Healthy community model

"Health" must go beyond hospitals – what a Healthy Community should look like

Health is often understood merely as the absence of disease. In reality, however, it is a much broader cultural concept that encompasses the highest attainable standard of living for an individual.

It is not the level of medical care, but rather the environment and living conditions that have the greatest impact on a person’s health. It is essential, for both the government and society, to rethink what health truly means. This is one of the core goals of Health Solutions.

Health must extend beyond the walls of hospitals. People need to be encouraged and motivated — through health education initiatives, and by fostering a culture in which health is a shared value. Responsibility for health should not lie solely with doctors, but also with policymakers, teachers, civil society organizations — every active stakeholder in society.
Tetyana Havrysh, co-founder, Director of Strategic Development of Health Solutions.

The decentralization reform has demonstrated that health in communities must become a priority. Decentralization has enabled the implementation of health programs tailored to the specific needs of each community’s residents — taking into account demographic data, social factors, culture and traditions, environmental conditions, and more.

Before the full-scale war began, we were inspired by the German model Gesundes Kinzigtal (“Healthy Kinzigtal”), which, within a few years, significantly improved the health outcomes and life expectancy of its residents through systematic interventions.

In March 2022, the “Public Health” program of the International Renaissance Foundation supported the initiative of the Kharkiv Expert Group in Health Care Reform to implement a Healthy Communities model. The team behind “Health Solutions,” which is the successor and continuation of the “Public Health” program, continues to advance the development of such communities. In 2023, with support from ULEAD with Europe, the project “Healthy and Resilient Community” was launched.

Despite the ongoing war, we must already look toward the future and build a healthcare system that preserves human capital, promotes individual health, and supports people’s ability to self-actualize — both for those who remain on the home front and those returning from the front lines.
Victoriia Tymoshevska, co-founder, executive Director of Health Solutions.

The healthy community model we are adapting for Ukraine was originally developed and implemented by German family physicians with the expertise of Optimedis GmbH. The Kinzigtal model has been tailored to fit the Ukrainian context.

We strive to support communities in implementing new approaches that will enable:

• Local authorities to develop high-quality, health-focused local policies tailored to the needs of their residents;
• Healthcare providers to acquire the knowledge and skills necessary to build trust with the community;
• Local civic initiatives to become an integral part of the decision-making processes that affect the quality of life within their specific communities.

We began our work with the Bucha community. Together with local leaders — officials, healthcare providers, and civic activists — we learned to shift the focus: from spending budgets on one-time material aid to investing in prevention, the long-term health of residents, and the sustainability of the community itself. Those who maintain good health are better equipped to work, nurture others, and contribute to restoration. For example, we helped establish a targeted municipal program for the prevention and treatment of diabetes.

As a result of the war, Ukrainians are migrating: young families are moving away, resulting in many communities being left predominantly with elderly residents and internally displaced persons (IDPs). Veterans are returning from the frontlines and require comprehensive rehabilitation to reintegrate into civilian life. Our initial goal — to change society’s attitude towards health — remains unchanged, but a new context has emerged: preserving human capital. Mass migration, demographic shifts, and an increase in the number of people with disabilities all need to be taken into account in strategic health planning.

A key component for further progress is transitioning to health management based on objective data. When we define health as a social category, measuring community health goes beyond the walls of hospitals, and other community stakeholders become involved in the data collection and processing. Currently, there is no reliable, ready-made data available to support decision-making in communities.
Mykhailo Dovhopol – community health expert.

Therefore, we do not just teach communities to collect health data — we have created tools for this purpose. The analytical dashboard became the first step toward systemic solutions: now communities can see the real picture — compare, analyze, and act based on evidence.

It is symbolic that this initial conversation took place in Bucha — a city where, after de-occupation, people were counted by the number of windows with lights on. Similarly, today we are still “guessing” the health status of communities instead of truly knowing it. Our goal is for every community to have an accurate map of its well-being — and the ability to improve it.
Tetyana Havrysh, co-founder, Director of Strategic Development of Health Solutions.

The shift to a new data management approach is a transition to a new culture of governance — a system that does not wait for problems but anticipates them.

We see two key objectives in working with communities:

1. Maximizing the preservation of human potential.
2. Returning people to active life through timely social and medical support.

The integrated services model, developed together with the Bucha community, has since been offered to four other selected communities:

• Skvyra (Kyiv region)
• Mukachevo (Zakarpattia region)
• Pervomaisk (Kharkiv region)
• Kramatorsk (Donetsk region)

We want to show our residents that integrated care is not just a special program or a procedure performed by a nurse in a hospital. It’s about the community taking responsibility for the health of its people.
Mykola Baksheyev, mayor of Pervomaisk

For six months, our Foundation implemented the Healthy and Resilient Community project in five communities: Bucha, Skvyra, Mukachevo, Kramatorsk, and Pervomaisk. In each of these communities, we established cross-sectoral working groups — “integrators” — composed of representatives from local government, healthcare institutions, education, and civil society.

Despite the challenges of wartime, these communities not only responded to immediate needs but also worked on long-term planning. As Victoria Tymoshevska, co-founder of the Foundation, noted, even after experiencing occupation, the Bucha community envisions a future worth living in. The same can be said for the Pervomaisk and Kramatorsk communities — front-line areas where the urgency of survival does not stand in the way of a vision for growth.
Victoriia Tymoshevska, co-founder, executive Director of Health Solutions.

The Fastiv and Yasinyanska communities expressed interest in adopting the Healthy Community model and have since started working with our Foundation.

Examples of Local Initiatives:

• Skvyra Community focused on raising awareness and engaging residents. Health fairs, educational activities for schoolchildren, and first aid training sessions were organized to promote active participation.
  
