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14
UDC: 351
DOI: https://doi.org/10.32689/2617-2224-2019-4(19)-275-292
Fedorenko Tatyana Anatolievna,
postgraduate student of the Department of Social and Humanitarian Policy, National Academy of Public Administration under the President of Ukraine, 03057, Kyiv, Str. A. Tsedyka, 20, tel.: (044) 481-21-55; e-mail: [email protected]
ORCID: 0000-0003-1175-6404
Федоренко Тетяна Анатолпвна,
астрант кафедри сощальног i гумат-тарног полтики, Национальна академя державного управлтня при Президентов Украгни, 03057, м. Кигв, вул. А. Цедика, 20, тел.: (044) 481-21-55; e-mail: tf-doctor@ ukr.net
ORCID: 0000-0003-1175-6404 Федоренко Тетьяна Анатольевна,
аспирант кафедры социальной и гуманитарной политики, Национальная академия государственного управления при Президенте Украины, 03057, г. Киев, ул. А. Цеди-ка, 20, тел.: (044) 481-21-55; e-mail: [email protected]
ORCID: 0000-0003-1175-6404
MINISTRY OF HEALTH OF UKRAINE IN THE MECHANISM OF INTERACTION WITH THE PUBLIC ON ISSUES OF FORMATION AND IMPLEMENTATION OF STATE POLICY IN THE FIELD OF MEDICINE
Abstract. The publication is devoted to the study of the problems of the theory and practice of functioning of the Ministry of Health of Ukraine in the mechanism of interaction with the public on issues of the formation and implementation of state policy in the field of medicine during the transformation period.
The functions and powers of the Ministry of Health of Ukraine regarding the involvement of civil society institutions and socially active citizens (the public) in improving legislation and management practices in the field of health care and conducting medical reform in Ukraine in 2016-2019 are analysed.
The main subjects that provide the effectiveness of party-side democracy in the healthcare sector in Ukraine are studied. In particular, the processes of or-
ganizational and managerial transformations of the subunits of the Ministry of Health of Ukraine are investigated, which ensure the involvement of the public in the implementation of medical reform. The conclusion is substantiated that in the future it would be possible and desirable to create in the structure of the Ministry of Health of Ukraine a department (expert group) on interaction with the public in the field of formation and implementation of sectorial state policy within the existing directorates. For example, in the Directorate of Strategic Planning and European Integration.
The main methods and forms of interaction between the Ministry of Health of Ukraine in the mechanism of interaction with the public on the issues of formation and implementation of state policy in the field of medicine are generalized and systematized. It is noted that the organizational and managerial mechanism of involving the public in the formation and implementation of state policy in the field of health care in Ukraine will be incomplete without differentiating civil society institutions in the medical sphere into medical organizations (associations); patient organizations; and human rights organizations with a clear understanding of the differentiation of the interests of each of these groups of civic organizations, as well as without understanding that the political actors and representatives of financial and industrial groups and business in the field of providing medical services, pharmacology and health insurance.
Keywords: health care, public health policy, the Ministry of Health of Ukraine, public, civil society institutions, participatory democracy.
МШЮТЕРСТВО ОХОРОНИ ЗДОРОВ'Я УКРА1НИ У МЕХАН1ЗМ1 ВЗАеМОДП З ГРОМАДСЬКЮТЮ
З ПИТАНЬ ФОРМУВАННЯ ТА РЕАЛ1ЗАЦП ДЕРЖАВНО! ПОЛ1ТИКИ У СФЕР1 МЕДИЦИНИ
Анотащя. Дослщжено проблеми теори та практики функщонування Mi-шстерства охорони здоров'я Укра!ни у MexaHi3Mi взаемоди з громадсьистю з питань формування та реалiзащ! державно! полгтики у сферi медицини у трансформацшний перюд. Проаналiзовано функцп та повноваження Mrnic-терства охорони здоров'я Украши щодо залучення шститулв громадянсько-го сусшльства та сощально активних громадян (громадськосп) до удоскона-лення законодавства та управлшсько! практики у сферi охорони здоров'я та проведення медично! реформи в Укра!ш у 2016-2019 роках.
