Sustaining NCD services at primary care level in Ukraine: a repeated qualitative study, 2016–2022

Background

Noncommunicable diseases account for nearly 90% of deaths in Ukraine, driven by cardiovascular diseases and cancers. To strengthen NCD care at the primary health care level, the Ministry of Health and WHO introduced a two‑day interdisciplinary training for providers based on the WHO Package of Essential Noncommunicable Disease Interventions. Implemented across seven regions between 2016 and 2018, the programme trained over 10,000 providers, about 55% of the workforce. This study examined the scope and sustainability of practice changes following the training in the context of health reform, COVID‑19, and war.

Methods

We collected qualitative data at two time points, informed by qualitative longitudinal methods. At T1 (2018–2019), 74 focus group discussions explored early adoption and practice transformation. At T2 (2022), 56 in‑depth interviews assessed sustained changes and contextual influences. Data were analyzed using deductive thematic analysis guided by the Dynamic Sustainability Framework, complemented by inductive coding.

Results

At T1, providers reported strengthened focus on NCD prevention, early detection, and management, with increased confidence in risk assessment, lifestyle counselling, and integrated management of hypertension and diabetes, supported by task shifting and managerial engagement. By T2, many practices were sustained, but NCD preventive activities declined due to COVID‑19 and the attention shifted toward patients with established NCDs and complications. Sustainability was further challenged by administrative burdens, workforce shortages, rising patient loads, and, during the war, increased stress and psychosomatic complaints among patients.

Conclusions

WHO PEN–supported practice changes were maintained over five years but weakened under systemic pressures, pandemic disruptions, and wartime conditions. Providers demonstrated resilience, underscoring the need for continued investment in PHC capacity and integrated NCD care.

Key messages

• Interdisciplinary training strengthened NCD prevention and management in Ukrainian primary care, with many practices sustained despite reform, pandemic pressures, and war.

• Sustained practice change shows PHC resilience, but systemic pressures, COVID 19, and war reduced preventive care, highlighting the need for continued investment in PHC capacity.