Ukraine has maintained universal population coverage under the Program of Medical Guarantees (PMG), ensuring that all citizens and permanent residents can access health services included in the PMG improving protection against financial hardship from cost of healthcare. Central pooling of funds and their management by the National Health Service of Ukraine (NHSU) enabled continued financial coverage in territories affected by war that had lost their own locally generated revenues.Launched at a joint event in Kyiv, the report highlights the impact of the war on Ukraine’s health system and the challenging context in which health financing reforms continue to be implemented. This report is the third in a series of reports, jointly produced by WHO and the World Bank, assessing progress in reforming Ukraine’s health financing system since the reforms were launched in 2017.“Ukraine has sustained the universal health coverage through the Program of Medical Guarantees, ensuring that all citizens can access essential health services while strengthening protection against financial burden,” said Dr Jarno Habicht, WHO Representative in Ukraine. "Through regional consultations, joined by local stakeholders across 10 Ukrainian oblasts, we have gathered local perspectives on the implementation of health financing reforms in Ukraine and explored ways forward. These consultations are crucial for tailoring health financing to meet regional needs, especially in frontline areas affected by the war. By adapting reforms to local contexts, we ensure that health systems not only remain functional but also play a vital role in supporting recovery where it is most needed."“Improving people’s health should be the main objective of health systems everywhere. This also includes making sure that we are protecting people from the often severe financial burden of out-of-pocket payments for medicines or other health costs,” said Dr Natasha Azzopardi Muscat, WHO/Europe’s Director of Country Health Policies and Systems at the launch event. “This new report shows that effective health financing is key to achieving these goals—efficiency, transparency, accountability, and most importantly, equity when it comes to ensuring affordable access to health care. As Ukraine’s health system continues to face extraordinary challenges, resilience and equity in health financing are more important than ever to provide everyone, everywhere with the care they need it, whenever they need it.”“It is encouraging to see the Government’s commitment to the ongoing implementation of these ambitious health sector reforms to increase the efficiency of Ukraine’s healthcare system,” said Bob Saum, World Bank Country Director for Eastern Europe. “In the context of challenging budgetary restraints, improving the efficiency of public financing for health is the only way to ensure that Ukraine can look after its people, whose healthcare needs are growing as a direct result of Russia’s invasion. The continued rollout of these reforms will also prove critical for the modernization of the health system in line with Ukraine’s ambition to join the European Union.” “The task, which Ukraine's healthcare system has been for almost three years now, is to combine the priorities of peaceful life with the challenges of war, ensuring that Ukrainians have universal access to quality, affordable, and free medical care. And our healthcare system is managing this task. In particular, thanks to changes in financing approaches, which allow us to be adaptive and flexible in decision-making. Despite the war, we continue implementing reforms: last year, we completed the formation of a capable network of healthcare facilities, allowing for more efficient use of available resources. The state budget for 2025 envisages a significant increase in healthcare spending: an additional 6.3 billion UAH will be directed to expand the “Affordable Medicines” Program and modernize medical infrastructure. The total amount of expenditures will exceed 217 billion UAH, of which more than 175.5 billion UAH will be allocated to finance the Program of Medical Guarantees, which is 16.8 billion UAH more than last year. Regular progress reports on the implementation of health financing reforms in Ukraine by WHO and the World Bank serve as a kind of compass, helping us understand whether we are moving in the right direction. The positive assessments I heard today motivate us to work even harder to strengthen the resilience of the healthcare system,” said Viktor Liashko, Minister of Health of Ukraine.The report highlights that health financing reforms, initiated in Ukraine in 2017 are on the right track. These reforms have played a critical role in strengthening the resilience of the health system during the COVID-19 pandemic and the war. The report underscores the importance of safeguarding public financing and investment in health, particularly in the challenging war context. Preserving human capital is essential for Ukraine’s long-term economic recovery and social cohesion.However, the fiscal space for government health spending will remain limited due to the war’s economic impact and the need to prioritize defense and security spending. Moving forward, health financing reforms need to prioritize efficiency of spending, maximizing health for the money while also emphasizing equity in access, financial protection against catastrophic out-of-pocket payments, and improving quality of services. The review recommends several policies and actions from a health financing toolkit to help take reforms forward, and improve health system performance across these key health financing objectives.Strengthening primary health care (PHC)Strong PHC is important for efficiency and equity of health system. The review recommends actions to make it easier for the people to sign-up and change their PHC providers, to support sustainable financing of PHC, implement incentives for improved performance, update clinical guidelines to improve quality and cost-effectiveness of care, provide additional measures to support PHC in the areas of high IDP concentration as well in war-affected areas with very low population. As PHC is the gateway to the rest of the health system for the population, the report highlights that Ukraine needs to build on its success of 86% of population having signed declarations with PHC providers and achieve universal registration. Internally displaced people require special attention to ensure their access to PHC as less than 20% of IDPs had changed their registration to a provider at their new location.Ensuring transparent