage and looking for work abroad.
Egalitarianism is created deliberately! This situation leads to leaching of personnel. Our service rests on the professionals close to retirement age. Because of the unions we have made certain allowances in the system of emergency care.
After a certain number of years they earn 60% surcharge for complexity, intensity. Now the salary of a paramedic that works on a 1.5% rate in points-based, taking into account night – to 10000. People keep allowances.
Question – will the nurse to study to become a paramedic, for 8000 hryvnia. Besides, he may lose all of their deserved allowance. Nobody said that medical allowance will remain.
They come to me. I say, want to study for paramedic study. But for the consequences of your step, I am not responsible.
Part of the reform efficiently sabotaged
– Say, you often criticize health reform…
– There! Of course, there are positive aspects. The main achievements of the reform – to optimize methods calls, harmonization of aid modalities, cars and standards of Protocol.
I agree with the reformers that the main emphasis should be done on physician assistants. The level of qualified paramedics are sufficient to provide assistance.
But he must constantly upgrade their skills. Not once in five years, but every day.
We’ve been through a war. The wounded were delivered to the airport, went to Mariupol, was brought out of the patients because they had no regional hospital. They had heavy babies, pregnant, mothers. Our staff night was going, and raced to Mariupol. Dnipropetrovsk and Kharkiv regions we have practically extended the area of the ATO.
In Rozovka came the APC, he was falling wounded boys. There started to help, then we drove them to the hospital in Kuibyshev, Zaporozhye were taken.
I can say that we really worked out of the combat experience. But we lose the experience, skills and if how says Mrs. Suprun, we will not have training centers.
I fully support this direction of reform. Improving the quality of care lies in the hands-on training.
But for some reason went the other way. They want to rename all paramedics. Issued an order, and eligibility requirements. But we this piece of very high quality reform is sabotaged. Wrote a letter to Prime Minister Groisman, wrote an appeal to the regional Council. We do not understand why this is done, and if we do not understand, will not do.
We started to carry out accurately, and then it turned out that all they have no money, no resources. Lately the word “paramedic” is not even mentioned.
In Cherkasy medical Academy the first course of the paramedic graduates in three years. In Ternopil medical University scored. By the way, what region was the pilot project is a nod of obedience.
But let’s think – who benefits from that our paramedics have been trained to be paramedics and have got international certificates, which are traded abroad?
The state spends on their education money, they will receive a certificate and… why do they need “ambulance” with a salary of 4,000 hryvnia? They with this certificate will travel to Toronto and will receive the same 4000, but canadian dollars. Young definitely going. And in these areas, and it will happen.
I am in no way against reform, I see the pitfalls and talk about it. Suicide is not reform.
You need to remove some points of the old system, I support it. But we should not all indiscriminately to break. The strategy is – let’s make a good ambulance. I agree! Show me the points, and secure in legal terms. And then you get there nafantaziruete, and will come to me with questions. I want to see a road map of reforms, so I know what’s coming next.
Photo By Alexander Prilepy