Sustaining Health Sector Reform in Ukraine Phase 2

The reform of the Healthcare system since 2017 has been influenced dramatically by the full-scale invasion in February 2022. Till December 2024, the direct damage to the health sector infrastructure has amounted to US$ 1.56 billion. Despite unprecedented challenges, the modernization of Ukraine’s health sector has continued. Even with a limited budget and high staff turnover, the Ministry of Health (MoH) and the National Health Service of Ukraine (NHSU) continued to function, ensuring the continuity of health service financing and the gradual rollout of reforms.

Phase 1 of the project supported health sector reforms and modernization and enhanced the MoH in prioritizing reconstruction initiatives and investments and coordinating the recovery of the health sector. Furthermore, it was instrumental for increasing Primary Health Care (PHC) financing and for making hospital payments more strategic. Health system reform is foundational for all Swiss-supported health interventions in Ukraine.

Further healthcare reform is crucial, and Phase 2 of the project will strengthen health sector governance arrangements by strengthening oversight and transparency, sharpening the public financing for health approach, and raising quality of service delivery.

The key challenge ahead is the continued healthcare system transformation while simultaneously addressing the consequences of war and ensuring sustainable health system financing.

Direct: MoH of Ukraine, NHSU, Parliamentary Health Committee, healthcare experts, academia.
Hospital networks, primary and secondary level healthcare service providers, healthcare managers.
Civil Society Organizations and Patient Advocacy Groups.

Indirect: The people of Ukraine, including vulnerable groups will benefit from better access to and more efficient and patient-oriented care.

Objective 1. Enhance the robustness, transparency and accountability of existing health institutions, including engagement of key stakeholders and civil society.

Objective 2. Enhance efficiency in the use of funds by promoting sustainable public funding, strengthening purchasing mechanisms, and improving financial protection

Objective 3. Ensure better quality, efficiency and accessibility of health service delivery networks, particularly for vulnerable populations.

Resultados previstos:  

• Establishment of mechanism for implementing and monitoring of the Health Strategy 2030.
• Transparent and accountable decision-making related to the Program of Medical Guarantees (PMG) is ensured.
• Capacity of MoH and NHSU to govern the health system is strengthened.
• Collaboration between civil society and the MoH and NHSU is institutionalized.
• Mechanisms for purchasing of PHC and specialized care services are revised and made more strategic.
• Mechanisms for improving and monitoring quality of care are developed and implemented.
• A strategy for channelling recovery investments in the health sector are developed to support transparent and informed investment decisions.

Resultados de las fases anteriores:  

• Development and adoption of the National Health Strategy 2030 and adaptation of it to the wartime context.
• Introduction of new PHC financing under the Program of Medical Guarantees, rationalizing hospital contracting.
• Support the expansion of primary health care (PHC) to 32 million enrollees and nearly 3 million participants in the Affordable Medicine Program (AMP).
• Technical Assistance helped the MoH develop and rapidly expand rehabilitation and mental health services.
• The voice of patients and citizens in the management of the health system was strengthened.
• To enhance Health Financing Sustainability healthcare financing must be analyzed further focusing on state budget spending, out-of-pocket payments, fund allocations, and utilization.
• City and oblast administrations should be engaged systematically in the health system development to complement the work done at the ministry level.
• Civil society should be actively involved to help the MoH safeguard the progress made to date.
• A bigger focus on improving quality of healthcare service provision at both national and local levels is needed.