A new WHO/Europe report delves into the current state of primary health care (PHC) financing in Ukraine and presents 5 policy recommendations to enhance health outcomes, optimize public spending and increase value for money.
Ukraine is making significant strides in expanding PHC amid the war. Recent health financing reforms have prioritized strengthening PHC, introducing measures to increase services and improve quality, including on: implementing a PHC service package within the Program of Medical Guarantees (PMG) definition; ensuring patient choice and provider autonomy expansion; and implementing the Affordable Medicines Programme.
These reforms have led to a robust PHC-centred system in the country. Now, the new WHO policy paper, “Primary health care financing in Ukraine: a situation analysis and policy considerations”, puts forward a series of recommendations to take these reforms further. These include:
- strengthening the PHC service delivery system
- ensuring access to a comprehensive and affordable PHC service package for everyone
- securing adequate funding and priority for PHC in budget allocation
- redesigning and resourcing PHC provider payments
- using contracting mechanisms to strengthen PHC service delivery.
Consensus moving forward
At a national policy dialogue on 8 November 2023 in Kyiv, Ukraine, representatives of the National Health Service of Ukraine (NHSU), Ministry of Health, Ministry of Finance, Parliamentary Health Care Committee, primary care facilities, professional associations, development partners, and patient and civil society organizations reviewed the action points outlined in the new policy paper. As an outcome of the discussion, participants reached a consensus on defining priorities for the upcoming years based on this study.
Ukraine’s public spending on PHC remains among the lowest in the WHO European Region.
“Considering Ukraine’s financial challenges, it is imperative to prioritize spending on primary health care services. Identifying health problems at an early stage is the best cost-effectiveness strategy and way to save lives and improve public health outcomes,” said Dr Jarno Habicht, WHO Representative in Ukraine. “This study presents actionable steps to accelerate such transformative progress and capitalize on the resilience displayed by the health sector amidst the ongoing war.”
Ensuring access to comprehensive PHC for everyone
As of May 2023, 80% of Ukraine’s population was registered with a PHC provider, but regional disparities persist, and the rise of internally displaced people worsens this scenario.
“The Program of Medical Guarantees and the Affordable Medicines Program adopted during the health system reform have played a key role in improving access to primary health care in Ukraine, making essential medicines and services more affordable. However, persisting gaps in the benefits package continue to lead to high out-of-pocket spending on medicines and diagnostic services,” explained Dr Tamás Evetovits, Head of the WHO Barcelona Office for Health Systems Financing. “The policy paper outlines concrete steps to address these gaps and ways to strengthen financial protection.”
Redesigning the providers’ payment system
Redesigning the PHC providers’ payment system is a priority to offer better services aligned with the population’s needs. Currently, the model does not take into full consideration the increased health care needs for older patients or address the higher expense of delivering PHC services in rural areas. The funding for PHC services should also be adjusted to keep up with inflation and wage increases.
The PHC budget and payment model should reflect provider costs to deliver the services defined in the PMG, as this limits the need for patients to pay for these services out of pocket. To ensure this, the NHSU, with the support of WHO, conducted a study on the cost of PHC services and developed a methodology for updating the per capita payments for providers.
“The methodology developed from this costing study represents a powerful tool to create more transparent budget estimates for various PHC policy proposals,” said Natalia Husak, Head of the NHSU. “This evidence-based approach assists us in advocating for more appropriate funding for PHC within the general budget, allowing us to allocate resources better for expanding the PHC package and responding to the population’s health needs.”
Technical assistance and financing for the study
This new study received technical assistance from WHO under the Biennial Collaborative Agreement between the Government of Ukraine and the WHO Regional Office for Europe 2022–2023, as well as financial support from the Government of Canada.