On 5 February, Kyiv’s District Administrative Court forbade Uliana Suprun, hailed by many as one of the few truly reform-minded public servants left in Ukraine, to perform her duties of acting Health Minister. The decision not only topped off the several years of resistance to Suprun’s reforms but pointed to the problems within Ukraine’s judiciary. In particular – the existence of judges and courts which are ready for making political decisions.
The court decision was related to a lawsuit by Ihor Mosiychuk, an MP from the Radical Party of Oleh Liashko. The court partially satisfied it and forbade Suprun to perform duties of acting Health Minister while allowing her to continue in the role of deputy Health Minister.
The court’s explanation was that one can be an acting minister for only a month and Suprun’s US citizenship. Ukrainian law does not allow for dual citizenship.
The day before, Suprun said that Mosiychuk had filed two lawsuits against her. They are related to the alleged incompetence of the acting Minister.
Suprun assumed the position of acting Health Minister on 27 July 2016, after 15 candidates reportedly declined the post, being intimidated by the difficulty of the office and severe situation of the health sector in general. While immediately undertaking an ambitious plan to completely overhaul Ukraine’s healthcare, she had never been voted in by the Parliament as Health Minister proper – opposition to her steps was, and remains, significant.
Suprun’s supporters unanimously called the decision to suspend her duties as politically motivated. Speaking to Euromaidan Press, Dmytro Sherembey, Head of the CO “100% LIFE” (former Tne Network) told that the decision against Suprun is an attempt of the old guard profiting from financial flows in the healthcare sector to get their corruption schemes back.
“Uliana Suprun is an obstacle for them because she turned off all the financial taps. For the [corrupts], it is a question of survival. So they will buy the decisions of courts or other institutions which would allow to remove her,” said Dmytro, who is actively involved in the healthcare reform.
According to Sherembey’s estimates, the healthcare mafia lost UAH 6 bn ($220.8 mn) over the last year because of Suprun’s reforms. Earlier, this money ended up in their pockets.
What were the arguments of the MP?
Mosiychuk explained his claims to Suprun on his Facebook page with the pathos-filled populist rhetoric so typical of his party.
“I, and all the team of the Radical Party of Oleh Liashko, fight not against Uliana Suprun, but for the health of Ukrainians, for medicine to be available for every Ukrainian citizen. During the last week, together with the Leader [capitalized (sic!) – Ed], we have visited several oblasts and at every meeting, people stressed they don’t have appropriate health care. Ukrainians can’t call the ambulance, they can’t find a doctor, and medicines in pharmacies are sold at exorbitant prices. People are suffering from measles massively, seven have died since the beginning of the year, there are no vaccines, but the epidemic is not only not announced but even hushed up.”
The MP also called the Prime Minister to submit the candidacy of a new Minister of Health to the parliament.
What did she do and why was she criticized?
Suprun was born in the USA in a Ukrainian family and studied medicine there. In 2013, she and her husband Marko Suprun moved to Ukraine where they actively participated in the Euromaidan revolution. Later, when the Russian-backed war started in eastern Ukraine, the couple organized tactical medicine courses for Ukrainian soldiers and provided them with NATO-standard improved individual first aid kits. Funds for them were collected in Canada and the USA. In 2015, President Poroshenko signed a decree on providing Ukrainian citizenship to the couple. In 2016, he supported the initiative of Prime Minister Hroysman to appoint her as deputy Healthcare Minister. After a month, she started to perform the duties of acting Minister but was never voted in as Health Minister proper – rumor goes that there wouldn’t be enough votes in parliament.
Since then, Suprun started to actively reform Ukrainian drastically underfunded and therefore brimming with corruption healthсare system, earning lots of enemies among politicians and representatives of the old guard of Ukrainian healthcare, as well as supporters among civil society. For many Ukrainians, her reforms were radical in every way. She earned the title of “medical myth debunker” with her regular Facebook posts stating that, for instance, that hydrogen peroxide – a medical staple from Soviet times – does not disinfect wounds, that homeopathy does not work, and that safe doses of alcohol don’t exist and giving instructions on healthy eating which often contradicted Ukrainian national food habits. Recently, she called upon the Parliament to legalize medical marijuana.
This, as well as a smear campaign run by select politicians and outlets, may have been the reason why in August 2018 Suprun topped the list of the most hated Ukrainian politicians and civil servants, according to research of the IRI.
Uliana Suprun has the highest anti-rating among all Ukrainian politicians. Source: IRI poll
One of the major changes Suprun implemented was the introduction of the British-type state healthcare model. One of its envisioned changes was to make “money follow the patients.” As part of the change, Ukrainian families had to enter contract relations with a chosen doctor. The more contracts a doctor has, the more she earns, meaning that good doctors whom patients trusted would be financially rewarded. Other changes envisioned by the reform included a shift from financing medical institutions to financing the services provided to the patient, financial and managerial autonomy for hospitals, and a reshuffle of hospital districts in an attempt to optimize the meager funds available for healthcare in a poor nation.
But perhaps the most drastic changes Suprun introduced was to replace the Soviet-era concept of free healthcare with an insurance-based system. This was arguably one of the most painful innovations for Ukrainians to digest. Although the concept of free healthcare for all stopped working after the Soviet Union fell apart in 1991 and since then healthcare patients were accustomed to paying for everything from syringes to surgery, it is still enshrined in the Ukrainian Constitution. Its replacement with a “capitalist” model in a country with 25% of the population living below the poverty line has made many nervous and fueled populist rhetoric.
