Dr. Oleksandr Petrenko¹, Dr. Hannah L. Weiss², Dr. Raghav Malhotra³, Dr. Sofia Marković⁴
¹ Department of Health Policy and Digital Medicine, Eastern European Institute of Public Health, Kyiv, Ukraine
² Center for Global Digital Health Innovation, Northeastern Medical University, Boston, MA, USA
³ School of Health Informatics and Systems Engineering, Institute of Digital Healthcare Solutions, Pune, India
⁴ Department of Public Health and Health Systems, Balkan Institute for Health Equity, Belgrade, Serbia
Correspondence
Dr. Oleksandr Petrenko, Department of Health Policy and Digital Medicine, Eastern European Institute of Public Health, Kyiv, Ukraine
Email: [email protected]
Abstract
Following the dissolution of the Soviet Union in 1991, Ukraine inherited a centrally planned healthcare system characterized by underinvestment, inefficiencies, and limited technological capacity. Although incremental reforms were introduced in the decades that followed, substantial transformation began after 2014, when systemic restructuring created the foundation for a modern, digitally enabled healthcare system. This viewpoint article examines the evolution of Ukraine’s digital health infrastructure, highlighting key policy initiatives, technological advancements, and governance reforms that have supported its development. At the same time, the analysis considers the severe constraints imposed by the ongoing war, including infrastructure damage, workforce displacement, and disruptions to service delivery. Nevertheless, Ukraine’s healthcare system occupies a distinctive position in leveraging digital health solutions to address workforce shortages, maintain continuity of care, and support post-conflict reconstruction. By building on existing digital expertise and innovation capacity, Ukraine has the potential to accelerate the transition toward a resilient, efficient, and equitable healthcare system in the future.
Keywords: Digital health, Healthcare reform, Health system resilience, Workforce challenges, Post-conflict reconstruction, Ukraine.
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INTRODUCTION
The Russian Federation’s full-scale invasion of Ukraine on 24 February 2022 marked a profound turning point for the country’s social systems, with healthcare infrastructure among the most severely affected. A defining feature of the ongoing conflict has been the systematic targeting of civilians and civilian infrastructure, including repeated and deliberate attacks on healthcare facilities and medical personnel. Conservative estimates from the first 11 months of the war report more than 700 assaults on healthcare facilities and dozens of direct attacks on medical workers, resulting in significant loss of life and injury [1]. As a consequence, hospitals and clinics have been destroyed, damaged, or forced to cease operations, pharmacies have closed, and critical medical supplies have become scarce. In many regions, healthcare delivery has been displaced to improvised settings such as basements and temporary shelters, often supported by an increasingly strained and depleted workforce. At the same time, the rapid adaptation and innovation observed in battlefield medicine has emerged as a powerful example of resilience and ingenuity under extreme conditions [2].
As the conflict enters its fourth year, cautious optimism persists regarding both its eventual conclusion and the long-term preservation of an independent Ukraine. Looking ahead to the reconstruction phase, the rebuilding of the healthcare system and the revitalisation of its workforce will be central to national recovery. In this context, the development of a robust, future-oriented digital health system will be essential for restoring services, improving efficiency, and enhancing system resilience. Ukraine’s pre-war experience and demonstrated capacity in digital healthcare provide a critical foundation for these efforts, positioning digital solutions as a key enabler in shaping a sustainable and adaptive healthcare system for the post-conflict era.
HISTORY OF UKRAINIAN HEALTHCARE
Following independence in 1991, Ukraine inherited a healthcare system shaped by the late Soviet model, which was already in a state of structural and financial decline. Although the principle of universal and free access to healthcare was formally retained, in practice the system remained chronically underfunded, highly bureaucratic, and vulnerable to corruption. Informal payments, preferential treatment, and “care for cash” became defining characteristics of service delivery, undermining equity and public trust [3]. Allocation of financial resources to public hospitals was frequently influenced by political connections rather than population health needs or clinical priorities. As a result, many Ukrainians faced high out-of-pocket expenditures for care that was often of poor quality, with catastrophic health spending and household financial collapse not uncommon. By 2014, however, comprehensive healthcare reform was initiated at an unprecedented pace [4]. A fundamental redesign of healthcare financing was introduced, shifting away from rigid budgetary allocations toward activity-based funding.
