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，国内日益严重的健康不平等（农村/城市、男性/女性鸿沟）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（比欧盟平均水平低11岁），男女预期寿命差距超过10年。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，完全不足以应对当前非传染性疾病和结核病/艾滋病毒/艾滋病流行病日益严重的挑战。在乌克兰人民的支持下，现政府表现出认真的意愿，对国家进行改革，并在决策中使用证据。然而，鉴于人口健康状况的严峻状况以及政治和经济困难，他们可能会选择迅速介绍其他国家的现成例子，而将对乌克兰情况下什么可行/可行和不可行/不可行的基本分析留给未来。然而，我们认为，评价过去的方案/政策以及为评价今后的干预措施创造条件，对于设计确保改善人口健康的改革至关重要。乌克兰公共卫生计划/政策的过去经验不应被浪费，在全面研究中，我们希望评估这些计划/政策，以告知有效的PH系统的发展并促进其实施。为此，我们将首先进行发展研究。这项研究将侧重于以下方面：㈠探讨国家一级公共卫生方案/政策的演变情况，绘制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，㈡评估定量和定性数据的可得性和质量，㈢评估收集更多数量和质量数据的可能性，以提高评价未来公共卫生方案/政策的可能性，以及（iv）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，并改进方法学方法，就日常数据收集提供建议，以提高其质量，并将新兴的公共卫生社区引入基于证据的决策。

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.