Overview

Key points

• Ukraine’s health system has a single national purchasing agency, the National Health Service of Ukraine (NHSU), which contracts public and private health care providers and implements the Affordable Medicines and the Medical Guarantee Programmes.
  
• Regional and local authorities manage their health facilities and providers have a high degree of autonomy.
  
• Entitlement is based on legal residence with those internally displaced by the Russian invasion entitled to access services anywhere.
  
• Public spending on health grew from 2.5% of gross domestic product (GDP) in 2000 to 4.1% in 2021, and accounted for 51% of health spending in 2021, up from 44.8% in 2019.
  
• Out-of-pocket payments are still high (nearly half of all health spending), as is catastrophic health spending.
  
• The largest share of health spending is on inpatient care, followed by medical goods.
  
• Despite attacks on health care facilities, 93% of those inspected by WHO were fully operational in 2023.
  
• Still, the war poses major challenges for infrastructure, security, patients and health workers.
  
• Historically, health workforce numbers were high, although there were concerns about health workforce ageing. The Russian invasion has displaced professionals across the country.
  
• Health reforms were disrupted by the invasion, although there are ongoing efforts to strengthen primary care and develop digital health and remote services. Furthermore, reforms are being built into the Ukraine Recovery Plan to ensure greater efficiency.
  
• Life expectancy was 73.3 years in 2019, but the impacts of the COVID-19 pandemic and the war are not yet clear.
  
• Maternal mortality rates have declined by half since 2000, while premature mortality rates from noncommunicable diseases (NCDs) have decreased but remain comparatively high (more than double the EU average).