Public Health in War Contexts: Capacity Assessment of Regional Public Health Centers in Ukraine

Abstract The war in Ukraine has critically weakened the public health system, causing staff losses and destruction of health facilities hindering healthcare delivery and surveillance. In 2021 Public health reforms were underway to shift regional surveillance functions from Sanitary Epidemiological Laboratories to newly established Regional Centers for Disease Control and Prevention (RCDCPs) with new roles, and functions such as vaccine supply chain management. As part of the USAID-funded Public Health Systems Recovery and Resilience Activity (PHS R&R), we conducted a rapid online assessment of 25 RCDCPs to evaluate staffing levels, training needs, and the implementation of essential public health functions. The questionnaire, developed with input from the PHS R&R consortium and the Ukrainian Ministry of Health, was distributed in January 2022 and received responses from 24 RCDCPs. Data were analyzed using descriptive statistics. Staffing levels correlated with population size (r = 0.87, p < .001). On average, 51% of staff had 10-30 years of experience, 10% had under 10 years, and 39% had over 30 years. Each RCDCP lost an average of 31 staff (6%). War-affected oblasts saw greater staff losses (42 staff on average) compared to central (30) and western (23) oblasts. Losses of surveillance staff (doctors, epidemiologists, assistants) were also greater in war-affected oblasts (14 on average), compared to 7 in the west and 6 in the center. Only 33% of RCDCPs reported sufficient staffing to perform necessary functions. Additionally, 20% reported a lack of staff with adequate skills. Key training needs included vaccine supply chain management, NCD surveillance, data analysis, and emergency response. Improved communication across health system actors was also cited as essential for better coordination and data sharing. These findings highlight the vulnerability of public health systems in war-affected areas and the need for targeted support to strengthen regional capacities in Ukraine. Key messages • The war in Ukraine has weakened RCDCPs by causing staff losses and disrupting key public health functions, especially in war-affected oblasts. • In war-affected areas, public health institutions face gaps in staffing, skills, and resources, underscoring the need for targeted support, training, and resilience to maintain essential functions.