Дослщжено основш суб'екти, як забезпечують дiевiсть партисипаторно! демократа у сферi охорони здоров'я в Укра!ш. Зокрема, висвгглено проце-си оргашзацшно-управлшських трансформацш шдроздшв Мшютерства охорони здоров'я Украши, як забезпечують залучення громадськосп до проведення медично! реформи. Обгрунтовано висновок, що в подальшому можливим i бажаним було б створення в структурi МОЗ Укра!ни вiддiлу (експертно! групи) щодо взаемоди з громадсьюстю у сферi формування та реалiзацil галузево! державно! полiтики в складi iснуючих директоратiв. На-приклад, в Директорат стратегiчного планування та евроштеграцп.
Узагальнено та систематизовано основш методи i форми взаемоди Мн шстерства охорони здоров'я Украши у механiзмi взаемоди з громадськютю з питань формування та реалiзацп державно! полiтики у сферi медицини. Наголошено, що оргашзацшно-управлшський механiзм залучення громад-ськостi до формування та реалiзацi! державно! пол^ики у сферi охорони здоров'я в Укра!ш буде неповним без диференщаци iнститутiв громадянського суспiльства в медичнш сферi на лiкарськi оргашзаци (асоцiацi!); пацiентськi органiзацi!; правозахиснi оргашзаци, з ч^ким усвiдомленням диференщаци iнтересiв кожно! з названих груп громадських оргашзацш, а також без розумшня, що повноцiнними акторами ще! системи в Укра!нi, прямо чи опосередковано, виступають полiтичнi елiти i представники фшансово-про-мислових груп i бiзнесу в сферi надання медичних послуг, фармакологi! та медичного страхування.
Ключовi слова: охорона здоров'я, державна полiтика у сферi охорони здоров'я, Мiнiстерство охорони здоров'я Укра!ни, громадськiсть, iнститути громадянського сусшльства, партисипаторна демокрапя.
МИНИСТЕРСТВО ОХРАНЫ ЗДОРОВЬЯ УКРАИНЫ В МЕХАНИЗМЕ ВЗАИМОДЕЙСТВИЯ С ОБЩЕСТВЕННОСТЬЮ В ВОПРОСАХ ФОРМИРОВАНИЯ И РЕАЛИЗАЦИИ ГОСУДАРСТВЕННОЙ ПОЛИТИКИ В СФЕРЕ МЕДИЦИНЫ
Аннотация. Исследованы проблемы теории и практики функционирования Министерства охраны здоровья Украины в механизме взаимодействия с общественностью по вопросам формирования и реализации государственной политики в сфере медицины в трансформационный период. Проанализированы функции и полномочия Министерства охраны здоровья Украины в сфере привлечения институтов гражданского общества и социально активных граждан (общественности) к процессам усовершенствования законодательства и управленческой практики по вопросам охраны здоровья и проведения медицинской реформы в Украине в 2016-2019 годах.
Исследованы основные субьекты, обеспечивающие действенность парти-сипаторной демократии в сфере охраны здоровья в Украине. В частности, освещены процессы организационно-управленческих трансформаций подразделений Министерства охраны здоровья Украины, которые обеспечивают привлечение общественности к проведению медицинской реформы. Обосновано вывод, что в дальнейшем возможным и желательным было бы создание в структуре МОЗ Украины отдела (экспертной группы) по взаимодействию с общественностью в сфере формирования и реализации отраслевой политики в составе существующих уже директоратов. К примеру, в Директорате стратегического планирования и евроинтеграции.
Обобщены и систематизированы основные методы и формы взаимодействия Министерства охраны здоровья Украины в механизме взаимодействия с общественностью по вопросам формирования и реализации государ-
ственной политики в сфере медецины. Акцентировано внимание на том, что организационно-управленчиский механизм привлечения общественности к формированию и реализации государственной политики в сфере охраны здоровья в Украине будет неполным без дифференцации институтов гражданского общества в сфере медицины на врачебные организации (ассоциации); пациентские организации; правозащитные организации с четким определение интересов каждой из названных групп общественных организаций, а также без осознания, что полноценными акторами этого механизма в Украине, прямо или опосредовано, выступают политические элиты и представители промышленно-финансовых групп в сфере предоставления медицинских услуг, фармакологии и медицинского страхования.
Ключевые слова: охрана здоровья, государственная политика в сфере охраны здоровья, Министерство охраны здоровья Украины, общественность, институты гражданского общества, партисипаторная демократия.
Problem statement. It is well known that a healthy nation in the 21st century is a priority value for the successful development of a modern state and society. After all, foreign, political, economic, financial, military and other resources of each of the states of the world function effectively and multiply at the expense of the so-called 'Human capital' only. The latter includes not only demographic, educational and professional indicators, but also the health of the nation, the provision of which is impossible without an effective system of public administration in this area of public relations.
