WHO and the World Bank present a report assessing progress in implementing the reform of financing the Ukrainian healthcare system in the context of war
The World Health Organization and the World Bank have presented a new report “Health Financing in Ukraine: Reform, Resilience and Recovery.” It demonstrates that despite the consequences and challenges of a full-scale war, financing reforms have strengthened the resilience of Ukraine’s healthcare system. This report is the third in a series of joint publications by the WHO and the World Bank assessing progress in healthcare financing reforms since the launch of the reforms in 2017.
“To combine the priorities of peaceful life and the challenges of war in such a way as to provide Ukrainians with universal access to high-quality, affordable and free medical care - this is the task facing the Ukrainian healthcare system for almost three years now. And our medical system can handle it, in particular, due to changes in approaches to financing, which allows us to be adaptive and flexible in our decision-making. Despite the war, we are continuing our reforms: last year we completed the formation of a capable network of medical institutions, which allows us to use available resources more efficiently. The state budget for 2025 envisages a significant increase in healthcare spending: an additional UAH 6.3 billion will be allocated to expand the Affordable Medicines program and modernize medical infrastructure. The total amount of expenditures is over UAH 217 billion, of which over UAH 175.5 billion will be allocated to finance the Medical Guarantee Program, which is UAH 16.8 billion more than last year. Regular reports on the progress in implementing healthcare financing reform in Ukraine from the WHO and the World Bank are a kind of compass that allows us to understand whether we are moving in the right direction. The positive assessments I have heard today motivate us to continue working even harder to strengthen the sustainability of the healthcare system.”
Despite the war, Ukraine has maintained universal healthcare coverage under the Medical Guarantees Program, providing citizens access to basic medical services. The centralized accumulation and management of funds by the National Health Service of Ukraine allowed us to continue funding in the territories that were severely affected by the war and had lost their revenues from local budgets.
“Ukraine has maintained universal healthcare coverage through the Medical Guarantee Program, which ensures access to basic healthcare services for all citizens while strengthening protection against financial burden. During the regional consultations, which were attended by representatives of 10 oblasts of Ukraine, the authors of the report gained a clearer vision of how the health care financing reform is being implemented on the ground in Ukraine and explored possible ways to further implement it. Such consultations are important for adapting healthcare financing to regional needs, especially in war-affected areas. By adapting reforms to local conditions, we are helping to ensure that the healthcare system not only continues to function, but also plays an important role in supporting recovery where it is most needed.”
“Improving people’s health should be the primary goal of health systems around the world. This also includes ensuring that people are protected from the heavy financial burden of paying for medicines and other healthcare costs out of pocket. This new report demonstrates that effective healthcare financing is key to achieving the following goals: efficiency, transparency, accountability, and, most importantly, equity when it comes to ensuring access to healthcare. As Ukraine’s healthcare system continues to face extraordinary challenges, sustainability and equity in healthcare financing are more important than ever to ensure that everyone gets the care they need, whenever and wherever they need it.”
“It is gratifying to see the government’s commitment to implementing ambitious healthcare reforms aimed at improving the efficiency of Ukraine’s healthcare system. In the face of budgetary constraints, improving the efficiency of public healthcare financing is the only way to ensure Ukraine’s ability to care for citizens whose healthcare needs are increasing as a result of the russian invasion. Further implementation of these reforms will also be crucial for modernizing the healthcare system in line with Ukraine’s aspirations to join the European Union.”
The joint report examines the impact of the war on Ukraine’s healthcare system and the difficult conditions in which reforms to finance the system continue to be implemented. It also emphasizes that despite the difficult conditions, the reforms are effective. In particular, they have played a key role in strengthening the resilience of the healthcare system during the COVID-19 pandemic and the war. However, due to the many challenges of the war, healthcare spending remains limited. In the future, healthcare financing reforms should focus on increasing cost efficiency, maximizing value for money, ensuring equal access, improving the quality of services, etc. The study also provides recommendations on policies and measures that will help improve the healthcare system’s performance on key healthcare financing goals.
In particular, it is about strengthening primary health care and ensuring transparency and accountability of institutions.
- Primary care is essential for ensuring access and efficiency of the healthcare system. The report recommends steps to facilitate concluding and changing declarations with primary care providers, support sustainable financing of primary care, introduce financial incentives for performance improvement, etc.
- Transparent and accountable institutions are crucial for the success of the reform. It is recommended that an oversight body be established to provide strategic oversight of the PMG process and the NHSU, and that regulations and internal procedures be revised to ensure transparent, evidence-based, and timely PMG decision-making processes.
In addition, the report also discusses how to build a stronger healthcare system, focusing on modernizing healthcare delivery, optimizing hospital networks, and strengthening institutions.
For reference: The report was prepared with the financial support of the Swiss Agency for Development and Cooperation under the project “Support to Health System Reform in Ukraine”, the Government of Canada and the European Union under the project “Healthcare System Development in Ukraine” and the Universal Health Coverage Partnership.
In the process of preparing the report, numerous discussions were held between WHO and World Bank experts, technical consultations with national authorities, including the Ministry of Health of Ukraine and the National Health Service of Ukraine, as well as regional roundtables to obtain a vision of the implementation of health care financing reform in Ukraine at the local level.