Intended for healthcare professionals

Opinion

Ukraine can build back a better health system

BMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p1449 (Published 27 June 2023) Cite this as: BMJ 2023;381:p1449
  1. Ara Darzi, co-director
  1. Institute of Global Health Innovation, Imperial College London

In April 2023, Imperial College London, in partnership with the British Red Cross, hosted a gathering of over 100 Ukrainian clinicians, humanitarians, and health system experts. This first ever Ukraine Health Summit was a chance for the UK and Ukraine to collaborate on how healthcare can be improved in the current conflict and its aftermath.

The war has had a significant impact on healthcare in Ukraine. Preliminary data found that in the first seven months of war, 906 healthcare institutions were seriously damaged and 123 were ruined.1 Thousands of clinicians have left Ukraine, while others have enlisted in the armed forces, resulting in a constrained workforce. The World Bank has calculated that the cost of restoring disrupted healthcare in Ukraine is over $15 billion.2

In restoring its healthcare system there are two clear opportunities to build back better. The first is to ensure that primary care is central. What better way to assert independence than for Ukraine to move away from large Soviet era hospitals to a more primary care led model? Modern, multi-disciplinary primary care facilities can focus on keeping people out of hospital. This is both better for people’s health and wellbeing and a more efficient use of resources.

There needs to be a concerted development of the primary healthcare infrastructure. The focus must be on facilities that include modern diagnostics and that will support a concerted effort to increase childhood immunisations, which have been impacted by covid-19 and then by the Russian invasion.

The second opportunity is to make better use of digital healthcare. Ukraine has already made ambitious strides in digital public services using mobile apps, for example, to access government services such as driving licences.3 Ukraine should look to build on this success by making greater use of digital healthcare. Ukraine’s mental health services were already stretched pre-war. Now, the Ukrainian government estimates that 50% of the population will have war related mental health needs.4 Tools such as computerised cognitive behavioural therapy could help to meet this new disease burden.

Online learning could also help tackle the disruption of clinical education. There is potential for UK institutions to support remote learning in Ukraine through effective partnerships with Ukrainian universities. Ukraine could also use this as a chance to overhaul education, by developing a more modern and practical curriculum.

The UK can support Ukraine to build back a better health system, but Ukraine must lead.

Ukrainians based in the UK, both refugees from the war and those who have settled here for much longer, can facilitate the necessary collaboration by acting as intermediaries familiar with both contexts. The work of the Health Alliance for the Conflict in Ukraine, established by the British Red Cross and now led by the Ukrainian Medical Association, is vital here.

I look forward to the connections made at the Ukraine Health Summit supporting the rebuilding of Ukraine’s healthcare system. The Ukrainian people have suffered much, but we can stand with them to help create the healthcare system they deserve.

Footnotes

  • Competing interests: Since the Ukraine Health Summit, Ara Darzi has accepted an offer to be Patron of the Ukrainian Medical Charity.

References