"Money followed the patient," and this created new realities for state and municipal medical institutions. Old approaches were destroyed, while new ones are only being formed and implemented. Such radical changes rarely occur calmly and without conflict.
UNN spoke with Dmytro Govseiev, Director of the Municipal Non-Profit Enterprise "Perinatal Center of the City of Kyiv," about how a medical institution can survive and develop in conditions of rapid change.
Context
Medical reform has been ongoing in Ukraine for several years. One of its stages was the reform of state hospitals—the formation of a capable network—launched in 2023. All state hospitals were divided into three levels: general hospitals for basic care, simple surgeries, and common illnesses; cluster hospitals—district hospitals that treat complex diseases (e.g., heart attack or stroke); and supra-cluster hospitals—where doctors perform the most complex surgeries and treat rare diseases. For the system to work, institutions had to merge. Two small hospitals in neighboring communities merged into one more powerful entity. A separate cardiology center and an "adult hospital" became a single cluster. Highly specialized top-level institutions formed supra-cluster structures with their own research centers.
In the state's view, such a system should facilitate the optimal distribution of resources and the effective provision of medical care.
The Kyiv Example
The formation of a capable network also affected Kyiv. As part of the reform, Kyiv City Maternity Hospital No. 5 and the Perinatal Center (which was originally created on the basis of the seventh maternity hospital) merged. They formed a third-level medical cluster. The legal merger of the two institutions allowed for the concentration of the best specialists and the most modern equipment within a single management structure—without duplication. Since 2007, Dmytro Govseiev—one of the country's most authoritative obstetrician-gynecologists, who combines practical surgery, management of a large medical institution, and scientific activity—had headed the fifth maternity hospital. He was appointed to lead the updated medical institution.
— Dmytro Oleksandrovych, after the merger of the fifth maternity hospital and the Perinatal Center, you headed the formed supra-cluster medical institution. For this, you are accused of raiding and seizing the Perinatal Center, and of firing specialists.
I will put it somewhat bluntly, but honestly: this is a lie and an information attack by certain groups of medical lobbyists who want to impose their interests and obtain excess profits from the activities of the capital's Perinatal Center.
When the reform started, we began receiving funds from the NHSU not for the number of beds, but for the treated case—in our case, births and surgeries. That is, even before the start of the full-scale war, we understood that less powerful institutions simply would not "pull through" in such conditions. Competition was becoming tougher even among municipal institutions. Private ones are a separate story; they are also starting to work with the National Health Service and are becoming our competitors.
Understanding where the development of the medical industry was heading, we saw the need to create a powerful center that would handle not only extragenital pathology but everything related to perinatal medicine.
This merger was not forced or pressured. We quite calmly—I as the head of the fifth maternity hospital and Ms. Viktoriia Bila as the head of the Perinatal Center—sat down and decided that it was worth merging and creating one powerful Perinatal Center with two branches. We reached an agreement. By the way, we have known each other for more than 40 years. There were no problems. I took on the role of director, and she remained the medical director (Viktoriia Bila remains the deputy director of the Perinatal Center to this day – Ed.).
— And did the Ministry of Health approve the merger?
Yes. And after that, we remained the only mono-profile obstetric institution in Kyiv. A very powerful institution, a very large number of births—what we earned through the National Health Service of Ukraine was absolutely enough for us.
— To maintain the institution?
Absolutely. And even to develop.
— You mentioned that private institutions are also starting to compete with you for NHSU funds. Are municipal medical institutions threatened with extinction due to competition with private clinics?
I do not believe that municipal or state medicine will disappear. But there is a need—and the supply must match it. Today, in my opinion, the supply is greater than the need. And this needs to be balanced. We shouldn't treat this as a crime or a betrayal.
Today, we need a certain number of doctors—and no more. And the reality is that patients follow the doctor. This should encourage doctors to have enough professional authority so that women want to give birth specifically with that obstetrician-gynecologist. It is quite logical that the advantage will go to the doctor who has delivered 18 babies, not the one who has delivered one. In our profession, this is absolutely normal.
— Was the medical staff of both institutions reduced after the merger?
First of all, during the merger, there was a condition: medical staff is not reduced. Only administrative staff is reduced. Each institution had its own accounting department, its own planning department. When we merged, we cut the units that duplicated functions. This applied exclusively to administrative positions.
