“When we had to leave our home, I didn’t know how we would get medical care. But when I registered with a new family doctor in the host community, they saw me quickly and helped me get my medications. It made me feel like I wasn’t forgotten.”

These are the words of an internally displaced person from Luhansk, now living in Dnipro, Ukraine. 

PHC is the most inclusive, equitable and cost-effective way to achieve UHC. It is also key to strengthening the resilience of health systems to prepare for, respond to, and recover from shocks and crises.

The health consequences of war are significant for the Ukrainian population. According to a WHO war-impact survey:

• 59% of participating PHC providers reported an increase in mental health conditions and 63% reported an increase in cardiovascular diseases.
• Overall, 3.8 million people have become internally displaced and report limited access to regular PHC services for their basic needs.
• In addition, 39% of PHC providers that participated in the survey indicated the number of veterans registering as patients had increased significantly since 24 February 2022. Veterans have a unique profile of health needs compared with other groups of the population.

WHO, through the UHC Partnership and with the support of the Government of Canada and the European Union, has supported the Government of Ukraine to adjust the PHC financing model to account for evolving health needs during the war, implement new evidence-based approaches to financing and enhance transparency and equity in PHC budget planning. 

Between 2021 and 2024, WHO through the UHC Partnership and with the support of the Government of Canada, the United Nations Joint Sustainable Development Goals Fund and the European Union supported the development of a comprehensive methodology and two nationwide studies for estimating the costs of providing PHC services for both new and existing health needs. 

Conducting this work during wartime posed immense challenges, yet those involved in collecting and analysing the data went to extraordinary lengths to ensure their work was completed. 

The studies allowed the Government of Ukraine to:

• Understand PHC funding needs and provided evidence to advocate for increased payments.
• Align stakeholder perspectives on PHC financing needs, which resulted in a PHC payment increase in 2025.
• Adopt a detailed methodology for calculating the payment rate for PHC services, ensuring transparency for budget and payment rates setting in the future.
• Revise the payment design increasing funding for mental health services at PHC level and strengthening access to care in the most underserved and conflict-affected areas. 

These changes have enabled PHC providers across the country to receive financing aligned with the specific health needs of their population and which reflects the actual costs of PHC provision. 

The UHC Partnership operates in over 125 countries, representing over 3 billion people. It is supported and funded by Belgium, Canada, the European Union, France, Germany, Ireland, Luxembourg, Japan, the United Kingdom of Great Britain and Northern Ireland, and WHO.  

WHO has worked with the Government of Ukraine to strengthen its health system over many years since 1994. This long-term support and the establishment of trusted relationships means that in the context of the war, the system shows resilience in the face of many ongoing challenges. Beyond coping, it is making progress and improving access to PHC services for millions of people. 

Despite immense fiscal constraints, demographic shifts, evolving health needs, disrupted services, and repeated attacks on health facilities caused by the war, maintaining and improving access to quality care, equity, and financial protection remain key national priorities for Ukraine.

“In conflict-affected settings, primary health care plays a vital role in addressing urgent health needs, building community resilience, and laying the groundwork for long-term recovery. It forms the backbone of a functioning health system – both during and after conflict,” said Dr Jarno Habicht, WHO Representative in Ukraine.

“In Ukraine, the Ministry of Health has made the development of primary care a key priority of its health reform agenda, recognizing its critical role in disease prevention, early detection and treatment, and in reducing the pressure on specialized medical care. WHO remains committed to supporting the Ministry of Health and the National Health Service of Ukraine in strengthening the delivery and financing of PHC to improve access, expand service scope, and enhance overall system performance,” Dr Habicht continued. 

To strengthen PHC services and the Government’s approach to funding PHC, WHO carried out 2 study exercises nationwide involving 180 PHC providers between 2021 and 2024 to identify the costs of providing PHC across the country. 

The data collection process was incredibly challenging because of the practicalities of operating in a war zone. PHC providers were trying to treat patients and provide services while under immense pressure, as well as collect and share data on costings. Their commitment to the process and their understanding of the long-term necessity of the study was exemplary.  The challenges of submitting data were often extreme. 

“When there was no electricity, there were problems, the medical information system did not work. There was electricity for two hours after four hours of being off, so it was difficult for the doctors. They first did it on paper, then entered it into the system. Or they entered it from home,” said one PHC provider from Zhytomyr oblast in centre macro-region. 

