Systemic Transformations of Healthcare Governance Mechanisms

The current healthcare sector in Ukraine is being transformed due to the destruction of the country's overall infrastructure and life support system as a result of military aggression.Establishment of effective public administration of the healthcare sector at the local level is becoming key to the implementation of Ukraine's policy on governance capacity.The development of the public health system in Ukraine has been taking place in parallel with decentralisation transformations.Local governments of the territorial communities and the oblast, based on the adopted regulatory changes and relying on local contextual data, were able to develop adequate measures for their territory.These measures, in parallel with government programmes, were intended to strengthen public health.The public administration bodies of territorial communities have failed to ensure quality management of healthcare facilities at the local level.The results of the healthcare decentralisation reform have shown that in order to ensure affordable and quality healthcare, it is necessary to manage the healthcare delivery process and the hospital network at both the national and regional levels.As of the beginning of 2023, hospitals were autonomous units whose managers solved problems within the operational and strategic objectives of their hospital structure.Competition for patients between different hospitals was unleashed on the healthcare market, increasing the fragmentation of services, worsening routing, reducing their quality and safety for patients.At the level of hospital districts, there was no multi-level system of medical care that would allow for differentiation of cases depending on their complexity and severity of the patient's condition.Журнал «Наукові інновації та передові технології» № 3(31) 2024 (Серія «Управління та адміністрування», Серія «Право», Серія «Економіка», Серія «Психологія», Серія «Педагогіка») 50To organise quality healthcare, the state must create rules and conditions that will encourage hospitals to transform.In turn, local governments and healthcare departments should learn how to create an effective network of healthcare businesses.In addition, they need to improve their competencies in good governance, monitoring, accounting, communication, and many others.An important consequence of the infrastructure stage of the healthcare reform is that local governments have become owners of healthcare enterprises, not institutions or facilities.They have to choose an effective leader, a model of management, reporting, investment, and much more.Hospital owners also have to implement strategies in partnership with local health departments and boards.The maximum effect of management activities in the medical sector is largely determined by the level of development of the main sections of management, including planning, management, control and adjustment.