PIPES

The Distinguished Art of Smoking Tobacco

Archive for the ‘tobacciana pipes’ Category

Ukrainian Smoking

without comments

WOODEN TOBACCO SMOKING PIPE WITH LID UKRAINIAN HANDMADE
WOODEN TOBACCO SMOKING PIPE WITH LID UKRAINIAN HANDMADE
$7.53
Time Remaining: 24d 9h 7m
Buy It Now for only: $7.53

Long Hand Carved Wooden Pipe Ukrainian Tobacco Smoking Pipe
Long Hand Carved Wooden Pipe Ukrainian Tobacco Smoking Pipe
$5.99
Time Remaining: 15h 37m
Buy It Now for only: $10.99

Ukrainian Handmade Wooden Smoking TOBACCO PIPE 10
Ukrainian Handmade Wooden Smoking TOBACCO PIPE 10
$7.99
Time Remaining: 3d 8h 54m
Buy It Now for only: $7.99

Hand Carved Wooden Ukrainian Smoking Pipe Original UA
Hand Carved Wooden Ukrainian Smoking Pipe Original UA
$5.50
Time Remaining: 12d 20h 23m
Buy It Now for only: $5.50

Long Ukrainian Authors Hand Carving BIRD EAGLE Smoking Pipe + Pouch
Long Ukrainian Authors Hand Carving BIRD EAGLE Smoking Pipe + Pouch
$31.99
Time Remaining: 27d 13h 44m
Buy It Now for only: $31.99

WOODEN TOBACCO SMOKING PIPE WITH LID UKRAINIAN HANDMADE
WOODEN TOBACCO SMOKING PIPE WITH LID UKRAINIAN HANDMADE
$7.53
Time Remaining: 24d 6h 19m
Buy It Now for only: $7.53

Ukrainian Hand Carved Tobacco Smoking Long Stemmed Pipe
Ukrainian Hand Carved Tobacco Smoking Long Stemmed Pipe
$14.00
Time Remaining: 14d 1h 32m
Buy It Now for only: $14.00

Ukrainian Authors Hand Carved DRAGON Smoking Pipe 9mm filter
Ukrainian Authors Hand Carved DRAGON Smoking Pipe 9mm filter
$26.84
Time Remaining: 18d 21h 42m
Buy It Now for only: $26.84

Long Hand Carved Wooden Pipe Ukrainian Tobacco Smoking Pipe
Long Hand Carved Wooden Pipe Ukrainian Tobacco Smoking Pipe
$5.99
Time Remaining: 21h 20m
Buy It Now for only: $10.99

Hand Carved Wooden Ukrainian Tobacco Smoking Pipe + Lid HQ 59
Hand Carved Wooden Ukrainian Tobacco Smoking Pipe + Lid HQ 59
$16.99
Time Remaining: 23d 18h 11m
Buy It Now for only: $16.99

WOODEN TOBACCO SMOKING PIPE UKRAINIAN HANDMADE
WOODEN TOBACCO SMOKING PIPE UKRAINIAN HANDMADE
$6.45
Time Remaining: 7d 11h 57m
Buy It Now for only: $6.45

Ukrainian hand carved Face smoking pipe  Folk art
Ukrainian hand carved Face smoking pipe Folk art
$10.00
Time Remaining: 19d 20h 33m
Buy It Now for only: $10.00

BRIAR UKRAINIAN HAND CARVED Tobacco Smoking Pipe Pipes TIGER 3
BRIAR UKRAINIAN HAND CARVED Tobacco Smoking Pipe Pipes TIGER 3
$34.15
Time Remaining: 14d 14h 4m
Buy It Now for only: $34.15

Wooden Small Ukrainian Smoking Pipe for Cigarettes ART
Wooden Small Ukrainian Smoking Pipe for Cigarettes ART
$0.99
Time Remaining: 9d 21h 41m
Buy It Now for only: $0.99

Ukrainian Hand Carved Briar Tobacco Smoking Pipe
Ukrainian Hand Carved Briar Tobacco Smoking Pipe
$6.00
Time Remaining: 17d 25m
Buy It Now for only: $6.00

Long Hand Carved Wooden Pipe Ukrainian Tobacco Smoking Pipe
Long Hand Carved Wooden Pipe Ukrainian Tobacco Smoking Pipe
$5.99
Time Remaining: 1d 8h 44m
Buy It Now for only: $10.99

