Instituto de Estudios Políticos y Derecho Público "Dr. Humberto J. La Roche"
de la Facultad de Ciencias Jurídicas y Políticas de la Universidad del Zulia
Maracaibo, Venezuela
Esta publicación cientíca en formato digital es continuidad de la revista impresa
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Vol. 41, Nº 78 (2023), 296-308
IEPDP-Facultad de Ciencias Jurídicas y Políticas - LUZ
Transformation of the State
policy of Ukraine in the healthcare
sector during martial law
DOI: https://doi.org/10.46398/cuestpol.4178.21
Olesia Batryn *
Iryna Chekhovska **
Natalia Uvarova ***
Tatiana Zhehlinska ****
Alona Komziuk *****
Abstract
The purpose of the article was to highlight the essence and
specic features of the transformation of the Ukrainian state
policy in the health sector during the development of martial law.
The methodological basis of this research grouped a set of general
and special scientic methods of scientic cognition (deductive,
comparative and legal, comparative, systems analysis method, formal
and logical method, etc.). Everything indicates that, the destabilizing
factors aecting the state policy include the reaction to the armed
aggression of another state and the subsequent introduction of martial
law. The authors have emphasized the regulatory legal acts of the national
legislation of Ukraine, which establish the principles for the formation and
implementation of state policy in the health sector. Specic features of the
transformation of state policy in the health sector during martial law have
been identied and revealed. It has been concluded that the state policy
in the health sector is characterized by a dual nature, which consists in
its stability, on the one hand, and at the same time, wide adaptability to
changes and needs caused by martial law.
Keywords:
martial law; state policy; health system; right to health;
specicities and duality.
* PhD in Law, judge of the Pecherskyi District Court of Kyiv, Kyiv, Ukraine. ORCID ID: https://orcid.
org/0000-0001-9798-201X
** Doctor in Law, Professor, Leading Researcher, Head of the Department of Private Law Educational and
Scientic Institute of Law State Tax University, Irpin, Ukraine. ORCID ID: https://orcid.org/0000-
0002-7030-2456
*** Doctor in Law, Professor of the Department of Civil Law and process of Dnipropetrovsk State
University of Internal Affairs, Dnipro, Ukraine. ORCID ID: https://orcid.org/0000-0001-5940-
**** Senior lecturer of the Department of Theory and History of State and Law Dnipropetrovsk State
University of Internal Aairs, Dnipro, Ukraine. ORCID ID: https://orcid.org/0000-0001-7707-2561
***** PhD in Law, Lecturer of the Department of Administrative Law and Process of Kharkiv National
University of Internal Aairs, Kharkiv, Ukraine. ORCID ID: http://orcid.org/0000-0002-2615-103X
-1878
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CUESTIONES POLÍTICAS
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Transformación de la política de Estado de Ucrania en
el sector de la salud durante la ley marcial
Resumen
El propósito del artículo fue resaltar la esencia y las características
especícas de la transformación de la política estatal de Ucrania en el sector
de la salud durante el desarrollo de la ley marcial. La base metodológica
de esta investigación agrupo un conjunto de métodos cientícos generales
y especiales de cognición cientíca (deductivo, comparativo y legal,
comparativo, método de análisis de sistemas, método formal y lógico, etc.).
Todo indica que, los factores desestabilizadores que afectan la política
estatal incluyen la reacción a la agresión armada de otro Estado y la
posterior introducción de la ley marcial. Los autores han hecho hincapié en
los actos jurídicos reglamentarios de la legislación nacional de Ucrania, que
establecen los principios para la formación e implementación de la política
estatal en el sector de la salud. Se han identicado y revelado características
especícas de la transformación de la política estatal en el sector de la
salud durante la ley marcial. Se ha concluido que la política de Estado en
el sector salud se caracteriza por una doble naturaleza, que consiste en su
estabilidad, por un lado, y al mismo tiempo, amplia adaptabilidad a los
cambios y necesidades ocasionados por la ley marcial.
