Since the Russian invasion of Ukraine in February 2022, over 1200 healthcare facilities have been damaged, totaling about 3 facilities per day. Of those, 174 have been completely destroyed. Losing these facilities has led to delays in civilian access to primary healthcare and medications, long lines at the few facilities that are still functioning, and in the most extreme cases, people have died for lack of emergency care.

“I think the idea is the same as what [Russia is] doing by targeting energy infrastructure,” explains Ukrainian national Iryna Kurinna, a senior technical advisor on Palladium’s health financing team. “They’re trying to exhaust the population, break the spirit, and in terms of healthcare facilities, they’re trying to disconnect people from basic services and make their lives as difficult as possible.”

A recent WHO report noted that pain medicine, antibiotics, and heart medicine were the most needed medicines, and that security, time, and cost were the leading reasons Ukrainians had a serious problem accessing these medicines. For Clint Cavanaugh, Palladium Senior Director for Global Health Security, the situation in Ukraine echoes his work responding to the HIV epidemic. “During the HIV response, it was critical to maintain uninterrupted support.”

“In order to maintain services, we introduced multi-month dispensing of drugs, knowing that clients will have interim challenges in accessing services. We provided decentralised services, which meant people didn’t have to access treatment from what could be dangerous or unavailable access points.”

What’s the solution for civilians of a wartorn country in need of basic and emergency healthcare?

“In the southern regions that were still occupied until recently, they are still experiencing a lot of active fire and missile strikes, so it is not safe to rebuild health services,” Kurinna explains. “In the meantime, the solution is to establish temporary health points where people can get access to the basic services, especially in the rural areas.”

While temporary solutions are necessary to ensure that the population still has access to essential services, Ukrainians are already rebuilding healthcare facilities and planning to “build back better” at both national and regional scales. There is an opportunity in this process to build systems that are more efficient, more aligned to the needs of the citizen of Ukraine, and more forward leaning in terms of planning for health priorities, global health security, and preparedness for other emerging threats.

Cavanaugh explains that the legacy Soviet healthcare system in Ukraine meant that there has historically been a disconnect between infrastructure and epidemiology, burden of disease, and facility census needs. The need for reform has existed for decades and has just been brought to the forefront as a result of the war.

From Kurinna’s point of view, the idea of reform and upgrading the healthcare system is a top priority. “Ukraine has excessive capacities in terms of hospital buildings and medical staff, but most of those facilities need renovation, need new equipment, and better trained staff.”

“We need to analyse the demand first, then instead of rebuilding three hospitals, just rebuild one, with new technologies and according to modern standards,” explains Kurinna.

There is also a lot of uncertainty in terms of population, with millions of Ukrainians fleeing the war, either to neighboring countries or to different regions within the country. The population is not only in flux, but it’s unclear whether people will ever return to the country. Some rural areas, like Bakhmut in eastern Ukraine, have been completely destroyed.

Cavanaugh notes that there are lessons to be learned from other contexts where there has been population flux due to political civil unrest. “Regardless of the population flux, we know that there will be critical infrastructure and supply chain needs that must be resilient, and will be driven by related data and analytics to inform proper allocation of services.”

One way to address unknowns around population is to develop solutions that are adaptable and scalable, like digital engagement and telemedicine services. There is already an increased need for mental health services as a result of the war, and ensuring integration of mental health support into digital innovations will be necessary to rebuild a stronger, holistic healthcare system.

Kurinna says that plans are already well underway. “Ukraine is building an overall e-health system which, when completed, will cover all medical information about patients, medical records, and include their financing system and some centralised data stored on the level of the National Health Service.”

“It's an ongoing process,” she adds.

The health of a population has a direct impact on economic growth – healthy people can work and fully support rebuilding the economy. The expectation is that some refugees will eventually return to Ukraine, and will need access to quality, affordable healthcare services, as well as mental health and rehabilitation support. While temporary solutions are already in place, opportunities to apply and institutionalise innovations in both healthcare facilities infrastructure and e-health systems will be crucial for rebuilding the country as whole.

Read 'The Catalyst Special Report: Ukraine' or contact info@thepalladiumgroup.com for more information.