WHO staff also experienced intense challenges in continuing their everyday work when the war began. During frequent power outages, WHO’s national consultant Olena Zahriadska used a modem for mobile internet. 

“My husband drove me across the city in search of a spot with a stable signal. In the middle of winter, we sat together in the car with the engine running to charge my laptop, while I guided PHC providers on how to complete the data collection forms. The entire team continued working under extremely difficult conditions amidst shelling, blackouts, and constant uncertainty,” said Olena. 

Dr. Olha Karpenko performing a physical examination on Halyna Karpenko at the Family Medicine and General Practice Outpatient Clinic.
@Aiiub Gagramanov, Kyiv.

In July 2024, the Ministry of Health formally adopted the first methodology, developed with WHO support, for costing and calculating the capitation rate for PHC services. This marked a significant step toward greater transparency in PHC budget planning and allocation, as it provides a solid foundation for government decisions on payments to PHC providers. 

The institutionalized methodology provides tools to ensure that payments accurately reflect any changes in the scope of PHC services needed to meet the population’s evolving health needs due to the war, as well as changes in input costs resulting from the war’s impact such as expenses for uninterruptible power supply devices during electricity outages, rising inflation and wages. 

“The methodology developed from this costing study represents a powerful tool to create more transparent budget estimates for various PHC policy proposals. 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,” said Natalia Husak, Head of the National Health Service of Ukraine.    

Since the onset of the full-scale war, the demand for mental health services in Ukraine has surged. A WHO-supported survey revealed that 59% of participating PHC providers reported an increase in mental health conditions among their patients. The Health Needs Assessment of Ukraine’s adult population found that approximately 72% of adults have experienced mental health challenges since the start of the war.

“After the war started, I began feeling anxious and couldn’t sleep well. I didn’t know who to ask for help, so I was really surprised that my family doctor turned out to be the one who could actually support me,” said a 29-year-old woman from Vinnytsia. 

Since 2018, WHO has been supporting the Ministry of Health to build the capacity of PHC workers to deliver mental health services in line with the WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide. With new evidence about the impact of war on mental health, WHO supported efforts to train PHC doctors and nurses to identify and manage common mental health conditions and integrate mental health services into the PHC service package. From 2025, all PHC providers are now required to deliver mental health services, and WHO provided technical guidance to the Government to ensure that these services receive adequate financing. 

WHO has also supported the Ukrainian Government to improve access to health services for people in rural and remote areas, and importantly in the most underserved and war-affected regions, where access to PHC is severely constrained by the destruction of infrastructure and shortages of healthcare workers. During the three years of full-scale war, 1984 medical facilities were damaged, and 301 were destroyed.  As of 28 May 2025, there had been 960 attacks on primary health care facilities, resulting in 13 deaths and 47 injuries.

Around 30% of Ukraine’s population lives in rural communities, yet only 17% of PHC doctors and 24% of nurses serve these areas. Although rural providers often have fewer patients, they tend to be older, sicker, and require a higher volume of care. Without targeted interventions, limited access to services in rural and conflict-affected regions risks deepening health inequities, as these populations often face greater health needs.

Findings from the costing study showed that PHC providers in rural areas incur approximately 20% higher costs than their urban counterparts, largely due to higher labour, facility, transportation, and equipment expenses. WHO provided policy recommendations to adjust PHC financing to better reflect the realities of rural and conflict-affected areas. 

Today, one in three PHC providers operate in rural settlements across the country, including war-affected regions, and receive additional payments to ensure access to essential PHC services in these largely underserved areas. This vital support translates into improved access to essential care for over five million Ukrainians, ensuring that no matter the circumstances, the health system continues to serve those who need it most. 

“The war, now ongoing for more than a decade, continues to severely test Ukraine’s health system, undermining its capacity to deliver essential health services and meet the population’s health needs. WHO remains committed to supporting the health system through emergency response efforts, with a strong focus on maintaining access to essential health services, particularly in affected regions,” said Dr Jarno Habicht, WHO Representative in Ukraine.
 

Explore more data and analysis on health financing in Ukraine on UHC Watch – an online platform tracking progress on affordable access to health care in Europe and central Asia.