Palabras clave: ley marcial; política de Estado; sistema de salud;
derecho a la salud; especicidades y dualidad.
Introduction
Eective state policy in the healthcare sector is the basis for the stable
functioning of the health care system of any country in the world. At
the same time, the proper state of health of the population has a direct
relationship to the economic potential, defense capability, level of cultural
and social well-being and other important components, which inuence on
the successful development of the state.
The formation and implementation of the state policy in the healthcare
sector requires both legal and organizational inuence on social relations,
and timely response to internal and external factors. Such factors can have
both positive and negative content, because their action can contribute to
the improvement (electronic governance, increased funding, optimization,
etc.) or destabilization (state of emergency, martial law, nancial crisis,
etc.) of a certain system.
The action of negative factors may often be combined, which can lead
to greater destabilization of a certain system. For example, the level of
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Olesia Batryn, Iryna Chekhovska, Natalia Uvarova, Tatiana Zhehlinska y Alona Komziuk
Transformation of the State policy of Ukraine in the healthcare sector during martial law
corruption risks may increase during simplied public procurement in
the context of counteracting the spread of COVID-19 (Teremetskyi et al.,
2021; Lohvynenko et al., 2022; Knysh and Yakymets, 2022). The ability of
the state policy to timely transform and implement the necessary changes
into the national health care system becomes extremely important under
such circumstances. It becomes possible due to the timely response of
national governments to the changing conditions, challenges and threats
accompanying the healthcare sector.
Based on the above, the study of the transformation of the state policy
of Ukraine in the healthcare sector will be carried out in the context of the
introduction and operation of a special legal regime of the martial law.
1. Methodology of the study
The scientic and theoretical basis of the research was the works of
specialists focused on the legal, managerial, organizational, medical-
social and military aspects of the formation of the state policy and the
implementation of public administration in the healthcare sector. The
informational and regulatory basis of the work consists of acts of national
law that regulate relations in the healthcare sector within the normal
period and under emergency conditions (martial law), political and legal
journalism, scientic and journalistic works on public administration, open
sources of documentary information, ocial registers and databases in the
Internet.
The choice of the research methods is determined by the purpose,
objectives and subject matter of the scientic article. The process of
scientic search conditioned the mutual application of general scientic
and special methods of scientic research. The indicated approach made it
possible to form scientically based conclusions.
Thus, the deductive method assisted to form the idea of the general
principles of the state policy in the healthcare sector on the basis of the
analysis of certain components and the dynamics of their changes in a
particular period. The comparative and legal method made it possible to
reveal specic features of legal regulation of the healthcare sector at the
international and national levels. The comparative method contributed to
determine the main components of the state policy in the healthcare sector
in certain countries.
The application of the system analysis method made it possible to
identify the main components of the state policy in the healthcare sector,
which cause the need for its transformation during the martial law. The
formal and logical method has been used to determine the perspectives
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for improving the implementation of the state policy of Ukraine in the
healthcare sector in a special period.
2. Results and Discussion
The sustainable development of any state is related to the successful
formation and implementation of the state policy. Conventionally, it can
be imagined as a certain cyclical process: a) formation of development
perspectives; b) creation of a regulatory framework; c) organizational
guaranteeing for implemented changes on the basis of adopted acts; d)
assessment of results and formation of perspectives for the future. After
that, everything starts again.
The healthcare sector in Ukraine is no exception. The inconsistency and
unsystematic nature of the state policy is characteristic for this area, which
was repeatedly emphasized by experts in the medical and legal eld. Real
reforms in the healthcare sector of Ukraine started very late. Those reforms
are characterized by insucient systematicity and continuity, as well as the
absence of an approved reform strategy that takes into account existing and
potential risks while implementing transformations (Lehan et al., 2018).
At the same time, the protection of citizens’ medical rights requires more
eective tools, especially in emergency situations, when rights become
more vulnerable (Teremetskyi and Muliar, 2020).
