The Ukrainian TB Epidemic: Who Is At Fault?



The Ukrainian Fund for People Living with Drug Addiction's “Drop-In Center” raises the issue of the tuberculosis (TB) epidemic in Ukraine. Recently, its Web site Motylek published several articles describing the scale of this problem, as well as challenges Ukraine faces in fighting the disease.

According to the World Health Organization (WHO) ranking, Ukraine is among the top five countries with the highest TB rates in the world — 78 cases per 100,000 people. According to media reports, today about 100,000 Ukrainians are sick with an active form of TB and 35,000 new cases are registered each year. But some experts say that the real TB situation in Ukraine is actually much worse, since many of the people infected with TB belong to high-risk groups, such as the homeless, drug addicts, and people recently released from prison who don't apply for a medical assistance.

The publications posted on the Web page imply that Ukraine could significantly decrease their TB problem if the country better cooperated with international health aid organizations. Today, the Ukrainian government does not use all available opportunities to receive support from international donors for fighting the TB epidemic. This is happening in part because of weird tax policies and the poor performance of health care authorities.

In the article “TB Epidemic: Ukraine's own fault?” Mr. Andreas Tamberg, a representative of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said the following:

Ukraine has applied for TB funding a few times. In 2008 the government imposed taxes on the TB medications bought with the Global Foundation financial resources, including a 20 percent value added tax and 6 percent customs duty. Consequently, a very significant part of the grant went to the state budget of Ukraine in the form of taxes. This was a reason for us to stop funding of the project. We believe that taxing funds aimed at fighting the epidemic is totally unacceptable. This problem is still not solved.

The other issue with international health assistance is that the health care authorities do not take measures to stop the epidemic, even when they have financial resources provided by the international donor organizations to fight TB .

In 2006, the World Bank temporarily suspended its special loan for combating the HIV and TB epidemics in Ukraine, which had a total value of USD 76 million. According to the World Bank, the reason for the suspension was a lack of progress in project implementation. In other words, the Ministry of Health of Ukraine failed to develop TB and HIV prevention and treatment programs in compliance with the World Bank requirements. From 2003, when the agreement was signed, to the end of 2006 only 2 percent of the loan was used. As for today, according to the World Bank Web site, this project is still on hold.

The head of the public movement “Ukrainians against Tuberculosis” said that in fact Ukraine desperately needs these funds to research and fight the epidemic:

The expert urges that the real situation with the spread of TB in Ukraine could be much worse. It can affect up to 1.5 million people. It is really hard to assess the real scale of the epidemic as Ukraine still does not have an integrated database of TB patients. This database could be developed with the support of the World Bank funds.

Ukraine's government has declared its intention to fight the TB epidemic and to provide all sick people with free medication and medical care, but it just doesn't have enough resources to do this.

According to media reports, the government purchases most TB medications from a local producer. These medications are much cheaper, but more toxic and less effective than modern imported TB drugs. In addition, even these medications are supplied in fewer quantities than what is needed.

The medical personnel of government-funded TB hospitals are substantially underpaid and do not have sufficient social guarantees. This leads to a significant shortage of doctors and nurses in TB hospitals.

Also, the medical facilities used for TB treatment are very old and need to be renovated. Recently, the local Internet community was shocked by pictures of the Kiev TB hospital #2 posted on a popular Ukrainian Web blog Infoporn.

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