New WHO assessment reveals resilience of Ukraine’s primary health-care system amid the war

While nearly half of Ukraine’s primary health-care (PHC) facilities have experienced staff absences due to the war, the majority have continued to provide essential health services with the available workforce, according to a recent WHO assessment on continuity of essential health services during the war in Ukraine.

The volume of services changed in 2/3 of facilities due to decreasing patients’ attendance in some regions with simultaneous increase in other regions. An increased volume of services was mainly related to caring for non-registered patients or changes in patients’ needs due to hospitality.

Ukraine’s primary health-care system has already been under stress since the COVID-19 pandemic and then faced additional hardships due to the full-scale war since 24 February 2022. The war has brought new challenges for access to health care and has significantly changed the health needs of the population and continuum of care.

The new WHO assessment, “Continuity of essential health services during the war in Ukraine”, conducted through 2 rounds of surveys in 2021 with a third round in early 2023, showcases the impact of both the COVID-19 pandemic and the war on Ukraine’s PHC system and the continuity of essential health services.

“Ukraine’s primary health-care system has demonstrated exceptional resilience during the COVID-19 pandemic and the war. Our latest assessment provides valuable insights into how these emergencies have affected the primary health-care system, the primary health-care staff, financial management and service delivery,” said Dr Jarno Habicht, WHO Representative in Ukraine. “Tailoring support for various types of facilities and maintaining a focus on training and preparedness are key strategies to strengthen the health-care system amid the ongoing challenges.”

Changes in service delivery

The war in Ukraine has caused large population movements, together with the changing needs to which the PHC facilities had to adapt quickly, while increasing or decreasing the volume of services. The assessment outlines that public PHC facilities have stayed open, providing essential health services, with half of them adjusting working hours and using digital solutions, especially in regained territories. Over 1/3 of PHC facilities have provided free services to non-registered patients.

However, in regained areas, 1/5 of PHC facilities reduced services since the onset of hostilities. While service modalities slightly decreased, the overall service volume remained relatively stable. Facilities in urban areas reported more reductions in services compared to rural facilities, while the latter more actively developed and implemented plans to deliver services to patients with tuberculosis and HIV, as well as to pregnant women.

War impact on PHC staffing

WHO’s new assessment revealed that half of PHC facilities in Ukraine faced staff absences due to the war. However, the overall number of staff who remained and continued to provide services was high.

In regained areas, there is a need for mental health services to be available for staff, with over 1/3 of facilities indicating this demand. During the hospitality, the main changes in health worker management included the repurposing of skills towards mental health or rehabilitation services and the reassignment of staff to different units or responsibilities, according to the assessment findings. However, the impact of the hospitality on health worker management appears to be less severe than that of the COVID-19 pandemic.

3/4 of facilities conducted additional staff training to address changing population needs, with a focus on areas such as chemical, biological, radiological and nuclear (CBRN) exposure and mental health. However, the relevance of training could be improved, especially among private and smaller PHC facilities, and in the areas of mass casualty management and rehabilitation.

financial management

The assessment results showed that reliance on financing from patients has not changed significantly since the start of the war. While 1/4 of health-care facilities charged user fees, half of which increased prices, some services and population groups – such as veterans – were exempt from fees. 1/3 of public providers received additional funds from facility owners and donors since the war began, while almost no additional public funds were directed towards private facilities.

Additionally, the majority of primary health-care facilities have maintained regular salaries for their health workers and have also provided overtime pay where relevant, bringing stability to health-care workers during the war.

Adapting to war challenges

The assessment results demonstrated that the majority of PHC facilities have shown resilience to the war, quickly adapting with alternate power supplies, shelters and supplies of medicines and vaccines. Strong teamwork and relationships with local authorities were identified as key factors contributing to the resilience of PHC facilities during these challenging times.

The assessment findings aim to inform the Government of Ukraine and other stakeholders as the country adapts and strengthens its PHC system amid the current challenges, also moving towards universal health coverage under the country’s ongoing health reforms and sustainable development goals implementation.

This assessment was conducted with the financial support from the Government of Canada and within the Universal Health Coverage Partnership.