and accountable institutionsThe report suggest that the National Health Service of Ukraine (NHSU) can step up policies and actions as a more proactive purchaser of services based on oblast level health needs assessments, increasing NHSU capacity in regional offices, consolidating purchasing of complex services in higher volume and better quality facilities while maintaining geographical access for population, and improving financial incentives for efficiency and quality.Strong, transparent and accountable institutions are crucial for reform success. The review recommends establishing a governance body for strategic oversight over PMG processes and NHSU performance; and, to revise regulations and internal procedures to ensure transparent, evidence-informed, formal and timely processes for decision making concerning the PMG. To be able to execute its functions properly, the NHSU needs to be adequately resourced beyond the current 0.11% of total PMG expenditures, 10 times less than in comparable European countries.The report also outlines policy considerations for Ukraine to "build back better," with a focus on modernizing health service delivery, optimizing hospital networks, and strengthening institutions.Background information:While developing the report, multiple discussions were held between WHO and the World Bank experts, including meetings held in Barcelona in October 2023, Kyiv in January 2024 and Vienna in April 2024. Additional technical consultations were organized with national authorities including the Ministry of Health of Ukraine, the National Health Service of Ukraine and the Ministry of Finance of Ukraine.Additionally, WHO and the World Bank held regional roundtables in Odesa, Dnipro, and Kyiv in July 2024 to gather local insights on the implementation of the health financing reform in Ukraine. These regional consultations brought national and local policy-makers, primary health care and specialized care providers, and health facility owners from ten Ukrainian regions, including Odesa, Mykolaiv, Kherson, Dnipro, Zaporizhzhia, Kharkiv, Lviv, Rivne, Vinnytsia, Poltava to discuss primary and specialized care financing, the implementation of the Affordable Medicines Programme, and the role of the NHSU. Feedback from these discussions has been incorporated into this third joint health financing review - a series of reports, jointly produced by WHO and the World Bank, assessing the progress in health financing reforms, since their launch in Ukraine in 2017.Key takeaways from the consultations:The ongoing war impacts regions differently.Health financing adjustments are needed for more affected areas.Sufficient and equitable financing for PHC, including affordable medicines, delivers the best value for money.Developing a capable provider network is an opportunity for better quality and efficiency.Stronger NHSU interregional presence would enable more effective regional communication on health needs and provider capacities.The report has been produced with the financial support from the Swiss Agency for Development and Cooperation through the “Sustaining Health Sector Reform in Ukraine” project; the Government of Canada, and the European Union as part of the project “Health System Development in Ukraine” and within the Universal Health Coverage Partnership.To access the report, please follow the link.

“These latest attacks on energy installations are yet another cruel blow to civilians who have already endured so much,” said Türk, noting that on Tuesday, Ukraine marks the grim milestone of 1,000 days since the Russian Federation launched its full-scale invasion.“A winter power shortage will place the health and well-being of civilians, particularly older people, those with disabilities, low-income families, and the internally displaced, at grave risk,” he added.Nine previous waves of attacks against Ukraine’s energy facilities had left millions of Ukrainians without electricity over the summer, and the country grappling with a projected energy shortfall as winter approaches.The High Commissioner again called on the Russian Federation to meet its international obligations under the UN Charter, the order of the International Court of Justice and other applicable law, and to cease immediately its armed attack and withdraw all of its military forces from Ukraine.“It has been 1,000 days too many of senseless pain and suffering since Russia’s full-scale armed attack on Ukraine began. Violations of human rights have become the order of the day, both in the conduct of hostilities and in areas under occupation,” said Türk. “Russia’s ongoing armed attack, as well as intensified collective efforts to end it. must remain a central focus of the global agenda.”At least 12,162 civilians have been killed since the Russian full-scale armed attack began on 24 February 2022 – among them 659 children. At least another 26,919 civilians have been injured.Ninety-two per cent of civilian casualties have been the result of the use of explosive weapons with wide area effects. Ukraine is also now one of the most heavily mined countries globally. Explosive remnants of war pose ongoing dangers for civilians and are hindering recovery efforts.Numerous towns – including Bakhmut, Avdiivka and Vovchansk – have been almost entirely destroyed. Across the country more than 662 medical facilities have been damaged or destroyed, limiting access to healthcare.According to the latest figures from the UN Human Rights Office’s Monitoring Mission in Ukraine, civilian deaths and injuries in the three months to the end of September this year were the highest recorded since July 2022. Close to 2,000 drones were launched by Russian forces into Ukraine in October alone – an average of more than 60 per day.The High Commissioner also expressed concern at the human rights situation in occupied parts of Ukraine. Russian forces now occupy around one-fifth of Ukraine’s territory, including Crimea and parts of Donetsk, Kherson, Luhansk and Zaporizhzhia.“Repression, violence and impunity have become more deeply entrenched in the Russian-occupied territories of Ukraine, with residents living in a pervasive state of fear, marked by surveillance and undue restrictions on their rights to freedom of expression and movement,” he said.Ukrainian administrative, justice, education and other public sector systems have been systematically dismantled and replaced with Russian systems. The Ukrainian curriculum has been banned and replaced with the Russian curriculum, while young Ukrainians have been enrolled in youth organizations promoting patriotism to Russia.

