Abstract
Since its independence, rehabilitation in Ukraine has been constrained and lacked a systematic approach due to various factors, including insufficient recognition of its significance. Nevertheless, the full-scale war greatly hastened the development of a national rehabilitation system. In Ukraine, amid the war, nearly 250,000 patients require rehabilitation annually, affecting both civilians and military personnel [1,2].
The increasing demand for medical care for numerous victims of the Russo-Ukrainian war has accelerated the development of infrastructure for physical and psychological support, prioritizing medical rehabilitation in the healthcare system [3, 4].
In recent years, the World Health Organization (WHO) has been instrumental in advancing rehabilitation in Ukraine. Following a series of assessment missions that identified the key needs and limitations in the rehabilitation sector, WHO, in collaboration with Ukrainian experts, developed a comprehensive roadmap for systematically implementing new standards and enhancing infrastructure and human resources in the rehabilitation field [5]. This roadmap became a strategic document outlining step-by-step measures to enhance the rehabilitation care system, from training personnel to utilizing modern equipment and constructing new rehabilitation centers [6].
Consistent evaluation of the road map’s implementation results enables assessment of achievements at each planned stage. These assessments are carried out as WHO missions, which review progress and modify the plan based on emerging challenges.
A significant event for the advancement of rehabilitation was the joint visit to Ukraine in December 2015 by the WHO Evaluation Mission and the International Society of Physical and Rehabilitation Medicine (ISPRM) to conduct a “Technical consultation to support the development of a national plan for life activity restrictions, health, and rehabilitation for Ukraine.” Over the two-month preparatory phase, international experts assessed the entire scope of existing regulatory documents and the available statistical data concerning the operation of the rehabilitation system in Ukraine. The mission’s recommendations facilitated the start of significant reforms in this area, focusing on enhancing access to rehabilitation services and integrating them into the healthcare and social systems [7].
Several legislative documents were adopted to ensure the rehabilitation system’s effective functioning, with the Law of Ukraine “On Rehabilitation in the Health Care Sector” being pivotal. This law came into force on December 31, 2020, and was implemented on June 30, 2021. This law establishes a legal framework for delivering quality medical rehabilitation services and outlines the directions and principles for operating rehabilitation institutions.
The law specifies the specialists in the multidisciplinary rehabilitation team who deliver rehabilitation care: a doctor of physical and rehabilitation medicine, a physical therapist, an occupational therapist, an assistant to a physical therapist and an occupational therapist, a speech and language therapist, a psychologist/psychotherapist, a prosthetist-orthotist, a rehabilitation nurse, and a social worker. The law outlines a multidisciplinary rehabilitation team that is organized, functionally distinct, and united by shared rehabilitation goals and tasks. This team of specialists delivers high- and medium-volume rehabilitation services in both inpatient and outpatient settings during the acute, post-acute, and long-term rehabilitation phases [8].
The adoption of the Law of Ukraine “On Rehabilitation in the Field of Health Care” marked a major advancement towards developing a comprehensive rehabilitation system and enabled the creation of specialized packages for rehabilitation services under the state medical guarantee program initiated by the National Health Service of Ukraine (NHSU) [9].
Another significant step in advancing rehabilitation in Ukraine was the establishment of new specialities essential for the functioning of a multidisciplinary team. Since 2019, Ukraine has been training doctors through a four-month specialization program and later introduced the training of interns in physical rehabilitation medicine (PRM) [10]. At present, the PRM internship program spans over three years and aligns with the European training program for PRM doctors. Lviv Danylo Halytsky National Medical University was the first of the three medical universities in Ukraine to begin training PRM doctors under these programs. Today, Ukraine is preparing all the specialists required for a multidisciplinary rehabilitation team. The “Prosthetics and Orthotics” educational and professional program at the second (Master’s) level of higher education was introduced the most recently, and four universities have begun training specialists in this field.
Collaborating with European and global professional societies is crucial in developing a rehabilitation system in Ukraine. For instance, the Ukrainian Society of Physical and Rehabilitation Medicine is an active member of both the European Society of Physical and Rehabilitation Medicine (ESPRM) and the International Society of Physical and Rehabilitation Medicine (ISPRM). This collaboration offers extra opportunities within the scope of professional practice in rehabilitation medicine, including the execution of joint research projects [7].
A key aspect of advancing rehabilitation in Ukraine was the adoption of the International Classification of Functioning, Disability and Health (ICF). This system enables the use of unified and standardized language and frameworks to describe health conditions and related issues [11]. This classification introduces the definition of health components and certain well-being components related to health (like education and work). Using the ICF, attention is redirected from “disease consequences” to “health components.” “Health components” determine the elements of health, whereas “consequences” concentrate on the effects of diseases or other health conditions on the end result. In Ukraine, experts were trained who could subsequently instruct multidisciplinary rehabilitation teams. The National Classifier of Functioning, Disability, and Health was approved in April 2022. This established conditions for rehabilitation activities as a bio-psycho-social model that considers the patient’s functional state and environmental and personal factors.
