Yes! We can end TB! Powered by the state. Supported by the people. An interview with Ihor Kuzin

For over a decade, Ukraine has been transforming its tuberculosis control system – moving from a predominantly inpatient, outdated model to a modern, people-oriented approach. This process is taking place amid unprecedented challenges – the COVID-19 pandemic and a full-scale war.

Despite this, the country is demonstrating significant progress — in the implementation of modern approaches to diagnostics, treatment, and the development of outpatient care; the role of communities and partners is increasing. Even under extremely difficult conditions, modern medicines remain accessible in Ukraine, the implementation of short-course treatment regimens is being scaled up, etc.

At the same time, certain areas require further development and systemic scaling up. In particular, there are challenges that can only be addressed through joint efforts to reduce the burden of tuberculosis for Ukrainians, including beyond the medical sector.

In this interview, we have a candid conversation with the Chief State Sanitary Doctor of Ukraine, Deputy Minister of Health, Ihor Volodymyrovych Kuzin, about achievements and challenges, political leadership, the role of the state and communities, and what actually needs to be done for Ukraine to overcome tuberculosis.

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In this context, we would like to begin by assessing the key changes in public policy regarding tuberculosis control.

When it comes to the transformation of state policy on tuberculosis control, what key achievements do you consider most significant in recent years – taking into account the challenges posed by the COVID-19 pandemic and the full-scale war? And looking back: which of the planned changes have been implemented most effectively, and which areas require adjustments and a consolidation of efforts?

Thank you for the question – it is indeed a complex one. First and foremost, we need to distinguish between the initial logic of reforming the tuberculosis and pulmonology care system – as it was originally conceived – and the adjustments necessitated by the COVID-19 pandemic and the full-scale war.

The basic idea of ​​the reform was to modernize the system: optimizing the bed capacity, introducing modern treatment protocols, reducing treatment gaps and improving diagnostics, as well as ensuring equal access to medical services. It was these principles that formed the basis of the transformation.

At the same time, the pandemic and the war significantly influenced the pace and priorities of changes. Today we understand that, alongside the progress achieved, certain elements of the transformation need to be reconsidered. At this stage, the system of phthisiopulmonological care needs stabilization more than further revisions of the infrastructure or human resources.

Among the key achievements, I would highlight several areas. First, we have succeeded in optimizing the bed capacity in line with modern European approaches. Second, Ukraine has transitioned to modern, effective and shorter treatment regimens that meet best international practices. Third, even amid the war, we have managed to maintain a relatively high retention rate for patients in treatment – a joint achievement of healthcare workers, non-governmental organizations, and local governments.

Also important is the progress in implementing a systematic approach to the management of latent tuberculosis infection – in recent years, these processes have become more manageable at the level of state policy.

However, there are also a number of challenges and areas of risk.

The first is the structural legacy of the system: a significant part of the tuberculosis infrastructure was established during the Soviet era as a large-scale property complex, which requires significant resources for maintenance and does not fully align with the modern funding model under the Medical Guarantee Program. As a result, there is a significant imbalance between the rates set by the National Health Service of Ukraine and the actual costs of the facilities, which creates risks for maintaining human resources and the sustainability of service provision.

The second challenge is the lack of systemic progress in the transition to state funding for prevention, care and support of people undergoing tuberculosis treatment. While such a transition has partially occurred in the HIV sector (though it has been affected by the war), it is proceeding much more slowly in tuberculosis care.

Over the past few years, a package of regulatory and legal acts has been developed to govern social support for people undergoing tuberculosis treatment – in particular, service delivery protocols, cost calculations, and fee schedules. For the second year in a row, the Public Health Center has been implementing state programs for social support; however to achieve the expected results, these mechanisms require further scaling up and full implementation in practice.

