Switzerland's health support to Ukraine in view of the Russian invasion

SDC’s health programming in Ukraine

In the period 2020 until 2023 Switzerland defined the main objective of its support for health in Ukraine as: The Ukrainian Population, including people affected by the conflict, enjoys better health. The following two outcomes should be achieved:

• Outcome 1: National and local institutions, including in conflict-affected areas, provide more equitable and sustainable access to qualitative and affordable primary healthcare services that are responsive to users’ needs, with a focus on disease prevention and health promotion.
• Outcome 2: Men and women of all ages in selected regions adopt healthier lifestyles and hold healthcare institutions accountable for delivering quality services.

Governance reform, digital innovation and its effect on services including health

Public services, including health, are dependent on good governance and sufficient finance. For this reason, since 2014 Switzerland is supporting Ukraine’s decentralization reforms. Ukraine’s commitment to better governance and service provision facilitated the participatory elaboration of over 35 legal acts, which constitute the “decentralization reform package”. Since 2015 several rounds of municipal amalgamation have led to the creation of 1469 merged territorial communities. Thanks to financial decentralization average local revenues tripled over three years and the share of local budgets in the consolidated state budget increased by 20% in four years. Significant progress was made, with the support of Switzerland, in introducing e-governance, e-democracy and open data. Since 2015, 620,000 citizens have influenced local decision-making via e-petitions and participatory budgeting platforms; 347,000 have taken advantage of efficient e-services. Women’s effective participation in public life was promoted through the establishment of a network of local female leaders.

Health provision in Ukraine is divided according to needs and local decision making. Participatory and transparent budgeting is part of the system at all levels. Ukraine has 27 subdivisions, and of these 24 are Oblasts (regions). At the Oblast level highly specialized health-care is available. In each Oblast there are 6-7 Rayons/districts and at this level there is a hospital providing services such as deliveries and basic surgery. Subdivisions of the Rayons are communities/hromadas, at this level primary health care is provided. However, for some services a national system makes more sense, an example would be vaccination procurement and awareness raising campaigns.

SDC supported health programs for Ukraine prior to February 2022

Two SDC supported health programs implemented in the period before the invasion of February 2022 are given as examples below.

• Mental Health: This project supports the implementation of reforms in the mental health area by improving regulatory framework conditions, piloting integrated, community-based models of care and providing psychosocial support to communities affected by the ongoing conflict.
• Non-Communicable Diseases Prevention and Health Promotion: The program aims at improving the health and wellbeing of the Ukrainian population through strengthening the governmental capacities to counteract and monitor Non-Communicable Diseases (NCDs), such as cardiovascular and respiratory disorders, cancer, and diabetes. The project also aims at strengthening the skills and capacities of family doctors and nurses to support the control, early detection, and prevention of these diseases.

The Russian invasion of 24th February 2022

It is important to note, that in the aftermath of the invasion the Ukrainian health care system was resilient and did not collapse, despite severe local damages in affected areas. When health care infrastructure was destroyed, health care personnel were partly redeployed towards the West of Ukraine. It was important then, that the humanitarian response should support the health service in Ukraine and not attempt to set up inefficient “parallel” structures to existing functioning services.

It was important then, that the humanitarian response should support the health service in Ukraine and not attempt to set up inefficient “parallel” structures to existing functioning services.

Three examples of Switzerland’s humanitarian health response and the adaptation of Swiss Health Programs after the Invasion of February 2022

SDC increased financial support to partners working in mental health for IDPs and IDPDs with additional funding. The changes in mental health needs were noted, for example an increase in post-traumatic stress disorder (PTSD), stress, anxiety and depression treatments and adaptations were made to the program focus and thematic priorities.

Finally, the program will need to be extended and rather transformed from humanitarian intervention into development one, in order to be able to provide the whole rehabilitation cycle including provision of services at community level.

The SDC’s “triple Nexus” reorganization

A note on Switzerland’s SDC reorganization: Since two years SDC has been preparing a reorganization. On 1^st September 2022 this took place, according to the “fit4purpose” plan. Outside SDC “fit4purpose” is better known as “triple nexus”, bringing peace, development and humanitarian responses to work together in a more coordinated way. When the invasion started in February 2022 many of these working practices, bringing SDC’s development and humanitarian departments together, were already in place.

For example at this time one staff member was already working both for Section Health in the development department and in the Humanitarian Aid WASH section of SDC. This was being replicated in other departments, specifically in Protection and in DRR (Disaster Risk Reduction) /Environment. Another adaption was the amalgamation of the geographic sections into one “nexus desk”, with one program officer being responsible for one geographic region and including both humanitarian and development programming. In national offices, the staff have already being working on a portfolio of humanitarian and development projects.

The Nexus approach allows SDC’s National Program Officers and headquarter staff to be adaptive to the context and to implement programs with a blend of humanitarian and development responses and programs, to best address the needs of the affected populations. This is very well demonstrated in the examples of SDC’s health response in Ukraine where all interventions today are implemented on the boundary of humanitarian and development approaches.

The Nexus approach allows SDC’s National Program Officers and headquarter staff to be adaptive to the context and to implement programs with a blend of humanitarian and development responses and programs, to best address the needs of the affected populations.

1. GFA Consulting Group is one of the leading European consulting firms active in the development cooperation sector (GFA is short for Gesellschaft für Agrarprojekte in Übersee.