By Sergii Khomchenko, Olha Kovalchuk, and Diana Shcherbinina for ReLAB-HS
Learning, Acting, and Building for Rehabilitation in Health Systems (ReLAB-HS), a global activity funded by the United States Agency for International Development (USAID), ended activities in Ukraine in February 2023. Despite being faced with the realities of war, ReLAB-HS Ukraine made significant progress in advancing the rehabilitation landscape in Ukraine since launching in September 2021. We identified opportunities to strengthen rehabilitation and assistive technology (AT) services in the country’s health system, laying a strong foundation for ongoing efforts.
Conflict and rehabilitation are closely linked. War disrupts health services and leaves a legacy of injuries and chronic conditions that depend on a reliable health system and a strong rehabilitation workforce.
Ukraine is no exception. The war has destabilized the country, caused widespread trauma and injuries, and uprooted millions of people—an estimated 5.9 million people are internally displaced and more than 8 million refugees have fled to other countries in Europe. It has disrupted and overburdened the country’s health system, which was already faced with challenges that limit availability and access to care.
Rehabilitation and AT services in Ukraine have been narrowly focused on persons with disabilities, as opposed to being more broadly available to anyone with limited functioning and are not widely available at the community or primary health care levels. Exacerbated by war, there is a lack of qualified personnel to provide much needed services; infrastructure is damaged; access to services is disrupted; and elaborate procedures for obtaining assistive products are now further complicated.
Before the war escalated in 2022, Ukraine was undergoing significant health sector reform, which included improving financing mechanisms for primary health care services and essential medicines, increasing pay for health professionals, and working toward digitizing the country’s health records system. The Ministry of Health of Ukraine was committed to implementing change, providing a crucial opportunity to ensure that rehabilitation and AT were part of the broader health system reform.
Working in partnership with the Ministry of Health of Ukraine and other Ukrainian partners, we sought to co-design and implement innovative, comprehensive, cost-effective interventions that strengthen health systems for the provision of rehabilitation and AT services. Here, we highlight key contributions that ReLAB-HS has made towards this in Ukraine.
ReLAB-HS Key Achievements in Ukraine
Development of a National Strategy for Rehabilitation in Ukraine
Before the war intensified, the ReLAB-HS Ukraine team was engaged in important initiatives to develop the national strategy for rehabilitation and AT. Though these efforts were interrupted by the conflict, they served as important first steps that laid a foundation for the work to be continued when feasible.
The ReLAB-HS Ukraine team collaborated with the World Health Organization (WHO) to develop the draft National Rehabilitation Action Plan. As part of the process, the team engaged closely with and sought input from several key stakeholders among the government and rehabilitation professional community to ensure that the plan reflected shared goals and commitments. The draft plan was submitted to the Office of the President before the war escalated; our hope is that this plan will be approved and implemented as the situation improves.
An important step in facilitating the implementation of the plan is to have a good understanding of the costs for rehabilitation and AT services. To that effect, the ReLAB-HS Ukraine team conducted costing assessments in rehabilitation departments of hospitals in Kyiv and Lviv. At the request of, and in collaboration with, the National Health Service of Ukraine (NHSU), ReLAB-HS developed a customized costing tool adapted to the Ukrainian context. We used this tool to document the costs of services within the existing orthotic and neurologic rehabilitation packages financed by the government. While these efforts were disrupted by the war, we nonetheless completed the costing assessments for hospitals in Kyiv and Lviv.
Strengthening Education and Workforce Development
Despite the challenges of an ongoing war, ReLAB-HS identified several opportunities to strengthen rehabilitation education and workforce development. Given the increasing need for rehabilitation services in the country due to the current situation, this was an integral part of our activities in Ukraine, and the team implemented a range of activities.
