Shafranskyi V. Medico-social substantiation of the public health system in Ukraine

The dissertation presents a solution to an important scientific and practical problem of healthcare – a scientific substantiation of the public health system in Ukraine. The study systematically presents the problems of public healthcare in Ukraine and the ways of solving them have been systematically presented by means of the substantiation and development of a comprehensive system of public health based on management levels from national to local, the expediency of which has been expertly proved. In the course of the dissertation research an analysis of the international and national legislative prerequisites for the development of the public health system in Ukraine was conducted and it was established that said prerequisites exist in the country. The study also presents the dynamics and the state of health of the population of Ukraine and the sanitary and epidemiological well-being as factors of public health. Through sociological research among healthcare providers and doctors, their support for the establishment of a public health system in the country and their willingness to cooperate with the public health system have been determined: 82.6% of health care providers, 67.0±% of general practitioners, and 63.9% of the secondary and tertiary level doctors, as well as their willingness to work in the system: 39.5%, 43.4% and 41.4% respectively. By means of expert assessment, the system of Master’s degree training in the field of "Public health" has been defined, including the structure of educational discipline, the content of curriculum, the competence of public health professionals and the results of training. The importance of primary Master’s educational and scientific programme with the purpose of training public health teachers and specialists for scientific research at the level of modern international approaches has been substantiated. The system of public health in Ukraine has been substantiated and developed, based on the principle of distribution of the main organizational and special functions, organizational structure, the subjects of inter-sectoral interaction, resources, and the indicators of monitoring and evaluation, by national, regional and local management levels. The strategic course of the system is to preserve and strengthen the health of the population of the country while eliminating social inequities in field of healthcare and minimizing the negative impact of social determinants on health. The tactical course of the model is the epidemiological surveillance and assessment of the state of health and well-being of the population; monitoring and responding to health hazards in health emergencies; health protection, including environmental, labor, training, and food safety; public health promotion; disease prevention, including early detection of health disorders; communication and social mobilization in the interests of health, risk management for public health. The study proposes an algorithm for the establishment of public health system in Ukraine.