Integrated Community Care approach in Ukrainian districts/hromadas

Since 2017, the Ukrainian health sector is undergoing a continuous reform process starting

with the creation of the National Health Service of Ukraine (NHSU) as the single payer for

health care services and the administrative decentralisation moving the responsibility to

organise and manage health services to the district level. Despite the Russian military

aggression, the reform agenda focussing on strengthening primary care and on increasing

the resilience of local populations continues to be implemented. Starting in August 2023 a

group of national and international actors jointly worked on the development and

implementation of territorial integrated care for Ukrainian districts using the WHO IPCHS

standards and a “healthy community” approach based on a Population Health Management

(PHM) platform. Implementation partners were selected from districts, which were affected by

the first wave of Russian warfare.

Five districts were identified based on letters of interest and interviews with the applicants.

Healthy Hromada Dashboards were prepared with basic data provided by local authorities.

Managing PHM systems requires a local integrator function and to mobilise diverse

community actors and resources. Sensitization and capacity building of local public

authorities (LPA) let to setting up a local interdisciplinary expert group to bridge sectoral

boundaries, which would function as a local integrator: Five selection criteria were used to

district project proposals: a good mix of actors, a strong vision towards healthy communities,

access to relevant data, ability to agree on priorities and ability to attract financial resources

for the planed interventions.

The Bucha district local integrator group of community professionals was officially recognized

as the executive body to the city council. The Bucha Health Fair, organized by joint efforts of

the members of the local integrator team was a one-day event in the local city park

promoting health and wellbeing in the community. Bucha Health Trails were created to

encourage physical activity and promote wellbeing among residents. The trails were initiated

by family physicians to create a health and preventive care offer for district outside of the

healthcare clinic setting. Some doctors “prescribed” doses of healthy steps to patients, who

needed to increase their physical activity levels.

The Mukachevo district local integrator team chose to work on improving early detection of

Diabetes type 2 and educating high risk populations. Awareness raising through health fairs,

offering preventive care consultations, changing procedures to provide more access to blood

sugar testing also outside physician cabinets and counselling of identified diabetes patients

were key interventions. The intervention let to a significant increase of detected cases and

related visits to endocrinologists

The current health sector reform and the administrative decentralization leaves most Ukraine

districts and their LPAs ill equipment to manage related tasks and to coordinate ICPHs

services. The creation of local integrator platforms established an instrument for information

exchange, priority setting and managing joint interventions. Although most healthcare data

are currently available thanks to NHSU dashboards, very few data points are suitable for

strategic planning, management and the measurement of patient outcomes at district levels