This process culminated in the establishment of the National Health Service of Ukraine (NHSU) in 2017 as a single-payer purchasing agency. Under this model, a defined package of essential health services was guaranteed to all citizens, and providers were reimbursed based on services delivered. Crucially, the government mandated the use of a national electronic healthcare system as the exclusive platform for interaction between the NHSU and all healthcare providers, positioning digital infrastructure at the core of system governance and accountability. However, the full-scale Russian invasion in 2022 abruptly disrupted and slowed this digital transformation. Despite the profound disruption caused by the war, Ukrainian healthcare has not collapsed entirely [4,5]. Medical professionals continue to deliver care under extreme conditions, often operating from basements and bomb shelters while providing complex and specialised services. At the same time, new healthcare initiatives have emerged in response to wartime needs [6], including the rapid expansion of rehabilitation services aimed at supporting injured civilians and military personnel through advanced medical technologies.
Large segments of the healthcare workforce were relocated away from active conflict zones, while many female healthcare workers with dependent children evacuated to western Ukraine or other European countries during the early stages of the war, further intensifying workforce shortages. The most urgent challenges facing the healthcare system during wartime include the widespread mental health impact on the population, continuity of care for chronic diseases, escalating costs and limited availability of medicines and pharmaceuticals, and the near absence of functional healthcare services in occupied territories. In response, the World Health Organization (WHO) has identified four strategic priorities for the recovery of Ukraine’s healthcare system: restoring service delivery, mobilising capital investment, reforming health financing, and strengthening institutional capacity [7]. More recent WHO assessments have further highlighted the growing importance and complexity of digital health solutions in addressing these challenges and supporting long-term system recovery [8–10].
EVOLUTION OF THE CURRENT UKRAINIAN DIGITAL HEALTHCARE SYSTEM
In 2017, the Ukrainian Ministry of Health identified the development of a national electronic healthcare system (EHS), known as the e-Health project, as a strategic priority for health system reform [6]. The primary objective of this initiative was to maximise the exchange of health information while simultaneously reducing the administrative and regulatory burdens associated with the legacy paper-based system. Prior to 2016, digital capacity across public healthcare institutions was extremely limited: many facilities lacked basic information technology infrastructure, some did not have access to personal computers, and internet connectivity was inconsistent. As a result, healthcare managers had no reliable patient registries to support financial planning, and statistical data were often delivered too late to inform effective quality management and policy decisions. The 2017 reform vision proposed a unified, nationwide digital healthcare system supported by comprehensive registries of patients, healthcare professionals, and medical institutions.
At its core, the system was designed around a central national data repository responsible for standardized data collection and governance. In parallel, decentralised medical information systems (MIS) were introduced to address local and institutional needs. These MIS platforms were developed by private information technology companies operating in an open market, while remaining subject to government oversight and regulatory standards. This dual-level architecture was intended to balance national interoperability with local flexibility and innovation. By 2022, the scale and maturity of the EHS had expanded substantially. The central system had registered approximately 36 million patients, stored more than 1.6 billion electronic medical records, and supported around 400 000 active users. On average, the platform processed between 1 000 and 1 500 requests per second to the central database, reflecting its role as a critical digital backbone for healthcare delivery (Figure 1).
Public uptake of digital health services was rapid, driven by immediate and tangible benefits for patients, including online appointment scheduling, access to information on available medicines, electronic prescriptions, and the generation of digital sick leave certificates. The central EHS is integrated with more than 40 regional and institutional MIS platforms that support direct patient care and respond to local service requirements. This two-level digital architecture offers several important advantages. First, all MIS platforms transmit standardized data in uniform formats to the central repository, ensuring full interoperability across the healthcare system. Second, while data standards are harmonised nationally, local MIS platforms retain the flexibility to develop customised functionalities and services tailored to specific institutional or regional needs. Healthcare managers and clinicians can therefore guide the evolution of these systems to enhance clinical workflows and patient outcomes, while contributing to a coherent, nationally integrated digital health ecosystem.
Figure 1. Two-level architecture of the electronic healthcare system of Ukraine. The national electronic health system comprises a central database and peripheral medical information systems developed by local IT providers. This structure enables uniform national data acquisition while allowing local adaptation and innovation. API, application programming interface; EMR, electronic medical record; MIS, medical information system.