Unconscionable attacks by the Russian Armed Forces yesterday evening and today in the cities of Sumy and Odesa have killed and injured scores of civilians, including children. Residential areas were hit, destroying thousands of windows as temperatures are quickly dropping. These strikes follow the massive attacks on the energy infrastructure over the weekend, leaving already vulnerable civilians across the country to cope with power cuts and limited access to essential services like water supply and heating. Civilians and civilian infrastructure are protected by International Humanitarian Law and must never be hit. As we near a grim milestone of 1,000 days since the escalation of the war, the unbearable suffering endured by the people of Ukraine deepens. In recognizing their unbreakable resolve to overcome severe hardship, the continuous support of the international community is crucial for providing life-saving aid.  

Speaking in Geneva, Matthias Schmale described the anguish felt by Ukrainians as the war grinds on: “As we are not only approaching winter but also the sad 1,000-day mark since the Russian Federation’s full-scale invasion in 2022, we are of course thinking of the more than 12,000 people who have been killed.”“To date, civilian infrastructure has been decimated with over 2,000 attacks now on healthcare facilities and two million damaged homes.”Almost four in 10 people in Ukraine need humanitarian assistance but one of the most pressing concerns is for people living in high-rise buildings who face their third consecutive freezing winter, because of “systematic attacks” on energy infrastructure.Living without heat“I am told that by now, 65 per cent of Ukraine's own energy production capacity has been destroyed,” Mr. Schmale said. Where possible, UN aid teams and partners deliver solid fuel and warm clothing to vulnerable communities, but the situation is more precarious for the “huge number” of people living in apartment buildings.“You can evidently not deliver a tonne of solid fuel to a high-rise building,” Mr. Schmale explained, adding “points of invincibility” - collective shelters in cities and towns that provide warm meals, a shower and a hot drink were welcome, but “not enough”.One of the veteran humanitarian’s biggest concerns is if the Russian forces target the energy sector again, as the weather turns bitterly cold.Mass displacement threat looms“It could be a tipping point forcing further mass displacement both inside the country and outside the country,” Mr. Schmale warned. “So, this is not just about technical solutions, it’s about urging the international community to do its bit to stop this war.”To date, the UN, national and international NGOs and volunteer organizations have reached 7.2 million people in Ukraine with at least one type of aid, thanks to the $1.8 billion received for the humanitarian response.To prepare for winter and address the emergency needs of 1.8 million people until March by delivering solid fuel, ensuring water systems continue to work and by providing cash relief, the UN and partners require $500 million.But the situation is dangerous on the frontline for communities and aid workers, nine  of whom have been killed in the line of duty this year. Humanitarian facilities have also been damaged.Drone terror“Many people have told me on my visits that they feel civilians and civilian infrastructure and civil society are increasingly targeted by drone attacks; and drone attacks are terrible, I don’t need to describe that to you,” Mr. Schmale said, citing the testimonies of people describing being followed by drones.“Some of this is also psychological terror, because…you never quite know, will they strike or are they just observing?”Asked to assess how the new US administration might work to alleviate suffering in Ukraine, the UN aid coordinator highlighted the Secretary-General’s wish that the “significant” humanitarian support of the United States would continue. “They have been by far our biggest individual country supporter,” Mr. Schmale said.“The hope is that they understand like the present administration that there are huge humanitarian needs that need to continue to be addressed.”Source: UN news