Health systems in all countries of the world remain one of the most dynamic and, at the same time, most sensitive social systems. Therefore, today it is difficult to identify a single, exemplary system of public administration in the field of public health, which can be a good example for other countries and can be unconditionally and successfully implemented in them.
While in some countries of the world, medical reform has once transformed public health governance systems in the model (United Kingdom initiated the work of the National Health Service at once in 1948), then in others, they are permanent in nature, when each new the government is changing the value orientation, strategy and approaches to reforming public administration in the field of public health. A similar situation was typical for Ukraine until 2016, when the on-going and today's large-scale medical reform was initiated, the results of which are already qualitative transformations of the primary level of provision of medical services and the establishment of the National Health Service in 2017.
At the same time, in all cases public health management, as well as medical reform, will be effective only if the society is supported, the interaction of the profile ministry with civil society in the person of its institutions as public organizations, trade unions, and social networks, etc. So, G. Mintzberg in his
work Myths about Health Care. Without a Mistake, Reforming the Medical System (2017), analysing the main players in the field of medical services, deduces the main four basic quadrants that '... meet the four different worlds of the hospital and called treatment, care, control and community [1, p. 113]. According to G. Mintzberg, to the last component of the mechanism public health care should include professional associations of doctors who control the behaviour of their members, ' ...involved community of all types, together with groups of defenders (for example, patients' rights) and various associations related to health' [1, p. 113].
In general, we can agree with G. Mintzberg's position that the community, in the broad sense of this category, is an important component of the health care system of any country in the world, including Ukraine, and it covers the most diverse civil society institutions: from self-regulating medical organizations (Association of Dentists of Ukraine, etc.) to patient organizations as well as trade unions, employers' organizations, specialized public organizations that specialize in both human rights activities and support of medical reforms, media and more. These and other associations of citizens, both doctors and patients, as well as other socially active citizens who are not indifferent to the problems of medicine and affect the state and development of medicine. Their interaction with the ministry, which forms and implements state policy in the field of health care and conducts medical reforms, is extremely important, which necessitates the scientific substantiation of the relevant management mechanisms and
the emphasis on their functioning. In our study, this will be the mission of the Ministry of Health of Ukraine in the mechanism of interaction with the public on the issues of formation and implementation of state policy in the field of medicine during the transformation period.
Analysis of recent researches and publications. Problems of the theory and practice of public health management in Ukraine is a traditional subject of research in public administration science, and was covered by the following researchers, namely: M. Banchuk
[2], M. Bilynska [3], N. Vasiuk [4], V. Hryhorovych [5], V. Knyazevich
[3], T. Popchenko [6], N. Rynhach [7], L. Usachenko [8], O. Fedko [9], and N. Yarosh [3], etc.
The problem of interaction between public authorities and civil society institutions in the process of formation and implementation of various sectors of state policy in Ukraine remains equally relevant for scientists. Indeed, as O. Puhkal rightly states, 'As two components of a unified social system, civil society and the state interact in each other in their development' [10, p. 1].
At the same time, the issue of cooperation between the Ministry of Health of Ukraine as the main provider of medical reform in 2016-2019 and the public was investigated in Ukraine frag-mentarily only. In addition, in recent years, the number of publications in Ukraine on this topic has decreased.
The purpose of the article is to determine the mission and functioning of the Ministry of Health of Ukraine in the mechanism of interaction with the public on the issues of the formation and implementation of state policy in
the field of medicine during the transformation period, as well as substantiation of proposals for improvement of the relevant public-management activity.
Presentation of the main research material. Human health protection is one of the most important and sensitive spheres of life of the society and the state and the subject of their mutually beneficial cooperation. After all, the health of an individual and society as a whole is a determining parameter of the potential of human capital of each state of the world and an important indicator of the success of its political, socio-economic and cultural development [11, p. 113]. As in the second half of the 20th century, today a powerful mission in ensuring a balanced health policy belongs to the state, represented by its specially authorized bodies, which are traditionally ministries of health care. Ukraine is not an exception to this rule.