As for staff turnover—it always exists. Someone retires, someone leaves for other reasons. To say that we fired medical staff is absolutely untrue. Everyone who wanted to stay and agreed to work in one maternity hospital instead of two was accepted.
— But an obstetrician-gynecologist of the Perinatal Center, Kyrylo Ventskivskyi, was indeed dismissed after the merger. Is it really beneficial for a hospital to lose a high-level doctor?
Indeed, there was a work conflict that entered the public sphere. It arose precisely after the merger of the institutions and, in my opinion, was the result of insufficient communication. This was exploited by third parties—so-called medical lobbyists who tried to use the situation for their own interests. They began to escalate the work conflict. But Kyrylo is the grandson of my teacher—the prominent obstetrician-gynecologist, professor, and Honored Doctor of Ukraine Borys Mykhailovych Ventskivskyi, who made a significant contribution to the development of Ukrainian obstetrics. I have great respect for his family, but at the same time, I remain demanding of everyone without exception—regardless of personal connections.
— There was information that salaries for medical staff decreased after the merger.
Every year, our doctors' salaries only increase. There is salary growth, but not as much as we would like, of course, given inflation and the constant rise in the price of basic goods. As a manager, I would like salaries to increase and for medical workers to be more interested in their work. Here, everything depends on the number of births at the Perinatal Center. Because the only source of funding is the NHSU. And, unfortunately, a decrease in the number of births cannot ensure salary growth.
But I can say that in 2024 we had 8,300 births. In 2025—already 7,600. For the first quarter of 2026—already 250 births fewer than in the same period of 2025.
— Is that for both institutions combined?
For both, meaning we already count them as one. And this applies not only to our institution. We just received the Kyiv figures—it's the same across all institutions. In the first quarter of 2025, 5,029 children were born. This year—4,280. A difference of almost a thousand in a quarter. And we receive money from the NHSU exclusively based on this indicator.
— And is the salary of administrative staff and management growing?
The institution currently employs over 800 people. We didn't just merge the administrative staff; we reduced it. We cannot pay the people who remained the same amount they were paid before when there was half as much work. Accordingly, their salaries have increased. There are fewer people, and the salary is higher—because they handle a larger volume of administrative functions.
When you work as a doctor, it seems that the most important thing is to treat. But I always say: when you reach out your hand in the operating room, something must be placed in that hand—a scalpel, a swab, a clamp, medicine. They need to be bought, delivered, and brought to the patient. Only a comprehensive approach allows all of this to happen.
We have to save every penny. These are the times. And we reviewed, for example, how the repair and maintenance of equipment in the Perinatal Center was handled before the merger: now payment is made upon the actual provision of services, rather than for the possibility that a repair specialist's service might be needed someday. This was already the case in the fifth maternity hospital.
— How much does a birth cost in your institution, and what do patients need to bring with them?
The National Health Service has allocated a certain amount—it is less than 20,000 hryvnias for a normal birth, by any means—cesarean section or natural.
And overall, given the number of births we handle at the Perinatal Center, the total amount is quite significant. Sufficient. One can work with it. It is also important that there is no double payment—there is a medical guarantee program, and for those covered by it, the state covers the birth. That's it. Nothing more needs to be paid extra. Especially unofficially. I am categorically against these unofficial payments, some kind of "contributions" and the like. But doctors want to earn—that is absolutely normal. And that is why we have introduced a system of paid services. It can be used by those who do not fall under the medical guarantee system, or if a person wants to receive additional services.
We have created a system of personal patient support. How does it work? A patient comes and says: I want such-and-such a doctor. If people go to a doctor—that's good. He should be confident that for a larger number of births, he will receive a higher salary. No matter how disappointing it may be for the rest. But it's fair—he earned it, didn't steal, and didn't deceive anyone.
Choosing a doctor is not a medical service. A medical service is the provision of medical care. But choosing a doctor or obtaining specific accommodation conditions is a paramedical service; it should be taxed. And we can officially charge money for this. This is stipulated in our regulations. The doctor is protected, and the woman officially receives the service she paid for. And she receives certificates of completion, as strange as it may sound—to deliver a baby and issue a certificate—but it is work, it is a service.
— And does this stimulate doctors?