IMPACT OF WAR ON THE DIGITAL HEALTHCARE SYSTEM
Despite the profound disruption caused by the ongoing war, Ukraine’s digital healthcare system continues to play a central role in supporting national healthcare delivery. The electronic healthcare system (EHS) maintains a comprehensive set of core registries, including uniquely identified patients, healthcare facilities, institutional managers, patient–provider declarations, health professionals and specialists, electronic prescriptions, and electronic medical records. Together, these registries enable a high degree of automation across healthcare institutions and support the delivery of digital services to patients nationwide. Importantly, the EHS is interoperable with other government information systems. For example, integration with the national demographic register allows deceased patient data to be incorporated into prospective healthcare financing and planning. During the COVID-19 pandemic, the system demonstrated its operational value by centrally recording testing results and vaccination data, reinforcing its role as a critical public health infrastructure.
At the same time, the war has severely affected the digital health ecosystem that underpins the EHS. Many of the information technology companies responsible for developing and maintaining medical information systems (MIS) have experienced substantial financial losses, physical destruction of infrastructure, and the forced displacement or evacuation of highly skilled IT specialists. The immediate consequence has been a sharp reduction in the number and viability of MIS providers. Of the approximately 40 MIS platforms operating prior to the invasion, it is anticipated that only four to six may remain functional in the long term. This contraction poses significant challenges for system sustainability and continuity. Healthcare professionals trained to work within specific MIS environments may be required to rapidly adapt to alternative platforms, necessitating the reconfiguration of workflows and additional training under already constrained conditions.
In the short term, national digital health priorities remain focused on maintaining and expanding essential functionalities. Key initiatives include the implementation of digital inventory management systems (e-Stock), modernisation of the state register of medicines, development of a comprehensive registry of medical equipment and devices, digital medical certification for drivers, expansion of rehabilitation-focused digital services, blood donation management systems, the creation of a big data analytics platform, and the establishment of a unified state registry of medical professionals. While these objectives are critical for sustaining healthcare operations during wartime, meaningful expansion of the digital health agenda beyond these core goals will ultimately depend on the restoration of peace and long-term system stability.
FUTURE DIGITAL HEALTHCARE ISSUES IN THE UKRAINE
The adoption and use of Digital Health applications is predicted to be beset by numerous significant challenges within Ukraine’s context, as well as opportunities for Digital Health in the future to provide services to all citizens of Ukraine regardless of their geographic locations or access to care systems available to them. Digital Health in Ukraine presents both a challenge for improving access to quality care for those living outside major urban centres and an opportunity to develop new and innovative workforce solutions to address Ukraine’s health care workforce challenges. Digital Health in Ukraine must be embraced by both the public and private sectors to address these significant challenges. The successful integration of Digital Health into Ukraine’s evolving healthcare ecosystem could lead to an increase in the standard of care delivered to Ukrainian citizens and may also provide significant benefit to the delivery of healthcare services in the future.
CONCLUSION
While Ukraine has significant obsticles with regards to providing care for both its civilian population, and military patients, one of the major challenges facing The Ukraine Health System is rebuilding; and while rebuilding will require bricks, mortar, and restructuring of Wokforce, it also requires a broader vision and an innovative approach to avoid the current levels of devastation; in addition, the digital health system built over a period of six (6) years, is an indication of the vision, innovation, and creativity, which have been developed as part of this journey, and therefore, these digital tools are well positioned to address the infrastructure and dysfunctionality that many other healthcare systems have experienced; therefore, it is important that these digital tools are integrated into the healthcare reconstruction efforts being made by Ukraine post-conflict.
Author Contributions
Dr. Oleksandr Petrenko: Conceptualization, methodology, formal analysis, and writing—original draft preparation.
Dr. Hannah L. Weiss: Data curation, validation, visualization, and writing—review and editing.
Dr. Raghav Malhotra: Supervision, project administration, interpretation of findings, and critical revision of the manuscript.
Dr. Sofia Marković: Supervision, methodology guidance, interpretation of findings, and critical revision of the manuscript.
All authors have read and agreed to the published version of the manuscript.
Acknowledgments:
Beginning in June of 2022, a small group of doctors from Boston began working on developing a Rehabilitation Institute in Lviv, Ukraine. In addition, through ongoing professional collaboration, these two groups engaged in many conversations regarding the future development of the healthcare system in Ukraine. This report is a result of a Virtual Conference held on April 4, 2023.
Funding: This research received no external funding.
Conflict of Interest: The authors declare no conflict of interest related to the publication of this article.
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