Although total public and private health spending exceeds the global average for Ukraine’s income level, health outcomes remain weak in the country. Public health spending has averaged 4 per cent of GDP in recent years. Legislation and policy are also lagging in Ukraine which, for example, is one of the last countries in Europe with no universal law on salt iodization.
The challenging financial and policy environment contributes to poor quality of care, inadequate infrastructure, especially in rural areas, and the widespread practice of unofficial fees for services. In Ukraine, households contribute almost half of total health expenditure through out-of-pocket payments. This rate is among the highest rates in Europe.
In 2018, non-communicable diseases made up the heaviest disease burden in Ukraine: human immunodeficiency virus (HIV) and tuberculosis are the most serious diseases in Ukraine. The country has one of the highest HIV rates in the Europe and Central Asia, and tuberculosis continues to be the main cause of death among persons living with HIV.
Immunization coverage remains alarmingly low. In 2018, Ukraine suffered the largest measles outbreak in Europe with 47,000 cases that year, including 16 deaths (10 adults and 6 children). At the end of November 2018, immunization coverage was 76 per cent for the first measles, mumps and rubella (MMR) vaccination at 12 months; and 78 per cent for the second MMR vaccination at six years of age: both of these are substantially lower than the WHO-recommended figures of 95 per cent nationwide coverage. Meanwhile vaccination rates are under 55 per cent for vaccinations from diphtheria, tetanus and pertussis; hepatitis B and polio. The polio figure means Ukraine is at high risk of polio outbreak. Data from a 2018 National Health Index survey suggested that while support to vaccination remained at 75 per cent among parents with children under the age of 18, but 11 per cent of parents had negative attitudes to immunization.
Conflict-affected areas are particularly hard hit. Frequent water shortages, coupled with Ukraine's low immunization rates, also increase the risk of communicable diseases. This is concerning in a situation of high mobility and scanty healthcare services. Two-thirds of health facilities in areas closest to the ‘contact line’ have been damaged, hindering the population’s access to healthcare.
