Family Medicine and the Primary Health Care System in Ukraine

The Ukrainian system is transitioning toward the family doctor model as part of healthcare reforms, moving away from the Soviet-era separation of adult care (therapists) and child care (paediatricians) toward integrated family-centred care. However, therapists continue to play an important role in the current mixed system, particularly in areas where the transition to family medicine is still ongoing.

PHC Provider Network ( keeping in mind there have likely been massive demographic shifts and capacity impacts of the Russian full scale invasion in 2022)

As of September 2021:

• 1,960 total PHC providers contracted with NHSU:
  • 1,219 PHC centres (62%)
  • 221 private providers (11%)
  • 520 solo practices (27%)
• 7,016 practice sites nationally, with an average of 4.1 locations per PHC center
• Rural coverage: 51% of practice sites operate in rural areas

Workforce Composition

• 23,351 PHC doctors (2021 data):
  • 15,303 family doctors (66%)
  • 4,587 paediatricians (20%)
  • 3,461 therapists (15%)
• Critical age demographics:
  • 50% of family doctors are over 50 years old
  • 25% are beyond retirement age
  • Only 26% are aged 35 or younger

War Impact (2022-2025)

• Population displacement: Ukraine’s population decreased from 41.167 million to 31.47 million by the end of 2022
• Healthcare workforce losses: 89,000 medical workers (13.7%) left the system in 2022
• Infrastructure damage: As of February 2024, 1,643 attacks on health facilities recorded
• Service disruption: In Donetsk Oblast, only 33% of facilities remain operational

Greatest Gaps and Needs

1. Critical Workforce Shortages

• Aging demographic crisis with insufficient young professionals entering PHC
• Mass emigration of healthcare workers due to war
• Low prestige and poor compensation driving 50% annual attrition of trained family doctors
• Severe shortages in rural and conflict-affected areas

2. Infrastructure Deficits

• 71% of Feldsher-Midwifery Posts (FAPs) lack water supply
• 75% lack sewage systems
• 82% of rural clinics lack sanitation facilities
• Uneven quality and equipment availability across regions
• War damage requiring estimated $26 billion for healthcare system reconstruction

3. Limited Scope of Practice

• PHC doctors have minimal experience managing chronic conditions
• Mental health services remain outside PHC scope
• Limited preventive care and health promotion activities
• Nurses utilised primarily for administrative tasks (90% of their time)

4. Financial Challenges

• Rural FAPs lost stable funding after decentralisation
• Communities face 50-70% revenue declines, affecting ability to maintain facilities
• Implementation of “zero coefficient” in 2024 threatens facility funding
• Out-of-pocket payments remain high (48% report informal payments for PHC)

5. Geographic and Access Barriers

• Poor transportation infrastructure in rural areas
• Fuel costs increased 40% between 2022-2024
• Average distance between villages can exceed 30-40 kilometres ( with poor roads)
• Limited diagnostic equipment availability
• Weak referral systems (48.7% of referrals not completed in 2021)

6. Educational Gaps

• Medical education includes only 1-2 weeks of PHC training
• Limited continuous professional development opportunities
• Lack of training in chronic disease management
• Insufficient preparation for multidisciplinary team approaches
• No standardized competency frameworks for PHC nursing

7. System Integration Issues

• Poor integration between PHC and public health services
• Limited coordination with social services
• Fragmented care for HIV, TB, and mental health patients
• Ineffective e-health system focused on administration rather than clinical support

8. Rural Healthcare Crisis

• 40% decrease in FAPs between 2017-2022
• Many rural health posts operating without regular doctors
• Communities unable to fund healthcare workers’ salaries
• Closure of facilities leading to complete loss of access in some areas

CPD Requirements for Family Doctors in Ukraine

In Ukraine, the Continuous Professional Development (CPD) system for family doctors has undergone significant reforms to align with European standards and enhance the quality of healthcare services.ufmo.org.ua

• Annual CPD Points: Family doctors are required to accumulate a minimum of 50 CPD points each year. These points can be earned through various educational activities, including seminars, workshops, online courses, and conferences. uhpra.org
• Flexible Learning Formats: Physicians have the autonomy to choose CPD activities that best suit their professional needs and interests. This flexibility encourages self-directed learning and continuous improvement.
• Documentation and Verification: Doctors must maintain an educational portfolio documenting their CPD activities. This portfolio is subject to annual review and verification by their supervisors. uhpra.org
• Accredited Providers: CPD activities must be conducted by accredited providers to ensure the quality and relevance of the educational content. med-expert.com.ua
• Integration with Licensing: The accumulation of CPD points is linked to the licensing process. Physicians must meet the CPD requirements to obtain or renew their medical licenses. nlcmp.org
• Emphasis on E-Learning: The CPD system encourages the use of e-learning platforms, providing accessible and flexible learning opportunities for family doctors across the country.

Recommendations for Immediate Action

1. Emergency workforce retention programs with financial incentives for rural and conflict-affected areas
2. Rapid infrastructure investment focusing on basic utilities and safety measures
3. Expanded nursing roles to compensate for physician shortages
4. Integration of mental health services into PHC scope
5. Strengthened telemedicine capabilities for remote and dangerous areas
6. Reform of financing mechanisms to ensure sustainable rural healthcare
7. Accelerated training programs for chronic disease management
8. Development of clinical decision support in e-health systems