Ukraine’s Patient Call Center Serves as a Lifeline for Information, Support, and Hope

“I am an internally displaced person. I broke my arm and now I need surgery. Is it possible that I can have this surgery free of charge? Where can I have it done?”

“The medicines I need have been out of stock at my hospital for a month. What should I do?”

“My husband urgently needs Bortezomib. Our hospital does not have it and we do not have the money to buy it. What should we do?”

This is just a small glimpse into the thousands of calls that Ukraine’s patient call center has answered over the past two years. For patients and their families, the call center has become a lifeline to get the information they need and to identify the treatment options available to them through the State budget, especially during Russia’s full-scale invasion. Call takers speak directly to the patient and/or family member, allowing them to address their unique concerns and identify the specific set of actions they can take. In addition, the call center has become a resource for collecting information on medicine availability at hospitals – an issue that is more prevalent and even more dangerous in times of war.

Civil society organization and local partner Patients of Ukraine has operated the call center with the support of the US Agency for International Development (USAID) Safe, Affordable, and Effective Medicines (SAFEMed) for Ukrainians Activity since August 2022. Led by Management Sciences for Health, SAFEMed works with Patients of Ukraine to strengthen its technical capacity to respond to these calls, share information across the health system, and ensure the call center can be sustained for years to come.

From August 2022 through January 2024, the center responded to over 4,000 calls from patients and their loved ones. For many of these cases, the call center bridged information gaps and aimed to connect patients to the right care at the right time. In fact, nearly 80% of calls were questions about issues with treatment or diagnosis, the majority of which were to learn about how patients can access free or reduced services, including potential reimbursement or payment for prescriptions, surgery, or treatment, and clarify where medicines can be accessed. The National Health Service of Ukraine (NHSU) reimburses the cost of medicines and services to contracted hospitals and pharmacies and not directly to the patient.

Guiding patients on their right to free care

Many patients and their families call with the fear that they won’t be able to afford the medicine or health care services they urgently need. But with just a simple phone call, these worries can be alleviated.

Oftentimes, the requested medicine is included on the national Essential Medicines List (EML) and therefore should be available free of charge to patients at most inpatient facilities. For outpatient medications, many are commonly available at little to no cost for patients under the Affordable Medicines Program (AMP) at all pharmacies in the country that participate in the reimbursement program. SAFEMed supported the Government of Ukraine in launching the AMP in 2017 and the program continues to expand the list of medications it covers for chronic conditions. However, as can be expected, patients aren’t always aware of what is covered under the program or their rights as a patient.

For one mother in Kyiv, she began her call to the center thinking she was out of options and hung up with a clear course of action and a better understanding of her health care rights. After her 20-year-old son had been treated at a nearby hospital, the family was told they had to pay UAH 100,000 out of pocket for replacement immunotherapy. The family didn’t have the money and didn’t know where to turn, so they reached out to the call center. The call taker quickly identified the problem: the required medicine was included under the EML; however, the hospital was not contracted with the NHSU and therefore required patients to purchase medicines themselves that had already been purchased by the state. The call taker informed the family of their right to change their current hospital and switch to an institution where they could receive this treatment free of charge. With this guidance, the family had their son discharged from his current hospital and he soon received the entire course of treatment at no cost at another medical institution. The family not only protected their financial well-being but, most importantly, ensured their son could receive the care he needed.

Thanks to the USAID SAFEMed Activity, Ukraine has made significant strides to improve access to safe and affordable medicines. However, raising awareness about this access and ensuring patients take advantage of the treatment and health care services available to them remains a challenge, especially during the war. Among patients contacting the call center alone, 68% were unaware of their treatment-related rights and needed more detailed counseling.

This is largely due to several wartime conditions that have directly and indirectly impacted the health care system. The number of internally displaced persons (IDPs) in the country continues to grow, with patients forced to reside in unfamiliar communities, unsure of how to access care. The health care system faces capacity strain, with a rising number of injured civilians and soldiers requiring treatment and rehabilitation while economic hardships, destruction of medical infrastructure, and lack of medicine supply threaten treatment availability. Some pharmacies and health facilities at the frontlines are no longer operational or working amidst active combat, leaving patients to seek new providers or treatment options. According to the Ministry of Health (MOH), nearly 1,500 medical facilities have been damaged and 195 destroyed by Russian forces during the full-scale war.

Through SAFEMed’s partnership with Patients of Ukraine, the call center is helping to inform patients about their rights to free health care and medicines and guide them on what to do to access the services that are guaranteed to them. To resolve each case, the call taker offers detailed consultative assistance, which includes engaging a consultant and supporting the patient to access the care they need. This type of consultation involves ongoing collaboration (3-5 sessions) and receiving feedback from the client after the process concludes. Additionally, Patients of Ukraine may make appeals to heads of hospitals, local government authorities, and even the MOH directly, while also working closely with institutions and partner organizations including the NHSU, the Public Health Center, and the National Police. In turn, the organization not only helps patients connect to affordable, quality care at the right time, but also equips them with knowledge about where to go and how to access these services in the future.

Ensuring access to essential medicines

The call center also serves as a resource to monitor the availability of medicines – an issue even more critical as the war carries on. When patients call their respective hospital asking for medication, they may be informed that the medicine is out of stock due to budget constraints or other supply chain challenges. In these situations, patients can turn to the call center to report their experiences and also learn about other ways to receive this treatment. Then, with the help of SAFEMed, the call center consolidates information, and shares it with the MOH, the country’s central procurement agency Medical Procurement of Ukraine (MPU), and the Center for Public Health (CPH).

The hope is for this communication to expand across all levels of the health system and be distributed regularly. The MOH – as well as the MPU, CPH, NHSU, and others – can then use this data to continually increase the supply and accessibility of medicines, medical devices, and services. Establishing the call center as a shared resource hub that is both implemented and utilized by local partners will help ensure it remains intact and can adapt to the country’s ever-changing needs. The challenges that patients and health workers face in Ukraine are evolving each day. While the war has destroyed hospitals and health clinics and displaced thousands, initiatives like the call center have helped the country overcome barriers, respond to patient needs, and prevent these tragic circumstances from dismantling the health care system. Through these local partnerships and patient-centered approaches, SAFEMed is helping the country not only maintain but strengthen its pharmaceutical sector and implement reforms that will make lasting change.