A Field Report from War-Torn Remote Villages in South-Eastern Ukraine: Enhancing Healthcare Access Through a Community-Oriented Primary Care Model.

Abstract

The ongoing conflict in Ukraine has severely disrupted healthcare infrastructure, displaced medical personnel and restricted access to care, prompting an unprecedented international support. Since October 2023, the non-governmental organization EMERGENCY has conducted a field assessment to identify critical barriers to healthcare delivery in remote villages of Donetsk to inform an effective intervention. The assessment revealed that many health needs, particularly those related to chronic diseases and mental health, were pre-existing but had been exacerbated by the war, resulting in a secondary surge of unmet needs in rural communities facing growing barriers to basic care. In response, a Community Health Worker (CHW)-led intervention was developed to bridge gaps between communities and health services. Locally recruited CHWs conduct door-to-door assessments, monitor treatment adherence for chronic diseases, address mental health needs, arrange home-based care for bedridden individuals, deliver health education sessions, and facilitate timely referrals in close collaboration with nurse-led clinics. To strengthen resilience, CHWs are trained in basic emergency and disaster preparedness, including life support skills, improving community-level readiness for health emergencies. To address sustainability challenges, the intervention is integrated into Ukraine's primary care network, and provides CHWs with ongoing training and compensation through regular contracts. Aligned with national health priorities and the Health Cluster's strategy, the model targets marginalized groups, engages communities, and strengthens local health systems, ensuring efficient use of resources and continuity of care. This report outlines a scalable, context-sensitive approach to enhancing healthcare access in conflict settings, with relevance for other humanitarian contexts.