The third aspect concerns the persistence of high levels of stigma. Despite the measures taken, the results of sociological research indicate the presence of prejudices against people with tuberculosis. This is also reflected in the reluctance of some primary care physicians to work with such patients, which negatively impacts access to services and the quality of medical care. Therefore, both ongoing public awareness efforts and the need for additional support and training for healthcare professionals – particularly those in primary care – remain critical. 

And, finally, the lack of sustainable funding mechanisms remains a significant challenge. Although the medical guarantees program provides for a specific package of services, its cost has not been adjusted to reflect economic realities in recent years. For example, the cost of treatment for one person in 2023 was 49,000 hryvnias and remains at the same level in 2025, which does not compensate for inflation. This creates additional risks for the system in the medium term.

How do you define political leadership in the field of combating tuberculosis? What are its key characteristics in the context of intersectoral cooperation and current challenges?

For me, political leadership in the field of combating tuberculosis is, first and foremost, the ability of decision-makers to understand the issue of tuberculosis within the context of the authority and responsibilities of the sector in which they work.

This involves intersectoral understanding. In particular, it is important for representatives of the Ministry of Education to consider the impact of tuberculosis on the education system and the educational environment, and for justice system professionals to consider the specific nature of working with people in places of detention. In other words, effective political leadership requires integrating the response to tuberculosis into various government policies, rather than limiting it exclusively to the health sector.

At the same time, we are currently facing a number of systemic challenges. One of the key challenges is the high staff turnover among those involved in policy-making. Despite significant efforts at raising awareness and developing competencies, frequent personnel changes lead to a loss of institutional memory. As a result, there is a need to rebuild an understanding of the issue each time, which slows down the process of making high-quality management decisions.

Another important aspect is a simplified or fragmented perception of tuberculosis. There is a widespread tendency to view it as exclusively a medical problem or as a problem affecting only certain population groups. Such approaches do not reflect the true complexity of the situation and can lead to delayed decisions or the shifting of responsibility between sectors.

In this context, political leadership is the ability to make balanced, informed decisions based on an understanding of the complex nature of tuberculosis and involving interagency responsibility. It is essential to establish stable management teams capable of ensuring policy consistency and acting in the interests of people in need of assistance, without excessive “medicalization” or “socialization” of the problem. Ensure equal access and equal opportunities for all to receive care.

How do you see the achievement of the goal of “Tuberculosis-Free Ukraine”? What, in your opinion, does this outcome mean from in terms of public policy and accountability to citizens?

For me, “Tuberculosis-Free Ukraine” is, first and foremost, a state in which the government can responsibly and transparently guarantee citizens an adequate level of protection against this disease, and the healthcare system is capable of effectively preventing its spread.

This is not about the complete elimination of tuberculosis, but about achieving a level of control where the incidence rate matches that of European countries, and where people receive a timely diagnosis, begin effective treatment, and are under comprehensive care and provided with social support.

In this sense, it is no longer merely a matter of medical indicators – it is a matter of the state’s ability to fulfill its basic functions in the field of public health, to ensure systematic prevention, early detection, and continuity of treatment, as well as to bear full responsibility for the outcome before its citizens.

The legislative framework is a key foundation for systemic change. In particular, the Law of Ukraine “On Overcoming Tuberculosis in Ukraine” defines the state’s obligations to combat the disease and establishes an intersectoral approach –  involving not only the healthcare system but also social protection, education, the penitentiary system, and other sectors.

So, for me, this is first and foremost about the government’s responsibility to citizens and about trust in the state system.

Ukraine is demonstrating significant progress in combating tuberculosis, in particular in terms of the regulatory framework and the implementation of people-oriented approaches. At the same time, decentralization and the need to transform outdated infrastructure remain serious challenges, especially at the community level. What role, in your opinion, should civil society play in overcoming these challenges? And what approaches could also be effective in the context of fulfilling international obligations?

There are several fundamentally important aspects here.

The first is the issue of representation and human resources. In my opinion, effective advocacy does not necessarily require an extensive network of regional offices. International experience shows that network-based approaches – forming partnerships and coalitions around a common goal – are significantly more effective.