• Mukachevo Community developed a comprehensive strategy to encourage healthy lifestyles and prevention, including anti-smoking campaigns, promotion of physical activity, and mental health awareness efforts.
  
• Kramatorsk began exploring the creation of mobile medical teams to reach residents in remote areas with essential health services.
  
• Bucha Community, informed by its experience of occupation, initiated the development of a coordination hub — a "health integrator" — to align and streamline local health initiatives.

During the implementation of the project, we observed that most communities lack sufficient resources, expertise, or tools to drive systemic change in the field of health. Local civil society organizations are often represented by just a few dedicated activists and require institutional development, support in building partnerships, and the cultivation of a democratic decision-making culture.

To address this, we launched a mini-grant competition to support active participants from the communities that had completed the project’s training program. This initiative enabled them to implement their public health projects at the local level — applying the approaches developed throughout the project and receiving ongoing guidance from our experts.

More about the competition and its implementation

Examples of initiatives made possible through the mini-grants:

• Mobile check-ups: Family medicine doctors conducted health screenings at local businesses and in rural areas, with a particular focus on preventing cardiovascular disease and diabetes.

• Organizing Nordic walking sessions — offering an accessible way to promote physical activity and a healthy lifestyle.
• Running health education programs for people living with cardiovascular conditions and diabetes. Participants of these programs became public health ambassadors in their communities.

• Purchasing sports equipment for school competitions — to encourage children to be more active and adopt healthy habits.
• Creating a sports area at a social services center — designed specifically for older adults to stay active.

• We also initiated a partnership between the Pervomaisk community and students from the Kharkiv School of Architecture (KhSA), which evolved into a separate project. Together with the local NGO Dzherelo and under the guidance of architect Daria Ozhyhanova, the team designed inclusive, therapeutic spaces tailored to the real needs of the community.
  

The project began with the creation of a sports area on the grounds of the community’s geriatric center. From there, the team developed solutions tailored to the needs of veterans and people with limited mobility.

More about project

The students created:

• Design concepts for quick-impact spatial solutions.
• A practical guide, “The Spatial First Aid Kit,” containing clear, easy-to-adapt instructions for implementation in other communities.

The idea behind the Spatial First Aid Kit is to introduce temporary yet impactful architectural solutions that support both the physical and emotional well-being of residents.
Daria Ozhyganova, architect, co-founder of NOEMA studio

Even with limited resources, real change is possible when supported by knowledge and guidance. We are already seeing communities think more strategically, engage across sectors, and prioritize prevention. This is the strongest proof that investing in the growth of local leaders and communities truly works.

Our goal is to turn the development of healthy communities into a lasting movement — one that transforms not only how local budgets are shaped, but also how we understand the future of Ukraine: as one built on health and resilience.

To support communities in building healthier environments, we developed a comprehensive community development guide. This resource was prepared by experts from the Kharkiv Expert Support Group for Medical Reform, with backing from the International Renaissance Foundation and our Foundation. It serves as a practical tool for communities committed to actively shaping a healthier future for their residents. Mykhailo Dovhopol, Olena Reshetnyak, Tetiana Havrysh, and Oleksii Holovin contributed valuable insights, tools, and conceptual frameworks to help communities facilitate discussion and drive meaningful change.

Although the “Healthy and Resilient Community” project has concluded, our work continues. Our team remains closely engaged with these communities, providing ongoing support to ensure the successful implementation of initiatives. Our experts maintain active communication with community working groups, assisting them in navigating emerging challenges.

Mobile Healthcare in Kramatorsk: Ensuring Access to Health Services During Wartime

This initiative was a direct response to the challenges posed by destroyed infrastructure and limited access to medical services in remote areas.

The project provided high-quality healthcare access to residents of distant community districts severely affected by infrastructure damage caused by the war. Thanks to the mobile clinics, over 6,000 patients received medical care, including people with disabilities and those who had long delayed seeking treatment. Beyond delivering healthcare, the project facilitated training for medical staff, the development of practical guidelines, and research — valuable resources for other communities aiming to implement similar initiatives.

Results:

• Over 6,000 people received medical care, including individuals with disabilities and those who had not looked for medical help for years; 43% of these patients were seniors aged 65 and over, and 11.7% had disabilities.
• Recommendations were developed to scale the initiative in other communities.
• Medical professionals received training in tactical medicine, palliative care, psychological trauma, otoscopy, arterial hypertension, diabetes, and ultrasound. Portable ultrasound devices were provided as part of the project. Screening ultrasounds were also introduced, which 41% of patients reached by the mobile teams underwent. Among them, one in five showed abnormalities such as suspected gallstone disease, fatty liver, liver tumors, and more. These patients were referred to a higher level of care for more precise diagnosis.
• The collected data is being used for further research.

More about project

Insights from developing the Healthy Community model:

The Healthy Community model has demonstrated the effectiveness of an integrated approach to health management at the local level. Adapting the Gesundes Kinzigtal model to the Ukrainian context has made it possible to account for the unique characteristics of each community and ensure a systemic response to healthcare challenges.

We are continuing our work on scaling this model and invite other communities to join the initiative. With the support of UNDP, we have begun working with two additional communities in southern Ukraine — Bashtanka and Voznesensk in the Mykolaiv region.

We are now partnering with a total of nine communities, and our goal is to establish a Healthy Communities Alliance that will bring together at least 50 participants by 2027. In collaboration with our German partners at OptiMedis, we also plan to launch the Healthy Community Academy — an educational hub for sustainable capacity-building of local teams.

We aim to advocate among international partners and donors for a shift in how health and well-being are managed at the community level.

In 2025, we will expand the scope of our work with a stronger focus on:

• The rehabilitation and reintegration of veterans;
  
• Support for people with substance use disorders and their families;
  
• Enhanced engagement with families with children and women in communities.