Nowadays, the Ministry of Health of Ukraine, in our opinion, deliberately implements systematic measures to involve the public in the formation and implementation of state health policy and medical reform in 2016-2019. This is due to the fact that the relief changes in the field of healthcare management implemented in Ukraine require, firstly, clarification of their purpose, essence, content and final results, as well as their indicative indicators for the main subjects of the relevant reforms: citizens-patients and citizens-physicians; and secondly, providing feedback between the already mentioned consumers and the authors of the medical reform.
In support of the above conclusion, the materials provided by the Ministry of Health (MoH) of Ukraine
(Letter of the Ministry of Health of Ukraine dated March 3, 2018 № 16-20/0-2053/124/2887-3B), hereinafter referred to as the MoH Letter on our appeal dated February 7, 2018 (№ 0-2053) in the part of the request for information on 'the experience of involving the public, in particular civil society institutions (public organizations, voluntary organizations, medical and patient organizations, etc.) to the formation and implementation of state policy in the field of health care and to the implementation of the medical reform, which is extremely important for society [12].
In previous publications, we have repeatedly focused on the analysis of certain provisions of this MoH Letter to the Ministry of Health, in particular on the issues of authority of the Ministry of Health of Ukraine, including powers in the field of interaction with civil society institutions, organization of work with citizens' appeals and interaction with profile public organizations and trade unions, etc. [11; 13-15]. At the same time, the fragmentation of these publications requires systematization of the conclusions, propositions and proposals set out in them for the purpose of the integrated solution of the issue of the appointment of the Ministry of Health of Ukraine in the mechanism of interaction with the public on the issues of the formation and implementation of state policy in the field of medicine during the transformation period.
In accordance with Part 1 of Art. 6 of the Law of Ukraine "On Central Executive Bodies", any ministry is:
'... the central executive body, which ensures the formation and implementation of state policy in one or several of
the areas specified by the Cabinet of Ministers of Ukraine, which is entrusted to the Cabinet of Ministers of Ukraine by the Constitution and laws of Ukraine [17].
At the same time, the cited Law of Ukraine "On Central Executive Bodies" only reminds the public twice: in Art. 12, it lays down patronage services of ministries for public relations, and in Art. 14, it provides for the membership of boards of ministries for representatives of public associations [17]. In practice, each ministry organizes regular work with the public, the subjects, methods and forms of which are defined in the provisions of these ministries, approved by the resolutions of the Government of Ukraine.
The success of the interaction of civil society represented by a person as organized civil society institutions (public organizations, including medical, patient, human rights, etc., trade unions, employers organizations, media, etc.) and socially active citizens, who situationally combine their efforts to promote or counteract medical reform, the Ministry of Health of Ukraine in the field of formation and implementation of sectorial state policy largely depends on the effectiveness of the ministry's departments, authorized to carry out the respective tasks, functions and powers of the MoH of Ukraine.
In accordance with item 5 of the Regulation on the Ministry of Health of Ukraine, approved by the Resolution of the Cabinet of Ministers of Ukraine dated March 25, 2015, № 267, the Ministry of Health (MoH) of Ukraine, in order to organize its activities, provides the followings within the limits of the powers envisaged by law:
'...involvement of citizens in the management of state affairs, effective interaction with civil society institutions, public monitoring of the Ministry of Health, taking into account public opinion during the formation and implementation of state policy in areas that fall within the MoH competence [18].
At the same time, the Ministry of Health of Ukraine is engaged in a regular interaction with citizens and civil society institutions not in the entire leadership and all units of the Ministry of Health of Ukraine at the same time (although in 2016-2019, the leadership of this ministry has repeatedly directly communicated with the public, participated in various activities, as an example of the March of Equality in Kiev on June 23, 2019, etc.), and through the specially authorized units of the Ministry of Health of Ukraine. A similar public-management practice of conducting public consultations is characteristic of all public administration bodies in Ukraine and abroad, in particular, in the participating States and is carried out in the established manner.
In Ukraine, the procedure for conducting public consultations on the issues of formation and implementation of the state policy is approved by the Resolution of the Cabinet of Ministers of Ukraine dated November 3, 2010, № 996 "On Ensuring Public Participation in the Formation and Implementation of State Policy". The purpose of its regulatory influence on public-government partnerships, as stipulated in paragraph 2 of this Regulation, is:
'Conducting of consultations with the public should facilitate the establishment of a systematic dialogue between the executive authorities and the pub-
lic, improve the quality of preparation of decisions on important issues of state and public life taking into account public opinion and create conditions for the participation of citizens in the drafting of such decisions [19].
