Ukraine

Please note that the content of this factsheet has been compiled with care, but does not yet fully take into account the impact of the war in Ukraine.

Ukraine is a country in eastern Europe with a population of about 42,5 million people and an area of 603,628 km2 – making it the largest country in Europe. In recent years, important health reforms have been approved by Parliament. These reforms are being implemented at great speed and promised to deliver on much-needed changes such as altering the financing incentives in primary health care, introducing a National Health Service (NHS), e-Health and making hospitals autonomous (2019). Moreover, the Ukrainian government has shown great interest in working with the Netherlands because of the Dutch position as a top performer in healthcare. On top of that, Ukraine is receiving financial support from various international organisations to improve its healthcare systems like the World Bank, the WHO, USAID, and the European Union. This provides opportunities for Dutch companies, knowledge institutes and NGOs active in healthcare. However, the situation has changed since the Russian invasion in Ukraine in February 2022. The needs of the healthcare system have changed, and are continuously changing dependent on the situation on the ground. The demands of the healthcare system vary between humanitarian assistance, and recovery assistance for short, medium and long term rebuilding of the healthcare system and facilities.

Ukraine

Key indicators are data from prior to the start of the war in February 2022.

In late 2017, official reforms were passed to transform the Ukrainian health care system in a system that delivers patient-oriented health care. There has been a stable growth in health expenditure since the last 5 years. Allocation of funds changed and payments were done on the basis of healthcare output with a case-based, global budget. The idea is that money follows the patient. Family doctors were introduced in the system and primary care, palliative care, and emergency medical care are 100% funded by the state. Public hospitals became autonomous and private providers were included in the system. In 2021, the new healthcare system became fully operational. Alongside with these transformations, there exists a pressure towards increased efficiency in health care institutions. Managerial capacity needs to be enhanced and network optimisation needs to be implemented. Besides, there is looked with increasingly interest towards digital solutions and telemedicine.

During the war, many healthcare facilities have been destroyed or badly damaged. In addition, additional injuries and fatalities occur due to the war, both to military and civil persons, causing physical and mental injuries. This leads to a changing demand in healthcare service, e.g. increased demand for rehabilitation. Moreover, due to the internal displacement of people, the demand for healthcare in certain regions, especially in the Eastern and Western regions of Ukraine, has surged.

The World Bank’s Ukraine Rapid Damage and Needs Assessment describes the estimated damage to the health sector and the needs of the sector to cover the accumulated infrastructure damage and losses, as well as the scale-up of critical health services for the population in Ukraine. In July 2022, this has been estimated to be at least US$15.1 billion. Of these presented needs, US$1.2 billion is urgently needed in the immediate/short term.

From the perspective of the Netherlands the following market trends present before February 2022 in Ukraine are of interest:


Trade

Before the start of the war in February 2022, priority services in Ukraine that have high prices but only a limited supply in the country include:

  • Cancer diagnostics
  • Rehabilitation
  • Palliative and end of life care
  • Stroke treatment
  • Mental health

As described, the needs of the healthcare system have changed, and are continuously changing dependent on the situation on the ground. The major areas of needs are in the building of new infrastructure using a building back better approach and the immediate recovery of facilities that are partially damaged. In addition, as significant expansion of rehabilitation and mental health services is needed, to address the impacts of the war.
 

Regional priorities

Local authorities are important new players in the transited Ukrainian health system. They are the responsible entities for hospital (re)construction, capital investment, PPP equipment, consulting, digital solutions and hospital management. There are differences between level of development and innovativeness between regions and cities in Ukraine. Kiev, Lviv, Poltava and Vinnytsia.

The oblasts in which damage is most severe and needs of the healthcare system recovery are highest are Donetska, Luhanska, Kharkivska and Kyivska.

 

Most prominent NL valuechains

  1. Accessible Medical Technology for Sustainable Health and Care: Dutch organisations that produce, assemble and deliver medical devices, supplies and/or supply packages (medical kits) for diagnostics, treatments and/or rehabilitation, either high-tech or specifically designed or tailored for low resources settings (point of care).
  2. Infrastructure: Dutch organisations that are able to develop and execute turn-key hospital and clinic projects that include project finance, build, equipment, train and operate.
  3. Public Health: Dutch organisations that have expertise and solutions for Primary & Community-level models & interventions, Health system data management (digital platforms for data collection, assimilation, interpretation), Health Policy, Financing/Payments, Monitoring & Evaluation, Procurement & Supply Chain Management, and Training & Education (vocational, university, postdoc, including research education

 

Overview milestones & flagships

  • G2G (MoU, state visits)
  • Trade
  • Innovate (joint R&D projects, specific bilateral calls)
  • Invest (significant investments in the Dutch LSH sector)

 

Collective Trade Activities to Ukraine

2018

  • Incoming High-level delegation to World of Health Care / Health Holland Visitors Progamme

2019

  • Incoming High-level delegation to World of Health Care / Health Holland Visitors Progamme

2020

  • Healthcare Mission to Kiev (feb, 2020)

2021

  • Health~Holland Digital Meet-up Ukraine
  • Visiting Ukrainian delegation to the Netherlands (dec 2021)

2022

  • Ukraine-Netherlands Healthcare Recovery and Reconstruction Seminar
     

The way forward

The structural barriers that Dutch SMEs active in the Life Sciences & Health Sector doing business or wanting to do business in Ukraine experienced before the war, were predominantly related to language and culture differences. Besides, barriers finding good distributor was a barrier, as well as the experience of unfair business practices. Some companies experienced problems with laws and regulation, the ability to reach key decision makers and complex product registrations.

As the situation in doing business with Ukraine has drastically changed, Dutch SMEs are left with many questions about how to support Ukraine in the healthcare recovery. In 2023, a public-private platform to support the healthcare reconstruction in Ukraine is set-up. The overall purpose is to assist Ukraine and counter some of the reverse impacts of the war on healthcare. This platform is expected to showcase how public-private partnerships and other relevant business initiatives can contribute to (sustainable) solutions for economic and physical reconstruction in Ukraine of the healthcare sector. The main purpose is to facilitate entities (companies and (semi-) public organisations) to develop action plans in line with the needs of Ukraine and the policy of the Netherlands’ government. And to provide them with up-to-date information on the risks posed by the war.