This involves, in particular, collaboration with large organizations – associations of local governments, city associations, and sectoral platforms. Such structures have significantly broader influence and reach. n the context of staff shortages and demographic challenges, partnerships with networks – when there is a clearly defined agenda – can significantly boost advocacy effectiveness without a substantial expansion of resources.

The second aspect concerns the quality of advocacy and communication at the local level. For this work to be effective, a shift in focus is necessary. It is important for community leaders to clearly understand the consequences of inaction. This is not just a matter of public health, but also of specific governance risks: additional treatment costs, loss of labor potential, increased strain on local budgets, and reputational risks for local authorities. It is precisely this component that is often insufficiently addressed in advocacy efforts.

In addition, it is important to move from general explanations to practical solutions. Explaining the nature of tuberculosis is necessary, but insufficient. Community leaders need clear, practical tools – a list of priority steps they can promptly implement through administrative decisions, in particular at the level of local council sessions or executive bodies.

Accordingly, when discussing an effective advocacy model, it should be based on three key elements. Firstly, the presence of a strong expert and analytical core capable of developing substantive proposals. Secondly, the use of networking mechanisms to scale up impact. Thirdly, the provision of ready-made, practice-oriented solutions tied to specific administrative, financial, and reputational outcomes.

It is precisely this model that allows us to move from general advocacy to real influence on decision-making at the local level.

Speaking about the nearest future, which areas of combating tuberculosis are currently the highest priority? What should we focus on right now to lay the foundation for long-term and sustainable changes?

When it comes to priorities, I would not dwell on the issue of overcoming stigma. I see the progress that has already been achieved, in particular among healthcare workers, and I certainly appreciate it. But, in my opinion, there should be absolutely no stigma in a healthcare worker’s attitude toward a person suffering from tuberculosis or living with HIV. A zero level of stigma is not a wish, but a professional standard. And it is precisely in this direction that we must consistently move forward, as the effectiveness of the entire care system directly depends on it.

At the same time, it is no less important to address stigma in society as a whole. It is often one of the reasons for interrupting treatment when a person faces judgment, isolation, or internal fear. Therefore, systematic work to overcome stigma at the level of public perceptions remains a critically important task.

Another area that, in my opinion, is underestimated is working with employers and the field of occupational safety and health. We talk a lot about healthcare facilities, medical workers, and communities, but a significant part of a person’s life takes place at the workplace. The employer is the environment that interacts with the employee on a daily basis and can therefore play a significant role in creating safe conditions, providing supporting, preventing discrimination, and encouraging timely help-seeking. This area certainly requires more attention.

Separately, I would emphasize the need for Ukraine to strengthen its international advocacy efforts to reduce the cost of medicines and diagnostic technologies. For a long-term effect, the country must be an active participant in the global dialogue on providing more affordable solutions, in particular regarding modern diagnostics. For example, GeneXpert technologies are of immense value for the early detection of tuberculosis, but their cost objectively limits the potential for scaling up. This is precisely why Ukraine’s role in international advocacy can be truly significant.

Another key priority is supporting the non-governmental sector and community initiatives. As we prepare a new application to the Global Fund, it is crucial to maintain a balanced approach and prevent a decline in attention to tuberculosis or an imbalance in priorities between infections, sectors, or implementing partners. This is a complex, largely domestic policy challenge, but it is of strategic importance for the sustainability of the tuberculosis response.

Finally, it is crucial to invest in capacity building at the regional level. Undoubtedly, the Center for Public Health plays a vital role in policy formulation and coordination. But at the practical level in the regions, the key partners remain the health departments, regional tuberculosis and respiratory disease centers, and disease control and prevention centers. They are the ones who ensure direct coordination of activities, analyze the situation, and make management decisions on the ground. Therefore, strengthening their capacity — particularly in terms of analysis, forecasting, planning, and developing effective solutions — is one of the fundamental elements of the long-term sustainability of the system.