National legislation is regulatory legal basis for the formation and
implementation of the state policy of Ukraine in the healthcare sector.
First of all, it is the Constitution of Ukraine, which refers denition of
the principles of domestic and foreign policy, the implementation of
the state’s strategic course to acquire full membership of Ukraine in the
European Union and the North Atlantic Treaty Organization to the powers
of the Verkhovna Rada of Ukraine (c. 5 of the Art. 85 of the Constitution of
Ukraine).
Besides, the Cabinet of Ministers of Ukraine ensures the implementation
of the strategic course of the state for the acquisition of Ukraine’s full
membership in the European Union and the North Atlantic Treaty
Organization, as well as the implementation of nancial, pricing, investment
and tax policies; policies in the spheres of labor and employment of the
population, social protection, education, science and culture, nature
protection, environmental safety and nature management (c. 11 and c. 3 of
the Art. 116 of the Constitution of Ukraine).
The constitutional provisions on the formation and implementation
of the state policy of Ukraine in the healthcare sector are detailed in the
Fundamentals of the legislation of Ukraine on health care. They refer to
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Olesia Batryn, Iryna Chekhovska, Natalia Uvarova, Tatiana Zhehlinska y Alona Komziuk
Transformation of the State policy of Ukraine in the healthcare sector during martial law
such a priority area of state activity as health care, the formation of the state
health care policy, the implementation of the state health care policy, the
system of standards in the healthcare sector and health care agencies (the
Articles 12-15, Commentary on the Law “Fundamentals of the legislation of
Ukraine on healthcare”, 2021).
As it has been already mentioned, the state policy in the healthcare
sector can be transformed under the inuence of external factors. The latter
include the declaration of a state of emergency related to the COVID-19
pandemic (Teremetskyi and Duliba, 2020) or counteraction to the armed
aggression of another state and implementation of the martial law in this
regard.
The martial law is a special legal regime. It is introduced in Ukraine or
on some of its territories in case of any armed aggression or threat of attack,
danger to the state independence of Ukraine, its territorial integrity. The
martial law provides for the granting to the relevant public administration
entities of the powers necessary to avert the threat, to repulse armed
aggression and to ensure national security, to eliminate the threat of danger
to the state independence of Ukraine, its territorial integrity.
Temporary restriction of the constitutional rights and freedoms of a
person and a citizen, as well as the rights and legal interests of legal entities
with the indication of the period of validity of these restrictions is allowed
during the martial law due to the threat (Law of Ukraine “On the legal
regime of the martial law”, 2015).
As we know, the Constitution of Ukraine prohibits to restrict the rights
and freedoms provided in the Articles 24, 25, 27, 28, 29, 40, 47, 51, 52, 55,
56, 57, 58, 59, 60, 61, 62, 63 (the Art. 64 of the Constitution of Ukraine, 1996)
even in terms of the martial law. However, certain temporary restrictions
may be imposed on the exercise of other rights and freedoms, in particular
the right to health care.
In our opinion, the transformation of Ukraine’s state policy in the
healthcare sector during the martial law should take place taking into
account the following features: 1) changes in strategic documentation, as
well as amendments to the national legislation within the researched eld;
2) greater attention to vulnerable population groups (children, persons
with special needs, persons of the third age, internally displaced persons,
etc.); 3) strengthening military-civilian cooperation on medical issues; 4)
consolidation of health care standards under emergency conditions; 5)
search for perspectives in order to improve the national health care system.
Considering each of the singled-out features in details, we note that
regulatory legal framework that enshrines the right to health care is
undergoing changes. Assistance in realizing the right to health care in
emergency situations is the key aspect to such changes. It is related both to
specic legislation in the healthcare sector and strategic documents.
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It is not necessary to have a declaration for internally displaced persons
during the martial law, it is allowed to refer to primary care physicians –
pediatricians, therapists and family doctors, as well as narrow specialists
(Ministry of Health of Ukraine, 2022). The functional subsystem of medical
protection has been brought into readiness to perform assigned tasks in a
special period, and the implementation of the Civil Protection Plan of the
functional subsystem of medical protection for a special period has begun.
