Adaptive Management and Learning in Complex Programming: Health Systems Strengthening in Ukraine

In 2017, Ukraine began a series of reforms to overhaul its corrupt Soviet-style healthcare system, which failed to deliver high quality patient-centered care. USAID designed the Health Reform Support (HRS) activity to support the Government of Ukraine to implement these reforms, which would change the way healthcare was financed and delivered. HRS brought together a large multidisciplinary team to provide holistic support in health system governance, finance, health workforce, health information technology, and service delivery. The center of HRS’ CLA approach was its flexible activity design process, which allowed the team to prioritize the most important interventions given HRS’ wide scope. The process led the team to prioritize improving the service delivery and operations of healthcare facilities. HRS used a pilot and scaling approach to test innovations in patient-centered care at 15 healthcare facilities before expanding best practices to the rest of Ukraine’s nearly 2,000 public healthcare facilities. Within these ‘Centers of Excellence,’ HRS empowered local leaders by co-designing interventions alongside healthcare providers and used performance indicators to improve integrated care teams. HRS piloted other innovations, like e-tools for financial planning and supervisory boards for local oversight of healthcare facilities, which were eventually revised based on counterpart feedback and scaled. Patient satisfaction surveys at the Centers of Excellence found that 95% of patients who visited a Center were satisfied with their experience, compared to the national average of 73%. Centers of Excellence continue to model patient-centered care to other facilities.