The concept of “General Practitioner/Family Doctor” has evolved in some European countries on a time-specific historical background.

Family treatment practice should be viewed as the one that ensures a long-term care for the health of an individual and all his/her family members irrespective of disease character and state of body organs and systems in all periods of human life.

The importance of primary health care was stated in Alma-Ata Declaration of the World Health Organization (WHO) in 1978. Since then, many countries of the European region have strengthened their health care services, mostly through imparting the status of a major medical speciality to general practice/family medicine, “the representatives of which shall provide health care at the first contact with the patient and further observe the patients, as well as ensure health strengthening and disease prevention” (WHO Declaration, 1978).

Alma-Ata Declaration has initiated the implementation of reforms in the health care sector with the focus on development of the primary health care in many countries of the world, including Ukraine.

The process of family medicine introduction in Ukraine is long and difficult. It started from an experiment in Lviv oblast back in 1987, when the first out-patient general practice/family medicine clinic was opened in Drogobych city. Since 1995 Ukraine has started training of family doctors in accordance with curriculum approved by the Ministry of Health of Ukraine.

Long 14 years of cooperation between researchers and practicing physicians that withstood the test of time and life, have passed till the Ministry of Health developed, and the Government approved, the Resolution № 989 “On comprehensive activities to introduce the family medicine in the health care system” as of June 20, 2000, which envisaged the introduction of family medicine during 2000-2005.

The strategic approaches for its introduction have been defined in the Concept for the Development of Health Care for Ukrainian People, approved by the Decree of the President of Ukraine № 1313/2000 as of December 7, 2000 as the method to achieve the expected systemic changes in the sector.

The relevance of this sectoral reform and the need to develop it is confirmed by the Action Program of the Cabinet of Ministers of Ukraine “Consistency-Efficiency-Responsibility” approved by the Resolution of the Verkhovna Rada of Ukraine № 1602-ІV as of 16.03.04 and by the Strategy for Economic and Social Development of Ukraine “Towards European Integration” approved by the Decree of the President of Ukraine № 493/2004 as of 28.04.04.

During recent three years the Ministry of Health of Ukraine has been focusing on the training of professionals for the general practice/family medicine facilities.

To date, general practice/family medicine chairs have been opened at all 17 higher medical educational institutions and post-graduate centers that provide training, retraining and post-graduate education to the specialists that ensure continuity of pre- and post-graduate higher medical education in the speciality “general practice/family medicine”. Kharkiv and Zaporizhja medical academies for post-graduate education have established the departments of general practice/family medicine.

In order to create necessary conditions for the introduction of family medicine principles in the primary health care facilities, the Ministry developed and approved the package of normative documents that regulate the methods of family medicine introduction, in particular, 2 resolutions of the Cabinet of Ministers of Ukraine and 29 orders of the MoH of Ukraine.

Adoption of the above government resolution demonstrates that the principles of general practice/family medicine are being actively introduced in the national health care system.

Further development of the family medicine in Ukraine is targeted at the achievement of the general European level, which is specified in the Health for All Policy Framework for the WHO European Region (“Health 21”).

Target 15 envisages:

15.1 at least 90% of countries [of the European Region] should have comprehensive primary health care services, ensuring continuity of care through efficient and cost-effective systems of referral to, and feedback from, secondary and tertiary hospital services;

15.2 At least 90% of countries [of the European Region] should have family health physicians and nurses working at the core of this integrated primary health care service, using multiprofessional teams from the health, social and other sectors and involving local communities;

15.3 At least 90% of countries [of the European Region] should have health services that ensure individuals’ participation and recognizes and supports people as producers of health care.

Target 16

By the year 2010, Member States [of the European Region] should ensure that the management of health sector, from population-based health programs to individual patient care at the clinical level, is oriented towards health outcomes.

