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Assessment of Patient Barriers to Health Care in the Conflict-Impacted Areas of Eastern Ukraine

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Assessment of Patient Barriers to Health Care in the Conflict-Impacted Areas of Eastern Ukraine ASSESSMENT OF PATIENT BARRIERS TO HEALTH CARE IN THE CONFLICT-IMPACTED AREAS OF EASTERN UKRAINE June 25, 2021 Assessment of Patient Barriers in Conflict-Impacted Areas of Eastern Ukraine Contents Acronyms ............................................................................................................................................................................ 4 Executive Summary ........................................................................................................................................................... 4 Introduction ........................................................................................................................................................................ 5 Context ........................................................................................................................................................................... 5 Assessment Purpose and Hypothesis ...................................................................................................................... 5 Methodology ....................................................................................................................................................................... 6 Theoretical Framework .............................................................................................................................................. 6 Literature Review ......................................................................................................................................................... 7 Limitations of the Literature Review ................................................................................................................... 7 GOU Data Analysis ...................................................................................................................................................... 7 Limitations of the GOU Data Analysis ............................................................................................................... 7 Population Surveys ....................................................................................................................................................... 8 Limitations of the Population Surveys ................................................................................................................. 9 Partner Consultations................................................................................................................................................ 10 Ethical Considerations ............................................................................................................................................... 11 Findings .............................................................................................................................................................................. 11 Overview of Health Needs and Health Care Utilization .................................................................................. 11 Population Demographics .................................................................................................................................... 12 Impact of the Conflict on Social Determinants of Health ............................................................................ 13 Disease Prevalence ................................................................................................................................................ 13 Health Care Utilization ......................................................................................................................................... 14 Key Barriers to Health Care .................................................................................................................................... 17 Tier 1: Approachability & Ability to Perceive .................................................................................................. 18 Tier 2: Acceptability & Ability to Seek .............................................................................................................. 25 Tier 3: Availability and Accommodation & Ability to Reach ....................................................................... 29 Tier 4: Affordability & Ability to Pay ................................................................................................................. 38 Tier 5: Appropriateness & Ability to Engage ................................................................................................... 40 Recommendations ........................................................................................................................................................... 44 Improve Data for Decision-Making ........................................................................................................................ 45 Build Capacity of Health Care Providers and HCF Managers ......................................................................... 46 Increase Patient Literacy ........................................................................................................................................... 48 Enhance HCF Monitoring and Incentives .............................................................................................................. 49 Conclusions ...................................................................................................................................................................... 50 Annexes ............................................................................................................................................................................. 51 Annex 1. Literature Review Methodology Details ............................................................................................. 51 Annex 2. Summary Table of Key GOU Data and Analysis............................................................................... 54 2 Assessment of Patient Barriers in Conflict-Impacted Areas of Eastern Ukraine Annex 3. Population Calculation Methodology ................................................................................................... 56 Annex 4. Population Survey Questions ................................................................................................................. 59 Annex 5. Consultations with Partners .................................................................................................................. 68 References ........................................................................................................................................................................ 71 3 Assessment of Patient Barriers in Conflict-Impacted Areas of Eastern Ukraine ACRONYMS ALOS Average Length of Stay CPD Continuing Professional Development CPH Center for Public Health CT Computed Tomography EECP Exit-Entry Check Point ERW Explosive Remnants of War GCA Government-Controlled Area (of Eastern Ukraine) GIZ Deutsche Gesellschaft für Internationale Zusammenarbeit GOU Government of Ukraine HCF Health Care Facility HRS USAID Health Reform Support Project IDP Internally Displaced Person IOM International Organization for Migration IP Implementing Partner MOH Ministry of Health of Ukraine MRT Magnetic Resonance Tomography MTOT Ministry of Reintegration of Temporarily Occupied Territories NGCA Non-Government-Controlled Area (of Eastern Ukraine) NGO Nongovernmental Organization NHSU National Health Service of Ukraine OCHA United Nations Office for the Coordination of Humanitarian Affairs OECD Organisation for Economic Co-operation and Development OSA Oblast State Administration PBF Performance Based Financing PHC Primary Health Care PMG Program of Medical Guarantees SOE (eHealth) State Owned Enterprise SHC Specialized Health Care SSS State Statistics Service of Ukraine USAID United States Agency for International Development WHO World Health Organization EXECUTIVE SUMMARY The ongoing conflict in Eastern Ukraine has impacted population wellbeing and migration as well as infrastructure across sectors in Donetsk and Luhansk. The USAID Health Reform Support (HRS) project, co-funded by UK Aid and implemented by Deloitte Consulting LLP, theorized that people living in these conflict-impacted regions face unique barriers in accessing health care. To drive greater accessibility within the health care system in Ukraine, the HRS project undertook a mixed-method assessment to better understand the barriers to care in the Government-Controlled Area (GCA) of Eastern Ukraine. The assessment identified and mapped barriers to the ten dimension of access – approachability of care, patients’ ability to perceive health needs, acceptability of care, patients’ ability to seek care, availability and accommodations, patients’ ability to reach care, affordability, patients’ to pay, appropriateness, and patients’ ability to engage. With this comprehensive approach, the assessment found that patients in Eastern Ukraine face some major barriers that are similar throughout the country, such as poor signage at health care facilities (HCFs), low health literacy, lack of trust in health care providers, poor attitude of providers, lack of knowledge on health reforms and how to seek care, informal payments, lack of money to pay for health care, insufficient patient adherence, and low digital literacy. But patients in Eastern Ukraine also face some unique barriers, such as insufficient provider outreach and information-sharing,
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