I have doctors who provide such additional services to 18 patients a month. This is absolutely normal. Officially, such a comprehensive service includes the doctor, midwife, pediatric department, and anesthesiologist if necessary. A certain percentage goes to different departments. Everything works.
Currently, we have paid services in two areas: individual support and separate accommodation conditions—meaning a separate improved room where the mother can stay with her husband. But I emphasize once again: a regular birth—even with pain relief or if you want your husband to be present—does not require additional payment.
— And are charitable contributions made?
There is no such thing anymore. There used to be. But I always wanted to avoid this "mandatory optionality." And if such facts, God forbid, occur, I ask that they be reported to me personally, even through my social media pages.
— And did you rent out premises?
Yes, we had vacant premises, and we rented them out. This is not prohibited by law. In the fifth maternity hospital, since 2012, a private firm "Research Institute of Life" (NDI Zhyttia) rented (one of the premises - Ed.). It was engaged in laboratory diagnostics and pregnancy support. Essentially—competitors right next door. Later it turned out that they sublet the rented territory. And it turned out that this subtenant was "Medlife Plus." And they linked it to us, although our direct contract was with "NDI Zhyttia."
When this whole story started and they began linking the subtenant's activities to us, I said there was no point in continuing their work on our territory. They packed up and left quietly, without a scandal.
But understand: yes, the contract was concluded on certain terms, but I cannot interfere in the tenant's financial policy or control exactly what they charge money for. Under the terms of the contract, they must conduct medical activities, but how much they charge for it and how they distribute the funds is not my business, as it is a private firm with which neither I nor the maternity hospital have any connection.
— But this lease became the subject of close attention from a Kyiv City Council commission headed by Maryna Poroshenko. There was an inspection...
Commission representatives came. They tried to find where "NDI Zhyttia" was located, but by that time they had already moved out.
— And the contract had already been terminated?
Absolutely. Our employees showed where this firm used to be. But it was no longer there.
— After this, Poroshenko called on the Ministry of Health to suspend you from your post during the financial monitoring. Were you suspended?
First of all, the suspension is handled by the Healthcare Department of the Kyiv City State Administration. It found no legal grounds for implementing this.
— And has the financial monitoring already started?
We are expecting it. We are on the schedule. But I am surprised by the desire to suspend me from my post—the monitoring is supposed to ask me questions, but I wouldn't be at work during its conduct if I were suspended. I don't understand the logic. And the department did not support suspension during the inspection. Currently, while the commission is working, I have applied for leave to avoid creating a conflict situation, but I am ready to step in at any moment and provide all necessary explanations.
— But this whole situation surrounding your persona, the criticism of your actions that unfolded in the media—how has it affected the Center's work?
The number of births—I mentioned the figures to you... That's how it affected it...
But I cannot remain silent when people start throwing mud at me. Yes, it deepened the conflict. This is an unproductive path; I realized that everything was going the wrong way, and a split in the team emerged. But certain conclusions were drawn, including disciplinary ones. Some time has passed, and we are moving forward.
— Are you talking about Kyrylo Ventskivskyi now as well?
Yes. Kyrylo and I met, discussed everything, and we are cooperating quite calmly. And the decision to return was not due to someone's pressure; it is the result of our communication and mutual understanding. On the contrary, the pressure from those who tried to exploit certain misunderstandings was the cause of the situation that was spun and brought into the media.
I realized there were certain individuals from the very beginning who considered the Perinatal Center on Predslavynska Street their fiefdom. I did not satisfy them because from the start I said: no unofficial earnings, no "flows," no purchasing equipment in obscure ways. They realized they needed to remove me to return to their cozy spots.
And they—of course, no one will admit this directly—started this dirty fight. And they do not stop the attacks. These are certain lobbyists trying to destroy the system we are trying to build.
— And in addition to the scandals, one of the hardest Ukrainian winters was added. How did the Perinatal Center survive it?
Even before the full-scale invasion, we were offered to install a pellet boiler room, independent of the centralized heat supply. It's also cheaper.
Today, we are probably the only maternity hospital that can exist completely autonomously. Our own boiler room. Our own well—there is always water, even when there is nothing else. Water reserves. A kitchen block that works without external power supply. Generators at each branch. There are only six such hospitals in Kyiv that can be completely autonomous.
— Let's talk about the medical aspect of the work. Women are increasingly choosing cesarean sections consciously. What is your attitude toward this?
