Resilience of Primary Health Care in Ukraine: Challenges of the Pandemic and War

ABSTRACT

This commentary examines the resilience of primary health care in Ukraine amidst the ongoing war, drawing a few reflections relevant for other fragile and conflict-affected situations. Using personal observations and various published and unpublished reports, this article outlines five reflections on the strengths, challenges, and necessary adaptations of Primary Health Care (PHC) in Ukraine. It underscores the concerted efforts of the government to maintain public financing of PHC, thereby averting system collapse. The research also highlights the role of strategic adaptations during the COVID-19 pandemic in fostering resilience during the war, including the widespread use of digital communication and skills training. The commentary emphasizes the role of managerial and financial autonomy in facilitating quick and efficient organizational response to crisis. It also recognizes emerging challenges, including better access to PHC services among the internally displaced persons, shifting patient profiles and service needs, and challenges related to reliance on local government financing. Finally, the authors advocate for a coordinated approach in humanitarian response, recovery efforts, and development programs to ensure the sustainability and effectiveness of PHC in Ukraine.

Keywords:

• Fragile and conflict-affected situations
• primary health care
• resilience
• Ukraine
• war

Acknowledgments

The commentary uses many of the published and unpublished reports to which all members of the WHO Country Office in Ukraine have made significant contributions, working hand-in-hand with the Ministry of Health of Ukraine and the National Health Service of Ukraine.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author Contributor Statement

Conception of the work was led by Jarno Habicht and Elina Dale. Data curation and analysis was led by Julia Novak, Denys Dmytriiev, and Olga Demeshko. Drafting of the article was done by Elina Dale and Julia Novak with inputs from Olga Demeshko and Denys Dmytriiev. Critical revision of the article was led by Jarno Habicht. All named authors approved the article prior to submission.

Ethical Approval

Ethical approval for this type of study is not required. Ethical approval was received for published and unpublished reports used in the commentary.

Notes

1. Definition of what constitutes FCAS is complex. One widely accepted definition comes from the World Bank, and it is used here. Accordingly, fragility is “defined as a systemic condition or situation characterized by an extremely low level of institutional and governance capacity, which significantly impedes the state’s ability to function effectively, maintain peace, and foster economic and social development. Conflict is “defined as a situation of acute insecurity driven by the use of deadly force by a group—including state forces, organized non-state groups, or other irregular entities—with a political purpose or motivation. Such force can be two-sided—involving engagement between multiple organized, armed sides, at times resulting in collateral civilian harm—or one-sided, in which a group specifically targets civilians.” 1. World Bank. Classification of Fragile and Conflict-Affected Situations for World Bank Group Engagement. 10 July 2023. https://www.worldbank.org/en/topic/fragilityconflictviolence/brief/harmonized-list-of-fragile-situations (accessed 24 April 2024).

2. Excluding Luhanska oblast, Avtonomna Respublika Krym, and the areas of Donetska, Khersonska, and Zaporizka oblasts temporarily under Russian Federation military control, as well as health facilities within 0 to 10 km from the frontline or the Ukraine-Russia state border.

Additional information

Funding

The authors gratefully acknowledge support from the WHO Universal Health Coverage Partnership, including financial support from European Union and the Government of Canada, and the Ministry of Health and Care Services of Norway under the grant [UKR23/0016] Institutional Cooperation in the Health Sector. The contents of this publication are the sole responsibility of the authors and do not necessarily reflect those of the European Union, the Government of Canada, or the Government of Norway.