not compulsory to be treated in a state-run hospital as a number of private medical complexes do exist nationwide. The public sector employs most healthcare professionals, with those working for private medical centres typically also retaining their state employment as they are mandated to provide care at public health facilities on a regular basis. All of Ukraine's medical service providers and hospitals are subordinate to the Ministry of Healthcare, which provides oversight and scrutiny of general medical practice as well as being responsible for the day-to-day administration of the healthcare system. Despite this, standards of hygiene and patient-care have fallen. Ukraine faces a number of major public health issues and is considered to be in a demographic crisis because of its high death rate and low birth rate (the Ukrainian birth rate is 11 births/1,000 population, and the death rate is 16.3 deaths/1,000 population). A factor contributing to the high death rate is a high mortality rate among working-age males from preventable causes such as alcohol poisoning and smoking. In addition, obesity, systemic high blood pressure and the HIV endemic are all major challenges facing the Ukrainian healthcare system. Active reformation of Ukraine's healthcare system was initiated right after the appointment of Ulana Suprun as a head of the Ministry of Healthcare. Assisted by deputy Pavlo Kovtoniuk, Suprun first changed the distribution of finances in healthcare. Funds must follow the patient. General practitioners will provide basic care for patients. The patient will have the right to choose one. Emergency medical service is considered to be fully funded by the state. Emergency Medicine Reform is also an important part of the healthcare reform. In addition, patients who suffer from chronic diseases, which cause a high toll of disability and mortality, are provided with free or low-price medicine. Education According to the Ukrainian constitution, access to free education is granted to all citizens. Complete general secondary education is compulsory in the state schools which constitute the overwhelming majority. Free higher education in state and communal educational establishments is provided on a competitive basis. Because of the Soviet Union's emphasis on total access of education for all citizens, which continues today, the literacy rate is an estimated 99.4%. Since 2005, an eleven-year school programme has been replaced with a twelve-year one: primary education takes four years to complete (starting at age six), middle education (secondary) takes five years to complete; upper secondary then