Ukraine’s Cabinet of Ministers took almost 3,7 million USD from the budget program of the Ministry of Health, aimed at diagnosing cancer. Almost all funds were directed to the Lviv region for the reconstruction of roads and the restoration of the main building of the Ivan Franko National University of Lviv.
Against the backdrop of systemic underfunding of cancer diagnostics and treatment in Ukraine, this news caused a real scandal in social media. Outraged users wrote that cancer patients already receive budget crumbs from the table, and to pay for the treatment they have to go into debt and sell their property.
At the same time, Prime Minister Denys Shmygal calls this news manipulation. According to him, this year, the sum allocated for the treatment of cancer patients was 40% higher than in the past. He also appeals to the fact that money is being cut off from the roads: part of the funds were directed to the social support of Ukrainian miners.
Where the funds were initially supposed to go to
Statements about an active fight against cancer become more and more frequent in the Ukrainian media space. According to the president's instructions, Kryvyi Rih residents were promised to get the cancer diagnostics and treatment center renovated, and a European-style surgical building worth 15 million euros would be built. Also, thanks to the presidential poll, the issue of legalizing the use of marijuana for medical purposes appears on the agenda again. For cancer patients, it is especially relevant, because it removes a person from the state after chemotherapy without harm to the liver and other organs, unlike conventional drugs.
However, if we evaluate not statements, but real actions for cancer patients, it turns out that the funds do not have time to be spent on time by the end of the budget year, which is why they have to be transferred to other projects. The redistributed 3,5 million USD were planned to be spent on the modernization of the molecular genetic laboratory for the Cancer Institute.
With the help of this laboratory, one can determine the sensitivity of patients to chemotherapy. It's about a clearer understanding of what the dosage should be so that there are fewer side effects. In addition, this is the only laboratory where genetic diagnostics for children with cancer is possible. Here they create antitumor vaccines, for which scientists have already received awards, and develop innovative methods of immunotherapy. However, the laboratory has not been overhauled for the last 30 years.
After the expert community began to sound the alarm about the redistribution of funds, the prime minister assured that the project would be fully funded in 2021. However, this means more than just delays in the development of science. The laboratory planned active bone marrow transplants, for which Ukrainians usually travel abroad, often at public expense.
Ukrainian hospitals have finally begun to obtain licenses for such transplants, but too few are performed. This year, 450 transplants are planned instead of the estimated need for approximately 6,000 transplants. The hitch with the launch of the laboratory means that some of the Ukrainians who could be treated in their homeland will be forced to apply for medical tourism. Often - at their own expense, because not everyone can become a member of the "Treatment Abroad" state program. For the patient, the price of the issue is from 100,000 to 300,000 dollars, depending on the country.
President of the Ukrainian Association of Medical Tourism, oncologist Violetta Yanyshevska says that last year, before the pandemic, about 150,000 Ukrainian patients went to Germany, Turkey, Israel, Spain, Italy, and other countries for medical services.
Expressing a deep concern
The Cancer Institute prepared all the necessary documentation for the reconstruction of the laboratory. The matter remained with the Ministry of Health: officials were to announce tenders for the construction. The Deputy Minister of Health explained that this was done three times. The last time the procurement procedure for the construction work took place was September 22, but it was never completed.
Only one participant declared to take part in the project, and this is not enough to ensure the principles of competition. Therefore, it became clear that there would be no time to hold other tenders by the end of the year, for example, for the supply of equipment. This means that the project is being postponed indefinitely.
But why, in this case, no tenders were held during the first 9 months of 2020? Healthcare Minister Stepanov openly admits that as of the beginning of April there was no project for the reconstruction of this laboratory at all. And this despite the fact that plans to launch the laboratory have existed for several years. The Ministry of Healthcare promised to launch the laboratory for four years before the scandal, but it never came to tenders. Perhaps the point is also in the unprofessionalism of the representatives of the Cancer Institute, who did not submit the design and estimate documentation on time.
Viktoria Romanyuk, co-founder of the Athena. Women Against Cancer public organization, suggests that the inactive Ministry of Healthcare officials are to blame for what happened. Romanyuk notes the negligence of the ministry officials' approaches to the procurement of medicines, which began only in the middle of summer.
The authorities knew about the reallocation of funds in advance. Stepanov did not even hope that the construction would be completed by the end of the year, and he named the beginning of 2021 among the dates for the launch of the laboratory.
Funds for the modernization of the laboratory have been redistributed for several years already. In 2019, 1,7 million USD from the program also went to roads, and also to culture and exploration. But then the pandemic in the country was not yet raging and additional investments in infrastructure were not yet explained by the creation of jobs.
The story with the laboratory is just one example of numerous cases of reallocation of funds for the treatment of cancer patients, which vividly reflect the approach of the Ministry of Healthcare to the issue of cancer treatment in Ukraine. Last year, almost 2,1 million USD was spent on other needs, which were intended for the Cancer Institute.
And a few weeks ago, more than 23 million USD from the Oncology Fund was spent on flu vaccines. And this is in the middle of autumn. The children’s hospital budget for children with cancer is also cut by several million dollars annually. That 2.5 million USD saved in the purchase of drugs for cancer patients was spent not on additional drugs, but on the fight against Covid.
"Now money from programs that should be directed to improving the situation with cancer are being pulled in all directions. At the beginning of the year, part of the funds for Covid has already been taken from the program for the purchase of drugs. And now they are taking away from the same program for vaccines to prevent influenza," says Romanyuk.
Let's say the officials could not start purchasing on time. But why they did not lobby for the funds to remain in the directions that were discussed initially is unclear.
