Delivering psychiatric services in primary care: is this the right way to go for Ukraine?

Abstract

Ukraine is a newly independent state with a population of about 48 million. It inherited its national health system from the USSR. The Soviet system was conceived as part of a massively expensive socialist planning economy that was generally delivering poor value for money. Some aspects of the Soviet health system were, however, undoubtedly sound and certain public health measures were superior to those in the West. For example, infant mortality, despite possible underreporting, was probably lower in the USSR than in many Western countries (Anderson & Silver, 1986). The health system became increasingly corrupt and inefficient during the final years of the USSR's existence. Since independence, the health system has not been a state priority and has been chronically under-funded. In the past few years of rapid economic development in Ukraine, the share of the state budget allocated to the health system has remained static, leaving Ukraine in a disadvantaged state compared with other European countries (United Nations, 2007).

Factors Associated with Non-disclosure of HIV Status in a Cohort of Childbearing HIV-Positive Women in Ukraine

“…Healthcare providers reported lack of time and skills to conduct post-test counselling and a need for psychologists to support them in this, but none of the women who received a psychological referral had taken this up (54). This may partly reflect the fact that mental health services are widely stigmatised in Ukraine (55). Peer counselling and support groups are a potentially valuable alternative source of support for women embarking on the disclosure process, but may not be available to all women who need them or at the most relevant time, as provision is predominantly on an ad hoc basis by nongovernmental organisations and accessed by HIV-positive women after delivery (49).…”

Prevalence of depressive symptoms in pregnant and postnatal HIV-positive women in Ukraine: a cross-sectional survey

“…Adverse consequences of maternal depression for women living with HIV and their children may include a negative impact on uptake of and adherence to interventions to prevent mother-to-child transmission (PMTCT) [ 11 , 12 ] and on maternal HIV disease outcomes beyond pregnancy [ 13 , 14 ], as well as increased risk of preterm delivery [ 15 ] and of developmental and behavioural problems in the child [ 16 , 17 ]. Screening for depression is not currently part of routine perinatal or HIV care in Ukraine, and mental health services – historically delivered in secondary care – are highly stigmatised [ 18 ]. The aim of this analysis was to investigate the burden and correlates of perinatal depression among women living with HIV in Ukraine.…”