1. September 2022 White Paper: Cancer Care System in Ukraine: Current Status, Impact of War, Further Development |
Cancer Care System Evolution 1/4
2002-2006
Oncology National Program
The state National Program
“Oncology 2002-2006” (Program-
2006) created a standalone strategy
vision for developing oncology
service in Ukraine for 6 years in
conjunction with a separate
development road map of the entire
HC system of Ukraine.
The initial aim was to increase
prevention, early detection, and
treatment rates of oncological
diseases and reduce cancer
mortality and disability rates.
Expected Deliverables
▪ Elaboration of a legal
framework and social and
economic regulations to fight
against cancer;
▪ Timely and early diagnosis of
oncology disease;
▪ Monitoring of the population's
incidence;
▪ Identifying needs and priorities
in the organization of oncology
care for the population based
on the level, dynamics, and
structure of oncological
morbidity.
Regulatory base
▪ National Program “Oncology”
2002-2006 (1)
▪ The MOH and AMSU Order
#211/47 (2)
Budget
Under the Program-2006, the state
budget covered the centralized
procurement of medicines for
patients with oncology and medical
equipment, whereas local budgets
were dispensed for other measures
envisaged by the Program-2006.
The planned budget for public
purchases under the Program-2006
for 2002-2006 constituted EUR 119
mln and the actual expenditure
reached EUR 77 mln(3).
There is no consolidated data on
expenditures from local budgets.
Execution
The Program-2006 execution, to a
greater extent, was assigned to local
authorities and budgets, too.
Besides, the Program-2006
envisaged branches of measures
attributed to each year to reach
target indicators. Local state
authorities and governments of each
region were responsible for
implementing approved measures
within their administrative jurisdiction
using regional resources and
monitoring intermediate
performance by the oncology clinics
and dispensaries.
However, there is a lack of
consolidated analytical information
on program implementation in
regions.
In terms of indicators, in 2005, the
MOH endorsed Order under which
almost 7.8 mln 18+ yo women were
tested for cervical cancer. Alongside,
patients underwent screenings for
breast, rectal and lung cancers.(4)
Outcomes
▪ In 2017, after implementing the
Program-2006, the MOH, for
the first time, approved 38
national clinical guidelines for
various malignant neoplasms(5).
▪ Under the centralized
procurements in 2003-2005,
oncology hospitals and
dispensaries received 18
machines for RT, 1 LINAC, 8 CTs,
31 mammographs, 2 MRIs, 29
ultrasound machines.
While the other post-communist countries undertook an effort to meet these expectations, the Ukrainian health system remained in
virtually unchanged form throughout the entire period after the collapse of the Soviet Union. Any changes that were applied, were actually
apparent and inferior, including when talking about the Ukrainian cancer care system.
Sources: (1) CMU Resolution "On Approval of the State Program "Oncology" for 2002-2006"; (2) MOH/AMSU Order #1/2 “On Approval of the Measures of the Ministry of Health of Ukraine and the AMS of Ukraine regarding the implementation of the State Program "Oncology" for
2002-2006; (3) National Program “Oncology 2002-2006”—2005 Results and Directions for Further Development of Oncology Care for the Population“; (4) MOH Order #677 “On Approval of the Branch Program on Cervical Cancer Screening,” (5) MOH Order #554 “On Approval of
Protocols for the Provision of Medical Care in the “Oncology“ Specialty”; (6) CMU Resolution #983 “On Approval of the State Program on Children’s Oncology in 2006-2010”
15
2006-2010 Pediatric
Oncology State Program
This Program-2010 was the first
document ever to herald the
division of cancer care system in
Ukraine in two branches—children
oncology and adult oncology.
Since then, adult and children
oncology systems have different
budgets, different tariffs paid for
provided services and different
network of HC providers.
The separate budget for children
oncology was allocated only in
State Budget 2008. Previously, in
2006, the budgets for
pharmaceuticals for children with
oncology were set aside by the
local HC authorities having faced
the lack of funds in local budgets in
mostly all regions of Ukraine and
disability to purchase the needed
number of medicines.
