On 28–29 March 2023 in Lviv, the WHO Country Office in Ukraine hosted the first primary health care (PHC) conference since the Russian Federation’s full-scale invasion of Ukraine in February 2022.
WHO organized the conference jointly with the Ministry of Health of Ukraine and the National Health Service of Ukraine (NHSU), and in partnership with the Academy of Family Medicine of Ukraine. The event brought together nearly 200 PHC professionals along with health authorities and international partners to exchange knowledge and map the future of PHC during and after the war.
The conference served as an open and interactive platform for PHC workers, managers and experts to reflect on the progress of PHC reforms in the country, lessons learned, and the future direction of PHC in Ukraine amid the war and people’s growing health needs.
Dr Jarno Habicht, WHO Representative in Ukraine, explained, “Ukraine embarked on PHC reforms 5 years ago. While there have been some significant developments, the COVID-19 pandemic and the ongoing war have acted as a stress test to a resilient health system. Today, we witness disruptions to health services in some areas of the country due to the ongoing war. This conference marks a vital time to meet with experts and health workers to discuss solutions for the future and share experiences.”
Dr Natasha Azzopardi-Muscat, WHO/Europe’s Director of Country Health Policies and Systems, said, “As we gather here today, we are reminded of the critical importance of PHC in building a strong, resilient health system that can handle current and future health emergencies, including conflicts and wars.” She underlined that WHO “continues to stand with and by all Ukrainian health workers – including PHC workers – as they show resilience and professionalism in the midst of this war”.
PHC in the Face of War
Discussions focused on a wide range of topics, including PHC reforms in Ukraine and the interruptions that have resulted from the war. Participants discussed some of the challenges faced by PHC doctors and nurses, as well as the crucial role that multidisciplinary PHC teams play in providing care to people when and where they need it.
“I am from Afghanistan, a country in the midst of conflict and fragility. I have seen in my country how it is to operate on a patient in a surgery room under artillery shillings and bombardments,” shared Dr Suraya Dalil, Director of the WHO Special Programme on Primary Health Care.
“While going through war, I also know the mental health toll of this situation on the staff, their families and the entire community. But I also know that providing services close to the population with optimal quality will go a long way in saving lives and demonstrating commitment and responsibility toward the population,” Dr Dalil added.
In a session addressing specifically the role of PHC in the face of war, health workers from recently liberated areas – including Kyiv and Kherson oblasts – shared their testimonies of how their work has been affected by hostilities. Damage to health facilities, disruptions to health services and people’s forced displacement have been among the biggest challenges.
“PHC is people’s first point of entry into the health system, and when this is disrupted by war, people’s health is at serious risk,” Dr Habicht continued. “WHO is committed to ensuring that everyone in Ukraine can access the PHC they need, and we will continue to coordinate and provide technical support and capacity-building under the Ministry of Health’s leadership.”
This first national conference since the invasion was also an opportunity for international partners, including the European Union, the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and the United States Agency for International Development (USAID), among others, to come together and discuss opportunities to strengthen the health response to the ongoing emergency.
Other issues addressed during the event included the use and accessibility of digital tools such as telemedicine and digital consultations, the need to ensure consistent financing of PHC in the face of war, the use of mobile teams to access remote and hard-to-reach areas, and the inclusion of mental health services at the PHC level.
The event also saw the official launch of the Ukrainian-language edition of WHO/Europe’s first-ever “Pocket book of primary health care for children and adolescents”, a comprehensive manual for doctors, nurses and other health workers responsible for caring for children and young people in PHC settings.
First unveiled in March 2022, the pocket book includes guidance on the promotion of early childhood development and health messages for adolescents. Its primary task is to guide PHC professionals by using evidence-based practices that help to avoid unnecessary treatment and hospitalization.
WHO Support to PHC in Ukraine
PHC has been at the heart of WHO’s support to Ukraine before and after the invasion. In coordination with the Ministry of Health, WHO launched and supported a project to establish and operate mobile health units with a focus on treating noncommunicable diseases at the PHC level. The project was implemented in 2 waves and targeted 7 regions in the country. The WHO-supported mobile health units have now conducted over 17 000 consultations and nearly 600 community visits.
Between 2022 and early 2023, WHO also conducted a costing assessment of PHC in Ukraine to support the Ministry of Health and the NHSU with an evaluation of the current state of PHC facilities and the impact on the national budget.
The PHC conference was organized with the financial support of the Government of Canada within the framework of the project “Strengthening local and national systems of primary care and health care to ensure the recovery and resilience of countries in the context of COVID-19”.