TRUE - Trauma Rehabilitation in Ukraine - Inception Phase
Project Abstract
Ukraine adopted a National Strategy on Barrier-Free Society 2030 in 2021 defining rehabilitation as its cornerstone. Despite Russia’s full invasion in February 2022, the reform process has not wavered and rehabilitation is now a recognized, essential component of Universal Health Coverage and an effective emergency response, in addition to being a part of Ukraine’s obligations on integration with the European Union as per the EU Association Agreement. However, there are still enormous challenges, and the current rehabilitation remains inefficient and underperforming, with the capacities of the rehabilitation workforce limited by the lack of teaching staff, evidence-based knowledge, simulation and practice-oriented learning, and meaningful inter-professional exchange. This leads to major concerns about the quality of rehabilitation care and services, which Ukraine cannot afford at the current time while the number of persons impacted by trauma and needing access to the rehabilitation ecosystem is unfortunately continually rising.
Building on the War Trauma Rehabilitation (WTR) Project that was funded by Swiss Humanitarian Assistance, the goal of the Trauma Rehabilitation Project (TRUE), as a systems strengthening long term project funded by the Swiss Agency for Development Cooperation (SDC) is to improve the quality of care and physical rehabilitation outcomes for people with disabilities in Ukraine, with 3 outcomes:
1. Ukraine’s physical rehabilitation system governance and leadership is strengthened at the national and local levels
2. Rehabilitation service delivery is improved through the development of a functioning rehabilitation network and strengthened workforce capacities
3. Increased inclusion and tolerance, reduced stigmatization and discrimination towards persons with disabilities in society
Overall, TRUE will work with Ministry of Health and National Health Service of Ukraine to build up a functioning network of rehabilitation service delivery, including private actors that are compensated based on the volume and quality of services provided, and allowing Ukrainians a choice of providers.
Building on the 2020 Law on Rehabilitation in Healthcare System, TRUE will encourage rehabilitation to be seen as a continuum encompassing many phases - from acute treatment to rehabilitation at community level; requiring a multidisciplinary approach, integration across sectors, and giving important attention to Assistive Devices provision to ensure better outcomes for People with Disabilities (PwD).
The overall governance for PwD is complex in Ukraine because several Ministries are involved. Assistive Devices provision is generally under Ministry of Social Policy that also oversees social services - noting that in 2023, additional social workers were engaged to join the multidisciplinary rehabilitation teams to coordinate services across domains and work with local authorities. The Ministry of Education and Science oversees inclusive education and the Ministry of Economy inclusive employment etc. The multisectoral dimension holds the key to the success of wider rehabilitation reform and societal change, while continuing to note the importance of the primary healthcare linkage: 70% of Ukrainians have a family doctor, and the WHO Services Pyramid indicates 60-80% of rehabilitation services are best provided at community level.
Finally, it needs to be underscored that PwD in Ukraine are deeply stigmatized in a tradition with long roots from the Soviet era, and unfortunately reflected in the country’s legislation and social benefits model which has a charity model approach rather than promoting people with rights and for whom opportunities of education and employment should be created. Maintaining employment for people after trauma or elderly people after stroke etc. is not accompanied during the period of treatment and rehabilitation, while fear of not returning to work is among the leading mental health issues most especially for veterans. TRUE will advocate the potential of PwD to contribute to social and economic life, and work on improving employment opportunities and inclusivity of education and sport at community level.
