Key problems of the health care system of the oblast.
In recent decades, the old Soviet system of health care in Ukraine, including Lviv oblast, does not meet the needs of citizens with respect to high-quality medical care. The so-called "free" medical care is actually very expensive and ineffective for the population.
Among the main reasons for such situation are:
• Ineffective management system
• Chronic underfunding and irrational structure of the health care system budget
• Crisis in the provision of training for medical personnel and imbalance in the provision of urban and rural areas with medical staff
• Technology lags within the medical industry
Certain steps are being undertaken in oblast to implement reforms in the health care system. Lviv oblast was the first in Ukraine to initiate development of primary health care on the basis of general practice / family medicine. Close to 70% of the residents of the oblast obtain their medical care from family physicians. In the Lviv oblast a unified emergency medical care service has been established, with extraterritoriality in providing emergency medical care to the residents of the oblast. A road map has been created for optimizing the distribution of beds within the region's health care facilities. There is an ongoing reorganization of TB services. Technologies related to in-patient treatment are being constantly introduced, with development of a network of departments for providing palliative care.
At the same time, in collaboration with the scientists at Danylo Halytsky Lviv National Medical University, there is an ongoing work related to establishment of advanced centres for providing highly specialized medical care, with active cooperation with leading foreign clinics towards mastering modern medical technologies. Regionalization of perinatal care has been introduced in the oblast. The health care facilities of the oblast implement the system of management and external quality control of medical care, including via the introduction of clinical protocols.
Particular emphasis is focused on issues relating to crisis communications in the field of health care and of ongoing cooperation with NGOs.
In general, the two major problems identified with the Lviv oblast and Ukraine as a whole, are late diagnosis and high level of mortality from cancer.
Since 1993, the prevalence of cancer in the Lviv oblast has been gradually increasing, and as of 2013 this indicator increased by 40% compared to that of 1993. In 2013, among the total number of new cases of cancer in Lviv (8 307 people), 51% of the reported cases occurred among women (4 227 persons). Of these, breast cancer accounted for 18% (748 people), and cervical cancer accounted for 5.4% (229 persons).
Oncological diseases in Lviv oblast and in Ukraine in general are characterized by high mortality rate due to late diagnosis, significant level of disabilities, and by budgetary funding of palliative care for cancer patients.
The largest share of deaths from malignant tumors in young women accounts for cervical cancer. According to the Regional Cancer Registry of Lviv oblast, among the number of deaths from cancer in women under 45 years, the main cause of death accounted for cervical cancer (21%), the second - for breast cancer (15.6%), and the third - for ovarian cancer (11%)
Every year in the Lviv oblast around 250 cases of cervical cancer at the invasive stage are identified, with about 80% of patients being at I and II stages of the disease. A noteworthy feature is the dynamics of decline in dysplasia diagnosing of uterus and Ca in situ at simultaneous increase in the level of invasive cervical cancer which requires more careful monitoring of cytological screening.
In 2013, 229 cases of cervical cancer at invasive stages were registered, and 181 case at the stage in situ. The ratio of cases detected at the stage in situ, to cases detected in the stages I-IV, is 0.79, which is sufficiently low.
Breast cancer is the most common cancer occurring among women (23% of all new cancer cases) and the main cause of death associated with oncological diseases (14% of deaths from cancer) among women. Overall in 2013, 758 cases of breast cancer were reported, with 165 of these being detected in the first stage (21.8%). Currently, the screening coverage rate in the Lviv oblast does not exceed 5% of the total female population. Currently, a mammogram can be done only in Lviv.
Nowadays, it is difficult to provide accurate monitoring of cytological screening coverage of the female population (approximate estimates of coverage for women accounts for around 50%); this process is fully documented in a hard-copy format, which poses obstacles to the use of a differentiated approach to screening in different age groups. Mammographic screening at the population level in the oblast is unavailable, and mammography studies in general account for less than 5% of the needed screening.
Of particular importance in preventive oncology is systemic implementation of cancer screening for identification of precancerous and early stages of cancer, such as: cytological screening of cervical pathology, supported by information systems for personalized computerized control for screening coverage of the population, mammographic screening of breast cancer pathology.
The objective of the sub-project: Improving the health care among the population of the Lviv region in relation to combating malignant tumors by means of:
- Improving the level of early diagnosis of cancer through introduction of cervical cancer screening and breast cancer screening in the health care system of the Lviv oblast
- The introduction of effective anticancer technologies in cancer treatment
1. Improving access of the population to the methods of early diagnosis of cancer through introduction of cervical cancer screening and breast cancer screening in the health care system of the Lviv oblast.
2. Improving the quality and effectiveness of treatment of malignant tumors to reduce labor costs and disability related to approaches regarding cancer treatment.
3. Dissemination of knowledge related to preventive oncology among the medical community and the public.
Key expected results:
1. Early detection of breast cancer and cervical cancer (the ration of in situ cases to all cases of invasive cervical cancer - 0.88, the share of new cases of breast cancer detected at the stage I to all new cases of breast cancer - 30%) at the Cancer Treatment and Diagnostics Centre
2. Increase in the number of organ saving surgeries on the breast (25%), and surgeries related to cervical cancer (10%)
3. The share of the patients familiarized with the risk factors and with the preventive measures (increase by 20%)
The need for resources.The foreseen need for resources for project implementation amounts to 10.15 million USD as part of financing from the World Bank, with 1,293,600 USD as co-financing.
These resources will be directed to implement the following measures:
1. Implementation of the monitoring system of cervical pathology and breast cancer screening on the primary, secondary and tertiary levels
2. Providing centres with consumables for screening in the cities and districts of Lviv oblast
3. Organizational and technical support of multi-district screening centres (Lviv, Chervonograd, Drogobych, Sambir)
4. Operational support of the tertiary-level screening centre
5. Improving the provision of treatment for cancer patients
6. Development and holding public awareness-raising campaigns on prevention of oncological diseases
7. Popularization of knowledge regarding preventive oncology among the population.
8. Project Management