Expected Deliverables
▪ Elaboration of the regulatory
framework and clinical
guidelines in terms of the
treatment of children with
malignant neoplasms;
▪ Promotion of early diagnosis,
and timely treatment of
children oncology in PHC
institutions;
▪ Creation of specialized
diagnostic centers to provide
radiation, morphological and
genetic diagnosis of malignant
neoplasms;
▪ Improvement of the system of
state registration of children
with oncological diseases.
Regulatory base
▪ CMU Resolution #983 “On
Approval of the State Program
on Children’s Oncology in
2006-2010”.(6)
Budget
The total planned cost of the
Program for 5 years was set to EUR
52.3 mln (UAH 350 mln):
Most of the funds were set aside for
the centralized procurements of
medicines (immunosuppressivs,
chemo drugs, consumables used
for diagnostics), medical devices,
and medical equipment.
Purchases of pharmaceuticals were
estimated to be EUR 5.8 mln (79%),
and medical equipment—EUR 1.6
mln (21,3% of the total respectively).
Execution
In 2006, local HC authorities
became responsible for executing
the Program using the available
budget, which resulted in
considerable underfunding. Only at
the end of 2007 the State Budget
for 2008 included a separate
funding article for children’s
oncology. Consequently, the full-
fledged execution of the Program
started in 2008 from the detailed
and coherent articles in the State
Budget 2008.
The program considerably focused
on procuring pharmaceuticals for
kids suffering from oncohematology
conditions.
In turn, the patients were provided
with various kits for replacing
leukocytes, peripheral stem cells
and therapeutic plasma substitutes,
systems for leuko- and
thrombocytopheresis, and filters for
cleaning fluids (SQ40SKLE,
RC1VAE) and gases (BB25Y) used
in oncohematology.
4.5
10.0 11.5
13.6 15.7
2006 2007 2008 2009 2010
EUR, mln

2. September 2022 White Paper: Cancer Care System in Ukraine: Current Status, Impact of War, Further Development |
Cancer Care System Evolution 2/4
In contrast, at that time, the “Adult Oncology” program
did not contain any items to treat oncohematology
disease but predominantly chemotherapy drugs.
89%-92% of all procured products under the Program
were of foreign origin.
Outcomes
▪ Approval of clinical guidelines for the treatment of
malignant neoplasms in children;
▪ Established two levels of oncology medical care
delivery in Ukraine—adult and children, which
determined the further development of the oncology
care system nowadays;
▪ Focus on providing oncology medical care to
children with oncohematology diseases, which are
severe and place a substantial financial burden on
the patient's family.
2010-2016 Oncology National Program
This Program-2016 was bound to have been approved in
2007 after the termination of the Program-2006 yet, due
to the socio-political perturbations, it was endorsed only
at the end of 2009.
During 2007-2009, without the state program, the
financing was tiny, sporadic, and of far priority.
Expected Deliverables
▪ Improvement of the system of primary and
secondary prevention of oncological diseases and
early detection of cancer;
▪ Enhancement of methods of diagnosis of malignant
neoplasms and special treatment of cancer patients;
▪ Promote the palliative care system for cancer
patients;
▪ Increase the availability of medical care for cancer
patients and recovery rate;
▪ Reduce the mortality rate of cancer patients who die
within a year after diagnosis and mortality from
malignant neoplasms of some localizations (breast,
cervix, prostate gland).
Regulatory base
▪ The Law of Ukraine “On Approval of the National
Program to Combat with Oncological Diseases up to
2016” (1)
Budget
According to the Law, the total cost of the Program for 8
years amounted to EUR 346 mln:
The ratio between the state budget and local funds for 8
years was estimated to be 15.9%, meaning fixing the
direct responsibility of local governments for funding at a
determined rate for the first time.
Traditionally, most of the funds were set aside for the
centralized procurements of medicines
(immunosuppressive drugs, chemotherapy drugs,
consumables used for diagnostics), medical devices,
medical equipment, and scientific development of the
NCI.
However, in reality, the measures under the Program-2016
received only EUR 2 mln which is only 15.2% of the total
sum allocated. Therefore, it may be claimed that the
execution of the Program-2016 was enormously restricted
by the funding. Likewise, it reached limited results with
this budget volume.
