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COVID-19’s Impact on Strategic Health Purchasing: Lessons from Ukraine

Kelly Toves — Fri, 11 Feb 2022 18:28:32 +0000

Key takeaways from the adjustments the Ukrainian government made in purchasing arrangements for health services amid the COVID pandemic.

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Study Focuses on Preschool Teachers in Ukraine Amid Critical Reforms

Kelly Toves — Wed, 27 Jun 2018 17:35:11 +0000

The Early Childhood Workforce Initiative, co-hosted by the International Step by Step Association and Results for Development (R4D), launched the second study in a series, which examines the experiences and challenges faced by members of the early childhood workforce. This series was designed to help policymakers and others strengthen and support the early childhood workforce. This report, in particular, is focused on preschool teachers in Ukraine, and authored by researchers at R4D, the Ukrainian Step by Step Foundation, and the Institute for Education Development.

Related Resource: Supporting the Early Childhood Workforce in Ukraine

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Supporting the Early childhood Workforce at Scale: Preschool Education in Ukraine is released at a critical moment for early childhood services in Ukraine. Recently, policy reforms have focused on improving the quality of preschool education and encouraging inclusion in services. Still, additional focus must be placed on supporting preschool teachers in order to provide quality and inclusive preschool programs at scale. Recommendations for action from this study are primarily intended to support officials in Ukraine to strengthen and support preschool personnel through policies and programs.

In addition to providing actionable recommendations, this country study contributes to a broad knowledge base around early childhood workforce issues. Researchers illustrate the experiences of preschool teachers and identify the size and scope of the challenges they run into – offering insights into the training, recruitment and remuneration of preschool teachers in Ukraine.

“We are learning that countries are increasingly interested in learning from others about challenges the workforce faces and how to address them. We are excited that this report adds to that base of knowledge that countries can turn to,” says Vidya Putcha, senior program officer at Results for Development and co-author of the study.

Supporting the Early childhood Workforce at Scale: Preschool Education in Ukraine is part of a body of work being produced by the Early Childhood Workforce Initiative.

Find more research contributing to the understanding of the early childhood workforce across the globe here.

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About the Early Childhood Workforce Initiative

The Early Childhood Workforce Initiative focuses on the country system and policy level to support and empower those who work with families and children under age 8 (e.g. home visitors, preschool staff, community health workers), as well as those who supervise and mentor practitioners (e.g. supervisors, mentors and coaches, trainers). This initiative takes a holistic, multi-sectoral approach to bridge gaps in policy and practice and promote high quality, equitable services. This initiative is co-hosted by the International Step by Step Association (ISSA) and Results for Development.

About Results for Development

Results for Development (R4D) is a leading non-profit global development partner. We collaborate with change agents around the world — government officials, civil society leaders and social innovators — to create strong systems that support healthy, educated people. We help our partners move from knowing their goal to knowing how to reach it. We combine global expertise in health, education and nutrition with analytic rigor, practical support for decision-making and implementation and access to peer problem-solving networks. Together with our partners, we build self-sustaining systems that serve everyone and deliver lasting results. Then we share what we learn so others can achieve results for development, too. For more information, visit our website at: www.r4d.org.

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Olga Zues

Katie Fly — Fri, 20 Feb 2026 22:10:53 +0000

Olga Zues is a global health financing and health systems reform specialist with over 20 years of experience advising governments, national purchasing agencies, and development partners across Eastern Europe, Central Asia, and Africa. Her expertise spans strategic purchasing, health benefit package design, provider payment reform, funds pooling, and the integration of vertical programs — including rehabilitation, mental health, maternal newborn health, TB, and HIV — into primary health care (PHC) to advance efficiency, equity, and universal health coverage (UHC). She is particularly interested in strengthening purchasing institutions, designing innovative payment systems, and translating complex analytics into actionable policy.