Small Smoking Pipe MINI POCKET Ukrainian Authors Hand Carved
Small Smoking Pipe MINI POCKET Ukrainian Authors Hand Carved
$12.99
Time Remaining: 25d 20h 27m
Buy It Now for only: $12.99

2 Ukrainian Carved briar Small Tobacco Smoking Pipes
2 Ukrainian Carved briar Small Tobacco Smoking Pipes
$15.00
Time Remaining: 28d 1h 44m
Buy It Now for only: $15.00

Gorgeous Ukrainian Carved Tobacco Smoking PIPE 21
Gorgeous Ukrainian Carved Tobacco Smoking PIPE 21
$59.95
Time Remaining: 18d 1h 19m
Buy It Now for only: $59.95

Ukrainian Hand Carved briar Tobacco Smoking Pipe
Ukrainian Hand Carved briar Tobacco Smoking Pipe
$13.00
Time Remaining: 16d 3h 25m
Buy It Now for only: $13.00

UKRAINIAN SMALL HANDMADE WOODEN SMOKING TOBACCO PIPE
UKRAINIAN SMALL HANDMADE WOODEN SMOKING TOBACCO PIPE
$0.99
Time Remaining: 12d 10h 55m
Buy It Now for only: $0.99

Hand Carved Wooden Ukrainian Smoking Pipe Original UA
Hand Carved Wooden Ukrainian Smoking Pipe Original UA
$4.99
Time Remaining: 12d 19h 26m
Buy It Now for only: $4.99

Long Hand Carved Wooden Pipe Ukrainian Tobacco Smoking Pipe
Long Hand Carved Wooden Pipe Ukrainian Tobacco Smoking Pipe
$5.99
Time Remaining: 2d 9h 54m
Buy It Now for only: $10.99

Hand Carved Wooden Ukrainian Smoking Pipe Original UA
Hand Carved Wooden Ukrainian Smoking Pipe Original UA
$4.99
Time Remaining: 12d 19h 32m
Buy It Now for only: $4.99

Hand Carved Wooden Ukrainian Smoking Pipe + Lid NEW
Hand Carved Wooden Ukrainian Smoking Pipe + Lid NEW
$8.99
Time Remaining: 18d 21h 17m
Buy It Now for only: $8.99

Ukrainian Hand Carved Briar Tobacco Smoking Pipe
Ukrainian Hand Carved Briar Tobacco Smoking Pipe
$6.00
Time Remaining: 7d 1h 42m
Buy It Now for only: $6.00

2 Ukrainian Carved briar Small Tobacco Smoking Pipes
2 Ukrainian Carved briar Small Tobacco Smoking Pipes
$15.00
Time Remaining: 26d 2h 7m
Buy It Now for only: $15.00

Ukrainian Handcarved briar Tobacco Smoking Pipe
Ukrainian Handcarved briar Tobacco Smoking Pipe
$18.00
Time Remaining: 2d 1h 7m
Buy It Now for only: $18.00

Ukrainian briar Carved Tobacco Smoking PIPE Moustache
Ukrainian briar Carved Tobacco Smoking PIPE Moustache
$11.00
Time Remaining: 22d 23m
Buy It Now for only: $11.00

3 Ukrainian Handmade Wooden Smoking Tobacco Pipes
3 Ukrainian Handmade Wooden Smoking Tobacco Pipes
$12.99
Time Remaining: 2d 20h 31m
Buy It Now for only: $17.99

Ukrainian Authors Hand Carved Dragon POUNCES Long Smoking Pipe
Ukrainian Authors Hand Carved Dragon POUNCES Long Smoking Pipe
$44.99
Time Remaining: 6d 3h 51m
Buy It Now for only: $44.99

Tobacco Smoking Ukrainian briar Pipe Dali
Tobacco Smoking Ukrainian briar Pipe Dali
$52.00
Time Remaining: 11d 3h 14m
Buy It Now for only: $52.00

Gorgeous High Quality Ukrainian Tobacco Smoking Pipe Chess
Gorgeous High Quality Ukrainian Tobacco Smoking Pipe Chess
$50.00
Time Remaining: 19d 51m
Buy It Now for only: $50.00

