Informal Payments in Ukrainian Primary Healthcare System: cross-sectional study, 2022-2023 years

Countries with emerging and developing economies, particularly during crises like the ongoing full-scale war in Ukraine, face significant challenges in achieving universal health coverage. This secondary data analysis focused on informal payments (IPs) in Ukraine's public primary healthcare (PHC) system, using a dataset from a study that examined IPs across four priority healthcare services: childbirth, neonatal care, myocardial infarction, and stroke care. Conducted from June 1, 2022 till May 31, 2023, across all Ukrainian regions (excluding temporarily occupied territories), the study analysed anonymous surveys of 2,031 patients using multivariable regression in SPSS. We identified that women and individuals from larger households were more likely to make IPs at the PHC level. Older patients generally viewed IPs negatively, though age did not significantly correlate with IP behaviour. Lower-income individuals also viewed IPs negatively. Resistance to health system reforms was associated with more positive attitudes towards IPs, with regional variations observed. The study results will support the Government’s evidence-based policy decisions and data-driven interventions that reduce corruption and improve health outcomes in Ukraine.