Neglected Healthcare Amid Ukraine's Ongoing Crisis

In Ukraine, a significant decrease in the number of healthcare workers, with a notable 30% reduction in nurses between 2015 and 2022, has raised concerns about the quality and accessibility of healthcare services. This decline can be linked to various factors, including deregulation, economic pressures, and conflict.

Post-2014, Ukraine initiated wide-ranging reforms, including deregulation and privatization in the healthcare sector. While these reforms aim to increase efficiency and reduce state control, they can also lead to workforce instability, especially in economically challenging contexts.

Deregulation has resulted in job insecurity and redundancies for nurses, as hospitals undergo closures, restructuring, and privatization. Wage stagnation and migration have also been observed, as increased market pressures and reduced government funding fail to keep pace with inflation. This situation encourages skilled nurses to seek opportunities abroad or in other industries.

In addition to deregulation, other factors have contributed to the decline in the healthcare workforce. The ongoing conflict in eastern Ukraine and the full-scale invasion in 2022 have led to direct loss of life, displacement, and migration of medical personnel. Economic difficulties and inflation have further undermined the attractiveness of public sector healthcare jobs.

A common problem for caregivers in stationary facilities or emergency care in Ukraine is the intensification of work, manifesting in a higher number of patients per caregiver and the expansion of their tasks. This overload, coupled with reduced support services, has accelerated burnout, further driving attrition.

The psycho-emotional state of many nurses shows signs of compassion fatigue, impairing their ability to care for patients and meet their professional obligations. Iryna, a 49-year-old healthcare worker in Ukraine, earns 14,000 Hrywnia (298 Euro) per month for a full-time position. This low wage, combined with limited influence over workload or additional tasks, drives healthcare workers and medical trainees to leave the public sector in Ukraine.

Collective agreements for nurses can be ignored, and nurses may be prevented from seeing them. In some facilities, just one specialist and one assistant are responsible for an entire ward at night, and the cleaning of patient rooms has been outsourced, causing nurses to take on additional hygiene tasks. Insufficient physical safety at work, especially during night shifts, is a common problem for nurses in Ukraine.

Hospitals in Ukraine have gained autonomy to decide how many caregivers to hire and how much work they should do, often leading to fewer staff handling more work and an increase in overtime. This autonomy, coupled with the abolition of national workload standards for healthcare workers, has created legal uncertainty regarding their responsibilities in state and municipal healthcare facilities.

Restoring clear, nationwide standards for regulating nurse workloads is crucial to increase the number of mid-level healthcare professionals, fill open positions in healthcare facilities, and improve the quality of healthcare in Ukraine. The results of a study suggest that the restoration of national standards for workload is crucial to prevent the collapse of Ukrainian healthcare infrastructure.

In conclusion, while the 30% decrease in nurses is not solely attributable to deregulation, such reforms—especially when combined with economic strain, war, and broader sectoral instability—play a critical role in workforce attrition. The most plausible explanation is that deregulation, alongside war and economic crises, led to rapid emigration, layoffs, and reduced entry into the profession, particularly between 2015 and 2022. In 2020, a new financing mechanism was introduced in Ukraine's healthcare reform, where hospitals now receive funds based on care packages with specific requirements for doctors and medical equipment but few guidelines for staffing nursing and support staff. A study conducted in 2024 shows that the deregulation of the healthcare sector due to reform has affected all specialties, regions, and institutions of Ukrainian healthcare workers.

The science of workforce stability in the healthcare industry, particularly in the context of deregulation, is a crucial area of focus in light of the 30% reduction in nurses in Ukraine between 2015 and 2022.
Chronic kidney disease, cancer, respiratory conditions, and other chronic diseases may go unaddressed due to the lack of healthcare workers, as a result of deregulation and its related factors in Ukraine.
Digestive health may be at risk as well, given the already challenging work conditions for caregivers in stationary facilities and emergency care in Ukraine, exacerbated by deregulation and related factors.
Fitness and exercise programs may see diminished participation due to the reduced availability of healthcare professionals, a consequence of deregulation and its associated issues in Ukraine.
Mental health is another critical area that may be impacted by the workforce decline, as nurses struggle with compassion fatigue and burnout caused by overwork and reduced support services.
Skin care, including the treatment of conditions such as psoriasis and various skin conditions, may suffer from the lack of specialized care due to the decreased number of healthcare workers in Ukraine.
The implementation of therapies and treatments for various medical conditions, including cardiovascular health, may be affected by the shortage of trained healthcare personnel in Ukraine, a direct result of deregulation and its related challenges.
Medicare and other health and wellness programs may experience disruptions and reduced efficiency due to the 30% decrease in nurses and other healthcare workers, as a result of deregulation and its associated factors in Ukraine.
The quality and accessibility of healthcare services in Ukraine can be significantly improved through the reimplementation of nationwide standards for regulating nurse workloads, a vital step to address the attrition caused by deregulation, war, and economic crises.