Execution
In 2014, the government issued the CMU’s Resolution "On
Saving State Funds and Preventing Budget Losses" #65
dated 01.03.2014, introducing a moratorium on the
financing and amending of current programs and
restrictions on targeted ones, with a ban on the design of
new state programs.
It had enormously complicated the Program’s-2016
execution in terms of pharmaceutical provision to patients
with cancer and questioned the achievement of the
overseen goals.
Consequently, considering 2016 as a reference year to
estimate the success of the Program-2016, 30–75% of
patients with various localizations of cancer did not
receive special treatment in 2016, which, of course,
affected the mortality and survival rates of patients.
Besides, the financing of the medical services delivered to
the patients with oncology were not the subject of the
discussed Program-2016, so we may undoubtedly assume
that the rates of provided medical care did not meet the
modern requirements and real needs.
Outcomes
Overall, the Program-2016 showed limited success and
effectiveness, failing to reach the overseen goals by
having low indicators of prioritized deliverables (neglect
of disease, level of detection of I-II stages of breast and
cervical cancers, provision of specialized medical care for
cancer patients).(2)
2006-2010 Children’s Oncology State Program launched the first ever child-centred separated state program, which full-fledged
execution was postponed to 2008. 2010-2016 Oncology National Program faced a considerable funding reduction.
Sources: (1) The Law of Ukraine “On Approval of the National Program to Combat with Oncological Diseases up to 2016” #1794-VI dated 23.12.2009; (2)
16
21 25
30
36
44
52
63
75
2009 2010 2011 2012 2013 2014 2015 2016
EUR, mln
Rates
Indicator 2009 2016 Outcome
Rate of neglected cancer cases 14.9% 16.7% + 1.8%
Shares of diagnosed cancer at I-
II stages
51.0% 53.4% + 2.4%
Shares of diagnosed breast
cancer at I-II stages
75.5% 75.8% + 0.3%
Shares of diagnosed cervical
cancer at I-II stages
80.3% 77.0% + 3.3%
Mortality rate from malignant
neoplasms
(per 10 ths. people)
173.8 166.6 - 4.2%
Mortality rate of cancer patients
who die within one year after
diagnosis
34.5% 30.5% - 4.0%
Provision of specialized medical
care for cancer patients
66.7% 68.0% + 1.3%
Table 1. 2010-2016 Oncology National Program
Outcomes (according to official sources)

3. September 2022 White Paper: Cancer Care System in Ukraine: Current Status, Impact of War, Further Development |
Cancer Care System Evolution 3/4
National Cancer Control
Strategy 2030 (Strategy-2030)
Elaborated at the beginning of fall
2021, the draft resolution of CMU
had not been officially approved by
the government since the war in
Ukraine started. Protracted public
discussion and lack of political will
resulted in putting the Strategy into
the air until it had become in acute
need of reconsideration due to the
active hostilities in the country.
Unfortunately, the long-term vision
of oncology system development
created by hard work and good
coordination between the
stakeholders went awry. However,
we believe the Strategy will be
adjusted, updated, and signed as
soon as Russia is defeated and
withdraw from Ukraine completely.
Nevertheless, the good news is the
successful implementation of
oncology packages under the
national benefits package—the
Medical Guarantees Program,
which will stimulate the
development of oncology medical
care anyway.
Planned Deliverables
▪ Inform target groups about
the need to undergo
preventive medical
examinations and the risk
factors;
▪ Promote early diagnosis and
timely treatment of oncology
diseases;
▪ Provide coordinated and high-
quality medical services for
the diagnosis and treatment of
cancer diseases;
▪ Establish a capable and
coordinated system of
diagnosis and treatment of
malignant neoplasms in
children based on a
multidisciplinary approach,
with the achievement of a 5-
year overall survival rate of
children of at least 80%;
▪ Provide qualified
psychological and palliative
care;
▪ Ensure data collection and
analysis, timely obtaining of
high-quality and reliable data
for decision-making, and
improving treatment tactics;
▪ Recruit enough specialists
necessary to provide high-
quality oncology medical care
to patients.
