The number of private health service providers (PHSPs) has surged by 43% since 2020, according to a new WHO report on private provision of health services in Ukraine, and accounts for 84% of all providers that are licensed. However, PHSPs are much smaller than state and communal health facilities that still offer the bulk of health services to the population. In order to sustain access to health care and advance universal health coverage in Ukraine, the Government needs to align the roles and functions of PHSPs within the national health system.
It is a core task of governments to define the role of the private sector in promoting universal health coverage goals, and to create a policy framework through which this can be realized. To support this, a new WHO report “Private provision of health services in Ukraine: current challenges, future directions” identifies 4 core areas of action (legislation and regulation, purchasing mechanisms, information and intelligence, and stakeholder engagement) and offers recommendations on how the Government could incorporate the PHSPs into the health system.
“We can see how private health service providers develop their practice and how this sector contributes to the health sector in Ukraine. Taking this into account, it is vital to support the Government of Ukraine in amending legislation and regulation, strengthen data collection and engage stakeholders to align these newly emerging private providers with its goals and strategies,” said Dr Jarno Habicht, WHO Representative in Ukraine.
The report was launched in time for the Ukraine Recovery Conference in London on 21–22 June, where the evolving role of the private sector in supporting Ukraine’s recovery was emphasized. In particular, focus was given to addressing gaps in health-care service provision in areas where critical health facilities have been severely damaged or destroyed as a result of the Russian Federation’s invasion in 2022. Moreover, as the engagement of the private sector as an integral part of the health system is an element of the Health Strategy 2030, it requires a thorough regulatory framework – based on a deep understanding of the challenges and opportunities presented.
Addressing challenges
Policy considerations covered in the new report are based on data analysis, in-person visits to and engagement with PHSPs of different legal forms, expert legal advice, and 42 key informant interviews, including with state authorities, private sector associations, patients’ associations and international organizations. Overall, according to the report, as the majority of PHSPs exist outside of governmental contracting arrangements, the main levers of influence available to the Government are regulatory, including licensing. By strengthening regulation, the Government would enhance the safety, appropriateness and effectiveness of care, along with improved consumer protection.
WHO’s recommendation to integrate PHSPs into national health information systems was already initiated in April 2023, as all PHSPs have to register in the e-health system to ensure data exchange with the central health information system. In practice, though, the actual number of registrations is only a small fraction of those operating in the PHSP field, and further steps and enforcement are necessary to make progress in this area. Finally, WHO highly recommends cross-sector engagement to sustain dialogue, knowledge exchange and decision-making about PHSPs and their role in post-war recovery.
Overall, the report suggests 4 action areas to improve the environment for PHSPs to work effectively and contribute to the overall post-war recovery:
- strengthening the regulatory framework
- strengthening contracting arrangements through the National Health Service of Ukraine
- accelerating health information system integration
- enabling stakeholder participation in policy-making.