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The Health Solutions Foundation, as part of a study supported by Isar Ednannia under the Civil Society Sectoral Support Initiative project, continues to analyze the model of war veteran rehabilitation in Ukraine.

Currently, Ukraine is reforming and developing a rehabilitation system that addresses both the needs of civilians and military personnel. This reform includes transforming the medical model into a biopsychosocial one.

Medical Model

The essence of the medical model is that it views functional limitations as defects or diseases that primarily require medical interventions. In contrast, the biopsychosocial model of providing rehabilitation services is based on a comprehensive (holistic) approach.

In simple terms, this means that during rehabilitation, an injury or illness is not viewed solely from one perspective, such as physiological. Instead, psychological, social, and other factors must be considered when assessing an individual's rehabilitation needs.

Example

After treatment, a patient needs to undergo daily physical therapy at a rehabilitation center located in the city, while the patient lives in a village and cannot afford to travel there daily. In such cases, when assigning rehabilitation, social components such as the patient’s financial capability and the distance to the location providing rehabilitation services should be taken into account.

Important

The biopsychosocial model of rehabilitation is based on a multidisciplinary approach, involving various specialists in the rehabilitation process. For example, if a person has undergone an amputation and requires prosthetics, the rehabilitation process will involve at least a physical and rehabilitation medicine doctor, a psychologist, a prosthetist, and other specialists.

Specific Issues in Military Rehabilitation

• Rehabilitation is not an integral part of continuous medical care. It is not uncommon for military personnel not to receive rehabilitation services during the acute phase (or immediately after treatment), with the need for rehabilitation being determined by the MMC (military medical commissions). This results in the loss of valuable time, potentially leading to disability.
• There is no unified track for veteran rehabilitation. Due to the large number of state bodies responsible for military rehabilitation, there are many patient pathways. The absence of a standardized pathway leads to complete disorientation for military personnel in the rehabilitation process, as they do not understand “where to go and whom to contact.”
• There are no protocols or standards for providing rehabilitation services, and there is no comprehensive quality control system for such services.
• Rehabilitation for military personnel is often equated with spa and health resort treatments, which is quite questionable.
• In military medical facilities, there is practically no multidisciplinary approach to rehabilitation.
• The social component is not fully integrated into the military rehabilitation process. In medical facilities, there is unlikely to be a social worker who can provide veterans with comprehensive information about social protection, including mechanisms for providing rehabilitation aids, social assistance and payments, and navigating the MMC or ESDA (existing system of disability assessments) processes.

Currently, involving a social worker in the multidisciplinary team is a pilot project being implemented in about 14 healthcare institutions.