Health intervention reprioritization after 2025 funding cuts in Ukraine: a systems thinking analysis

Background

Health needs in crisis always outmatch available resources. Prioritisation is essential for effective response, yet remains poorly understood compared to routine healthcare. Substantial reductions in development assistance in early 2025 forced health partners globally to reprioritise their portfolios, offering a unique learning opportunity. This study documents impact of the cuts and reprioritisation decisions using systems thinking methodology, with Ukraine as a case study.

Methods

We conducted 26 semi-structured interviews with representatives from key national and international organisartions, and donors in Ukraine. Purposeful text analysis was used to extract decision relevant statements, and causal relationships from interview transcripts. Findings were translated into causal loop diagrams to model feedback structures.

Results

Funding cuts significantly disrupted service delivery. The use of explicit prioritisation process was limited. Directing remaining US-funded projects toward a narrow set of life-saving interventions led to duplication and the inability to fund supporting activities, which undermined the delivery of some life-saving activities. Non-US donors stepped up to cover emerging funding gaps, but lacked scale and often favored high-visibility interventions over long-term capacity building or coordination. Cuts accelerated response localisation; however, the absence of capacity-building support risks undermining quality over time. Partner coordination proved relatively resilient, but was largely achieved through staff overwork, which is unsustainable in the long term and, with delay, risks deteriorating coordination below the pre-cuts level.

Conclusions

Non-US donors helped fill emerging funding gaps; however, limited use of explicit prioritization resulted in several key areas remaining underfunded. Strengthening the use of explicit prioritization in future crises can improve allocation and impact of limited response resources.

Key messages

• Non-US donors helped fill funding gaps; however, limited use of explicit prioritization resulted in several key areas remaining underfunded.

• Directing remaining US programs to implement only life-saving interventions caused duplication and eroded support functions, undermining delivery of the intended life-saving interventions.