Doctors in Mykolaiv appealed to Kim and Sienkevych: «We are under psychological pressure from the health deparment»

Employees of Mykolaiv Primary Health Care Centre №1 expressed disagreement with the plans of the city health department to liquidate the centres, illustrative photo by NikVesti

The staff of Primary Healthcare Centre №1 in Mykolaiv appealed to the head of the regional military administration, Vitalii Kim, the mayor of the city, Oleksandr Sienkevych, and the National Health Service to assess the actions of the city health department, which wants to liquidate profitable family outpatient clinics. The doctors claim psychological pressure, mass dismissals and devastating consequences of this decision for patients and the city's healthcare system.

The doctors sent a corresponding appeal, a copy of which is available at NikVesti on 24 April.

According to the employees, the decision to liquidate the healthcare department of the Mykolaiv City Council has been communicated to medical institutions despite the fact that it has not yet been actually adopted by the City Council. It is not only about the Primary Healthcare Centre №1 — five out of seven medical centres in the city may disappear. The decision to be submitted to the city council for consideration envisages the merger of five polyclinics with the other two — №2 and №3. In particular, polyclinics №1 and №7 are to be merged with centre №2, and polyclinics №4, №5 and №6 with centre №3. At the same time, it is noted that the network of outpatient clinics and the scope of medical services should be preserved.

It is noted that the teams are in a state of uncertainty, and doctors and nurses who work under fire in the war do not know what awaits them next.

«The staff of Primary Healthcare Centre №1 is outraged and surprised by this decision. Why are they liquidating 5 out of 7 medical centres and other medical institutions in Mykolaiv? These are at least a thousand employees of medical institutions who are now, under martial law, under systematic shelling, day and night bombardments, performing their duties and enduring the psychological pressure of the health department to liquidate them and do not know what will happen to them next», the appeal says.

As you know, the Mykolaiv Health Department announced plans to liquidate medical institutions «in order to save money» a year ago, but the deputies of the Mykolaiv City Council refused to consider this issue. However, this has already had an impact on the work of the medical facility — doctors have started to resign en masse due to this instability.

Advertising

«Such a refusal of the deputies could not have a timely and positive impact on the staff of our Centre №1, and medical workers, looking for stability and a permanent job, began to resign en masse (for the period 01.01.2024 and during 2024. 13 doctors and 14 nurses resigned)», the statement reads.

Employees of the Primary Healthcare Centre note that the dismissal of doctors has a negative impact on their work, as patient declarations are terminated, and the medical institution is financed for the patient declarations signed with the doctor.

In addition, it is noted that at the end of 2024, the NHSU tightened its requirements for medical institutions, namely, data verification measures were introduced to ensure the relevance and reliability of patient data in the electronic healthcare system (EHS). These requirements include the mandatory need to verify patients under the age of 18 who have submitted declarations on the choice of a primary care physician.

«This is necessary to avoid the application of a zero coefficient for the care of such patients. A tremendous amount of work has been done, and the efforts of all medical staff are still focused on verifying and concluding new declarations, as this affects the financing of our medical institution,» the statement reads.

Also, from the beginning of 2025, a mechanism for calculating the amount of monthly payment in 2025 under the package «Primary Healthcare» was introduced for healthcare workers, which introduces the corresponding downward adjustment factors for the cost of declarations (0.8) instead of the previously introduced (1.0) and an individual coefficient of patient visits to a primary healthcare provider (if a patient has not visited a facility in the last three years, the NHSU does not pay the facility for such a declaration at all).

«Our team overcomes and withstands all challenges and difficulties, despite all the difficulties during martial law, and continued to provide primary healthcare, X-ray and fluorography services, ultrasound diagnostics, clinical diagnostic laboratory services, and gynaecological services to the population. As a result, the indicators of verification of persons are growing and the number of declarations concluded with our institution is increasing (in the 1st quarter of 2025 alone, the number of patients who signed declarations with the institution increased by 686 people). In addition, our institution provides services to the military, IDPs and other patients who have not signed declarations with the institution but have sought medical care. The institution is constantly working to increase medical services. Currently, a new package of medical services has been drawn up and submitted for consideration, and we are waiting for the signing of an agreement with the NHSU on the package «Expanded primary healthcare services for certain categories of people who defended the independence, sovereignty and territorial integrity of Ukraine», the staff said in a statement.

It is emphasised that the financial activity of the institution is currently profitable, and salaries and related taxes have been and are being paid on time.