Relevant public consultations may be conducted on a mutual initiative. On the one hand, the ministry, which forms the state policy in a certain area, carries out (a) planned, provided the indicative plan for conducting public consultations, and (b) unscheduled, when initially developing a draft legal act concerning the socio-economic development of the state, the approval and realization of constitutional rights and freedoms, satisfaction of its political, economic, social and cultural needs. On the other hand, according to item 7 of the Decree of the Government of Ukraine of November 3, 2010, № 996, civil society institutions, namely, '...public associations, religious, charitable organizations, trade unions, trade unions and their associations, associations of employers and their associations, bodies of self-organization of the population, non-state mass media, other non-profit associations and institutions legalized in accordance with the law..' [19] independently go to the ministry with suggestions on adoption of the norm legal acts that reflect the interests of the public in a certain area of public policy and are the subject of public consultations with the ministry, or the issue for consideration by the public council under the Ministry.
In the first and second cases, the consideration of public opinion in the formation of state policy in the field of health and medical reform in Ukraine
is always a common result of interaction: (a) the public and civil society institutions, including medical associations and patient organizations; (b) the leadership of the Ministry of Health of Ukraine and the leadership of its divisions, primarily the Directorates General, which were created as the main providers of medical reform in Ukraine; and (c) under sections of the Ministry of Health of Ukraine, which provide constant communication with the public, etc. In particular, we can mention the political elites and business, which, with respect to civil society and the state, have long been '...developed, in essence, in parallel', according to O. Pukh-kal's accurate assessment' [10, p. 19].
During the years of Ukraine's independence, units of the Ministry of Health of Ukraine, which communicates with citizens and institutes of civil society, have undergone a long and underdeveloped path of formation and development in the science of public administration. So, the following divisions for communications with the public were created and functioned for the last 15 years as a part of MOH of Ukraine only:
• In 2003 — Department of Informational and Analytical Support, Interaction with the Verkhovna Rada of Ukraine and Public Relations;
• In 2005 — Department of Information and Analytical Support and Public Relations;
• In 2006 — Department of Information and Analytical Support and Public Relations;
• In 2007 — Department of Information and Analytical Support, Relations with the Verkhovna Rada of Ukraine and Public Relations;
• in 2008 — Department for Ensuring Relations with the Verkhovna Rada of Ukraine and the Public Office for Programming, Information and Analytical Support and Relations with the Verkhovna Rada of Ukraine;
• In 2009-2010 — Department for Ensuring Relations with the Verkhov-na Rada of Ukraine and the Public Relations of the Administrative Department;
• In 2011 — Office of Strategic Planning and Analytical Support of Interaction with the Verkhovna Rada of Ukraine and Public Relations;
• In 2012 — Department for Relations with the Verkhovna Rada of Ukraine and the Public Relations of the Department for Health Care Reform and Development;
• In 2013 — Department for Ensuring Relations with the Verkhovna Rada of Ukraine and the Public Relations of the Department of Informational and Organizational and Documentary Support;
• In 2014 — Department of Communications with State Authorities and Public and Organization of Access to Public Information of the Department of Organizational and Documentary Support;
• In 2015 — Office of Communications with State Authorities and the Public;
• From June 2016 till today — Department for Collaboration with Public Authorities and Public and Social Dialogue [11-14].
Summarizing and analysing the transformation experience of the units of the Ministry of Health of Ukraine in the 21st century, authorized to provide communication with citizens and civil
society institutions in the formulation and implementation of state policy in the field of health care, allows us to conclude that the units of communication with the public, even taking into account their tasks, functions and organizational and legal forms (independent departments and governance or divisions within the departments and departments of the Ministry of Health of Ukraine) were and remain important structural subdivisions of the Ministry of Health of Ukraine.
In 2016, Department for Ensuring Interaction with State Authorities and Public and Social Dialogue was formed by the Ministry of Health of Ukraine. It reflects the attention of the ministry's leadership to social dialogue in conducting medical reform in Ukraine. At the same time, the analysis of the current structure of the Ministry of Health of Ukraine, as defined on its official website [20], allows us to conclude that there is a certain substantive and functional dissociation between the directorates that provide medical reform in Ukraine and the department called to ensure the cooperation of the Ministry of Health (MoH) of Ukraine with the public. In the future, in our opinion, it would be possible and desirable to create a department (expert group) in the structure of the Ministry of Health of Ukraine on interaction with the public in the field of formation and implementation of sectorial state policy within the existing directorates. For example, as part of the Directorate of Strategic Planning and European Integration [16, p. 169-170].