Ms. Zues has extensive experience supporting ministries of health and national purchasers to design and implement strategic purchasing reforms. She has led the development of service specifications, payment mechanisms, contracting arrangements, and performance monitoring systems under Programs of Medical Guarantees, including reforms for PHC, hospital care, maternal and child health, and noncommunicable diseases. Her work includes designing risk-adjusted capitation models for PHC in Kazakhstan, Kyrgyzstan, and Uzbekistan; leading costing studies for rehabilitation, telemedicine, and TB services in Ukraine and Uzbekistan; and supporting DRG-based hospital payment reforms in Ukraine, Ghana, Vietnam, and Uzbekistan. She has also modeled annual budgets to assess financial risks for providers and purchasing agencies and advised governments on policies related to pooling, provider autonomy, and benefit design. In addition, she has strengthened ministry capacity to coordinate cross-sector reforms within sector-wide approaches (SWAp) and supported the use of costing data and National Health Accounts to inform resource allocation.

Ms. Zues brings deep expertise in TB financing and service delivery reform. She has led TB system mapping and facility-level costing; designed case-based payment models and laboratory payment approaches; and developed incentives to strengthen TB detection and treatment within PHC. She has supported the inclusion of TB services in State Medical Guarantee Programs and the design of TB contracting arrangements for national purchasers. She has also facilitated regional learning exchanges across Eastern Europe and Central Asia to build capacity in TB payment reform and contributed to multi-country assessments in Sub-Saharan Africa to address financial barriers to TB, HIV, and malaria services.

As a senior fellow at Results for Development (R4D), Ms. Zues supports the Rehab4U project, leading a national rehabilitation costing study in Ukraine to inform revisions to payment systems under the Program of Medical Guarantees (PMG) and supporting strategic purchasing dialogue with the National Health Service of Ukraine (NHSU) and development partners.

Publications:

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We need to improve the quality of preschool programs. And that starts with supporting teachers.

Kelly Toves — Fri, 29 Jun 2018 16:04:41 +0000

A new report reveals several insights for policymakers looking to strengthen the roles of personnel working with young children and families.

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Supporting the Early Childhood Workforce at Scale: Preschool Education in Ukraine

Leif Redmond — Wed, 27 Jun 2018 12:00:42 +0000

Strong and growing evidence on the impact of early childhood development (ECD) services on children’s development has contributed to efforts to increase access to ECD programs, although there are persistent challenges related to ensuring their quality. Although evidence indicates that the workforce is one of the most important factors influencing quality of center-based services, relatively little is known about it. Through the Early Childhood Workforce Initiative (ECWI) – a multi-stakeholder effort to support and empower those who work directly with young children led by the International Step by Step Association (ISSA) and Results for Development (R4D) – R4D is carrying out a series of country studies to understand the experiences and challenges faced by those in particular roles in several countries. The country studies intend to focus on a range of roles including professionals and paraprofessionals, paid and unpaid workers, and frontline workers and managers, from the education, health and nutrition, and social and child protection sectors.

This study, the second in this series (view the first here), focuses on the role of preschool teachers in Ukraine. The country, with a predominantly public network of preschool education, has achieved coverage for a significant proportion of the population. Nevertheless, it struggles to meet demand and ensure quality of services. In addition, Ukraine is at a unique moment where increasing attention is being paid in the country to improving the quality of preschool education and supporting inclusion, which have been elevated in recent policy reforms. Taking into account the significance of preschool teachers to the system of preschool education, this study aims to gain a better understanding of their experiences, including their backgrounds, the support that they receive, as well as the challenges that they encounter.

By illustrating the experiences of preschool teachers in Ukraine and identifying the size and scope of the challenges they face, it is hoped that this study will support officials within the Ministry of Education and Science (Ministerstvo osvity i nauky) in Ukraine as well as local education departments to strengthen and support preschool personnel through targeted policies and programs and contribute to the knowledge base around the early childhood workforce.

Related downloads:

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Supporting the government of Ukraine to strengthen physical rehabilitation

Katie Fly — Mon, 28 Oct 2024 22:05:34 +0000

As the need for physical rehabilitation climbs in Ukraine, R4D is supporting policymakers to strengthen health financing policies to expand access to quality, affordable rehab services.

