The Ukraine Recovery Conference in London heard details of 4 case studies from WHO demonstrating how health stakeholders are undertaking efforts to recover and resume their operations on the ground in the country. In a new report, WHO highlights how, following the Russian Federation’s invasion of Ukraine in 2022, the mobilization of international support for the country’s economic and social stabilization, including through private sector engagement, can lead to fruitful results in health-care recovery efforts.

Since the beginning of the full-scale war in February 2022, WHO has verified over 1000 attacks on health care, with the cost of direct damage to the sector estimated at US$ 2.5 billion. Yet, even in the 10 most conflict-affected regions, nearly 90% of health facilities are now functioning. Thanks to the joint efforts of national, international, and local stakeholders, the health system has demonstrated remarkable resilience and there are already examples of early investments into the reconstruction of health facilities.

“A lot can be learned from current efforts, many of which have the potential to be expanded or scaled up, while recognizing that solutions need to be tailored to the specific needs and circumstances of various geographical areas, types of services and modalities of engagement,” said Dr Jarno Habicht, WHO Representative in Ukraine.

Recovery efforts in Ukrainian health-care facilities

The new WHO report “Case studies of health system recovery in Ukraine: focus on the role of the private sector” documents 4 case studies illustrating the role of private and other nongovernmental actors in the early rebuilding and recovery process.

1. The Adonis medical network includes a maternity hospital in the Kyiv region and a multiprofile clinic in Bucha. The clinic required relatively moderate investment to resume operations despite fierce fighting in Bucha. Adonis owners invested their own funds and the facility reopened in June 2022. A considerable shift in target group needs and resources required re-profiling the facility towards rehabilitation services. This example illustrates partial recovery of operations by a national private service provider, requiring relatively moderate investment. However, there is uncertainty about other business operations that require substantially larger capital investment. For example, the maternity hospital, which continued to receive women in labour in the first days of the invasion, is now unfit for use and the owner lacks access to capital. The hospital was directly hit by tank shells before being occupied by Russian forces, looted, and severely damaged, including by fire. When and if it will start functioning again depends on arrangements to finance these kinds of recovery projects, which are currently absent.
2. Apteka 911, a national pharmacy chain, used its own funds to finance the reopening of its pharmacies, around 30% of which had been damaged or destroyed in the Kharkiv region. The pharmacy network reopened in areas very close to the front line, sometimes just a couple of weeks after the area returned to the control of the Ukrainian Government, and is now often the only provider of pharmaceuticals in those areas. Apteka 911 quickly adapted to the reality of the war and offered mobile delivery of medicines to remote areas, online consultations for patients in settlements where health facilities had been destroyed, and delivery of medicines by mail.
3. The Makariv primary health-care (PHC) centre, which had provided services to 28 000 people prior to the invasion, was attacked by shell fire and completely destroyed. “I didn’t believe that our ambulatory unit would be rebuilt at all,” said Serhiy Solomenko, Head of the Makariv PHC centre. Yet it is now fully restored thanks to a private foundation of the Kyiv School of Economics (KSE Foundation), which organized a series of fundraising events to collect US$ 800 000 needed for reconstruction and supervising the process.
4. The Mala Rohan rural ambulatory unit in the Kharkiv region was also hit by artillery and tank shelling, which resulted in damage to the walls and the roof. After the area was retaken by Ukrainian forces, health-care workers began to provide care in the damaged facility despite it missing windows and part of a wall. The national nongovernmental organization Patients of Ukraine used investment of around US$ 43 000 from Crown Agents International Development (CAID) for restoration, which was sufficient to fully restore the facility. Under its agreement with CAID, Patients of Ukraine restored 25 damaged health facilities to enable them to function again, most of which required even smaller investments than the Mala Rohan case. All projects are conducted in cooperation with the Ministry of Health, taking into consideration estimates of local population return and demand, availability of health workers and military advice concerning the security situation in the area. The example demonstrates that often a small-scale investment to fix damaged windows or roofs can play a profound role in a facility’s capacity to function and provide health-care services, while a contract with the National Health Service of Ukraine can cover future recurring expenses.

Overall, all case studies presented by WHO/Ukraine show the resilience of the health system and recovery driven by cooperation between national and international actors, with engagement from the private sector. Despite the war, health-care facilities are being restored and the Ukrainian Government continues to implement health reforms to make the health system more efficient and patient-centred, while moving towards universal health coverage for the entire population.

https://www.who.int/ukraine/news/item/21-06-2023-early-success-in-health-system-recovery-in-ukraine–new-who-report-highlights