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What to do if a narcologist refuses to register a client for the OST program explaining it by the absence of seats according to the contract between the facility and the NHSU?

REAct was approached by an OST program client asking for support in receiving drugs. After the woman was discharged from a TB dispensary, she contacted her local narcologist to continue her OST. The doctor was reluctant to switch her to unsupervised OST intake, looking for excuses: suspicions that she has forged her discharge certificate, absence of proof of her TB diagnosis, etc. The claim that NHSU has contracted his facility for treating a definite number of clients and he was unwilling to take more as “he’s not paid for that” was another excuse.

What should be done in such cases:

  1. You need to approach the chief physician of the health facility with a written report (complaint) demanding to remedy the violation of the right to receiving free OST services. The complaint must be duly registered, with an incoming registration number assigned.
    1. At the same time, you can call OST hotline to report about the situation and to ask for support in ensuring OST. OST hotline has experience in responding to clients’ calls, the contact information of responsible people in this field in the regions and can be engaged to improve the situation.

If a narcologist says that it is impossible to register a person for the OST program referring to some alleged limits of the number of patients, you need to know the following.

  • A health facility receives public funding for provision of certain services covered by relevant benefit package. In this case, it is the state-guaranteed benefit package “Treatment of persons with mental and behavioral disorders caused by opioid consumption with the use of substitution maintenance therapy drugs.”
  • First of all, you need to verify the claim of the narcologist through the official NHSU website. Click on the “Signed contracts” item in the menu on top of the page. You will be forwarded to the page with links on the left. Click on “Contracts with specialized health facilities” and select your oblast from the list. Then select the health facility and click to download the contract between the health facility and the NHSU for provision of healthcare services to population under the program of medical guarantees for 2021. The service we are looking for is listed in the annexes to the contract.
  • If the number of patients is defined (e.g., 37), this does not mean that the healthcare provider will reject you. On the contrary, during contract validity period, the parties may review and modify the planned cost of medical services. Each health facility receives public funding for more than one benefit package which means a certain balance range to ensure possible reallocation between the packages.
  • And more to that. According to the previous plan of the Ministry of Health to expand OST coverage to 5% of the estimate number of opioid drug users, significant quantities of OST drugs were procured. This means that OST drugs are available, stored in warehouses at oblast level, so a health facility can request additional quantity of drugs should a need arise (the number of an OST site patients exceeds expectations). This is based on the Ministry of Health order on need-based reallocation of OST drugs in line with a relevant institutional procedure.

This ensures legal grounds to demand registering the client for the OST program in this health facility.

  • If the efforts mentioned in paragraphs 1 and 2, were not successful, you need to file a written report (complaint) to the municipal or oblast health department about absence of response by the chief physician and demanding to remedy the violation of the right to healthcare. The healthcare department must duly register the complaint and respond to it. 
    • At the same time, you can approach the National Health Service of Ukraine (NHSU) and submit a complaint using the online form on the NHSU website. Usually, NHSU does not ignore such messages and may take measures up to terminating public funding provided to the healthcare facility. Therefore, the administrations of health facilities try to avoid such complaints and prevent conflicts.