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Effective Rehabilitation in the Healthcare Sector: What Should It Be Like for the War-Affected Population?

May 13, 2024

On 2 May, Kyiv hosted a national roundtable discussion, Effective Rehabilitation in the Healthcare Sector: What Should It Be Like for the War-Affected Population, organised by Right to Protection with the support and assistance of the ACCESS Consortium.

The event aimed to discuss topical issues related to the provision and receipt of rehabilitation care in the healthcare sector, namely:

• ensuring quality, timely, evidence-based, and accessible rehabilitation care through the implementation of the World Health Organization's recommendations; 
• the potential for involving family and attending physicians in the provision of such care; 
• barrier-free provision of rehabilitation services; 
• practical aspects of providing rehabilitation care under martial law.

The roundtable brought together representatives of public authorities, the public sector, physical and rehabilitation medicine doctors, heads of rehabilitation centres and representatives of the scientific community who train future specialists in rehabilitation care in the healthcare sector.

Opening the event, Nadiya Kovalchuk, Programme Director of the Foundation, noted that rehabilitation in the healthcare sector is critical in the context of a full-scale invasion. 

Ksenia Gedz, Advocacy Coordinator of the Foundation, who moderated the event, drew attention to the fact that, according to the World Health Organization, approximately 2.5 billion people worldwide live with health conditions that can be improved through healthcare rehabilitation. 

Mykhailo Radutskyi, Chairman of the Verkhovna Rada Committee on National Health, Medical Assistance and Medical Insurance, delivered a welcoming speech.  

"The subject of the roundtable is crucial, as it will become a major issue and topic in the healthcare system in the coming decades. The Verkhovna Rada of Ukraine has adopted the Law of Ukraine On Rehabilitation in Healthcare. After the law's adoption, rehabilitation services are provided on a multidisciplinary basis and begin not only when a patient is transferred from inpatient or emergency treatment but also from the first days of stabilisation. They are provided following the logic of the ICF biopsychosocial approach. The multidisciplinary teams include doctors of physical and rehabilitation medicine, physical therapists, ergotherapists, psychologists, and others. Last year, over 200,000 patients received rehabilitation care. The National Health Service of Ukraine has contracted over 500 healthcare facilities, of which 37 are private. A licensing system has also been introduced for medical facilities that provide rehabilitation care," said Mykhailo Radutskiy. 

Olena Kulchytska, Advisor to the Minister of Social Policy of Ukraine, spoke about the role of prosthetics-orthotics specialists and social workers in multidisciplinary rehabilitation teams.

"We are implementing a holistic approach to the rehabilitation system and the concept of health, as health is a state of complete physical, mental, and social well-being. Our efforts aim to actively involve prosthetists-orthotics and social workers in multidisciplinary rehabilitation teams. Our biggest challenge in the prosthetics-orthotics sector is improving service quality. We focus on the non-formal education of such representatives. The classifier of professions already includes this profession. We are also developing a higher education standard for a master's degree programme in prosthetics-orthotics. The second step is to involve social workers in the work of multidisciplinary rehabilitation teams. We are now striving to raise the professional level of such social workers and help institutions choose the form of their involvement. 

The task of the Ministry of Social Policy of Ukraine is to equip a living space, if necessary, to equip a car, to adapt a workplace because the ultimate goal of rehabilitation is to return a person to an active and independent social life so that the person can realise their potential and talents," said Olena Kulchytska. 

The first panel of the roundtable was devoted to the current state and directions of development of rehabilitation assistance because of the challenges of armed aggression. 