New Hand Carved Collectable Ukrainian Smoking Pipe Pipes DRAGON
New Hand Carved Collectable Ukrainian Smoking Pipe Pipes DRAGON
$46.99
Time Remaining: 29d 8h 36m
Buy It Now for only: $46.99

UNIQUE Authors Wooden Inlaid Briar Tobacco Smoking Pipe UKRAINIAN TRYSUB Nice
UNIQUE Authors Wooden Inlaid Briar Tobacco Smoking Pipe UKRAINIAN TRYSUB Nice
$31.52
Time Remaining: 19d 7h 54m
Buy It Now for only: $31.52

Ukrainian Hand Carved Briar Tobacco Smoking Pipe
Ukrainian Hand Carved Briar Tobacco Smoking Pipe
$11.00
Time Remaining: 10d 2h 20m
Buy It Now for only: $11.00

3 Ukrainian Handmade Wooden Smoking Tobacco Pipes
3 Ukrainian Handmade Wooden Smoking Tobacco Pipes
$12.99
Time Remaining: 2d 20h 32m
Buy It Now for only: $17.99

Lot 5 Wooden Ukrainian Smoking Pipes for Cigarettes ART
Lot 5 Wooden Ukrainian Smoking Pipes for Cigarettes ART
$9.99
Time Remaining: 5d 15h 49m
Buy It Now for only: $9.99

Unique Ukrainian Tobacco Smoking Pipe briar
Unique Ukrainian Tobacco Smoking Pipe briar
$47.00
Time Remaining: 21d 1h 7m
Buy It Now for only: $47.00

Ukrainian Folk Art Wooden Smoking Tobacco Pipe SNOOT
Ukrainian Folk Art Wooden Smoking Tobacco Pipe SNOOT
$11.99
Time Remaining: 16d 8h 37m
Buy It Now for only: $11.99

Long Ukrainian Authors Hand Carving DRAGON Smoking Pipe + Pouch
Long Ukrainian Authors Hand Carving DRAGON Smoking Pipe + Pouch
$31.99
Time Remaining: 6d 4h 41m
Buy It Now for only: $31.99

Hand Carved Wooden Ukrainian Smoking Pipe + Lid NEW
Hand Carved Wooden Ukrainian Smoking Pipe + Lid NEW
$8.99
Time Remaining: 18d 21h 8m
Buy It Now for only: $8.99

BRIAR UKRAINIAN HAND CARVED Smoking Pipe Pipes TIGER+GIFT
BRIAR UKRAINIAN HAND CARVED Smoking Pipe Pipes TIGER+GIFT
$46.99
Time Remaining: 12h 40m
Buy It Now for only: $46.99

Smoking Pipe CROWN fits 9mm filter Ukrainian Authors Hand Carved
Smoking Pipe CROWN fits 9mm filter Ukrainian Authors Hand Carved
$22.10
Time Remaining: 2d 23h 56m

Ukrainian Tobacco Smoking Pipe briar Mini Pitcher
Ukrainian Tobacco Smoking Pipe briar Mini Pitcher
$32.00
Time Remaining: 12d 1h 37m
Buy It Now for only: $32.00

Ukrainian Handmade Folk Art Wooden Smoking TOBACCO PIPE
Ukrainian Handmade Folk Art Wooden Smoking TOBACCO PIPE
$5.00
Time Remaining: 10d 20h 4m
Buy It Now for only: $5.00

Gorgeous Tobacco Smoking Ukrainian Pipe Snail
Gorgeous Tobacco Smoking Ukrainian Pipe Snail
$47.00
Time Remaining: 7d 20h 26m
Buy It Now for only: $47.00

Ukrainian briar Carved Tobacco Smoking PIPE Moustache
Ukrainian briar Carved Tobacco Smoking PIPE Moustache
$17.00
Time Remaining: 14d 24m
Buy It Now for only: $17.00

Ukrainian briar Carved Tobacco Smoking PIPE Moustache
Ukrainian briar Carved Tobacco Smoking PIPE Moustache
$14.00
Time Remaining: 21d 53m
Buy It Now for only: $14.00