Regulatory base
▪ The Draft CMU Resolution "On
Certain Issues of the National
Strategy for the
Implementation of Cancer
Control Until 2030" (1)
▪ The Operational Plan
Supplemented to the National
Cancer Control Strategy (2)
Detailed Measures
▪ Possible inclusion of HPV
vaccination to the National
Vaccination Calendar;
▪ Various public health
programs to tackle smoking,
lousy nutrition, and sedentary
lifestyle;
▪ Procurement of 20 LINACs to
regions and other medical
equipment for RT;
▪ Elaboration of new screening
programs with alternative
methods referred to the
prevention of colorectal,
breast, and cervical cancer;
▪ Update the clinical guidelines
in the area of diagnostics and
treatment of oncological
diseases;
▪ Implement MEAs for
procurement of high-priced
medicines against cancer.
Budget
Not set
National Cancer Control Strategy was a long-awaited strategic policy since the completion of the previous one in 2016. After a lasting
period of negotiation and alignment, the Strategy was a couple of steps from approval, yet the war had started.
Sources: (1) Draft CMU Resolution "On Certain Issues of the National Strategy for the Implementation of Cancer Control Until 2030“; (2) The Operational Plan Supplemented to the National Cancer Control Strategy
17
Ministry of
Health
National Cancer
Control Strategy
2030
Figure 14. Stakeholders Actively Involved in Development, Public Discussion, and Advocacy of the National
Cancer Control Strategy 2030
Parliament Healthcare
Sub-Committee On
Cancer Care
Patient
Organizations &
Advocacy Groups
Professional
Oncology
Associations
Business
Community and
Industry Experts Adult Cancer
Care Givers
Pediatric Cancer
Care Givers
National Health
Service of Ukraine
State Service of Ukraine on
Medicines & Drugs Control “Medical Procurement Of
Ukraine” SE
National Cancer
Institute
World Health
Organization experts

4. September 2022 White Paper: Cancer Care System in Ukraine: Current Status, Impact of War, Further Development |
Cancer Care System Evolution 4/4
The Ukrainian cancer care system evolved very slowly, without the government's significant public interest or strategic focus until 2015-16.
Only at that time did real and practical plans for reforming the health care system begin to mature, when public interest in participating in
restructuring state functions and institutions increased significantly.
Sources: 1) “Ukrainian health care system and its chances for successful transition from Soviet legacies”,—https://doi.org/10.1186/s12992-018-0439-5; 2) Law of UKR "On State Financial Guarantees of Medical Services For The Population“. Notes: The 2002-2019 data was calculated
based on the official State Budget Execution laws of Ukraine using official National Bank of Ukraine average period UAH/EUR rates.; Data for the 2020-2022 was derived from the NHSU website
18
“Oncology 2002-2006”
State Program
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
2001
22.8
2023 2024 2030
…
Planned Execution
Cancer care medical guarantees package
added by the NHSU for the 1st time
Medical Procurement of Ukraine started
acting as the main state procurer
“National Cancer Control Strategy 2030”
State Program operational plan
Drafting
Endorsement of national benefits package consisting
of basic medical care packages
All hospitals can sign
Agreements with the
NHSU and
declarations with
HCPs
Draft of the
National
Strategy on
Health Reform
1996—Creation of the National
Cancer Register and
introduction of automatization
of cancer accounting.
Separation of
adult and
pediatric
oncology
Pediatric
oncology
system
received its first
budget
Palliative care becomes one of the
priorities as a part of the state Program
Local budgets became partly
responsible for funding the
oncology needs.
