WHO and the World Bank have unveiled their new joint report “Health financing in Ukraine: reform, resilience and recovery”, which highlights the critical role of health financing reforms in strengthening Ukraine's health system amid unprecedented challenges.
The report, launched at a joint event in Kyiv on 20 November during a high-level health systems mission to the country, underscores how recent reforms have bolstered Ukraine’s health system resilience during the COVID-19 pandemic and the ongoing war. It details the importance of sustained investment in health and outlines concrete steps to ensure the system remains equitable, efficient and prepared for future crises.
Progress despite adversity
Ukraine’s transition to a health financing model based on general government revenues rather than employment-linked contributions has been pivotal. This shift has ensured continuity of health-care coverage for all citizens and permanent residents, even as the war disrupts economic activity and displaces millions.
Centralized management of funds by the National Health Service of Ukraine (NHSU) has allowed resources to flow to war-affected areas, maintaining access to essential services under the state-guaranteed benefits package, the Program of Medical Guarantees.
“This report, jointly developed by WHO and the World Bank, is critical in guiding Ukraine’s health financing reforms,” said Dr Jarno Habicht, WHO Representative in Ukraine. “It offers a roadmap to ensure the resilience and further development of Ukraine’s health system, along with its capacity to respond to evolving health needs, especially during the war.”
Investing in a sustainable future
The report highlights the dire impacts of the war on Ukraine’s population health and demographic profile, emphasizing that a well-performing health system is crucial for national recovery. The report underscores the importance of safeguarding public financing and investment in health, particularly in the challenging context of war. Preserving human capital is essential for Ukraine’s long-term economic recovery and social cohesion.
However, the fiscal space for government health spending will remain limited due to the war’s economic impact and the need to prioritize defence and security spending. Moving forward, health financing reforms must focus on maximizing health for the money spent by promoting cost-effective services and medicines as well as overall efficiency, while also emphasizing equity in access, financial protection against catastrophic out-of-pocket payments, and quality of services.
The review recommends several policies and actions from a health financing toolkit to help advance reforms and improve health system performance across these key health financing objectives.
“It is encouraging to see the Government’s commitment to the ongoing implementation of these ambitious health sector reforms to increase the efficiency of Ukraine’s health-care system,” said Mr Bob Saum, World Bank Regional Country Director for Eastern Europe.
“In the context of challenging budgetary restraints, improving the efficiency of public financing for health is the only way to ensure that Ukraine can look after its people, whose health-care needs are growing as a direct result of Russia’s invasion. The continued rollout of these reforms will also prove critical for the modernization of the health system in line with Ukraine’s ambition to join the European Union,” Mr Saum added.
Ukrainian Minister of Health Dr Viktor Liashko expressed, “The task, which Ukraine's health-care system has been [working on] for almost 3 years now, is to combine the priorities of peaceful life with the challenges of war, ensuring that Ukrainians have universal access to quality, affordable and free medical care. And our health-care system is managing this task, in particular thanks to changes in financing approaches which allow us to be adaptive and flexible in decision-making.”
Dr Liashko emphasized, “Despite the war, we continue implementing reforms: last year, we completed the formation of a capable network of health-care facilities, allowing for more efficient use of available resources. The state budget for 2025 envisages a significant increase in health-care spending: an additional 6.3 billion Ukrainian hryvnia will be directed to expand the Affordable Medicines Program and modernize medical infrastructure.”
The Minister of Health noted that total expenditures will exceed 217 billion hryvnia, of which more than 175.5 billion hryvnia will be allocated to finance the Program of Medical Guarantees. This is 16.8 billion hryvnia more than last year.
Dr Liashko concluded, “Regular progress reports on the implementation of health financing reforms in Ukraine by WHO and the World Bank serve as a kind of compass, helping us understand whether we are moving in the right direction. The positive assessments I heard today motivate us to work even harder to strengthen the resilience of the health-care system.”
The report identifies primary health care as a critical area for prioritization. As the most cost-effective component of the health system, primary health care serves as the gateway to comprehensive care, from routine check-ups to referrals for specialized services. The report calls for adequate funding of primary health care, particularly in war-affected areas, to ensure continuity of care.
Given Ukraine’s constrained fiscal environment, the report also stresses the importance of maximizing efficiency without compromising access. This involves measures such as:
- enhancing the prioritization and cost effectiveness of services under the Program of Medical Guarantees;
- balancing hospital financing reforms with stable, predictable funding in conflict zones; and
- strengthening governance and transparency of the health financing system at both central and regional levels to build public trust.
The report outlines policy considerations for Ukraine to build back better, with a focus on modernizing health service delivery, optimizing hospital networks and strengthening institutions. This includes integrating lessons from the pandemic and the war to enhance preparedness for and resilience to future challenges.
Reforms in health financing are complemented by recommendations for better planning and regulation of health services, especially in areas experiencing active hostilities. Targeted adjustments to financing mechanisms in these regions can stabilize operations and support health-care workers, who are critical to maintaining services under extraordinary circumstances.
The WHO–World Bank report emphasizes that no single policy measure can achieve these goals. A coordinated approach involving health financing, service delivery and governance reforms is essential. As Ukraine rebuilds, the resilience of its health system will be a key determinant of its recovery and future prosperity. The report offers a comprehensive toolkit to guide policy-makers in navigating this challenging but critical path forward.
Global and local perspectives
While developing the report, WHO and World Bank experts engaged in multiple discussions, including at meetings in Barcelona in October 2023, Kyiv in January 2024 and Vienna in April 2024. Additional technical consultations were organized with national authorities, including the Ministry of Health, the Ministry of Finance and the NHSU.
Additionally, WHO and the World Bank held regional roundtables in Odesa, Dnipro and Kyiv in July 2024 to gather local insights on the implementation of the health financing reforms in Ukraine. These regional consultations brought together national and local policy-makers, primary care and specialized care providers, and health facility owners from 10 Ukrainian regions: Dnipro, Kharkiv, Kherson, Lviv, Mykolaiv, Odesa, Poltava, Rivne, Vinnytsia, and Zaporizhzhia. They discussed primary and specialized care financing, the implementation of the Affordable Medicines Program and the role of the NHSU.
The consultations yielded the following key messages:
- The ongoing war impacts regions differently.
- Health financing adjustments are needed for more affected areas.
- Sufficient and equitable financing for primary health care, including affordable medicines, delivers the best value for money.
- Developing a capable provider network is an opportunity to improve quality and efficiency.
- Stronger NHSU interregional presence would enable more effective regional communication on health needs and provider capacities.
Feedback from the consultations was incorporated into this third joint health financing review. This series of reports, jointly produced by WHO and the World Bank, assesses the progress of health financing reforms since their launch in Ukraine in 2017.
The new report was produced with financial support from the Swiss Agency for Development and Cooperation through the “Sustaining Health Sector Reform in Ukraine” project; the Government of Canada; and the European Union as part of the project “Health System Development in Ukraine” and within the Universal Health Coverage Partnership.