Ukrainian briar Carved Tobacco Smoking PIPE Moustache
Ukrainian briar Carved Tobacco Smoking PIPE Moustache
$11.00
Time Remaining: 10d 18h 24m
Buy It Now for only: $11.00

Ukrainian Smoking Pipe Hand Carved Sadko
Ukrainian Smoking Pipe Hand Carved Sadko
$53.00
Time Remaining: 22d 1h 42m
Buy It Now for only: $53.00

LONG Wooden Pipe Hand Made Smoking Pipe Ukrainian Pipe
LONG Wooden Pipe Hand Made Smoking Pipe Ukrainian Pipe
$3.99
Time Remaining: 3d 10h 16m

Hand Carved Ukrainian Tobacco Smoking Pipe Stand
Hand Carved Ukrainian Tobacco Smoking Pipe Stand
$46.00
Time Remaining: 18d 2h 20m
Buy It Now for only: $46.00

Hand Carved Wooden Ukrainian Smoking Pipe Original UA
Hand Carved Wooden Ukrainian Smoking Pipe Original UA
$4.49
Time Remaining: 12d 19h 30m
Buy It Now for only: $4.49

Lot 3 Wooden Ukrainian Smoking Pipes for Cigarettes ART
Lot 3 Wooden Ukrainian Smoking Pipes for Cigarettes ART
$6.99
Time Remaining: 5d 15h 52m
Buy It Now for only: $6.99

Unique Ukrainian Tobacco Smoking Pipe Sailfish briar
Unique Ukrainian Tobacco Smoking Pipe Sailfish briar
$45.00
Time Remaining: 13d 53m
Buy It Now for only: $45.00

Ukrainian Tobacco Smoking Pipe Anchor Encrusted
Ukrainian Tobacco Smoking Pipe Anchor Encrusted
$58.00
Time Remaining: 20d 4m
Buy It Now for only: $58.00

Ukrainian High Quality Tobacco Smoking Pipe Panther
Ukrainian High Quality Tobacco Smoking Pipe Panther
$58.00
Time Remaining: 1d 56m
Buy It Now for only: $58.00

Long Hand Carved Wooden Pipe Ukrainian Tobacco Smoking Pipe
Long Hand Carved Wooden Pipe Ukrainian Tobacco Smoking Pipe
$5.99
Time Remaining: 3d 19h 49m
Buy It Now for only: $10.99

Tobacco Smoking Ukrainian briar Pipe Horn
Tobacco Smoking Ukrainian briar Pipe Horn
$34.00
Time Remaining: 8d 1h 34m
Buy It Now for only: $34.00

Unique Ukrainian Tobacco Smoking Pipe Maritime
Unique Ukrainian Tobacco Smoking Pipe Maritime
$38.00
Time Remaining: 16d 2h 4m
Buy It Now for only: $38.00

Ukrainian Handcarved briar Tobacco Smoking Pipe
Ukrainian Handcarved briar Tobacco Smoking Pipe
$9.00
Time Remaining: 8d 16h 31m
Buy It Now for only: $9.00

Gorgeous Ukrainian Tobacco Smoking Pipe briar
Gorgeous Ukrainian Tobacco Smoking Pipe briar
$45.00
Time Remaining: 14d 1h 1m
Buy It Now for only: $45.00

Ukrainian Tobacco Smoking Pipe briar Middle Pitcher
Ukrainian Tobacco Smoking Pipe briar Middle Pitcher
$38.00
Time Remaining: 13d 1h 31m
Buy It Now for only: $38.00

Gorgeous Tobacco Smoking Pipe Ukrainian Tryzub
Gorgeous Tobacco Smoking Pipe Ukrainian Tryzub
$60.00
Time Remaining: 14d 1h 47m
Buy It Now for only: $60.00

Tobacco Smoking Ukrainian Pipe Saxophone
Tobacco Smoking Ukrainian Pipe Saxophone
$39.00
Time Remaining: 4d 2h 40m

Unique Ukrainian High Quality Tobacco Smoking Pipe Cat Paw
Unique Ukrainian High Quality Tobacco Smoking Pipe Cat Paw
$70.00
Time Remaining: 25d 1h 56m
Buy It Now for only: $70.00

Unique Ukrainian Tobacco Smoking Pipe Boar
Unique Ukrainian Tobacco Smoking Pipe Boar
$70.00
Time Remaining: 12d 2h 13m
Buy It Now for only: $70.00

