In 2020, once the administrative and territorial reform was complete, the municipality of Holovyn, Rivne Oblast, faced an important challenge: how to provide the rural population with access to primary healthcare given that the neighbouring Kostopil municipality – the former district centre – was unable to keep their rural health posts (the RHP) running? The municipality’s senior officials decided to look for their own, tailored solution – and received the consulting support they needed from the Regional Office of U-LEAD with Europe in Rivne Oblast, including setting up, managing and opening a healthcare facility.
The municipality decided to create its own healthcare facility
"We had been thinking about the task a lot and for a long time, calculated the risks, studied the experiences of other small municipalities. Our people used to receive medical services from Kostopil Primary Healthcare Centre, but the municipality decided to reform its network. That is when we decided to set up our own municipal non-profit enterprise basically from scratch," said Oleksandr Bachuk, еру Head of Holovyn Village Council.
He also noted that the village council had considered creating Holovyn Primary Healthcare Centre in the future. The village council members supported this idea and adopted a decision to set up a legal entity in form of a communal nonprofit enterprise at the village council meeting.
First steps with the support of U-LEAD experts
The municipality was not left alone in the process of creating its own Primary Healthcare Centre. It received advisory support from the Regional Office of U-LEAD with Europe in Rivne Oblast as well as from healthcare experts.
"We supported Holovyn municipality at the stage of opening a healthcare enterprise, helped them to sort out legal, HR and financial issues and shared the best practices of other municipalities that had already succeeded on this path," said Ruslan Syvyi, the Head of the Regional Office of U-LEAD in Rivne Oblast.
U-LEAD experts provided comprehensive support: they helped to draw up statutory documents in legally accurate manner, advised on holding a competition for the position of the head of the institution, explained the procedure for the certification with the National Health Service of Ukraine (NHSU), as well as provided guidance on choosing the best model of financing the enterprise.
Ruslan Syvyi also pointed out that the experience of Holovyn municipality could be scaled up to other small municipalities that were only planning to create their own healthcare facilities: ‘U-LEAD with Europe is willing to support this type of initiatives and provide expert assistance in the future.’
Public awareness campaign
In January 2022, when Kostopil municipality officially started the process of redundancy of healthcare workers, Holovyn municipality was ready to accept medical specialists and patients to the newly established municipal enterprise. In March of the same year, the contracts were concluded with the NHSU to enable full operations.
"Winning people’s trust was not an easy task. Even before decentralisation, the locals were used to receiving medical services in Kostopil municipality, which, as a former district centre, had an extensive network of rural health posts in the villages. People had been going to the same outpatient clinics for years, so when they needed to change the usual route and re-conclude declarations with our new Primary Healthcare Centre, it caused unclarity and worries," Oleksandr Bachuk said.
To explain the new terms to residents, the municipal team carried out public awareness activities through the website, social media, offline meetings and consultations. Thanks to these consistent efforts, the mood has gradually shifted: more than 50% of the municipality’s residents have already signed declarations with local doctors.
Outcomes: the municipality’s own facility and new opportunities
According to Oleksandr Bachuk, the healthcare facility is fully functional today. Over the past few years, the municipality has been provided with the necessary means, including a physiotherapy office and equipment for basic diagnostics, and the range of services is gradually expanding. In addition to the better monitoring of the quality of services, this allows to build public trust in the medical system:
"When it is your own facility, when doctors are part of the community, this changes things. We can monitor the quality of services, respond promptly to challenges and focus on the development. If this were a facility in another municipality, we wouldn’t be able to do so."
Other challenges
Today, the key problem for Holovyn is the lack of personnel. The municipality still needs family doctors and a paediatrician. They are even ready to provide housing for specialists to attract new staff.
"However, despite these challenges, the case of Holovyn municipality shows that small municipalities that are willing to take decisive steps can both maintain access to medical services and improve their quality bringing them closer to people. Here, U-LEAD’s support for these initiatives is a key resource for a strong start," summarised Ruslan Syvyi, the Head of Regional Office of U-LEAD in Rivne Oblast.
