The capacity to treat soldiers and civilians directly injured in Russian attacks is clearly vital to Ukraine’s resilience. But effective, accessible healthcare is also essential to build and sustain national morale. Healthcare is a critical link between citizens and their governments, and trust in a country’s health system often translates into confidence in government and other public institutions.
Ukraine’s government has adopted a series of important healthcare reforms since 2017. Still, the country must go further to modernise care, meet European standards, and respond effectively to the complex demands of a conflict environment. For example, while recent reforms entitle citizens to receive many free healthcare services at their local health facilities, with the costs covered by the National Health Service of Ukraine (NHSU), displaced people confront uncertain access to care.
In a war-ravaged environment, the healthcare system must be built on a set of strategically designed networks. Ukraine’s leaders seem to recognise this necessity, at least to some extent: the country recently developed a “capable hospital network,” which organises specialty hospitals into clusters. But the NHSU still lacks the ability to contract with the network, rather than individual facilities, and the network’s creation has not yet led to consolidation of hospitals.
Strategic network design begins with an analysis of who and what needs to be connected, with those results then guiding the construction of new links and the structure of the overall network. Policies and regulations, digital connectivity, and formal and informal collaboration can all support the development of resilient and sustainable networks.
Such a strategic approach would go a long way toward improving the efficiency of Ukraine’s healthcare system. More than 90% of the health services a person receives during their lifetime are likely to occur at the primary-care level, where acute and minor illnesses and injuries are diagnosed and treated. In Ukraine, however, excess capacity at secondary and tertiary levels risks undermining delivery of primary care.
A strong primary-care system supports better health outcomes and more efficient service. To this end, policymakers should build on past reforms to spur the development of mesh-type primary-care networks, with clinics spread over as much of the country as possible. Beyond boosting resilience in the face of the current conflict, such a structure would prove valuable in the event of another pandemic, as it would enable people to avoid congregating at a central site.
Secondary care (the management of specified conditions such as hypertension, pregnancy, or HIV) and tertiary care (which requires hospitalisation) require a different network structure, organised around decentralised hubs that encourage the consolidation of expertise and economies of scale. Primary-care clinics would funnel patients to these hubs as needed, without forcing patients to undergo repeated tests and diagnoses at each level.
With such networks in place, a patient with a war-related injury could move from hospital care to secondary-level rehabilitation, while continuing to meet their basic health-care needs (including mental-health and social services) at the primary level, all with minimal friction or barriers to access. Flexible alternative solutions, such as telemedicine, can provide added redundancy, so that people with limited access to their usual providers can still receive care.
The establishment of well-connected groups of providers, patients, facility owners, and others, which are linked to others at the local, provincial, national, regional, and international levels, would support a shared sense of ownership of the health system, enabling faster adoption of reforms and best practices. Such networks could even evolve into healthcare governance mechanisms in their own right, performing functions such as licensing providers, accrediting facilities, and holding providers and facilities accountable for the care they deliver.
Ukraine’s digital “e-health” system can buttress this strategy. Already, Ukraine has made great strides in building digital systems for telehealth, electronic records, payment processing, and procurement. But the e-health system is far from complete. For example, Ukraine still needs an overall digital-governance framework to enable the e-health system to track contracts, record services provided, and maintain patient records – all critical to efficient allocation of resources.
The e-health system could also offer a mechanism for providing feedback on service provision, and it could help to integrate the now-separate military, government, and public healthcare systems. Moreover, it could play a central role in strengthening systemic resilience by providing redundancies through cloud-based data storage. And the development of Ukraine’s e-health system would give a boost to “e-government” more broadly – an area where Ukraine is already a global leader.
In fact, health-related network activities would yield many benefits beyond healthcare. Governance improves when local facilities are adequately funded and providing quality services. Investment and collaboration on health-related needs, such as physical rehabilitation, can galvanise and engage the private sector. The networks Ukraine builds now, in healthcare and elsewhere, can be connected to larger European Union networks as Ukraine moves closer to membership.
Upgrading Ukraine’s health infrastructure, policies, and processes would strengthen the country’s ability to hold Russia at bay. In the longer term, such an effort could enable Ukraine to leapfrog over other countries in the region when it comes to provision of public goods and services. — Project Syndicate
For all their fortitude and tenacity, Ukrainians have paid an incalculably high price for Russia’s war. It is only appropriate that they also secure some long-term benefits.
- Anne-Marie Slaughter is CEO of New America. Kelly Saldaña is Vice-President for the Resilient Health Systems portfolio at Abt Global and a former director of the Office of Health Systems at USAID.