Unique Ukrainian Tobacco Smoking Pipe Ship
Unique Ukrainian Tobacco Smoking Pipe Ship
$70.00
Time Remaining: 6d 31m
Buy It Now for only: $70.00

Hand Carved Wooden Ukrainian Smoking Pipe for Cigarette
Hand Carved Wooden Ukrainian Smoking Pipe for Cigarette
$6.99
Time Remaining: 21d 20h 26m
Buy It Now for only: $6.99

Gorgeous Ukrainian Smoking Pipe Briar Authors Signature
Gorgeous Ukrainian Smoking Pipe Briar Authors Signature
$55.00
Time Remaining: 5d 1h 30m
Buy It Now for only: $55.00

Tobacco Smoking wooden Ukrainian Pipe Hyphen
Tobacco Smoking wooden Ukrainian Pipe Hyphen
$37.00
Time Remaining: 3d 1h 43m
Buy It Now for only: $37.00

Long Hand Carved Wooden Pipe Ukrainian Tobacco Smoking Pipe Folk Art
Long Hand Carved Wooden Pipe Ukrainian Tobacco Smoking Pipe Folk Art
$5.99
Time Remaining: 4d 20h 18m
Buy It Now for only: $10.99

Gorgeous Ukrainian Smoking Pipe Briar Authors Signature
Gorgeous Ukrainian Smoking Pipe Briar Authors Signature
$40.00
Time Remaining: 29d 59m
Buy It Now for only: $40.00

Hand Carved Wooden Ukrainian Smoking Pipe AUTHENTIC
Hand Carved Wooden Ukrainian Smoking Pipe AUTHENTIC
$12.99
Time Remaining: 7d 21h 35m
Buy It Now for only: $12.99

Gorgeous Ukrainian Tobacco Smoking High Quality Pipe
Gorgeous Ukrainian Tobacco Smoking High Quality Pipe
$40.00
Time Remaining: 18d 43m
Buy It Now for only: $40.00

Ukrainian Hand Carved Tobacco Smoking Pipe Breeze
Ukrainian Hand Carved Tobacco Smoking Pipe Breeze
$47.00
Time Remaining: 12d 1h 42m
Buy It Now for only: $47.00

Tobacco Smoking Ukrainian briar Pipe Kuban
Tobacco Smoking Ukrainian briar Pipe Kuban
$48.00
Time Remaining: 7d 2h 4m
Buy It Now for only: $48.00

Unique Ukrainian Tobacco Smoking Pipe Expression
Unique Ukrainian Tobacco Smoking Pipe Expression
$58.00
Time Remaining: 14d 1h 56m
Buy It Now for only: $58.00

Long Hand Carved Wooden Pipe Ukrainian Tobacco Smoking Pipe Folk Art
Long Hand Carved Wooden Pipe Ukrainian Tobacco Smoking Pipe Folk Art
$29.99
Time Remaining: 5d 16h 16m
Buy It Now for only: $39.99

Ukrainian briar Carved Tobacco Smoking PIPE Moustache
Ukrainian briar Carved Tobacco Smoking PIPE Moustache
$14.00
Time Remaining: 17d 21m
Buy It Now for only: $14.00

Ukrainian briar Carved Tobacco Smoking PIPE Moustache
Ukrainian briar Carved Tobacco Smoking PIPE Moustache
$14.00
Time Remaining: 14d 23h 41m
Buy It Now for only: $14.00

Unique Tobacco Smoking Pipe Ukrainian Grandmaster
Unique Tobacco Smoking Pipe Ukrainian Grandmaster
$47.00
Time Remaining: 27d 1h 16m
Buy It Now for only: $47.00

Hand Carved Ukrainian Tobacco Smoking Pipe Knightly
Hand Carved Ukrainian Tobacco Smoking Pipe Knightly
$53.00
Time Remaining: 18d 22h 50m
Buy It Now for only: $53.00

Hand Carved Wooden Ukrainian Smoking Pipe Original UA
Hand Carved Wooden Ukrainian Smoking Pipe Original UA
$14.99
Time Remaining: 3d 21h 55m
Buy It Now for only: $14.99