The funds earned by the medical institution from the NHSU are spent not only on salaries of employees, but also on additional payments to interns, current repairs of premises, repair and technical inspection of sanitary vehicles, computers, office equipment.computers, office equipment, household equipment (boilers, washing machines, generators), communication services, internet, automatic fire alarm, burglar alarm and video surveillance services, software (accounting software, HR software, document management software), etc.

In addition, given that «local programmes are not fully funded», the hospital is forced to partially purchase items for people with disabilities using the NHSU funds earned: diapers for adults and children, faecal and urinary tracts, urological pads, and special food.

It is noted that the only financial assistance from the budget received by the primary healthcare centre №1 is for utilities.

«The work of the healthcare facility is planned, patients are used to the healthcare facility and its convenient location, everyone knows their doctor, and the doctor knows his patient. But by the decision of the healthcare department of the Mykolaiv City Council, they decided to liquidate our institution», the statement reads.

The doctors additionally emphasise that if the decision to liquidate the medical institution is made, all employees, including doctors, will be dismissed according to the procedure. This means that, in accordance with the requirements of the NHSU, declarations with patients will be automatically terminated and, as a result, «the complete lack of funding for the institution, which is currently operating and profitable».

«The depression and anxiety in this situation negatively affects the mental health and mental state of healthcare workers and their motivation in work. Emotional strength is spent on the uncertainty of the situation created by the Health Department of the Mykolaiv City Council», the statement reads.

The trade union of the Centre notes that as a result of this reorganisation, the institution may lose about a third of its patients.

«The NHSU only finances declarations signed with patients, and while we were working on concluding declarations, we had nothing to pay salaries with», the statement reads.

The doctors note that if the purpose of the liquidation is to save funding for medical institutions, the authorities should pay attention to the fact that Mykolaiv region remains one of the eight regions that still has city health departments, although in other regions they have long been merged with regional ones. This would «significantly affect the cost savings in our city for public health care».

It should be noted that the primary healthcare centre No. 1 in Mykolaiv has been headed by Ruslana Bernatska (Omelianchuk) since October 2024. Ruslana Bernatska is also the coordinator of the All-Ukrainian Mental Health Programme initiated by Olena Zelenska «How are you?» in Mykolaiv region.

Ruslana Bernatska and Iryna Shamrai during the third Summit of First Ladies and Gentlemen, photo by Vogue

Commenting on the disagreement of doctors with the reorganisation, Iryna Shamrai, head of the Mykolaiv Health Department, reminded that some of the heads of primary healthcare centres are temporary and may not have the necessary qualifications.

Reorganisation of Mykolaiv hospitals

As you know, Mykolaiv's healthcare department has come up with an initiative to reduce the number of hospitals in the city from six to three by merging them. In addition to merging hospitals, the reform will also include Maternity Hospital №3, which, unlike other maternity hospitals in the city that were merged with hospitals last year and became departments, remained an independent legal entity.

• The ambulance hospital and hospital No. 4 are to be merged with hospital №1;
• Maternity Hospital №3 and Children's Hospital №2 — to Hospital №3 (Dubky);
• Hospital №5 (Korabelnyi district) will not be affected by the reform.

During the commission meeting, Iryna Shamrai, Head of the Mykolaiv Health Department, explained that the need to reorganise and merge large hospitals in Mykolaiv this year was due to the requirements of the National Health Service of Ukraine to provide full funding for medical services.

Olena Kiselyova, head of the deputy commission on legality of the Mykolaiv City Council and a member of the European Solidarity party, expressed strong criticism of the plans to reorganise the city's medical network.

Optimisation of maternity hospitals in Mykolaiv

As you know, in May 2023, the city authorities in Mykolaiv began to study the issue of merging maternity hospitals. The number of births in the city was declining. On 31 July 2023, the Mykolaiv City Council decided to reorganise maternity hospitals №1 and №2, merging them into City Hospital №1 and City Hospital №3, respectively. The head of the city health department, Iryna Shamrai, explaining the need to reorganise medical facilities, stated that over the past 7 years, the number of pregnant women in Mykolaiv had decreased by 5 times.

Due to the actual liquidation of Maternity Hospital №2 in Mykolaiv, 42 people were laid off. The staff of Maternity Hospital №2 called the decision of the city authorities to actually liquidate and preserve only one specialised medical facility in the city a mistake.