Nowadays, more and more women want to give birth via cesarean section. For example, a woman comes and says: "Doctor, I chose you, you must give me a cesarean section. I don't want pain." The chosen doctor looks for medical indications for this, which might not even exist. In such situations, the main thing is to explain to the woman all the possible consequences so that, in choosing such a path of birth, she consciously understands all possible outcomes.
What is most important for a woman? The baby and that no one sees the scar. But the scar remains on the uterus. And there are second births, third births. And, unfortunately, there is now such a pathology as placenta accreta. This is a serious pathology that can eventually lead to the necessity of removing the uterus. When I was studying, this almost never happened. Previously, only 9% of births were by cesarean section. And we weren't praised for that. Now it's 30% of births. And it will be more. Not only because women want it, but also because the list of indications has been expanded. And with a first scar, few doctors now go for a natural birth. And this provokes the development of the pathologies I mentioned.
Obstetrics is the specialty with the most unpredictable bleeding. Very fast and very powerful. You can lose a liter of blood in a minute. If a doctor hasn't mastered the specialty perfectly, he could simply lose the woman. But we have developed our own proprietary method for preserving the uterus. It involves performing organ-preserving surgery, a highly complex surgical intervention for patients with high obstetric risk. Thanks to it, it is possible to save the woman's uterus and her reproductive potential.
We operate on such patients every week. Yes, there are situations where we can no longer do anything and save the organ... I believe the technique is unique. And it needs to be passed on to future generations, as it can help a large number of women.
And for a doctor, it is important not to interfere with nature. Birth is a natural process. And the doctor's task, first and foremost, is to see the pathology in time and intervene, rather than interfering and rushing the process for some convenience.
Unique surgery with uterine preservation for placenta previa and accreta
— What is your attitude toward home births?
My position is: home births—within the walls of a maternity hospital. We created these conditions—back in the fifth maternity hospital, about 500 births a year took place in this format. We created completely comfortable conditions within the maternity hospital—with hydromassage tubs, without gynecological chairs. Women gave birth however was comfortable for them. On the floor, on a stool—as they wished. Of course, we cannot deviate from our protocols, and we must protect the woman from complications. But we are ready to create conditions that are more comfortable for the woman: she stays in the position that is more convenient for her, or, for example, stays in a tub where the pain of contractions is somewhat reduced. These births may take a bit longer, but the woman feels that she is in control of the process: she and the baby.
A woman needs to be protected so that she doesn't do this at home and without medical assistance. At one time, this was very popular. And there were many problems—both with children and women losing a lot of blood, and, unfortunately, there were fatal outcomes.
— You were accused of tolerating early births in girls; is that true—do you welcome early births?
These accusations are blatant manipulation based on a quote taken out of context from an interview. We were talking about a medical fact and the physiological characteristics of a girl's body development, not about any "normalization" of early births, let alone any unacceptable phenomena. Such cases happen, and we as doctors are obliged to professionally provide assistance and deliver the baby when necessary. Interpreting these words as "agitation" is a deliberate distortion aimed at blackening my name. My only position is the protection of women and adherence to ethical and professional standards of medicine.
— What age, in your opinion, is optimal for having a child?
From a physiological point of view—from age 20. But 30 and older is also normal. I don't share the standards that existed before—the "elderly primigravida." Back then, it was the norm that for a woman giving birth at 25, we already had to indicate that. Yes, the risk of certain genetic anomalies increases with age. But we have the opportunity to conduct testing—there is genetic screening, the possibility to completely reconstruct the chromosomal history of the fetus... The technologies are completely different now.
— And who was the oldest woman to give birth in your practice?
62 years old.
— And how does the constant stress of the full-scale war affect pregnant women? Has the number of premature births increased?
Perhaps my answer will surprise you, but at the very beginning of the full-scale war, the number of premature births decreased. The woman's body seemed to mobilize and pull itself together. My colleagues and I even discussed this. But now everything has returned, and the number of premature births is the same as it was before the start of the full-scale war.
— Dmytro Oleksandrovych, thank you. And finally: who are being born more in 2026—boys or girls?
The first to be born in 2026 was a girl. And who are there more of? You know—children are being born, and that is life, that is what's important. We put an information ticker at the main entrances to the departments—how many boys and girls were born today—and everyone is delighted because it is the most life-affirming information there can be.