Gorgeous Ukrainian Smoking Pipe Briar Authors Signature
Gorgeous Ukrainian Smoking Pipe Briar Authors Signature
$40.00
Time Remaining: 5d 55m
Buy It Now for only: $40.00

Unique Ukrainian Tobacco Smoking Pipe Shell
Unique Ukrainian Tobacco Smoking Pipe Shell
$47.00
Time Remaining: 6d 2h 8m

SMOKING PIPE Ukrainian tabacciano souvenir caporal
SMOKING PIPE Ukrainian tabacciano souvenir caporal
$26.99
Time Remaining: 6d 16h 23m
Buy It Now for only: $26.99

SMOKING PIPE wooden Ukrainian gift tabacciano modern
SMOKING PIPE wooden Ukrainian gift tabacciano modern
$52.99
Time Remaining: 16d 14h
Buy It Now for only: $52.99

Ukrainian Tobacco Smoking Pipe Lion on Globe briar
Ukrainian Tobacco Smoking Pipe Lion on Globe briar
$55.00
Time Remaining: 24d 1h 25m
Buy It Now for only: $55.00

Unique Ukrainian Tobacco Smoking Pipe Bowl
Unique Ukrainian Tobacco Smoking Pipe Bowl
$45.00
Time Remaining: 25d 1m
Buy It Now for only: $45.00

Tobacco Smoking Ukrainian briar Pipe Tomahawk
Tobacco Smoking Ukrainian briar Pipe Tomahawk
$45.00
Time Remaining: 6d 29m
Buy It Now for only: $45.00

Unique Ukrainian Hand Carved Smoking Pipe Stone Belt
Unique Ukrainian Hand Carved Smoking Pipe Stone Belt
$52.00
Time Remaining: 26d 1h 53m
Buy It Now for only: $52.00

6 Ukrainian Handmade Wooden Smoking Tobacco Pipes 6 1 2
6 Ukrainian Handmade Wooden Smoking Tobacco Pipes 6 1 2
$22.99
Time Remaining: 6d 12h 33m
Buy It Now for only: $29.99

Ukrainian Authors Hand Carved DRAGON Smoking Pipe 9mm filter
Ukrainian Authors Hand Carved DRAGON Smoking Pipe 9mm filter
$21.99
Time Remaining: 6d 4h 14m
Buy It Now for only: $21.99

Ukrainian Authors Hand Carved Inlaid TIGER PANTHER Smoking Pipe
Ukrainian Authors Hand Carved Inlaid TIGER PANTHER Smoking Pipe
$31.99
Time Remaining: 7d 1h 16m
Buy It Now for only: $31.99

Ukrainian Authors Hand Carved COCKER SPANIEL DOG Smoking Pipe
Ukrainian Authors Hand Carved COCKER SPANIEL DOG Smoking Pipe
$44.99
Time Remaining: 5h 42m
Buy It Now for only: $44.99

Ukrainian Handmade Wooden Smoking TOBACCO PIPE 7
Ukrainian Handmade Wooden Smoking TOBACCO PIPE 7
$7.99
Time Remaining: 19d 17h 56m
Buy It Now for only: $7.99

Hand Carved Wooden Ukrainian Smoking Pipe Original UA
Hand Carved Wooden Ukrainian Smoking Pipe Original UA
$14.99
Time Remaining: 3d 21h 55m
Buy It Now for only: $14.99

Ukrainian Authors Inlaid Incrusted REGATTA SHIPS MARINE Smoking Pipe
Ukrainian Authors Inlaid Incrusted REGATTA SHIPS MARINE Smoking Pipe
$33.99
Time Remaining: 6d 3h 40m
Buy It Now for only: $33.99

Ukrainian Smoking
Ukrainian Smoking

Democracy Watch, 2011 - Issue 8

According to Article 49 of the Constitution of Ukraine, every citizen is entitled to free healthcare, medical treatment and medical insurance. The health care sector is run by the state and financed under respective social, economic, health and sanitary programmes, as well as preventive medicine and rehabilitation initiatives. The Constitution specifically demands that public health care be provided free of charge and that the existing network of medical establishments shall not be reduced. Under constitutional law, the state must favour and promote the development of health centres regardless of their ownership.