Planned period Program extension
“Oncology 2010-2016”
State Program
Program period
“Pediatric Oncology
2006-2010” State Program
Program period
The CMU
approves the
Concept of
Reforming of
the Health
Care
Financing
6 national screening programs were added in
the Medical Guarantees Package by NHSU
Managed entry agreements became an acting
instrument to procure innovative oncology drugs
Medical cannabis
law was voted
19.0
EUR
mln
24.5 25.2 24.5
35.7
40.2
26.8
31.7
33.4
38.3
44.5
35.1
26.0 25.1
45.6
66.0 67.4
80.8
33.2
68.8
Figure 13. State Procurement of Cancer-
Related Drugs and Medical Devices
Source: Eirhub

5. September 2022 White Paper: Cancer Care System in Ukraine: Current Status, Impact of War, Further Development |
Current System Status & National Cancer Control Strategy 2030 (draft)
Notes: *2021 data. SOURCES: DIRAC; National Cancer Register of Ukraine; Ministry of health of Ukraine; Interviews with experts;
19
Current Cancer
Care System Status*
Infrastructure / Adults
Ministry of Health of Ukraine
40 BT machines
33 LINACs
26 oncology dispensaries
(regional/city/district cancer
centers)
25 children specialized
oncology dispensaries
4 PET/CT machines
Infrastructure / Pediatric
Scientific research medical
centers
2 scientific research medical
centers (“Ohmatdyt”)
Resources / Total
1,709 Oncologists, adults
74 Co60/Ir192 machines
457 out-patient oncology
departments
34 Oncologists, children
3 children city oncology
hospitals
3,392 Endoscopes
44 Radiotherapy centers
Epidemiology
High oncology morbidity compared to the EU countries
Diagnostics & Treatment
Very high mortality rates from oncology diseases
High disability rates caused by oncology diseases.
Significant psychological and budget burden on patient’s
families.
380 cases / 100.000 people—the highest rate in Europe.
+25% new cases yearly during last 10 years and continues
growing at a 2.6-3% rate yearly
women: breast, stomach, colon, rectum, ovaries, cervix
men: lungs, stomach, rectum, prostate, colon
Insufficient level of and access to early diagnostics = late
diagnoses
Lack of modern PET/CT, SCT/3D CT, LINAC
Old and technologically outdated Co60/Ir192, gamma cameras, x-
ray machines, infusion machines, monitoring equipment
Medical personnel
Lack of RTTs, Medical Physicists, Radiologists.
A significant proportion of doctors who treat by “soviet”
standards.
cancer is the 2nd frequent mortality reason
Low level of public awareness of cancer prevention
Low life quality level of patients with cancer
Education quality of physicians is often obsoleteor insufficient.
Insufficient low quality of and access to palliative care.
The level of confidence in the system is low enough.
Challenges
Decrease
morbidity
rates
Decrease
mortality
rates
Increase the quality of
oncology patients’ lives
and their families
Key Program Aims
Strategic Targets:
1. Primary prevention of oncology diseases and
precancerous conditions
2. Screening and early detection of oncology
diseases
3. Equality and continuity of access to a capable
network of health care facilities, HCPS,
diagnostics, and treatment of cancer
5. Standardization of diagnosis, treatment, and
rehabilitation of oncology patients
6. Rehabilitation, personal and palliative care for
oncology patients, and support for their
caregivers at all levels
7. Development of IT systems for cancer
registration and monitoring of oncology patients
to identify and observe trends and evaluate the
results of cancer control measures
9. Promotion of research and development
activities in oncology, followed by adopting the
results in the oncology treatment practice
8. Increasing the level of professional education of
physicians, nursing staff, and other medical
personnel
4. Adequate infrastructure for providing high-
quality, coordinated, and affordable treatment of
oncology diseases in children
(iii)
(ii)
(i)
National Cancer
Control Strategy 2030
Target Program KPIs
Decrease of mortality rates induced
by oncology diseases by 5-10%
I.
Decrease of morbidity rates induced
by oncology diseases by 5-10%
II.
Increase in five-year survival rates
for oncology patients
III.
Decrease of mortality rates in
patients during the first year after
an oncology disease is diagnosed
by 5-10%
IV.
Increase the 5-year survival rate of
children with cancer to at least 80%
V.
Development of a system of
palliative and hospice care for
oncology patients.
VI.
Expected
Results
Implementation
Financing
Responsible:
▪ Central,regional, and local authorities,
▪ Civil society (NGOs/ PAGs (control),
▪ International organizations (advice)
The Project was expected to be financed
from:
▪ State Budget,
▪ other legal sources,
▪ International organizations
Legal framework:
▪ A standalone Law “On the National
State Program to Fight Oncology
Diseases 2030” must be developed
and voted in April 2020
▪ Each Strategic Target must be
followed by a regulatory document
defining such Target KPIs per each
Target.
▪ Each year the CMU and the public
agree on the set of activities to reach
each Target.
Implementation
& Financing
National Cancer Institute
(NCI)
Other Authorities