Ukraine is making significant progress in expanding physical rehabilitation services, but gaps in financing threaten to hold back their full potential. Two new reports from the WHO Country Office in Ukraine, developed with the European Observatory on Health Systems and Policies and the WHO Barcelona Office for Health Systems Financing, provide evidence and recommendations to help the country prioritize rehabilitation more strategically and allocate funds more efficiently.
The report “Financing rehabilitation services in Ukraine: a situation assessment and policy options” examines how rehabilitation is financed under the Programme of Medical Guarantees (PMG) in Ukraine. It highlights recent changes in financing methods, their impact on the provision of services and people’s ability to access them, while also highlighting some of the key challenges that still lie ahead.
The second report, commissioned by the WHO Country Office in Ukraine, “Strengthening rehabilitation care: learning from countries’ experiences on organizing service delivery and financing”, documents how 14 different countries from the WHO European Region are developing and maintaining rehabilitation services. By offering this subregional mapping of the current rehabilitation landscape, this study offers a menu of policy tools for countries, such as Ukraine, aiming to strengthen rehabilitation care. Both reports were launched at a high-level event in Kyiv on 30 September 2025.
“The studies show that Ukraine’s rehabilitation budget has grown significantly, from 1.2% of the PMG budget in 2020 to a projected 4% in 2025. But increased funding alone is not enough,” said Dr Jarno Habicht, WHO Representative in Ukraine. “Resources need to be matched with smart prioritization to ensure they deliver the greatest impact. The findings suggest that spending could be better aligned with population needs, as some lower-priority conditions receive substantial funding while higher-need groups remain underserved.” “These reports,” Dr Habicht continued, “give us accurate and timely evidence to guide reforms that can expand access to rehabilitation – strategically – even in the context of war.”
Smart investments to meet rising demand for rehabilitation
As Ukraine continues to rebuild its health system under the pressure of war, strengthening rehabilitation has emerged as a strategic priority.
Demand for rehabilitation has surged since the start of the conflict in 2014 and grew even further following the Russian Federation’s full-scale invasion in 2022. The need reflects not only war-related injuries but also strokes, trauma and chronic diseases, aggravated by an ageing population and mounting strain on the health sector.
“The development of rehabilitation is one of the key priorities of the Ministry of Health and a flagship project within the implementation of the National Barrier-Free Space Strategy. We have an ambitious goal — to create the strongest rehabilitation system in Europe in Ukraine. We are building a network of centres of excellence, bringing services closer to people in communities, training and motivating a new generation of specialists, approving modern standards and implementing digital solutions. Together with our international partners, including WHO, we are forming a system that will become the foundation of modern medicine and a guarantee of quality, accessible and free rehabilitation care for Ukrainians,” said Ukrainian Minister of Health Viktor Liashko.
The key conclusions from the Ukraine-focused analysis and priority areas for action in health financing are organized around 3 questions of strategic purchasing: what to buy and for whom, from whom to buy and how to pay. Examples of findings include the following.
- In 2024, mild musculoskeletal conditions, such as dorsopathies and arthropathies, accounted for more than half of all outpatient rehabilitation cases. By contrast, only 1.5% of stroke patients with moderate to severe disability received outpatient rehabilitation after hospital discharge.
- Current rules grant access to publicly financed rehabilitation mainly by diagnosis, without considering patients’ functional status or capacity to benefit. This leads to inefficiencies and even incentivizes providers to “game” diagnosis codes to fit restrictive eligibility rules.
- Just 6% of patients completing inpatient rehabilitation continue treatment in outpatient settings, reflecting gaps in referral pathways, clarity of provider roles and standards for community-based rehabilitation. The number of contracted providers has almost doubled since 2021, but expansion has been largely supply-driven rather than based on population health needs or strategic planning. This has resulted in wide regional variation.
- Payments for both inpatient and outpatient rehabilitation are set per “cycle” of treatment with a minimum duration of 14 days, which may not always align with individual patient needs or promote efficient resource use.
Country examples to inform policy decision-making in Ukraine
The cross-country comparative report "Strengthening rehabilitation care: learning from countries’ experiences on organizing service delivery and financing" explores how rehabilitation is financed across 14 European countries that were purposefully selected to ensure maximum variation and provide a rich set of case studies. This selection includes countries with diverse levels of health system funding and resources, various models of service delivery and financing and different governance structures. The selected countries provide diverse approaches to organizing and financing rehabilitation services along with several examples of how to integrate rehabilitation into a general health system.
The research shows that:
- rehabilitation services are inherently fragmented and dispersed, therefore coordination underpins their efficient use and increases quality patient-centred care;
- countries finance rehabilitation care mainly through public sources from the health sector complemented by funds from other sectors, but multiple funding sources may result in inefficiencies;
- better financing rehabilitation care can be achieved through coverage policies and purchasing strategies, which steer existing resources to higher value services in the most appropriate setting of care; and
- there is no one-size-fits-all solution, but a range of policy tools and approaches can be tailored to each country’s context to build responsive and well-performing rehabilitation systems.
The research and data collection come against the backdrop of global and complex health challenges, such as population ageing, climate change, the rise of chronic conditions and increased health emergencies. It is in this context that WHO has underscored the importance of integrating robust rehabilitation services across the continuum of health care. This is aligned with WHO’s “Rehabilitation 2030: a call for action”, which calls for worldwide efforts to make rehabilitation a fundamental component of national health systems.
“This work highlights the importance of rehabilitation services for individual health outcomes, population health and health system efficiencies and wider economic and social outcomes. As the need for rehabilitation services will only grow, this area of care is typically requiring immediate investment in terms of both human and financial resources,” said Dr Ewout van Ginneken, Director of the European Observatory on Health Systems and Policies.
The way forward for rehabilitation financing in Ukraine
Based on international experience and Ukraine’s country context, 4 priority areas can guide the strengthening of rehabilitation financing.
- Set clear eligibility criteria that combine diagnosis and functional status to target those most likely to benefit from rehabilitation.
- Expand access to outpatient and community-based services through better referral systems, stronger primary care involvement and improved patient pathways.
- Strengthen contracting and provider accountability by linking contracts to service quality, population needs and regional coverage gaps, rather than simply expanding supply.
- Improve data and payment design by enhancing coding quality and moving from fixed 14-day cycles to more flexible, patient-centred models that reflect patients’ health needs and reward continuity of care.
“Financing rehabilitation effectively is not just about allocating more funds – it’s about making sure the right patients receive the right care in the right setting,” said Tamás Evetovits, Head of the WHO Barcelona Office for Health Systems Financing. “Ukraine has made remarkable progress in expanding affordable access to rehabilitation, but challenges remain to ensure that every hryvnia spent brings maximum benefit. These reports provide practical solutions for strengthening rehabilitation financing, even under the extraordinary pressures of war and economic strain.”
Explore more data and analysis on health financing in Ukraine on “UHC Watch” – a digital platform tracking progress on affordable access to health care in Europe and central Asia.
WHO’s technical assistance on rehabilitation health financing in Ukraine is supported by the Directorate-General for Enlargement and Eastern Neighbourhood (DG ENEST) as part of a project titled “Inclusive strengthening and resilience building of rehabilitation services in Ukraine”.