Taras Tarasenko, Member of Parliament of Ukraine, stressed the importance of improving the quality of rehabilitation care in the healthcare sector, in particular by raising the professional level of members of multidisciplinary teams. The MP also emphasised the importance of achieving rehabilitation goals in the healthcare sector and ensuring rehabilitation care continues at the hromada level, primarily through exercise and sports 

Yevgen Kostin, Chief Specialist of the Department of Health Benefit Packages Development of the National Health Service of Ukraine, spoke about the current state of rehabilitation care under the Medical Guarantee Programme and the requirements for rehabilitation care specialists. He also noted that the medical institutions of Kyivska, Lvivska, and Dnipropetrovska oblasts provide the most rehabilitation services for patients under the Medical Guarantee Programme.

"The task of the NHSU, hromadas, and medical institutions is to do everything possible to ensure that everyone who needs rehabilitation care, while receiving it, can adapt to everyday life by improving functional abilities, such as mobility, communication, and self-care," said Yevgen Kostin. 

Vitalii Muzychenko, Head of the Fund for Social Protection of Persons with Disabilities, drew attention to the importance of providing assistive devices during and after rehabilitation and presented statistics on the allocation of funding for the purchase of rehabilitation aids and further state policy measures to provide the population with rehabilitation aids. 

Olena Dolynna, Head of the Rehabilitation Centre, Doctor of Physical and Rehabilitation Medicine at the Vinnytsia Regional Clinical Psychoneurological Hospital named after Academician O. I. Yushchenko of the Vinnytsia Regional Council, revealed the content of evidence-based rehabilitation, outlining five steps that help to ask the right questions and find answers to them to determine the best interventions that can be included in an individual rehabilitation plan for a patient. Olena also spoke about the critical role of rehabilitation centres of excellence — "rehabilitation elevators" — seven of which are currently operating in Ukraine. 

In general, the speakers of the first panel of the roundtable focused on rehabilitation's relevance in the healthcare sector, achievements, and the need to address the challenges that arise in the rehabilitation process. 

The second panel of the roundtable was devoted to ways to develop rehabilitation and brought together representatives of the public who work in this field. 

Olena Semiorkina, an Analyst and Expert in the field of lawmaking at the Ukrainian Helsinki Human Rights Union, stressed the importance of easing the patient's route to rehabilitation and the need to simplify the medical and social expert examination, in particular by ensuring that documents can be sent to the MSEC through the patient's electronic card. 

Mykhailo Serebriakov, Executive Director of Together Against Corruption NGO, also focused the participants' attention on the importance of digitalising the process of passing the MSEK.

Maryna Stashyna-Neimet, Accessibility Expert at Group of Influence NGO, addressed the critical issue of ensuring information accessibility when receiving rehabilitation services and outlined specific recommendations for providing such accessibility.

Olena Nizhelska, Project Manager at the Luhansk Association of Organisations of Persons with Disabilities, presented the results of a study on the needs and challenges faced by healthcare facilities providing rehabilitation services to people who have been injured or wounded due to the war.

Mykola Nadulichnyi, Head of the Luhansk Association of Organisations of Persons with Disabilities, noted the need to develop healthcare facilities' capacity to provide rehabilitation services and the importance of working with the families of those undergoing rehabilitation. At the roundtable, Olena Levchyshyna, Legal Analyst at R2P, presented the results of a survey conducted by the Foundation on access to healthcare rehabilitation for civilians in Dnipropetrovska, Mykolaivska, Sumska, and Kharkivska oblasts and recommendations for improving the rehabilitation system in Ukraine. 

The event also featured a video on the procedure for obtaining rehabilitation assistance in the healthcare sector, which the Foundation prepared with the support of the ACCESS Consortium. The video will be distributed on information platforms to raise public awareness of the opportunities to receive rehabilitation in the healthcare sector under the Medical Guarantees Programme.

Following the roundtable, all participants supported the Foundation's initiative to raise awareness among the public about opportunities in the field of medical rehabilitation, agreed with the recommendations to simplify the procedure for passing the medical and social expert commission, in particular through its digitalisation, and to ensure multidimensional barrier-free access to rehabilitation facilities, as these factors are vital to providing quality, effective, affordable, patient-oriented rehabilitation care in Ukraine.