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

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Box 1: Brief on Ukraine’s health financing, primary health care and out-patient medicines related reform

Since 2015, the Ukrainian government embarked on reforms of its health care system. In October 2017, parliament adopted the Law on “Government Financial Guarantees of Health Care Services” (Law 2168) and associated regulations, laying the foundation for the new health financing system.^Citation6 On 1 April 2018, a new single purchasing agency, the National Health Service of Ukraine (NHSU) was established, and already by July, it started contracting PHC providers. For the first time in Ukraine’s health system, the population had free choice of providers and could register with any provider, regardless of the place of official residence. There was a notable increase in the funding allocated to primary healthcare, accompanied by substantial investments in information systems. Primary care providers changed status, becoming autonomous entities able to sign contracts with purchaser, as NHSU. Input-based line-item payment method was replaced by capitation with providers having autonomy to manage their own funds.^Citation6

To increase the availability of outpatient medicines and to address one of the key drivers of catastrophic spending, the government also introduced the Affordable Medicine Program for outpatient prescription medicines reimbursement. ^Citation7,Citation8 Although modest in size, it was an important step in line with global evidence on measures for increasing financial protection and strengthening the role of PHC providers. ^Citation9

Figure 1. Prioritization of PHC in government spending, 2014–2022.

Notes. PHC includes feldsher—midwife points of contact (budget code 0725) and PHC centers (budget code 0726).

Sources: Consolidated budget expenditures based on functional classification from the State Treasury Service of Ukraine; National Health Service of Ukraine Budget Programme Passports.

Figure 2. Changes in service delivery since the full-scale invasion on 24 February 2023.

Notes. Survey covered 500 PHC facilities.

Source: WHO survey on continuity of essential health services, 2023.

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