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Priceless? A New Framework for Estimating the Cost of Open Government Reforms

Katie Fly — Thu, 12 Oct 2017 20:25:11 +0000

“Open government” is a response to the belief that citizens have the right to access government information, to actively participate in government decisions that affect their lives, and to hold government officials and service providers to account. Interventions and policies that seek to open government to citizens and civil society have proliferated in the past decade. However, given the reality of increasingly limited development resources from external funders, being able to weigh the full costs of open government initiatives is critical to ensuring that governments are allocating and using resources in the most efficient and effective manner possible, especially in low- and middle-income contexts.

This set of reports and tools was developed as part of a new initiative, led by Results for Development and supported by the World Bank, to contribute new evidence to this field. The Governance & Citizen Engagement practice at R4D designed and tested a tool that can be adapted and used to estimate the costs of a variety of open government programs in different countries. The methodology developed through this initiative represents an important step toward conducting more sophisticated cost-benefit analyses – and ultimately understanding the true value – of open government reforms, insights that have been sorely lacking in the open government community to date.

The result of this initiative includes the following resources and analytical products:

A detailed and comprehensive Framework and Methods for costing various types of open government reforms;
Case Studies of applying that Framework and Methods to two real-life open government programs, the ProZorro e-procurement platform (Ukraine) and a national government Open Data Program (Sierra Leone);
A Costing Tool and Manual (in the form of a series of interlinked spreadsheets) that can be directly utilized by those interested in conducting costing analyses of additional open government programs on their own; and,
A Comprehensive Report that compiles the framework and methods, case studies, costing tool description, and conclusions from the overall initiative.

All of these resources are available to download using the links below.

Learn about the new costing method for open government initiatives:

Framework & Methods report

Understand the cost estimates for specific open government initiatives:

Undertake your own costing analysis of an open government initiative:

Learn about everything and how it all fits together:

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Comparative and International Education Society 2018 Conference: Focusing on Early Child Development

Leif Redmond — Wed, 14 Feb 2018 18:47:37 +0000

The CIES Annual Meeting will be convened in Mexico City under the theme “Re-mapping Global Education: South-North Dialogue” and under the leadership of President-Elect Regina Cortina (Teachers College, Columbia University). This conference builds upon the call made just over two decades earlier at the 1997 conference to embrace diversity and pluralism in our work. The conference aims to shift the traditional starting point of research and practice to a greater extent towards the global South. Emphasizing South-North dialogue and South-South collaboration, the aim is to expand our awareness of and engagement with the voices, actors and knowledge producers that have historically been marginalized in educational research and institutions.

R4D will be attending the conference and will be participating in two panels. In addition, please visit us in the Exhibit Hall at booth 66.

The Equity Initiative: Traveling the Road of Expanding Access to Quality Pre-Primary Education Opportunities: Towards a Competent and Efficient Sub-sector
Tuesday, March 27, 5:00 to 6:30pm
Hilton Reforma, 2nd Floor, Don Genaro

This panel considers the following system level challenges and solutions: (1) analysis and coherence in developing the pre-primary sub-sector; (2) pre-primary teacher workforce development; and (3) governance and decentralization of pre-primary services. Each theme will be explored separately in the context of expansion of pre-primary education. The panel will discuss lessons learned, and propose strategies and actions that are needed to strengthen planning for expansion and implementation at scale. This panel is relevant to both the global education and early childhood scholarly and practitioner communities.

R4D panelist:
Michelle Neuman

Strengthening and supporting the early childhood workforce at scale: A comparative review
Thursday, March 29, 8:00 to 9:30am
Hilton Reforma, Suite 3

This paper addresses some of these questions by presenting findings from country studies of the early childhood workforce in Peru, South Africa, and Ukraine. The research aims to shed light on the challenges affecting the quality and supply of the early childhood workforce, identify recommendations to overcome these bottlenecks in each country, as well as share broader cross-country lessons to inform efforts to improve policies for the early childhood workforce in diverse contexts. Each country study focused on specific members of the early childhood workforce who work in programs for children birth to age 8 and their families. These programs include the Cuna Más Home Visiting program in Peru, preschool programs in Ukraine, and first 1,000 days services in South Africa. In each country, the research teams carried out key informant interviews and focus groups of early childhood practitioners, parents, local and national policymakers, and representatives of training and professional organizations and then analyzed these data using qualitative methods. Where feasible, cost data were incorporated into the analysis.