Target 17

By the year 2010, Member States [of the European Region] should have sustainable financing and resource allocation mechanisms for health care systems based on the principles of equal access, cost-effectiveness, solidarity and optimum quality.

Target 18

By the year 2010, all Member States [of the European Region] should have ensured that health professionals and professionals in other sectors have acquired appropriate knowledge, attitude and skills to protect and promote health.

Target 19

By the year 2005, all Member States [of the European Region] should have health research, information and communication systems that better support the acquisition, effective utilization and dissemination of knowledge to support Health for All.

The Main Research and Methodological Center for General Practice/Family Medicine was established in Kiev (MoH order № 406 as of 12.10.2001). The Center head is Latyshev E.E., candidate of medical sciences, chief specialist of the MoH of Ukraine on general practice/family medicine.

Key tasks of the Center include:

1. Establishment of the database of legislative and other regulatory acts and scientific and practical documents on the PHC provision on the basis of family medicine and participation in their development.

2. Implementation of analysis of the state of PHC readjustment on the basis of family medicine; participation in the development of national and regional programs on family medicine issues for its efficient introduction and initiation of activities at the city and rayon levels.

3. Organization of and participation in the research of PHC issues on the basis of family medicine.

4. Development of technical and methodological approaches to the introduction of family medicine.

5. Promotion of the development of infrastructure of general practice/family medicine facilities in Ukraine and of the international cooperation in the area of PHC.

The beginning of operations of the research and methodological center of general practice/family medicine at the MoH of Ukraine contributed to a more active development and adjustment of the regulatory documents on the issues of family medicine.

In order to develop primary health care on the principles of family medicine, the specialists of the MoH of Ukraine and of the Research and Methodological Center created 5 expert groups that included specialists of all levels, from a family nurse to a physician, head physician, head of the chair and representatives of the secretariat of oblast health care administrations and the Ministry, whose activities resulted in the development of a number of the MoH orders and instructions.

The composition of Coordination Council for the introduction of family medicine was revised twice in order to create an effective coordinating body and to regulate the process of reorganization of PHC (orders of the MoH of Ukraine № 48 as of 06.02.03, and № 511 as of 04.11.2003).

Provisional state norms to provide health care on the basis of “general practice/family medicine” were developed and introduced on a pilot basis (order of the MoH of Ukraine № 191 as of 05.05.2003).

Orders that regulate the assessment of physician and paramedical personnel were revised (orders of the MoH of Ukraine № 221 as of 19.05.2003, № 447 as of 23.09.2003 and № 25 as of 19.01.2004).

In 2004 the representatives of the regions with the participation of the employees of the Research and Methodological Center of Family Medicine initiated the approval of the order of the MoH of Ukraine № 1 “On the improvement of monitoring of primary health care on the principles of family medicine and on unification of the corresponding medical reporting documentation” as of 08.01.2004.

In order to develop and introduce the evaluation and quality control system for primary health care on the principles of family medicine, an experiment was started in Komsomolsk, Poltava oblast, to implement the project for the development of local self-governance aimed at the creation of an up-to-date innovative model for the provision of quality medical services to the public with the prioritized introduction of family medicine (order of the MoH of Ukraine № 16 as of 16.01.04).

In order to develop the methodology for a differentiated funds distribution by the levels of health care provision taking into account the needs of PHC on the principles of family medicine, and in accordance with the order of the MoH of Ukraine № 88 as of 17.02.04, a pilot project is being implemented in 5 regions of Ukraine. It is planned to develop the material incentives on the basis of this pilot project results.

Within the framework of cooperation with the European Union and according to the order of the MoH of Ukraine № 338 “On the implementation of experiment with international participation in order to introduce an up-to-date family medicine model in the Autonomous Republic of Crimea, Zaporizhja and Khmelnitsky oblasts” as of 06.07.04, a corresponding experiment is being implemented.

Note: You can turn with your proposals, express your opinions and receive health care, if you send your letter to the address: fammc@moz.gov.ua