The visit was organized by ZDOROVI with the support of Gro Buttingsrud, a Norwegian health secretary, volunteer, board member of Helsesekretærforbundet i Delta – the national association of health secretaries in Norway, as well as the Association itself.

The aim of the internship was to gain an in-depth understanding of practical models of primary care in Norway, the role of mid-level and auxiliary medical staff, as well as the minimum training and equipment requirements for conducting diagnostic tests. These aspects are critically important for Ukraine in the context of war, staff shortages, and the significant strain on the healthcare system.

The internship was a continuation of the partnership between ZDOROVI and Norwegian colleagues. Earlier, as part of this collaboration, ZDOROVI organized Ukraine’s first webinar dedicated to the profession of health secretary, titled “Applying the Norwegian Primary Care Model: A New Experience for Ukraine’s Healthcare System.” The event brought together primary care professionals, executives of medical institutions, and healthcare administrators seeking modern and effective solutions to strengthen their teams.

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Who represented Ukraine?

The delegation included executives of primary healthcare centers and nursing representatives from different regions of Ukraine.

Primary care executives:

Oksana Dzham, CEO of the Bucha Primary Healthcare Center;

Eleonora Koliada, CEO of the Primary Healthcare Centre №1 of the Dniprovskyi district of Kyiv;

Victoriia Pokoievchuk-Zraiko, CEO of the Primary Healthcare Centre “Yuvileiny” of Rivne.

Nurses:

Alla Kuzhel, Chief Nurse of the City Children's Clinic №6 of Odesa;

Olga Puzenko, Deputy Medical Director for Nursing of the Primary Healthcare Centre №2 of Mykolaiv;

Lesia Hryhorchuk, Chief Nurse of the Ivano-Frankivsk Regional Clinical Hospital.

This combination of managerial and practical perspectives allowed participants to assess what they observed not in theory, but through the lens of the real challenges faced by Ukrainian healthcare institutions.

Five Days – Dozens of Practical Solutions

The internship program was comprehensive and covered both municipal and private healthcare institutions. The delegation visited the municipal medical center in Bærum, a private medical center in Greverud, the Østfold County Regional Hospital – one of the newest in Norway – as well as the largest emergency department in Europe at Oslo University Hospital.

A separate focus was on educational and professional structures, including a meeting with Hans-Christian Myklestul, Head of the Norwegian Association of General Practitioners; a visit to the private training center K2 Kompetanse AS, where health secretaries are trained; and to the main office of Helsesekretærforbundet i Delta, the national association of health secretaries in Norway.

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Primary Care as the Foundation of the System

One of the key conclusions of the internship was the central role of the family doctor. In Norway, primary care handles up to 90% of all patient cases, and the family doctor acts as a full-fledged manager of a person’s health.

Family doctors independently determine the size of their patient lists – from 500 to 1,200 patients, depending on age distribution and case complexity. This approach prioritizes quality of care over the sheer number of patient registrations.

“In Norway, the family doctor initiates and resolves around 90% of all medical cases. Without the family doctor’s decision, almost no clinical action takes place in a patient’s care – this makes the primary care a true pillar of the entire healthcare system,” says Victoriia Pokoievchuk-Zraiko, CEO of the Primary Healthcare Centre “Yuvileiny” of Rivne.

Patients cannot see a doctor without an appointment or referral, as there is a clear procedure for medical interaction. In cases of acute conditions, patients are directed to the hospital emergency department, where family doctors operate on a separate schedule.

Health Secretary: The Backbone of the System

One of the most significant discoveries for the Ukrainian delegation was the role of the health secretary – a fully recognized, regulated profession that currently does not exist in Ukraine.

In Norway, health secretaries:

Triage patients;

Organize appointments and patient flow;

Collect biological samples;

Conduct basic screenings (CRP, glucose screening, CBC, GUA, and HbA1c);

Maintain electronic records and financial documentation.

“In Ukrainian primary care, these tasks are typically performed by at least three different employees. In Norway, they are handled by a single, clearly trained and regulated specialty. Doctors openly acknowledge their importance, saying, ‘What would we do without medical secretaries?’,” emphasizes Oksana Dzham, CEO of the Bucha Primary Healthcare Center.

Training for medical secretaries lasts three years and combines theoretical knowledge, communication skills, and hands-on practice in fully equipped simulation rooms.

Laboratories and Patient Trust as the Cornerstones of Quality

A dedicated part of the internship focused on the work of the private laboratory Fürst in Oslo, which conducts up to 25,000 tests daily and is the national leader in laboratory diagnostics.

All processes – from sample collection to results – are highly automated, and all laboratories in Norway undergo mandatory external quality control. Laboratory personnel primarily perform oversight functions, with only about 20% of complex pathological analyses carried out manually.

“I was impressed not only by the scale but also by the underlying philosophy: quality, speed, and trust. Laboratory services are fully integrated into primary care centers, allowing doctors to order necessary tests directly, without unnecessary referrals,” notes Alla Kuzhel, Chief Nurse of the City Children's Clinic №6 of Odesa.

During a meeting with the Ukrainian delegation, Head of Patient Services Marit Hagberg emphasized that basic skills in venous blood collection can be taught in just one week, without the need for expensive equipment or complex infrastructure.

This insight is particularly relevant to the Ukrainian context, where nurses are overworked and registrars often lack clinical competencies.

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Health Secretary is a Vital Yet Missing Link

A dedicated part of the internship focused on the profession of health secretary – a key role in the Norwegian healthcare system, but virtually absent in Ukraine. These specialists handle patient triage, sample collection, primary documentation, and communication.

“In Ukraine, there is a huge gap between nurses and unqualified registry staff. We saw that training health secretaries can significantly relieve the system and make care more accessible,” notes Kateryna Malysheva, Project Manager of Educational Events at ZDOROVI, who accompanied the delegation.

A Partnership Set to Continue

The internship partner was Gro Buttingsrud, a health secretary at the municipal medical center in Bærum, board member of the National Association of Health Secretaries in Norway, and volunteer with SLAVA Ukraini Norway. Over the past year, she has visited Ukraine three times, including two visits to medical facilities in collaboration with ZDOROVI.

Thanks to her involvement, contacts were established with trade unions, training centers, laboratories, and key representatives of the Norwegian healthcare system. Today, joint projects are being discussed to translate triage tools and educational materials, and to establish the health secretary profession in Ukraine based on the Norwegian model.

A Glimpse into the Future

The internship in Norway has demonstrated how international solidarity, trust, and practical knowledge can transform a healthcare system. At the heart of this model is the healthcare professional: protected, well-trained, equipped with resources, and respected. As the Norwegian experience shows, this is where quality patient care truly begins.