A joint discussion paper by WHO, the United States Agency for International Development (USAID)/Ukraine, the World Bank and the European Union (EU) highlights key priorities for the recovery of the health system in Ukraine over the next 2 years amid the Russian Federation’s ongoing invasion.
The document, which is intended to complement Ukraine’s National Recovery Plan, was informed by discussions with the Ministry of Health and other stakeholders. It presents an analysis of critical priorities for the health sector across 4 domains:
- service delivery – finding early opportunities to restore priority health services in ways that scale up the Government of Ukraine’s vision for health service reform, while addressing critical health risks facing the Ukrainian people due to the impacts of the war;
- capital investment – identifying critical choices and trade-offs for the Government and its partners to consider when planning for major investments in recovery and reconstruction with long-term consequences for the health system, to enable Ukraine to protect health in the near term while building back better for the long term;
- health financing – setting financing priorities to sustain essential services in the face of severe fiscal constraints and achieve more with the available funds; and
- strengthening institutions – supporting the needs of the central and local government health-sector institutions responsible for policy, planning, stewardship and governance functions, and sustaining ongoing health-care financing and governance reforms that are vital to an effective, accountable health-care system and Ukraine’s aspirations of European integration.
“Despite the immense challenges caused by the war, the national health system is functioning and provides health services to millions of Ukrainians with support from development partners and the humanitarian community,” said Dr Jarno Habicht, WHO Representative in Ukraine.
“The support provided by the international community to the health system both now and in future will greatly affect not only the health and well-being of people in Ukraine, but also future development of the sector. Investments in health and the health sector are an integral part of both the emergency response and developmental support towards the country’s recovery. Health system recovery cannot wait to start until the war is over.”
The joint document was created with an understanding that, despite ongoing security, humanitarian and economic challenges, the Government of Ukraine and its partners are implementing emergency actions to stabilize the system while planning for longer-term recovery and rebuilding.
“This discussion paper underscores the close and continuing partnership among key development partners and the Government of Ukraine in this historic endeavour to strengthen the resilience of Ukraine’s health-care system during wartime, while laying the foundations to build back better,” explained Mr Ben Zinner, Director of USAID/Ukraine’s Office of Health.
“USAID is committed to supporting the ongoing reform and recovery of Ukraine’s health-care system to meet the needs of Ukrainians now and in the future, while helping to protect public health and support those affected by Russia’s brutal war.”
With the war continuing into 2023, the paper acknowledges that critical choices and trade-offs will have to be made in allocating scarce resources. Both national authorities and international supporters will face decisions on what investments could bring the most benefit to the population and the health system during a period of significant need.
In the near term, macro-fiscal pressures on Ukraine’s public budget will strain public services. This will require attention to ongoing reforms and investments to increase efficiency and sustain progress, as well as short-term measures to sustain access to high-priority services.
Dr Caryn Bredenkamp, Lead Economist for Human Development at the World Bank, said, “The Ukrainian authorities have demonstrated remarkable resilience in responding to the urgent needs of the health-care sector despite severe fiscal constraints – and also doing so in a way that is aligned with the longer-term reform vision.”
She continued, “Coordinated support from partners it essential. A new Health Enhancement and Lifesaving (HEAL) Ukraine project – which brings together emergency funding from the World Bank and other development partners for rehabilitation care, mental health, provision of essential primary health-care services and medicines, and reconstruction of the health facility network – will help to realize that vision.”
The new joint discussion paper contributes to the ongoing dialogue regarding a well considered and prioritized response, which is essential to rebuilding a smarter, more efficient health system in the country. Ukraine and its partners face an historic opportunity to approach these challenges in ways that help to address new needs while restoring access to essential services that have been disrupted due to the war, and setting the country on track for sustainable progress towards universal health coverage.
Ms Alexandra Janovskaia, Policy Officer for the EU Delegation to Ukraine, added, “The previous health reform agenda has undoubtedly contributed to the resilience of Ukraine’s health system. Despite difficult circumstances linked to Russia’s full-fledged war of aggression, it’s important to continue on the reform path, especially on Ukraine’s commitments in the areas of public health, medical procurement, etc. This progress will be instrumental in strengthening Ukraine on its path of EU integration.”