In addition to medical and social factors, the education system plays a key role in overcoming stigma. After all, attitudes toward tuberculosis are formed as early as in school and during the training of future healthcare professionals. In your opinion, does Ukraine today have the potential to systematically update educational programs – both at the school level and in higher medical education – with the aim of fostering a modern, non-discriminatory approach to tuberculosis, even in the context of war?

Thank you for this question – it is indeed extremely important in the context of long-term changes.

I will start with a brief comment on labor relations. As part of Ukraine’s European integration commitments, a draft of a new Labor Code has already been developed and submitted to the Verkhovna Rada of Ukraine for consideration. In particular, it contains provisions aimed at regulating informal labor relations, which has the potential to positively impact access to medical and social services.

As for educational standards, their role cannot be overstated. I would divide this issue into two interrelated areas: school education and higher medical education.

School education forms basic concepts of health, a responsible attitude toward it, as well as the skills of recognizing symptoms and understanding when to seek medical care. From this perspective, I see no fundamental barriers to updating the relevant educational materials. Such discussions have already taken place, in particular between the Ministry of Health and the Ministry of Education and Science. The main disagreements concerned certain sensitive topics, in particular issues of sexual and reproductive health. At the same time, I am convinced that, through professional dialogue, these issues can be resolved while taking into account age-appropriate content and educational approaches.

Higher medical education presents a more complex and systemic challenge. Today, we are seeing a situation where graduates of medical institutions do not always possess sufficient knowledge regarding modern approaches to managing people with tuberculosis. This applies to both understanding of treatment models and practical aspects, including working with contact persons and using tools to support adherence to treatment.

Given the autonomy of higher education institutions, professional associations – particularly those of phthisiologists and pulmonologists – must play a key role in this process. They are the ones who can drive change, initiate updates to standards, and ensure the integration of modern, evidence-based, and EU-aligned approaches into curricula.

Therefore, I would consider the issue of education more broadly – not only as an update of school materials, but as a comprehensive transformation of approaches to training specialists, with an enhanced role for professional communities in shaping the content of medical education.

Speaking of the strategic goal: will Ukraine be able to overcome tuberculosis – and what will be crucial for making this a reality in the near future?

I am convinced that Ukraine will overcome tuberculosis. It is not a matter of faith – it is a matter of time, decisions, and responsibility.

The key factor is coordinated action. Overcoming tuberculosis is impossible solely within the healthcare system. It requires coordinated leadership at the level of overall state policy – involving the sectors of social protection, education, economic, penitentiary sectors, as well as other areas.

Today, we already have a foundation: established leadership from the Ministry of Health, modern approaches to diagnostics and treatment, and experience in effective collaboration with civil society and international partners. At the same time, further progress directly depends on the extent to which this responsibility becomes shared by all sectors.

The decisive factor is the transition from fragmented actions to a comprehensive, coordinated national response – when tuberculosis ceases to be perceived as a narrowly medical problem and becomes a matter of national public health policy.

Therefore, the answer is clear: we will overcome tuberculosis.

The only question is how quickly we can unite our efforts and make decisions that deliver results.

And in this sense, it is no longer just about the healthcare system – it is about the maturity of the state and its responsibility to its citizens.

On behalf of the Secretariat of the Partnership “Stop TB. Ukraine”, we thank the Ministry for its leadership and the time to speak with us. We are grateful to everyone who continues to develop services and programs to combat tuberculosis today.

Yes! We can end TB! Powered by the state. Supported by the people.

This material was created by the Partnership “Stop TB. Ukraine”, whose secretariat is the All-Ukrainian Charitable Organization “Convictus Ukraine”, with support from the Government of the United States of America through funding for the project “Supporting Efforts to Combat Tuberculosis in Ukraine”, implemented by the PATH. The content of the material is the responsibility of the authors and does not necessarily reflect the views of PATH or the Government of the United States of America.