Summary: The present document aims to analyze the issues on the primary healthcare level in conflict-affected Donetsk and Luhansk oblasts (GCA) that result from the consequences of the conflict in the context of the recent health reform as well as challenges posed by its implementation for the fragilized healthcare system.
The following barriers to access quality public health care (PHC) services are analyzed as directly resulting from the conflict:
• Shortage of primary care doctors and a specific demographics of the health staff in Luhansk and Donetsk Oblasts (in the majority they are of retirement and a pre-retirement age);
• Damaged infrastructure;
• Power and water outages, problems with the Internet, poor network in primarily rural settlements;
• Absence of pharmacies and pharmacy points in settlements near the Line of Contact (LoC);
• Demographics of the majority of 60+ population in Luhansk and Donetsk Oblasts that requires additional medical attention;
• Impact of the consequences of the conflict on the mental health of the population that reduce opportunities to achieve qualitative results impelled by the health reform, as the current situation creates:
▶ Inability of Luhansk and Donetsk Oblasts to attract qualified medical professionals;
▶ Overwork and burnout among primary healthcare staff;
▶ Complicated access to health care services for the population residing in isolated settlements near the LoC;
▶ Inability to effectively implement State programmes, such as the Affordable Medicines Programme and telemedicine since national and regional governments do not provide the necessary support to alleviate the pressure on the healthcare in the conflict-affected areas, for instance:
Meaningful increase of the remuneration of the health staff;
Supplements to the income related to the hardship of work in a conflict-affected area and in the rural areas with reduced public transportation available;
Government programmes to attract qualified medical staff to the conflict-affected area;
Transition periods to adapt the implementation of the reform to the realities of the region;
The burden of the aforementioned issues to the healthcare system is further complicated by the COVID-19 pandemics impact in the area.
The factors described in the document consider that the conflict-affected areas require additional government support in the implementation of healthcare reform.