However, high state officials close to the President interpret these constitutional provisions in their own way. Irina Akimova, First Deputy Head of the Presidential Administration, disagrees with the current healthcare budgetary policy and believes that the reallocation of funds would help to improve medical service in Ukraine. In her view the Constitution does not directly prohibit paid medical services and the provisions on free health care restrict ability to reform.  

The authorities seem unwilling to adhere to the constitutional framework and directly violate fundamental civil rights. A number of districts within the Cherkaska, Vinnytska and other regions of Ukraine will see the closure of district hospitals in accordance with official policy. As a result a vast amount of Ukrainian citizens living in small towns will be left without emergency medical service within reachable distance. Medical staff and equipment will be lost for good making the future recovery of the hospitals virtually impossible. Another controversial decision will see a significant reduction in the patient capacity of the Ukrainian Children's Specialized Clinic for Maternity and Child Protection ("UDSB OHMATDET") situated in the centre of Kyiv.

Opposition figures attempt to rally public concern over the continued deterioration of the medical sector. Mykola Tomenko, Deputy Chairman of the Verkhovna Rada, recently exposed a covert reduction of medical establishments that has already started in Ukraine. According to Tomenko, the governing authorities attribute this to the reduction of budget available for health care in Ukraine for 2011.   

The 2011 budget sees finance for disease control reduced by 58 million UAH (10.05%) to 577 million UAH, despite the fact that Ukraine maintains the highest infection rate in Europe for tuberculosis, AIDS and cancer. Adding to the perspective, the medical bills for the annual treatment, diagnostics and health resorts of the average Rada Deputy are the equivalent to one year's health care expenses for 5,130 citizens. The new budget also increases the provision for air travel for high state officials to 189 million UAH – 30 times the total costs for treatment of the nations cancer patients and the victims of the Chernobyl accident combined. Ukraine currently allocates only 4% of its GDP to health care, compared with a 7% average in Europe.

Not surprisingly the population of Ukraine is decreasing. According to the Ministry of Economic Development and Trade the population totalled 45,778,000 people as of the 1st of January 2011 - 184.4 thousand people less than the same date in 2010.

Between 1989 and 2010, the population decreased by between10 and 30% in the majority of regions with the greatest loss in the northernmost regions.  The districts surrounding large cities have seen slower population decrease, due to migration gain. Ravil Safiulin, former Minister of Family, Youth and Sport, commented that by 2050 the population of Ukraine would drop to between 25 and 30 million people. Since gaining independence Ukraine has lost 6 million citizens (1989 - the population was 52 million people) with one of the major factors being the deterioration of the public health care.

The Ukrainian people themselves view the state medical service as unsatisfactory and corrupt. Research conducted by the Gorshenin Institute in February 2011 shows that 74.6% of respondents believe strongly that corruption has penetrated the state health care system. 43.4% of participants stated that they had personally witnessed medical workers operating at public medical centres who extorted money for their services. 44.6% of Ukrainians believe that an insurance-based healthcare system may be a possible solution to the problem. 

Professional comment:

The Constitution is the place to guarantee rights, not the place for defending an existing network of health care facilities and their often expired equipment. The Ukrainian network emerged from the Soviet era Semashko model which was aimed at communicable disease and episodic care for acute illnesses. This model is no longer relevant to the present burden of disease and is increasingly ineffective and costly to maintain. The burden of disease has shifted to non-communicable disease, conditions associated with behavioural risk factors and chronic conditions. Using the Constitution to maintain the old network is inappropriate, the system needs reform.

Buildings and equipment do not treat or care for the sick.  People do. Some are health professionals.  Others are not.  The venue for treatment and care need not be a hospital - it can be the home, or at a primary care ambulatory centre.  Ensuring timely and equal access to quality care at the right venue is more important than protecting existing buildings.  Developing a sound ambulance program to reach into rural areas and building better roads whilst improving medical training and the quality of practice, and ensuring adequate numbers of appropriately trained Family Medicine physicians is a much better investment.

The Constitutional prohibition against reducing the existing network of medical establishments freezes the health system in the past and bars efficient use of limited resources.  Countries like Georgia and Azerbaijan have progressed far with their health reform programs. They first optimised their health care network models, then proceeded to renew and modernise the remaining buildings and equipment.  No locality likes to see its health facility closed. But no one wants access to a health facility whose sole benefit is proximity, if it cannot provide quality care.  People will usually give up their demand for a facility in their area if they can be guaranteed access to quality care within a reasonable travel time.

