Even as Ukraine marks 8 months of a brutal war, the health care system in Ukraine continues to function overall, but spiraling costs, logistical hurdles and damaged infrastructure are making access to essential services all the more challenging for growing numbers of civilians.
These are among the key findings of a recent health needs assessment conducted by the WHO Country Office in Ukraine, shared with the Ukrainian Ministry of Health, international and national health partners, and humanitarian actors on the ground.
The assessment focused on identifying health needs and major barriers to access to primary and specialized care and medicines. The methodology took into account the correlation between income and access to specific categories of medical services and supplies for the 18-and-over population of Ukraine.
Some of the specific findings include insights from different geographic areas as well as the health needs of internally displaced persons (IDPs). The survey, conducted in September 2022, is the first such assessment since the start of the Russian invasion into Ukraine on February 24.
“People across Ukraine report that the major barriers to accessing health care are cost, time constraints to get to and from health facilities, as well as limited transport availability,” notes Dr Jarno Habicht, WHO Representative in Ukraine and Head of the Country Office. “Chief among these is the cost of care. Those who are living in temporarily occupied territories and active combat areas remain the most vulnerable, with 1 in 3 reporting reduced access to services and medicines, compared to 1 in 5 people nationwide.”
“At the same time, the findings recognize that, as of now, the country’s health system remains resilient and overall access to some level of health services is still high,” adds Dr Habicht. “From those who sought care, 95% report having had primary care services and up to 90% had access to health services for chronic conditions. But upcoming wintertime challenges and the latest escalation in fighting could add to a significant burden on the health system, with thousands of civilians living in damaged homes without fuel or power, potentially vulnerable to a range of dangerous cold weather conditions, from frostbite to pneumonia. Another challenge is COVID-19 coupled with seasonal influenza, with a significant percentage of the population still unvaccinated for COVID – a worrying situation at a time when respiratory infections traditionally increase.”
Compounding this scenario are analyses, conducted by the World Bank and the United Nations Development Programme (UNDP), that the war could push some 60% of the population, or even significantly more, below the poverty line. The WHO assessment clearly points to mounting economic woes that could further jeopardize the well-being of millions.
“The assessment’s results could support the Government and health partners to address critical gaps in designing an appropriate medium- and long-term response plan,” says Dr Habicht. “We will continue to partner closely with the Ukrainian Ministry of Health to find optimal solutions. Even before the war, Ukraine’s health reform process was showing promising results. We must build on that. The commitment to universal health care is real. WHO is here to stay, to support the health system to expand access to health for all, no matter how daunting the challenges may be.”
Details of the health needs assessment
Health needs assessment (HNA) is a systematic method for reviewing health issues facing a population, leading to agreed priorities and policies by health care decision-makers and managers in the country.
Key findings in the assessment include:
- 1 in 3 adult Ukrainians surveyed sought primary care;
- 1 in 2 respondents reported at least one barrier to accessing any level of care, the most common being cost;
- 1 in 5 Ukrainians couldn’t get the medication they needed; cost, availability and long queues at local pharmacies are the top 3 reasons; and
- those living in temporarily occupied territories and active combat areas tend to seek health care services less than those in other areas, while IDPs sought services significantly more than the wider population.
Regarding access to medicine, the survey finds that, overall, 1 in 5 people (22%) were not able to get the medicine they needed. In temporarily occupied and active conflict areas, this increases to 1 in 3 people. The situation with IDPs is similarly challenging.
The types of medicines most frequently cited by respondents as difficult to obtain were:
- medication for high blood pressure (49%)
- medication for heart conditions (49%)
- pain medication (41%)
- sedatives (33%)
- antibiotics (32%).
The main reasons for not getting medicine included the increased price of medicine (84%) and the unavailability of medicines at the pharmacy (46%).
Households that consist only of women have significantly less income and higher expenses for health care services and medicines than households that include men. Household income, not surprisingly, affects the level of access to health care services.
Regarding access to primary care, those living in temporarily occupied and active combat areas tend to seek health care services less than those in other areas, while IDPs sought services significantly more often than non-IDPs.
Regarding access to care for chronic conditions, 1 in 3 respondents stated that either they or a member of their household have chronic disease and more than half of these groups (52%) sought health care for chronic conditions. The most common conditions were cardiovascular disease (61%), diabetes (25%) and kidney disease (21%). This is a trend WHO continues to see throughout the country. Also, women respondents tend to have higher needs for services and a better chance of getting needed care compared to men.
The second round of the health needs assessment is planned for December 2022 to monitor changes in the health needs of the population as winter intensifies across the country.
Current health response
In response to ongoing, urgent needs, WHO continues to bring life-saving medical supplies into the country. More than 1350 metric tons of supplies have been delivered to Ukraine since 24 February in coordination with the Ministry of Health. And WHO continues to bring in much-needed supplies to newly liberated areas as well, including the Kharkiv and Donetsk regions. Areas including Izium, Lyman, Kharkiv and Sviatohirsk have been reached in the last few weeks with supplies.
Besides tangible medical and humanitarian supplies, WHO is also providing capacity-building and technical guidance to meet ongoing health needs. WHO has so far trained more than 11 000 health care workers on a range of issues, including trauma surgery, mass casualties, chemical exposure, epidemiology, and laboratory diagnostics.
Mobile health units supported by WHO continue to ensure that medical consultations can reach the most vulnerable and those who have returned to liberated areas. Our focus with partners has been to ensure extended primary care and support in managing chronic conditions, such as hypertension and diabetes, in numerous oblasts.
WHO is also contributing to the National Mental Health and Psychosocial Support Programme launched by the First Lady of Ukraine to support the wider population. Nearly 10 million people at this time are estimated to be at risk of developing a range of mental health conditions, from severe anxiety and stress to post-traumatic stress disorder and suicidal tendencies.