Institutionalization of the Metropolitan Space in the Field of Public Health of Ukraine in the Conditions of Martial Law and the COVID-19 Pandemic
Authors: Khomenko Iryna , Gladun Oleksandr , Korniychuk Oleksandr , Seryogina Nataliia , Ivakhno Oleksandra 
Published: November 2024

Accelerating institutional changes in the reform of the administrative-territorial system and the development of metropolitan regions in the interests of public health with the aim of reducing the morbidity and mortality of the population based on the priority development of family medicine, the consolidation and creation of state-of-the-art multidisciplinary hospitals has a development perspective in Ukraine. The cities of Dnipro, Kyiv, Odesa are included in the international project “Fast Track” as a global partnership between cities under the auspices of the International Association of AIDS Treatment Providers (IAPAC).
The city of Kyiv and the Dnipro-Kamensk agglomeration meet the criteria for special status. According to preliminary estimates of the reform of the administrative-territorial system in Ukraine, metropolises can be created at the regional level in twenty-five regions of Ukraine. They will probably include the cities of Zaporizhzhya, Vinnytsia, Kryvyi Rih, Sumy, Khmelnytskyi, Cherkasy, Zhytomyr, Chernivtsi, Mykolaiv, Poltava, Chernihiv and other cities (after deoccupation).
The objective: to analyze the state of morbidity and mortality from socially dangerous diseases in the metropolitan cities of Ukraine and in the Kharkiv metropolitan region and justification of the need for institutional support for the development of the public health system within the metropolitan area of Ukraine in order to improve the health of the population.
Materials and methods. Statistical information of the Departments of Health Protection of the metropolitan cities of Kyiv, Dnipro, Odesa, Lviv, Kharkiv, the State Statistics Service of Ukraine, the Center for Medical Statistics of the Ministry of Health of Ukraine for 2010, 2013–2014, 2018–2020 was analyzed. The research was carried out on the basis of a systematic approach using methods of comparative graphic analysis and synthesis, abstraction, logical generalization.
Results. The indicators of morbidity and mortality of the population and the peculiarities of the functioning of the health care systems of the metropolises of Ukraine (Kyiv, Kharkiv, Odesa, Lviv, Dnipro) and within the Kharkiv metropolitan region were evaluated. A comparative analysis of the incidence of certain socially dangerous diseases – hypertension, stroke, HIV/AIDS and AIDS-related deaths in metropolitan cities of Ukraine in the dynamics of 2010, 2013–2014, and 2018–2020 was carried out. Using the example of the Kharkiv urban agglomeration, which includes Kharkiv city and Kharkiv, Poltava and Sumy regions, the impact of changes in primary medical care on the morbidity of the population of the metropolitan region was assessed. The need for institutionalization of metropolitan processes through the adoption of the Law of Ukraine “On Metropolitanization” and its by-laws is substantiated.
Conclusions. In order to preserve the health of the population in the conditions of martial law and the COVID-19 pandemic, it is expedient to accelerate the reform of the administrative and territorial system regarding the consolidation of communities, districts, and regions in the interest of building a modern powerful network of medical institutions for their integration within the metropolitan area based on the adoption of the Law of Ukraine “On Metropolization” and its by-laws, taking into account the scientific and expert discussion of conceptual approaches and foreign experience.