The redistribution of funds can improve health care. Strengthening priority for primary care has the potential of meeting up to 80% of medical needs in a cost effective way.   Ukrainians face much higher rates of death and disease than their European neighbours. Adult male mortality rates are on par with Benin, Togo, Guinea, Haiti and Ghana and are directly linked to alcoholism and infectious diseases, like HIV/AIDS and tuberculosis.  About half of all deaths before age 75 are avoidable – approximately one third are preventable, one third are treatable and the rest avoidable through a combination of treatment and prevention.  About 80% of the deaths of working age males and 30% of working age females could be avoided by providing effective primary health care.  98% of premature mortality due to tobacco smoking, alcohol and road accidents could be avoided with adequate education and with these avoidable problems removed less hospital beds would be required.

The provision of "free" health care need not restrict reforms.  Most European countries have undergone major health system reform and offer useful lessons from their experience.  Primary amongst which is accessibility. Their health care financing is overwhelmingly from government, leaving the patient to pay relatively small amounts that can be privately insured, resulting in notionally "free" care.  Studies show however that the poor often do not seek necessary care because these relatively small charges plus time lost and travel are prohibitive.

On a Purchasing Power Parity basis (PPP) Ukraine health care expenditure per capita is almost one seventh of the average of OECD countries.   Ukrainian health care is underfunded. It has had low priority amongst all governments. Ukrainian lack of confidence and trust in the health care system is telling. That nearly half of the people think "insurance medicine" is a possible solution is evidence of grasping at straws, not evidence of informed public opinion on the costs, benefits and beneficiaries of "insurance medicine".

A systemic view and approach to reform is necessary. No single approach will solve all problems but western experience over the past six decades offers enough knowledge to suggest which approach leads to better or worse results. Attempting to use market  forces to ensure that people get the health care they need, at the time they need it, at the price they are willing to pay, has limited prospects – as is demonstrated in the USA.  The five "control knobs" of the health system: financing, payment, organisation, regulation and behaviour are well recognised. These knobs are interdependent. Their setting determines the efficiency, quality and accessibility of the system.  This in turn affects how well population-based performance goals of health status, customer satisfaction, and risk protection are realised. 

Unless there is informed and sustained political will for health system reform in the face of vested interests, it will flounder and fail. The President, Parliament and Government need to advocate for and protect the interests of the people. This role has not been realised by any authorities in power since independence and the results are strikingly obvious.

Myroslaw Kohut
Visiting Professor, MBA Programme in Health Care Management, International Management Institute (MIM-Kyiv).  International Health Sector Expert on planning and reform in 17 countries for the World Bank, national Ministries of Health and others.

People First Comment:

Health care and access to it is one of the primary political issues in all democratic nations.  If politicians cannot be trusted to look after the sick and infirm how can they be trusted to look after the rest of the nation.  Care of the sick is also one of the primary factors that define civilised society so one has to ask why in Ukraine it has such a low priority.  The reason is very simple.  It is not a political priority because politicians are not accountable to their local electorates.  If politicians were required by law to hold regular town meetings as in most other democracies and to listen personally to the woes of their constituents they would either force the government to act or risk losing the next election.  Whilst they remain immune to their electorate Healthcare will remain as a budget item and not an issue of public morality.

About the Author

Democracy Watch is the weekly monitor of the People First Foundation and serves to raise public awareness of how government and parliamentary action is impacting upon Ukrainian democracy and democratic due process.  The information is copyright free and may be reproduced but we ask that any comments are reproduced in full and with reference to the People First Foundation.

Could you really tell who was being cremated by the colour of the smoke at Auschwitz, as this survivor said?

The Sun (Vancouver)
Jan 12, 1985

"Friedman said the young prisoners even though they could tell whether fat or skinny people, Ukrainians or Poles were being cremated by the color of the smoke."

http://news.google.com/newspapers?id=TqJlAAAAIBAJ&sjid=pYwNAAAAIBAJ&dq=auschwitz%20smoke&pg=1494%2C1059445

In the light of such evil, that is hardly relevant.

Is it?

Written by admin

November 16th, 2010 at 8:29 am