At the same time, the degree of readiness is dened as “Full readiness”,
which was approved by the Order of the Ministry of Health of Ukraine dated
from February 25, 2022 No. 381 (Ministry of Health of Ukraine, 2022).
In turn, the Order of the Ministry of Health of Ukraine dated from March
17, 2022 No. 496 approved the requirements for improving the quality of
providing primary medical care in terms of the martial law, in particular,
vaccination in accordance with the requirements of the preventive
vaccination calendar (Ministry of Health of Ukraine, 2022).
We note legal regulation of administrative liability for violating
quarantine under the martial law. In particular, Resolution of the
Cabinet of Ministers of Ukraine dated from March 26, 2022 No. 372 “On
Amendments to the Resolution of the Cabinet of Ministers of Ukraine dated
from December 9, 2020 No. 1236” determined the specics of quarantine to
combat the coronavirus disease during the martial law in Ukraine (Cabinet
of Ministers of Ukraine, 2020).
According to the amendments made, the “green”, “yellow”, “orange”
or “red” levels of the epidemic danger of the spread of COVID-19 and the
corresponding restrictive anti-epidemic measures during the martial law
are not applied. Instead, the identied measures are related to counteracting
COVID-19 in emergency situations, primarily prevention and vaccination
(Chernetska, 2022).
As for increasing attention to vulnerable groups of population, it
primarily concerns population groups or types of health care. Regarding
population groups, the most important of them is children. A person is
formed physically, mentally and intellectually during the childhood, and
acquires all the necessary knowledge, skills and abilities. The future of the
state, its successful development and perspectives for existence in general
depend on the health of children.
Equally important is the organization of rehabilitation of victims
to the conict. Local self-government agencies and military-civilian
administrations have received wide powers and nancial opportunities in
modern conditions in order to properly resolve the issue of the realization
of human rights, in particular, regarding the medical and psychological
rehabilitation of persons, who suered as a result of the armed conict.
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Transformation of the State policy of Ukraine in the healthcare sector during martial law
Unfortunately, local initiatives for the formation of a rehabilitation
system, which would take into account the challenges associated with the
consequences of resisting the military aggression of the Russian Federation,
do not nd national recognition. In particular, ir is explained by the lack
of the unied state register of persons who have received injuries or other
harm of health from explosives, ammunition and military weapons, as well
as a corresponding state program that would make it possible to introduce
social protection measures for such persons and provide their nancing at
the regional level.
Strengthening of military-civilian cooperation in terms of the martial
law is carried out in many directions, where a prominent place among them
is occupied by the medical one. One should agree with Skrynnikova (2022)
that health care institutions function in an extremely complicated mode
providing assistance, rst of all, to military personnel.
The Verkhovna Rada of Ukraine in order to implement and properly
coordinate the work, as well as to ensure the proper treatment of military
personnel, made amendments to the Art. 11 of the Law of Ukraine “On
social and legal protection of military personnel and their family members”
(Law of Ukraine “On social and legal protection of military personnel and
their family members”, 1991). Those amendments improve the provision
of medical care to military personnel under the martial law and provide
treatment of military personnel both in military health care facilities and
in other facilities located both on the territory of Ukraine and abroad
(Skrynnikova, 2022).
In turn, Loboda and Mykhalchuk (2022) emphasize that it is the state
that forms the implementation of regulatory legal framework of health
services, the structures of the state security sector, and the civilian health
care system; it provides nancial and resource support for the needs of
the civilian population during the martial law. The Ministry of Health
of Ukraine together with the Ministry of Defense of Ukraine form and
maintain a certain number of territorial hospital bases for medical support
of the military and civilian population during the martial law.
