Helping systems and citizens in the region rebound
Over the past decade, infectious disease and mortality rates in the Newly Independent States in Eastern Europe have risen, and life expectancies have decreased. These indicators of poor health reflect people and systems struggling to adapt after the political, social, and economic upheaval of independence.
Where the Soviet system reached virtually every citizen with free health care through workplace-based networks, now individuals must proactively access the care they need—behavior change that is made more difficult by stressful economic conditions and a breakdown of the health system. In many cases, the services patients would seek are not available: facilities, equipment, and supplies are lacking, and health care providers’ skills need updating.
PATH has been helping strengthen health systems in the region since the mid-1990s. Photo: PATH.
Since the mid-1990s, we've been tackling pressing health issues in Eastern Europe—in countries such Belarus, Georgia, Moldova, and Ukraine. Our office in Kyiv, Ukraine, serves as the hub of our activities in the region. The health topics we address include HIV and AIDS, tuberculosis, women’s health, vaccines and immunization, and avian influenza.
HIV and AIDS
Ukraine has one of the fastest-growing AIDS epidemics in the world. Experts estimate that there are probably more than 400,000 people with HIV in Ukraine, the majority of whom are younger than 29. While injection drug use is linked with more than half of the HIV infections, sexual transmission is growing, and about 40 percent of known infections are among women. Our activities to prevent HIV transmission in Ukraine and elsewhere in the region specifically reach out to these high-risk, vulnerable groups. Our activities include:
- Providing trainings that strengthen the ability of staff at governmental health facilities and nongovernmental organizations in Ukraine and Georgia to provide voluntary counseling and testing services for HIV—especially to injecting drug users and commercial sex workers.
- Collaborating with governmental health authorities in Ukraine to procure essential equipment, medications, and other supplies for preventing and clinically managing HIV.
- Reducing mother-to-child transmission of HIV. We focus on building the skills of medical personnel to effectively counsel all pregnant and postpartum women on HIV prevention, including mother-to-child transmission of the disease.
- Fostering peer support programs. We work with local nongovernmental organizations to establish support and education programs for women coping with HIV. Giving a voice to those affected by the disease helps reduce the stigma associated with it. We also help link medical providers and health facilities with community-based resources, so they can in turn show patients the way.
- Promoting condom use among rural young adults, with a particular focus on peer education aimed at vocational education students.
In addition, we also helped more than 30 hospitals throughout the country modify procedures and reduce health workers’ exposure to bloodborne pathogens. Many hospitals continue to implement the infection-control systems we helped introduce. The results are safer working environments for medical personnel.
During the 1990s, Ukraine experienced a sharp increase in tuberculosis infection. PATH is currently strengthening tuberculosis control in Ukraine by improving quality control in laboratories, improving surveillance of the disease, and helping to advocate national health policies that coincide with international standards of care. Our trainings help health care specialists increase their clinical management and communication skills. To help the public and patients get information they need, we have created and distributed media messages and educational materials in communities and health facilities.
Between 1997 and 2000, PATH worked in several regions in Ukraine to improve breast cancer early detection, diagnosis, treatment, and rehabilitation. We updated clinical facilities and increased health care specialists’ clinical and communication skills through training and by coordinating exchanges with American and other European breast cancer experts and advocates. We also administered a small-grants program in 14 countries in the region. The program strengthened the capacity of local partners to address cervical cancer prevention.
From 2000 to 2003, we collaborated with local partners in selected regions of Russia and Ukraine to increase women’s access to emergency contraception (EC). We provided updated information on EC to gynecologists, social workers, and pharmacists, with the goal of ensuring that women know their options and have access to accurate information. As part of this work, PATH collaborated with local partners to disseminate client-education materials in clinical facilities and pharmacies.
Vaccines and immunization
In Belarus, Bulgaria, Georgia, Moldova, and Ukraine, PATH has been working with local governments to reform health information systems for vaccine-preventable diseases. We are helping improve the quality, reliability, and usefulness of data collected to track important indicators such as immunization coverage, vaccine supply, disease outbreaks, and disease incidence.
In Ukraine, we assisted the government in obtaining funds needed for immunizing children against hepatitis B. The funds were secured from the Vaccine Fund of the Global Alliance for Vaccines and Immunization. In addition, PATH undertook a study in collaboration with government partners to determine the incidence and major causes of bacterial meningitis and pneumonia incidence among children under five in Kyiv City.
In the mid 1990s, Ukraine experienced an adult diphtheria epidemic. PATH helped the Ministry of Health efficiently procure 32 million doses of adult diphtheria toxoid vaccine. We also increased public awareness of the epidemic through mass media. These efforts contributed to a halt in the epidemic’s growth.
To help prevent or control an avian influenza pandemic, PATH is strengthening preparedness in Georgia and Ukraine. In both countries, we are intensifying surveillance for human cases of avian influenza, heightening awareness, and procuring diagnostic and prevention supplies. These efforts aim to support WHO’s goal of ensuring rapid characterization of the new virus subtype and early detection, notification, and response to additional cases.
Our work in Ukraine and other Newly Independent States has been supported by a variety of donors, including the United States Agency for International Development; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; the World Health Organization; the United Nations Population Fund; the Open Society Institute; and individual contributors.
Photo: PATH/Mike Wang.