On what are the most pressing challenges right now

• Every war brings additional burdens to the medical system, because war means physical trauma, rehabilitation afterwards, an increase in infectious diseases, a large number of IDPs, and problems with mental health.
• The medical system was overrun already by the war and the two-year pandemic. Both the Medical Guarantees programme, a tool for procuring medical services, and the unified system responded quickly enough to the challenges. In the electronic system, we see an increase in trauma-related surgeries, a rise in burn injuries, and a rise in the number of people suffering from psychological trauma.

On whether the war affected the delivery of medical services to hotspots

• Meanwhile, access to medical care was maintained throughout Ukraine.

Even during the most difficult periods of occupation, in Kherson and Kharkiv oblasts, and even during the brief periods of occupation, in Kyiv and Chernihiv oblasts, access to healthcare was maintained.

• This weekend, I returned from Kramatorsk, where the Minister of Health and I saw that access to childbirth, psychological recovery, surgery, chemotherapy and all the most important services are still available. At the same time, all services are available to people who were forced to relocate to safer areas.
• I was in the Kherson oblast, the day after the dam was blown up, and there was a need for medical personnel, anticipating an increase in infectious diseases. In addition to blowing up the dam, Russia routinely shelled the area where the rescuers were working. The Ministry of Health, together with WHO, called on doctors of certain categories to join the mission to Mykolaiv and Kherson oblasts.
• In Donetsk oblast, there is a sufficient number of staff to cover the remaining population, and there is no significant need for additional doctors. In one frontline multidisciplinary hospital in Kramatorsk, they have a new service related to chemotherapy and there was a need for a rehabilitation doctor. But in general, the service has been greatly optimised.
• Before the full-scale invasion, there were many more maternity units in Ukraine-controlled regions of Donetsk oblast, but now there are fewer. At the same time, about 200 children were born in Donetsk oblast during this period. Therefore, the remaining staff calculated the need and formed a network with 3 maternity wards, an emergency centre, etc.

On whether the Program of Medical Guarantees (PMG) undergone any changes

• With the beginning of the full-scale invasion, the PMG introduced new services that we wanted to procure - psychological assistance in primary care.
• The WHO has developed a training course called "Management of common mental disorders in primary care using the mhGAP guidelines", designed for family doctors and nurses. Those who have completed the course can be contracted by the National Health Service of Ukraine to provide this type of care. This service is already provided by over 6000 doctors in Ukraine.
• Moreover, there is a new package of services known as"Preparedness to Provide Medical Care in the Territory of Active Hostilities," which allows us to procure and pay for services from hospitals located in these areas.
• We have improved our rehabilitation packages in response to the war's challenges, whilst having separated outpatient and inpatient rehabilitation. In addition to this, we have included in the option of receiving the needed rehabilitation in one or more areas in the service package. When we talk about multiple spheres, the tariff is correspondingly higher. Furthermore, the NHSU-funded rehabilitation duration for people with spinal cord injuries, traumatic brain injuries, and amputated limbs has been revised.

Daria Synhaievska, Analyst at UkraineWorld

Nataliia Husak, Head of the National Health Service of Ukraine