Thus, departmental medicine was integrated into a single medical space
in terms of the martial law, as it was earlier required by the concept of
medical reform. That made it possible to implement the principle of patient-
centeredness, to ensure the possibility of receiving high-quality medical
services by all subjects of legal relations within the healthcare sector.
The above corresponds to the provisions of the Military Medical Doctrine
of Ukraine approved by the Resolution of the Cabinet of Ministers of Ukraine
dated from October 31, 2018 No. 910 (Cabinet of Ministers of Ukraine,
2018). The Doctrine denes the ways for forming and implementing unied
approaches to preserving and strengthening the health of servicemen,
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providing medical assistance, their treatment and rehabilitation, as well
as combining the capabilities and eorts of military medical services and
civilian healthcare to form the unied medical space, improve material and
technical equipment of medical facilities.
Health care standards during the martial law also need to be reviewed
and optimized. Accordingly, the national standards and basic principles,
which should be the basis for the realization of the right to health care, must
be the fundamentals of the state policy in the researched area. For example,
it is applied to the standard of emergency medical care: “Medical triage
during mass admission of victims at the early hospital stage”.
At the same time, temporary measures are important, in particular
regarding the readiness of health care institutions to provide medical
assistance to victims of Russia’s military aggression against Ukraine. It
also includes the Order of the Ministry of Health of Ukraine dated from
March 10, 2022 No. 458, which approved the Minimum requirements for
ensuring the sanitary and epidemic well-being of the population during the
emergency arrangement of places of temporary stay for persons who are
forced to leave their places of permanent residence because of the military
aggression of the Russian Federation (Ministry of Health of Ukraine,
2022). The specied changes at the sub statutory level make it possible to
optimize the state’s eorts to implement the state policy in the healthcare
sector during the emergency period, to guarantee citizens the realization of
the constitutional right to health care.
Transferring to the perspectives for improving the national health care
system, we can point to the active participation of international partners
in this process. It is related to the de-occupation and reintegration of
the temporarily occupied territories of Ukraine, the restoration of the
functioning of public administration agencies on such territories, as well as
the proper guarantee of human and civil rights and freedoms.
The principles for restoration and transformation of the health care
system in Ukraine suggested by the WHO European Regional Oce can be
cited in this case. The position of international experts takes into account
the strategic directions of the post-war recovery of the health care system in
the short- and long-term perspective, simultaneously with the continuation
of the provision of basic services in the healthcare sector during the ongoing
hostilities. The suggested principles can be used as criteria for evaluating
potential investments into measures to ensure the provision of qualitative
individual and public health services, but not just to rebuild what was
destroyed during the war.
Those principles are dened as: 1) orientation for human beings; 2)
equality and nancial protection; 3) resilience (stress resistance); 4)
eciency and stability; 5) accountability. It is believed that the application
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Olesia Batryn, Iryna Chekhovska, Natalia Uvarova, Tatiana Zhehlinska y Alona Komziuk
Transformation of the State policy of Ukraine in the healthcare sector during martial law
of the above principles within the framework of the recovery strategy will
make it possible to align the investments and priorities of the post-war
policy with the main directions of the health care reform in Ukraine, in
particular, in relation to the requirements for joining the European Union
and accelerating the transformation of the national health care system
(World Health Organization. Regional Oce for Europe, 2022).
Approach by Zhovnirchyk et al. (2022) who suggest to use the positive
experience of other states in solving the urgent problem of transforming the
health care system is also very interesting. In their opinion, the health care
of military personnel and the civilian population during the martial law
does not meet the current domestic requirements regarding the guaranteed
volume and quality of medical care, treatment and rehabilitation. Besides,
scholars indicate the need to develop a military health care system.
We do not share the point of view regarding the development of the
departmental health care system in the Armed Forces of Ukraine. On
the contrary, in view of the treatment of a signicant number of military
personnel in health care institutions of various levels of subordination
and institutional aliation, the target-oriented improvement of the
qualications of medical employees is more perspective. It will preserve the
unity of the medical space, as well as to ensure the proper level of medical
services provision by qualied specialists.