In addition to the analysed subjects that ensure public participation in the formation and implementation of state
policy in the field of health care and medical reform, the methods and forms of interaction between the Ministry of Health of Ukraine and the public are also an important aspect of the problem under study.
According to items 3, 4 and 6 of the MoH Letter, the Ministry of Health of Ukraine actively introduces such innovative forms of open dialogue with citizens and civil society institutions as electronic consultations with the public on draft acts, the adoption of which is initiated by the Ministry. In particular, according to the Order of the Ministry of Health of Ukraine dated June 12, 2017, № 658 "On Approval of the Tentative Plan of the Ministry of Health of Ukraine to Conduct Consultations with the Public in 2017" [21], the following issues were put to the public discussion: (1) reform of the protection system health (creation of hospital districts, autonomy of health care institutions, new principles for the financing of specialized and highly specialized medical care); (2) procurement of medicinal products, medical products and equipment at the expense of the State Budget of Ukraine; (3) development of public health system; (4) improvement of the emergency medical care system (purchase of cars, equipment, creation of emergency medical care units, creation of operational-dispatching services, equipping of emergency medical care by GPS monitoring systems and radio communication); (5) the state of implementation of the Available Drugs Program; (6) since January 1, 2018, execution by healthcare institutions and institutions fully or partially financed from state and local budgets requirements of the Cabinet of Mini-
sters of Ukraine of March 25, 2017, № 333 "Some Issues of State Regulation of Prices for Medicinal Products and Medical Products" in the part of the primary purchase and provision of patients with medicinal products in accordance with the National List of Essential Medicines.
By Order of the Ministry of Health of Ukraine of February 14, 2018, №2 257, the new Tentative Plan of the Ministry of Health of Ukraine for Public Consultation in 2018 was approved. [22], the implementation of which contributed to the strengthening of the dialogue between the Ministry and the public, first of all, in the field of the launch of a large-scale medical reform. Although, not in all cases, the public was interested in the draft regulatory acts passed by the Ministry of Health of Ukraine for public discussion. For example, proposals for a draft resolution of the Cabinet of Ministers of Ukraine " On Approval of the Criteria for Assessing the Degree of Risk from Conducting Business Activities in Medical Practice and Determining the Frequency of Planned State Supervision (Control) by the Ministry of Health of Ukraine", posted on the official website of the Ministry dated September 17, 2018, have not been received [23].
It is expected that this year the Indicative Plan of the Ministry of Health of Ukraine for holding public consultations in 2019 will also be put into effect. Although, as of June 1, 2019, it is absent from the official web-site of the Ministry of Health of Ukraine in the traditional rubric 'Appropriate Plans and Reports for Conducting Public Consultations' . This, among other things, may be an indicator of the search for new methods and forms of public involvement
of the Ministry of Health of Ukraine for consultations on the formulation and implementation of state policy in this field of medicine.
The cooperation between the Ministry of Health of Ukraine and civil society institutes in the process of formation and implementation of state policy in the field of health care and conducting medical reform remains established and constructive. According to paragraph 7 of the MoH Letter, there are such non-governmental organizations as: STUDENT BROTHERHOOD, All-Ukrainian Youth NGO; UKRAINIAN DEMOCRACY, NGO; CONSCIENCE, Anticorruption Public Union; and G.F.S.I. UKRAINE, Public Union [11; 12]. At the request of these NGOs and in accordance with the Procedure for Assisting the Public Examination of the Activities of the Executive Bodies, approved by the Resolution of the Cabinet of Ministers of Ukraine dated November 5, 2008, № 976 [24], the MoH of Ukraine successfully conducted public examinations on their requests. Accordingly, these partners of the Ministry of Health of Ukraine remain both partners and 'controllers' of the effectiveness of medical reforms in Ukraine.
Conclusions. Summarizing the results of this research, it can be argued that the Ministry of Health plays a key role in the mechanism of interaction with the public on issues the formation and implementation of state policy in the field of medicine. This cooperation, which broadly reflects the level of participatory democracy in Ukraine, is currently systematized and represented by two main components of a unified mechanism, namely: (1) a legal and re-
gulatory mechanism, as a system of normative legal acts guaranteeing the right of citizens to participate in the management of public affairs, in particular the formation of and implementation of the state policy in the field of health care in Ukraine; and (2) the organizational and managerial mechanism represented by the system of the main actors in the medical sphere: public and institutionalized civil society institutions, including drug associations and patient organizations, etc.; the leadership of the Ministry of Health of Ukraine and its subdivisions, first of all general directorates, as well as units of the Ministry of Health of Ukraine, which provides constant public relations.
