A full-scale war has radically changed the medical map of Ukraine. People are changing cities, losing family doctors, and encountering barriers that did not exist before. How does the healthcare system function in these conditions? Who turns to whom? Which institutions are doing well, and which are disappointing?

ZDOROVI presents a large-scale study based on a survey of 754 respondents from all over Ukraine, which demonstrates not only how the structure of appeals to medical institutions is changing, but also what patients are actually experiencing - from finding a specialist to maintaining mental stability.

Primary care — in question?

Family clinics were mentioned by only 9% of respondents. At first glance, this figure may be worrying — after all, these institutions are supposed to be the “first entry” into the healthcare system. However, it is worth considering the territorial context: 77% of the survey respondents are urban residents, while family clinics and FAPs are most common in rural areas. According to the data, 32% of all visits to clinics/FAPs are from rural residents, which is the highest rate among all types of healthcare facilities. Another 11% of visits are from urban settlements.

This confirms that in rural communities, FAPs are often the only available option for medical care. At the same time, 58% of patients who mentioned clinics live in cities. This may indicate the presence of such facilities in urban areas as well, or the high mobility of patients who come to FAPs from other settlements. Thus, the small overall share of visits to clinics in the sample structure is more likely explained by the predominance of urban respondents than by the real attitude to this level of medical care.

Within the framework of the ongoing primary care reform, these institutions play a critical role. The high level of satisfaction with their work (70% positive assessments of the quality of services) and the large share of patients who are ready to recommend these institutions (79%) underline the potential of family clinics in providing affordable and high-quality care, especially in communities outside large cities.

Specialized medical institutions (10%) - in particular, oncology centers, cardiology centers, women's clinics - remain relevant for providing specialized care. However, their geographical concentration in regional centers limits access for residents of rural and remote areas, which highlights the need to develop referrals, telemedicine or mobile formats.

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When place of residence determines the quality of medical services

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As of 2025, more than one in ten respondents is an internally displaced person (IDP) - 5% received this status before February 24, 2022, and another 8% - after. In addition, 6% of respondents constantly change their place of residence without having official IDP status. This indicates that more than 19% of patients are in a situation of mobility or disintegration with their usual environment - and this directly affects access to medical services. People change their place of residence, often without being tied to a doctor or having a clear understanding of where to find medical care in a new region.

Rural residents (14% of all respondents) also report significant difficulties - both logistical and infrastructural. This once again emphasizes the need to develop mobile medicine, telemedicine, and - systemic support for primary care in communities.

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Money - as the main reason for not seeking help

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46% of respondents assessed their financial situation as "difficult" or "very difficult". Almost every fourth admitted that they are forced to save even on food. This not only affects general well-being, but also directly affects health - people are forced to postpone visits to the doctor, do not undergo recommended examinations or cannot afford to buy prescribed medications.

The state of the household determines not only the choice of the type of medical institution, but also subsequent adherence to treatment. Lack of funds limits the ability to fulfill a doctor's prescription - in particular, to purchase medications, provide transportation to a medical institution, undergo physical rehabilitation or consult with specialized specialists. Even if the service is free of charge, the actual costs of receiving it (travel, lack of

necessary drugs in the hospital, the need to buy consumables) make it unattainable for many patients.

This is especially true for people with chronic diseases, patients with limited mobility, as well as internally displaced persons, for whom unstable housing, limited access to a registered doctor or lack of local support become additional barriers.

At the same time, more than 40% of respondents are generally in the so-called “borderline welfare zone”: they have enough for food, but have to save or borrow for clothes, medicines or household appliances. This creates additional risks of interrupting treatment, losing motivation for preventive examinations and further deterioration of health.

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Quality of service: better, but not everywhere

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The assessment of the quality of medical services shows interesting dynamics: in general, 44% of respondents are satisfied with their last visit to a doctor. However, the level of satisfaction varies significantly depending on the type of institution. In private clinics, 80% of patients were satisfied or very satisfied with the service. In family clinics — 70%. In polyclinics — only 46%, in hospitals — 42%. The main complaints are long queues, lack of convenient access for patients with limited mobility, lack of information, uncomfortable infrastructure. The private sector, despite its cost, wins over the public sector in almost all parameters. It is worth noting that almost half of the respondents (from 36% to 48% depending on the type of institution) did not notice any changes in the quality of medical services over the past year. This may indicate both a certain stability and the absence of improvements that would be noticeable to patients. Positive dynamics are observed in communication with medical staff and the speed of service, but comments remain regarding the cleanliness of the premises, the availability of necessary medications and the ease of navigation in institutions.

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Psychological health — the calm before the storm

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The section of the report on mental health is particularly alarming. More than 70% of respondents are in a state of mild to moderate psychological fatigue, anxiety or stress. At the same time, only 13% received psychological help in the last year. Despite the growing openness to the topic of mental health, the experience of seeking professional support remains limited. The reasons are not only stigma, but also insufficient awareness of available services, as well as a lack of trust in the system. However, it is the primary link – polyclinics, primary health care centers and even FAPs – that are increasingly becoming the entry point for psychological help. This is the result of efforts to train staff, as well as the first step towards overcoming stigmatization. At the same time, the system is still not coping with the level of demand for mental support. This is a challenge that requires a systemic response: integrating psychologists into primary health care, regular training of medical workers, development of telemedicine and launching nationwide support programs.

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What needs to be changed?

Recommendations from patients. Respondents clearly formulated requests to the system:

1. Make institutions accessible to people with disabilities: ramps, elevators, tactile navigation.

2. Develop online consultations and telemedicine.

3. Train staff to work with patients with limited mobility.

4. Provide support and guidance in institutions, especially for older people and displaced persons.

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ZDOROVI: analytics that lead to action

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The data from this study are of strategic importance for planning the future activities of both ZDOROVI and other NGOs working in the medical field.

We see that polyclinics remain the main link in the system - this is where most patients turn, so supporting this part of the medical infrastructure should be our priority. At the same time, the primary link needs to be strengthened - not only in terms of material support, but also in communication with the population. People should know where to go, what services are available, and that help is nearby. Special emphasis is placed on psychological support. It should be integrated into all levels of the medical system: accessible, professional, and without stigma. Accessibility of medicine is not only about the physical availability of services. It’s about logistics, clear information, accessibility, inclusivity, and trust. Ukrainians trust medicine — but they expect it to be fair, accessible, and humane. Our task is to make that a reality.

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