Does Ukraine have enough funds to treat cancer?
In 2015, 10,5 million USD was allocated for cancer treatment in the country, in 2018 – 25 million USD. Lynchevsky, then deputy of ex-acting minister Uliana Suprun, wondered why the country spends money on oncology if the patients die anyway. In 2019, the approach finally changed, and the amount of funds was increased to 70 million USD, but this is still not enough: the estimated need for the sphere, according to Olga Bogomolets, is about 105 million USD.
According to the Ukrainian National Cancer Registry, an average of 137,000 cases of oncology are recorded annually in Ukraine. Ministry of Healthcare says about 150,000-170,000 patients. When recalculating funds per patient, this is only about 450 USD. For comparison, Ukraine spends twice as much on the treatment of one patient in a mild form of coronavirus.
At the same time, in Ukraine’s private clinics, a three-month period of cancer treatment, according to Violetta Yanyshevska, costs about 20,000 USD. The surgery costs from 1,100 USD, radiation therapy - from 1,700 to 3,500 USD, or even more. Targeted immunotherapy, depending on various combinations, can cost from 1,100 USD per course. Abroad, treatment will cost about 50,000 USD (depending on the country, the rates differ). Not only are there not enough free services for everyone, but also corruption additional payments fall on the shoulders of the Ukrainian. Diagnostics, for which the state has redistributed funds, is underfunded and often fails qualitatively without attracting personal funds of a Ukrainian.
"We have a minimum set of examinations, which are carried out at the expense of the state. But these examinations are not enough for a full-fledged diagnosis of oncological diseases. The minimum diagnosis may require about 175 USD. MRI, histology, biopsy, blood tests, consultations of narrow specialists... High-quality diagnostics, which answers all questions about the localization and spread of the tumor, will cost an average of 530 to 1,100 USD in Ukraine. At the same time, diagnostics in Europe will cost from 3,000 to 7,000 euros," the expert emphasizes.
According to the Ukrainska Pravda outlet, on average, oncological diagnostics cost a Ukrainian 350 USD. If funds for the reconstruction of the laboratory were used to identify diseases in Ukrainians, about 10,000 patients could be examined.
Oncologist Yanyshevska is convinced that the diagnosis of cancer in Ukraine is already suffering without the lack of medical insurance and professional examinations. Ukrainians seek help late, and this problem was exacerbated by the lockdown: Ukrainians were afraid to go to doctors, clinics were either closed or re-profiled to receive coronavirus patients, which affected timely diagnosis. Therefore, the expert considers the redistribution of funds from diagnostics to be absolutely unacceptable.
The situation with financing drugs for cancer patients (a separate budget item) is better. Especially in comparison with 2015, when the allocated funds were enough for only 18% of the needs. This year, medicines were purchased for 2019 funds. However, because of the savings on medicines, their quality suffers.
Due to underfunding, the oncosphere lacks special equipment. For comparison, Germany has almost 6 times more radiotherapy centers than Ukraine does. Rehabilitation services are also not provided to a sufficient extent: in our country, there is only one center in Kropyvnytsky, it was built at the expense of foreign investors. But in the future, the needs of cancer patients will grow even more. The WHO believes that by 2040 in countries with low incomes of the population, such as Ukraine, cancer patients will increase by 81%.
Jobs vs healthy taxpayers
In April, the Cabinet of Ministers allocated 7,2 million USD for state roads in the Lviv region, and then in July - another 53 million USD for local roads. At the same time, not only our state but also Poland is investing in the infrastructure of Western Ukraine. In August, the country's authorities sent another 100 million euros.
Lviv region will receive additional funding despite the fact that, according to the Ukravtodor State Road Agency of Ukraine, the worst roads at the moment are in Cherkasy, Mykolaiv, Luhansk, and Donetsk regions. However, journalists have already noticed a tendency in preferences and reasonably emphasized that investments in the region could be pleasant to the most diverse government representatives. At least PM Shmygal, Minister of the Cabinet of Ministers Oleh Nemchynov, and ex-Minister of Education Lubomyra Mandziy studied in Lviv.
Investing in roads means additional jobs during the coronavirus pandemic. However, for some reason, officials are missing one simple fact. The fact that Ukraine is already in second place in Europe in terms of the spread of cancer and the number of deaths from this disease has a negative impact on the Ukrainian economy. From the moment you started reading this article, another Ukrainian cancer patient has died. Every year about 33,000 able-bodied citizens die of cancer, who, with timely treatment, could replenish the budget with taxes.
In addition, the funds went not only to the roads and the university. Officials considered 1 million more necessary for the Ministry of Energy, the pilot training center, and also for the restoration of one of the buildings of the Bratsk monastery. There are a lot of options where, according to medical experts, this money could be more useful: from vaccination of Ukrainians against human papillomavirus and hepatitis B (to prevent cancer) and ending with financing bone marrow donation. Everyone who wants to become a donor needs to undergo analysis for 40 euros, and the state does not have enough funds for this.
Officials are well aware of the scandalous situation with the redistribution of funds from various projects to the roads. The reaction to the situation in the Ministry of Healthcare was reduced to PR on a positive project for cancer patients. A call center for the support of cancer patients and their loved ones "It's worth living" would start operating in November. This is a free online helpline, thanks to which cancer patients can consult an oncological psychologist and order a free taxi to a medical facility. The calculation is that it is dangerous for cancer patients during a pandemic to put their lives at risk and go out into society.
The financing of the oncological industry as a whole now depends on the expenses for the medical sector in the 2021 budget. Judging by the projects that appeared in the media, there is little optimism: they plan to allocate almost half the funds for guarantees of medical care.