According to the Decree of the President of Ukraine No. 369/2021 regarding the decision of the National Security and Defense Council of Ukraine dated July 30, 2021, “On the State of the National Healthcare System and Urgent Measures to Provide Citizens of Ukraine with Medical Care,” all citizens should receive comprehensive rehabilitation assistance from the first day of seeking help for injuries or diseases. This will be achieved by expanding the network of institutions offering rehabilitation services in health care, standardizing approaches based on evidence-based international practices, relevant standards, and protocols, expanding rehabilitation packages in the medical guarantee program by merging various budgetary rehabilitation programs, and enhancing methods for providing necessary technical and other rehabilitation means at all stages [12]. Therefore, as per the resolution of the Cabinet of Ministers of Ukraine dated February 28, 2023, all cluster and supracluster medical facilities must establish rehabilitation departments.
The NHSU, responding to the heightened demand for rehabilitation, created special packages that enable patients to access state-funded services [13]. This greatly eases access to services for victims, especially those wounded in conflict. As a result of this decision, the country is actively expanding rehabilitation centers that offer comprehensive services to these patients.
Primary challenges during the war included the inadequate training of rehabilitation specialists in spinal cord injuries, craniocerebral injuries, amputations, and burns [14]. There are too few specialized institutions/departments and no access to advanced equipment. Nonetheless, considerable progress has been made with the backing of international partners and professional organizations. Several programs focused on training staff and outfitting rehabilitation centers are active in Ukraine. New rehabilitation centers were founded across the country.
By November 2024, the NHSU had contracted 495 medical facilities for rehabilitation, offering free medical care under the Medical Guarantee Program. In general, free rehabilitation care is provided inpatiently in 314 medical facilities throughout Ukraine and 470 outpatient facilities. In 2024, the government-funded outpatient and inpatient rehabilitation services exceeded three billion hryvnias. Meanwhile, rehabilitation departments across the nation deliver over 12,600 rehabilitation sessions daily. In contrast, this number was under 4,000 sessions in 2022. This implies that a significantly larger number of patients can access the rehabilitation they require. Meanwhile, in 2024, over 350,000 patients accessed outpatient and inpatient rehabilitation services [15].
The Ministry of Health’s priority project, “Protection of Mental Health in the Structure of Medical Care,” focuses on developing outpatient mental health services [16]. For this purpose, a network of mental health centers will be created based on cluster hospitals in a capable network of healthcare institutions, of which 157 have been identified to date. The Ministry of Health’s upcoming phase of efforts to support Ukrainians’ mental health will involve psychological rehabilitation at health resort treatment centers, focusing on restoring individuals’ mental well-being [17].
Given the rapid advancements in rehabilitation, establishing university rehabilitation clinics is crucial. These clinics will serve not only as centers of assistance but also as training hubs for future specialists. Plans are underway in Lviv to establish a new, modern, multifunctional, scientific-medical, educational-practical, international National Rehabilitation Center at the Danylo Halytsky Lviv National Medical University. The primary aim is to offer Ukrainian citizens, especially war victims, innovative services in treatment and physical, psychological, and social rehabilitation. Students, medical professionals, and rehabilitation specialists will also be trained in advanced technologies, and cutting-edge scientific research in medical rehabilitation will be conducted. The Center comprises a 250-bed inpatient rehabilitation center, a diagnostic center, an outpatient rehabilitation center, and a rehabilitation institute (a scientific and educational center). The center’s construction will proceed according to the agreement between the Ukrainian and Austrian governments. The university clinic will support scientific research, test new treatment approaches, and enhance the qualifications of medical staff, which is a crucial step for advancing a modern rehabilitation system.
The Ministry of Health, Danylo Halytsky Lviv National Medical University, and the Nadija Foundation of the Children’s Hospital and Research Institute (Finland) signed a memorandum of cooperation to establish a Rehabilitation Center at the university for the physical and psychological rehabilitation of Ukrainian children who have suffered physical and psychological losses, injuries, and traumas due to a full-scale war [18].
As a result, the horrific war waged by the russian federation against Ukraine posed a significant challenge that triggered the reform of Ukraine’s rehabilitation system. Engagement with the WHO, the implementation of legislative initiatives, and the participation of international partners have significantly advanced various aspects of the medical rehabilitation care system. This system’s continued enhancement relies on consistent personnel training, infrastructure maintenance, and the advancement of scientific and educational centers.