The impact of war on Primary Health Care in Ukraine: a cross-sectional survey and qualitative interviews with service providers

Background Primary Health Care (PHC) is vital to supporting emergency preparedness and health care resilience. There is limited evidence of the impact of crises on PHC services and financing. We aimed to explore the impact of the full-scale invasion of Ukraine in February 2022 on PHC services in the country. Methods We used a mixed-methods approach. Survey data were collected using an online questionnaire sent to a sample (n = 86) of PHC providers in Ukraine in January-February 2023. Fifteen providers were then randomly selected for semi-structured interviews from among those that reported an impact of war and from those areas most affected by conflict. Interviews took place in March 2023. Results Thirty-seven percent of PHC providers reported being affected by the full-scale invasion. Qualitative data revealed greater impacts at the beginning of the invasion, to which facilities adapted by the time of the survey. The most reported disruptions were electricity cuts (76%) and currency depreciation/price increases (72%). The most reported increased medical need was cardiovascular disease (CVD; 58%) (with qualitative data suggesting an increase in CVD among younger patients) followed by mental illnesses and disorders (55%). Fifty-nine percent of PHC providers reported an increase in remote consultations. Among those facilities that reported a change in revenues, the nature of the change depended on the type of ownership. For example, only 9% of private providers reported increased revenues from humanitarian aid, while 79% (n = 58) of public providers indicated an increase in these sources. Conclusion To continue strengthening Ukraine’s PHC system, the benefit package must be aligned with clinical guidelines, particularly for CVD and mental health; increases in remote consultations should be closely monitored for quality; and payment systems must be adjusted to ensure equity of financing regardless of provider ownership. These findings offer insights for strengthening PHC and emergency-preparedness in other contexts.