Feasibility Study: Effectiveness of Public Health System (Programmes/Policies) in Combating Severe Population Health Crisis in Ukraine

乌克兰是世卫组织欧洲区域内的一个中等收入国家，长期以来一直面临严重的人口健康危机，而国内日益严重的保健不平等（农村/城市、男性/女性差距）加剧了这一危机。它是该地区预期寿命最低的五个国家之一（比欧盟平均水平少11岁），男女预期寿命差距超过10岁。自1992年独立以来，该国的保健和公共卫生系统几乎没有变化，完全不足以应对目前日益严重的非传染性疾病流行病和结核病/艾滋病毒/艾滋病流行病的挑战。在乌克兰人民的支持下，现任政府表现出改革国家和在决策中使用证据的严肃意图。然而，鉴于人口健康状况恶劣以及政治和经济困难，他们很可能选择不去快速介绍其他国家现成的例子，而不去分析今后在乌克兰的情况下什么可行、什么不可行。然而，我们认为，评价过去的方案/政策以及为评价未来的干预措施奠定基础，对于设计确保改善人口健康的改革措施至关重要。过去乌克兰公共卫生规划/政策的经验不应被浪费，在全面研究中，我们希望评估这些规划/政策，为制定有效的PH系统提供信息，并促进其实施。为此，我们将首先进行一项发展研究。本研究将重点研究以下内容：（一）探索国家一级公共卫生方案/政策的演变，绘制其在各区域和各时期的实际执行情况，评估其历史、背景、设计和逻辑；（二）评估定量和定性数据的可得性和质量；（三）评估进一步收集定量和定性数据的潜力，以提高评价未来公共卫生方案/政策的可能性；（四）反思乌克兰在卫生相关政策制定中使用证据的障碍。这将使我们能够选择被认为可评估的方案/政策，以缩小全面研究的重点，完善方法方法，就常规数据收集提供建议，以提高其质量，并向新兴的公共卫生界介绍基于证据的决策。

Ukraine is a middle-income country within the WHO European region which has long faced significant population health crisis exacerbated by growing health inequalities within the country (rural/urban, male/female divide). It is one of the five countries in the region with the lowest life expectancy (11 years less than the EU average) and more than 10 years life expectancy gap between males and females. The health care and public health systems in the country remained virtually unchanged since independence in 1992 becoming completely inadequate to deal with the current challenges of growing epidemics of Non-Communicable Diseases and TB/HIV/AIDs epidemic. Supported by the people of Ukraine, current government shows serious intentions to reform the country and use evidence in decision-making. Yet, given the dire state of the population health and political and economic difficulties, they are likely to opt out for a quick introduction of ready-made examples from other countries leaving the fundamental analysis of what does/did and does/did not work in a Ukrainian context for the future. Yet, we believe that evaluating past programmes/policies, as well as setting up the stage for the evaluation of future interventions would be crucial in designing reforms ensuring improvement of population health. Past experience of public health programmes/policies in Ukrainian context should not be wasted and in the full-scale study we would like to evalute such programmes/ policies to inform the development of effective PH system and facilitate its implementation.To do this, we will first undertake a development study. This study will focus on the following things: (i) exploring the evolution of the public health programmes/policies at the national level and mapping their actual implementation across regions and over time, assessing their history, context, design and logic, (ii) assessing the availability and quality of the quantitative and qualitative data, (iii) assessing the potential for additional quantitative and qualitative data collection to enhance the possibilities for the evaluation of future public health programmes/policies, and (iv) reflect on the barriers to use evidence in health-related policy making in Ukraine.This will allow us to select the programmes/polcies deemed evaluable to narrow down the focus of the full-scale study and refine the methodological approaches, provide recommendations as to the routine data collection to improve its quality, and introduce emerging public health community to the evidence based decision making.