Russia’s full-scale invasion has had a devastating impact on Ukraine’s health system.
Our overall recommendation is that international aid and resources devoted to Ukraine’s
recovery should be used to help the system to ‘leapfrog’ – to modernise the healthcare
system so that it can deliver care more efficiently to meet the goal of universal access
to affordable and high-quality care. To this end, we offer a set of key recommendations.
These are presented according to the corresponding WHO Health System Building Block
framework.
In terms of financing, we recommend that international aid be channelled through a
single independent agency and aligned with Ukraine’s objectives, and that formal costsharing should be avoided as it may exacerbate the existing problem of informal out of
pocket payments and is unlikely to generate significant revenue. For healthcare delivery,
we suggest (1) explicitly defining the basic healthcare benefit package (the Programme of
Medical Guarantees, or PMG) now, to avoid implicit rationing through refusal of care or
use of informal out-of-pocket payments, and to improve efficiency; and (2) introducing a
mix of public and private provision in the short and longer term, with one central agency
responsible for contracts.
Managing healthcare workforce should focus on (1) careful use of task-sharing to nurses,
initially in primary care, supported by training and supervision; and (2) increased efforts
to retrain staff in line with European standards and the changing health needs of the
population. This should be complemented with investments in staff retention, by means
of better working practices and higher salaries. There should be strong investment in
health information systems to address issues of security and interoperability between
different healthcare providers. Governance and leadership should aim to achieve two objectives: (1) developing the
current purchasing agency, the National Health Service of Ukraine (NHSU), into an
autonomous central strategic purchaser with clear objectives and clear targets; and (2)
introducing publicly available performance indicators at the national health agency and
provider levels.