We also emphasize the project of the Recovery Plan of Ukraine based
on the materials of the “Health Care” working group. The main goal for
the implementation of the Recovery Plan in the healthcare sector is the
restoration and development of the health care system with new quality
and availability of services to meet the needs of citizens. In order to realize
this goal, the Plan provides a number of measures, in particular:
1. strengthening the management of the process for restoring the
health care system;
2. ensuring the nancial stability of the health care system;
3. restoration and transformation of the network of health care
facilities;
4. strengthening medical services to meet the special needs of people
caused by war;
5. strengthening and increasing personnel resources;
6. strengthening the public health system and readiness to emergency
situations;
7. development of electronic health care and strengthening cyber
security;
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8. strengthening the quality management system at the national and
local levels;
9. restoring the pharmaceutical sector, improving access and proper
use of medicinal products (National Council for the Recovery of
Ukraine from the War, 2022).
While supporting the vectors oered by the project for reforming the
health care system of Ukraine in the post-war period, it should be emphasized
that the conceptual principles should be developed and consolidated in the
current legal acts.
The transformation of the state policy in the healthcare sector during
the martial law surely requires a balanced approach. Some components
of such a policy remain static (priority of preventive medicine, standards
and programs of medical care, unied medical space, patient-centeredness,
equality of medical care). At the same time, other components have a variable
nature (psychiatric and psychological care, rehabilitation, quarantine
restrictions, radiological safety measures, sanitary-epidemiological norms
and rules, etc.).
Considering the above, it can be concluded that the state policy in the
healthcare sector is characterized by a dual nature, which consists of its
resistance to destabilizing factors, and at the same time, wide adaptability
to changes and needs associated with the operation of a special legal regime
of the martial law.
Conclusion
The authors of the article have analyzed the transformation of the state
policy of Ukraine in the healthcare sector during the operation of the special
legal regime of the martial law. It has been found out that the ability of
the state policy to timely transform and implement the necessary changes
into the national health care system becomes possible due to the timely
response of national governments to the changing conditions, challenges
and threats accompanying the healthcare sector.
It has been emphasized that the sustainable development of any state
is related to the successful formation and implementation of the state
policy that can be imagined as a certain cyclical process: a) formation
of development perspectives; b) creation of a regulatory framework;
c) organizational guaranteeing for implemented changes on the basis
of adopted acts; d) assessment of the results and formation of future
perspectives.
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Olesia Batryn, Iryna Chekhovska, Natalia Uvarova, Tatiana Zhehlinska y Alona Komziuk
Transformation of the State policy of Ukraine in the healthcare sector during martial law
It has been concluded that the transformation of the state policy of
Ukraine in the healthcare sector during the martial law should take place
taking into account the following specic features: 1) changes in strategic
documentation, as well as national legislation within the researched eld;
2) greater attention to vulnerable population groups (children, persons
with special needs, persons of the third age, internally displaced persons,
etc.); 3) strengthening military-civilian cooperation on medical issues; 4)
consolidation of health care standards under emergency conditions; 5)
search for perspectives to improve the national health care system.
Certain components of the state policy remain static (priority of
preventive medicine, standards and programs of medical care, single
medical space, patient-centeredness, equality of medical care). Other
components are variable (psychiatric and psychological assistance,
rehabilitation, quarantine restrictions, radiological safety measures,
sanitary-epidemiological norms and rules, etc.). Thus, the state policy in
the healthcare sector is characterized by a dual nature, which consists in its
resistance to destabilizing factors and, at the same time, wide adaptability
to changes and needs in terms of the martial law.
Bibliographic References
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approval of the Military Medical Doctrine of Ukraine”. Available online.
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medichnoyi-doktrini-ukrayini. Consultation date: 13/02/2023.
CABINET OF MINISTERS OF UKRAINE. 2020. Resolution No. 372. “On
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Esta revista fue editada en formato digital y publicada
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