Supporting Continuing Professional Development
ReLAB-HS Ukraine supported continuing professional development (CPD) of rehabilitation professionals, educators, and students by delivering online rehabilitation education through the Plus eLearning platform. Of the 585 courses available in English, 89 have been translated into Ukrainian as of February 2023. Among these courses, custom learning programs (composed of a series of courses) on International Classification of Functioning, Disability and Health (ICF) and Rehabilitation in Disaster and Conflict Program were created at the request of the Ministry of Health of Ukraine and the rehabilitation community.
The Ministry of Health of Ukraine promoted the use of the translated courses among Ukraine’s health care institutions, as well as among the health care departments of both the regional and Kyiv military administrations. Additionally, Plus was integrated into the NHSU Academy website, making access to free online rehabilitation education widely available to Ukrainian rehabilitation professionals. Access to Plus will remain free to Ukrainians during the conflict and temporarily after to support rebuilding efforts.
Strengthening Leadership for Rehabilitation
As part of ReLAB-HS’s global initiative to strengthen leadership for rehabilitation-inclusive health systems, select Ukrainian rehabilitation and health system stakeholders participated in ReLAB-HS’s Global Rehabilitation Leadership Institute (GRLI) course. The GRLI developed participants’ competencies on understanding rehabilitation and health systems, developing a shared vision for rehabilitation, formulating a strategy for integrating rehabilitation within health systems, and collaborating with multi-sectoral and multi-disciplinary partners.
In October 2022, ReLAB-HS held a two-day workshop in Poland on “Leadership for Rehabilitation Education and Workforce Development,” with representatives from universities with rehabilitation programs, the Ministry of Education and Science of Ukraine, the Ministry of Health of Ukraine, and the USAID-funded Strengthening Rehabilitation Services within Health Systems (SRSHS) project. The workshop covered international standards for CPD of rehabilitation professionals, and participants created an action plan to work towards professional regulation. Participants were also introduced to the International Rehabilitation and Education Training Toolkit (IRETT), developed by ReLAB-HS in collaboration with international rehabilitation stakeholders, and guided through how to use it to strengthen their academic programs for physiotherapy and occupational therapy. These Ukrainian educators are now applying the tools to strengthen professional regulation and rehabilitation education.
Strengthening Educational Programs
ReLAB-HS also sought to strengthen rehabilitation educational programs in Ukraine by supporting standardization in curricula and providing opportunities for learning exchanges and mentorship.
To strengthen rehabilitation education, working with Ukrainian educators, we identified gaps in existing curricula compared with international standards. These findings highlight specific curricula changes that will make university educational programs more comprehensive.
From October 2022 to February 2023, ReLAB-HS hosted monthly online workshops to support learning exchanges between the Rueckert-Hartman College for Health Professions at Regis University in Denver, Colorado, and representatives of the National University of Ukraine on Physical Education and Sport, Ukrainian Catholic University, Lviv State University of Physical Culture, and Khortytsia National Educational and Rehabilitation Academy. Using the IRETT, these workshops supported each university to articulate a program philosophy, outcomes, mission, and vision for their respective programs.
In addition to these online workshops, ReLAB-HS facilitated an educator exchange between Regis University and Lviv State University of Physical Culture, providing faculty the opportunity to observe new teaching strategies and classroom management techniques and to gain a global perspective on rehabilitation education.
Mentorship and learning among Ukrainian educators and other rehabilitation professionals continues to be supported through ReLAB-HS’s Rehabilitation Community of Practice platform, launched in 2022. The platform provides a space that promotes shared learning and includes open forums dedicated to strengthening university educational programs.
Efforts to support Ukraine in strengthening education and workforce development for rehabilitation will continue to be supported by the SRSHS project, which will carry out remaining activities in collaboration with key stakeholders.
The Way Forward
During the short time that ReLAB-HS was present in Ukraine, we are proud of the accomplishments we made toward strengthening Ukraine’s health system for the inclusion of rehabilitation services. Our efforts established a strong foundation, but much remains to be done. Though we are concluding ReLAB-HS activities in Ukraine, the work will continue. Building on this progress, local and international stakeholders will continue to work together to ensure the availability of and access to appropriate rehabilitation and AT services for those who need them.