Read also: What Ukraine’s healthcare reform is about
No matter whether the directions chosen by her were right or wrong, one should consider where the criticism against her is coming from before falling for it. Often, the accusations are full of manipulations.
In Autumn 2018, the Parliamentary committee on healthcare supported a resolution by MPs calling upon the Cabinet of Ministers to dismiss Suprun and her deputy. Hromadske journalists analyzed the arguments of the MPs. It turned out that they are full of manipulative inaccuracies.
For example, the explanatory note to the decree said that “the dying out of Ukrainians has increased: if in 2016, there were 175,000 more deaths than births, in 2017 this number increased to 198,000.” The journalists pointed out that the statement is incorrect: during the last four years, the Ukrainian birth rate indeed went down, but this is explained by the economic crisis. Also, the authors of the resolution ignored the fact that the mortality index actually went down in recent years: in 2014, when Oleh Musiy was Health Minister, 100,000 more people died than during the time when Suprun was acting Minister in 2017.
Another statement said that 70,000 medical professionals moved abroad during the last two years and that 50,000 more will do so in the next years if the Ministry’s current policies are continued. Hromadske journalists said there exist no clear statistics on the numbers of medics who moved because official migration data is not broken down by professions. Suprun’s opponents say that the numbers were allegedly provided by the trade unions, but the Healthcare Ministry refuted them.
Hromadske journalists also refer to inaccuracies of the MP’s accusations of falling vaccination rates, international drug purchases, and underfunding.
The resolution itself was not legally binding and served as a recommendation to the government.
Experts named the lack of wide support among average Ukrainian healthcare professionals as one of the weakest points of Suprun’s policies. Viktoriya Tymoshevska, Head of the Public Health program of the International Renaissance Foundation’s Ukrainian office told DW that this factor slowed down the reform, as more autonomy given to individual institutions placed the responsibility on their heads. However, often they did not know how they should act in the new circumstances.
“Any changes are traumatic; that is why there is resistance even among people who want changes but are afraid of uncertainty,” the expert said.
Sherembey explained which directions of the reform will be affected the most if Suprun leaves the Ministry.
“Unfortunately, it can cause great damage to all the patients who depend on the treatment programs introduced by Suprun. Under her management, state drug procurements increased by 55%, despite the lack of resources. Also, it can harm international assistance directed to the Ministry. Most of all, we are worrying about the patients being treated in hospitals now, those who need chemotherapy. The system has to work.”
Who the opponents are
Among Suprun’s open haters is Olha Bohomollets, an MP from the Petro Poroshenko’s Bloc, the Head on the Parliament’s healthcare committee, and a presidential candidate. The MP had repeatedly referred to Suprun’s policies as a “genocide of the Ukrainian people.” Ihor Musiy, another MP who headed the Ministry in 2014, criticized Suprun for incompetency. Borys Todurov, a famous surgeon and medical functionary, criticized Suprun for alleged failures in medicine procurements.
Sherembey adds the medically engaged former members of the Party of Regions, the party of the runaway president Viktor Yanukovych, to the list of haters of Uliana Suprun.
As mentioned above, the decision to suspend Suprun’s duties also revealed the weak points of the Ukrainian judiciary. Civil society organizations involved in the reform pointed out that Serhiy Karakashiyan, the judge who made this decision, has made other fishy rulings in the past. In particular, in November 2018, this judge recognized the appointment of Artem Sytnyk, the Head of the National Anti-Corruption Bureau (NABU) as illegal, despite the court not identifying any violations in the NABU chief’s actions or asset declarations. As well, the judge ruled the commercials praising the achievements of the Prosecutor General’s Ofice as “social ads.” The ads, showing the controversial Prosecutor General Lutsenko in a positive light, were broadcast on Ukrainian channels and radio stations for free. All of them ended with the phrase “We implement the law and establish justice. Yuriy Lutsenko.”
Civil society representatives also have questions regarding the judge’s assets and remind that the judicial reform touted by President Poroshenko initially envisioned that the Kyiv Administrative Court where he works would be liquidated altogether. However, at some point, the Court was spared.
In December 2018, Karakashiyan was again involved in the controversial decision to reinstate the Fiscal Service Chief Roman Nasirov, one of the top suspects in large scale corruption, in his position.
Support for Suprun
On 5 February, Prime Minister Hroysman made a statement in support of Suprun,
Judith Gough, a British diplomat and the current Ambassador of the United Kingdom to Ukraine, and the Embassy of Switzerland raised their concerns regarding the news. The Embassy of US reacted saying that they are following the situation. Also, representatives of civil society announced a protest near the Kyiv Administrative Court in support of Suprun.
However, the position of President Poroshenko, the person who actually invited Suprun to the Healthcare Ministry, was the main question.
By the end of the day, the answer appeared. The President stated that he supports the acting Minister and emphasized that she is a citizen of Ukraine. He also reminded that it was he who provided her with Ukrainian citizenship.
Meanwhile, Ukrainian social media is brimming with behind-the-scenes speculations connecting Mosiychuk’s lawsuit and the court decision to the upcoming presidential election in March 2019. Journalist Kateryna Venzhyk summarized three main versions.
The first one says that the president, who has a high presidential anti-rating, wanted to remove an unpopular minister associated with him using somebody else’s hands.
The second is that the President’s Administration wants to play for Oleh Liashko who during the presidential elections can take votes from other populists, first of all, Poroshenko’s main competitor Yuliya Tymoshenko.
The third version goes that Poroshenko is not involved and that Liashko and Mosiychuk were just on the payroll of the old medical guard that lost its corruption schemes and profits from medicine procurement.