It is obvious that the organizational and managerial mechanism of involving the public in the formation and implementation of state policy in the field of health care in Ukraine will be incomplete without the followings: (a) differentiating civil society institutes in the medical sphere into medical organizations (associations); patient organizations; human rights organizations, with a clear awareness of the differentiation of interests of each of these groups of civic organizations; and (b) an understanding that full-fledged actors of this system in Ukraine, directly or indirectly, are political elites and representatives of financial and industrial groups, built primarily in the pharmacological business and health insurance business, as well as businessmen who reasonably see in the provision of medical services promising business.
Abstract
The publication is devoted to the study of the problems of the theory and practice of functioning of the Ministry
of Health of Ukraine in the mechanism of interaction with the public on issues of the formation and implementation of state policy in the field of medicine during the transformation period (20162019). It is emphasized that now the profile ministry is not only a manager but also a reformer of the system of public administration in the medical sphere.
The importance of the profile ministry in this mechanism is due to the fact that, firstly, explanation of their purpose, essence, content and final results, as well as their indicative indicators for the main subjects of the relevant reforms: citizens-patients and citizens-doctors; secondly, providing feedback between the already mentioned consumers and the authors of the medical reform.
The functions and powers of the Ministry of Health of Ukraine regarding the involvement of civil society institutions and socially active citizens (the public) in improving legislation and management practices in the field of health care and conducting medical reform in Ukraine in 2016-2019 are analysed. As one of the sources of this research was used the Letter of the Ministry of Health of Ukraine dated March 3, 2018, № 16-20/0-2053/124/2887-3b, which is a response to a request for information on 'the experience of involving the public, in particular civil society institutions (community organizations, voluntary organizations and medical and patient organizations, etc.), in the involvement of the public health services of Ukraine, to the formation and implementation of state health policy and to conducting a medical reform that is extremely important for society.
The main subjects that provide the effectiveness of party-side democracy in the healthcare sector in Ukraine are studied. In particular, the processes of organizational and managerial transformations of the subunits of the Ministry of Health of Ukraine are investigated, which ensure the involvement of the public in the implementation of medical reform. The conclusion is substantiated that in the future it would be possible and desirable to create in the structure of the Ministry of Health of Ukraine a department (expert group) on interaction with the public in the field of formation and implementation of sectorial state policy within the existing directorates. For example, in the Directorate of Strategic Planning and European Integration.
The main methods and forms of interaction between the Ministry of Health of Ukraine in the mechanism of interaction with the public on the issues of formation and implementation of state policy in the field of medicine are generalized and systematized. It is noted that the Ministry of Health of Ukraine should become not only a key subject the formation and implementation of state policy in the field of medicine, but also an entity that determines the level rules for the coordination at the national level of the interests of all major players, as well as procedures for carrying out medical reforms in the interests of the citizen, the state and society, an integral part of which is the business now.
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23. Звгг про громадське обговорення проекту постанови Кабшету Мшь стрiв Украши "Про затвердження критерпв, за якими ощнюеться сту-шнь ризику вщ провадження гос-подарсько! дiяльностi з медично! практики i визначаеться перюдич-нiсть проведення планових заходiв державного нагляду (контролю) Мiнiстерством охорони здоров'я Укра!ни" // Офщ. веб-сайт МОЗ
Украши [Електронний ресурс]. Режим доступу: http://moz.gov.ua/ uploads/ckeditor/%D0%93%D1%8 0%D0%BE%D0%BC%D0%B0%D0 %B4%D1%81%D1%8C%D0%BA% D0%B5%20%D0%BE%D0%B1%D 0%B3%D0%BE%D0%B2%D0%BE %D1%80%D0%B5%D0%BD%D0% BD%D1%8F/Zvit_pro_gromadske_
obgovorennya_20181130-2.pdf (наз-ва з екрану).
24. Про затвердження Порядку сприян-ня проведенню громадсько! експер-тизи дiяльностi оргашв виконавчо! влади : Постанова Кабшету Мшь стрiв Украши вiд 5 листопада 2008 р. № 976 // Офщ. вюн. Украши. 2008. № 86. Ст. 100.
