Keywords: rural healthcare; primary healthcare; health workforce; health policy; health system strengthening; Ukraine

Introduction:

Ukraine’s healthcare system faces significant challenges amid ongoing conflict, systemic instability, and rising health needs in underserved rural communities. Strengthening primary healthcare in these rural settings requires understanding what motivates healthcare workers and students to engage in rural practice and what barriers prevent them from doing so.

Method:

This mixed-methods assessment combined three focus group discussions with a structured survey of 406 respondents across nine regions of Ukraine, including rural and urban healthcare workers and students enrolled in healthrelated educational programs.

Results:

Findings revealed ambivalent perceptions of rural practice: while 56% viewed rural healthcare as respected, only 26% saw its good career prospects. Major barriers include low salaries, poor infrastructure, lack of housing, and limited career development, with safety concerns emphasized in conflict-affected areas. Key motivators were largely remunerative (higher salaries (30%), housing support (18%), and transportation assistance (16%)), complemented by professional development opportunities. Respondents valued closer patient relationships and community trust but stressed that these benefits cannot cover systemic gaps. Over 86% agreed that material incentives/ benefits and improved infrastructure would significantly increase willingness to work in rural areas.

Conclusions:

Strengthening rural healthcare in Ukraine requires a comprehensive approach combining financial incentives, housing, infrastructure, safety measures, and professional support. These findings inform policy recommendations to enhance primary healthcare access and resilience in rural communities during and beyond the current crisis.