R4D authors:
Kimberly Josephson
Kavita Hatipoglu
Michelle Neuman
Vidya Putcha

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Advocating for Open Government Reforms by Analyzing their Cost and Value

Katie Fly — Tue, 03 Oct 2017 19:02:07 +0000

R4D's unique open government costing framework and tool allow advocates to build evidence on the cost and the value of open government reforms to improve the effectiveness of these reforms and to promote their uptake globally.

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Joe Kutzin

Katie Fly — Mon, 24 Apr 2023 16:51:42 +0000

Joe Kutzin is a recognized leader in developing and applying core concepts in health financing and systems reform for universal health coverage. He is a health economist with over 35 years of experience in Africa, Asia, the Caribbean, Europe and the United States.

During his career with the World Health Organization (WHO), he served in Kyrgyzstan as Policy Advisor to the Ministry of Health, in Copenhagen and Barcelona as the European Regional Office’s lead advisor on health financing, and in Headquarters where he led the health financing team. Prior to joining WHO, he worked for the World Bank and the Project HOPE Center for Health Affairs.

Mr. Kutzin has published numerous conceptual and empirical articles and book chapters on health systems, health financing and Universal Health Coverage. Highlights include his 2001 publication that laid out the functional approach to health financing, his role as lead editor and main author of a 2010 book on implementing health financing reforms in Central and Eastern Europe and the former Soviet Union, and his lead authorship of a paper synthesizing key lessons on financing for universal health coverage in the 2016 Handbook of Global Health Economics and Public Policy. He also contributed to the revision of the System of Health Accounts to separate the reporting of the sources of health spending from the financing arrangements through which expenditures are made. Most recently, he was part of a WHO team developing guidance for recovery of the health system in Ukraine in collaboration with staff from the World Bank, USAID and the European Commission.

Mr. Kutzin holds a BA from the State University of New York at Binghamton, as well as an MA in Development Economics from Boston University. In 2012, he received an Honorary Doctorate from Semmelweis University in Budapest. He currently lives near Geneva, Switzerland.

Publications

Selected journal articles, books and book chapters

Kutzin, J, S Dalil, H Barroy, S Barkley, F Dkhimi, M Jowett, R Marten, I Mathauer, B Meessen, S Sparkes, K Xu (2022). An assertive, practical, and substantive agenda to catalyse meaningful change. The Lancet Global Health 10(5):E606-608. (commentary on the Lancet Global Health Commission Report on Financing of Primary Health Care)
Sparkes, SP, PH-V Eozenou, D Evans, C Kurowski, J Kutzin, A Tandon (2021). Will the quest for UHC be derailed? Health Systems and Reform 7(2).
Kutzin, J, S Sparkes, A Soucat, H Barroy (2018). “From silos to sustainability: transition through a UHC lens.” The Lancet DOI.
Kutzin, J, W Yip, C Cashin (2016). “Alternative financing strategies for Universal Health Coverage.” In Scheffler, RM, ed. Handbook of Global Health Economics and Public Policy. Volume 1; Ch. 5 p.267-309 – The Economics of Health and Health Systems. World Scientific Publishing.
Kutzin, J, and SP Sparkes (2016). “Health systems strengthening, universal health coverage, health security and resilience.” Bulletin of the World Health Organization 94(1):2.
Kutzin, J (2013). “Health financing for universal coverage and health system performance: concepts and implications for policy.” Bulletin of the World Health Organization 91(8):602-611.
Kutzin, J (2012). “Anything goes on the path to universal health coverage? No.” Bulletin of the World Health Organization 90:867–868.
Kutzin, J, C Cashin, M Jakab, eds. (2010). Implementing Health Financing Reform: Lessons from Countries in Transition. Copenhagen, Denmark: World Health Organization, on behalf of the European Observatory on Health Systems and Policies.
Kutzin, J, A Ibraimova, M Jakab, S O’Dougherty (2009). “Bismarck meets Beveridge on the Silk Road: coordinating funding sources to create a universal health financing system in Kyrgyzstan.” Bulletin of the World Health Organization 87:549-554.
Mossialos, E, A Dixon, J Figueras, J Kutzin, Eds. (2002). Funding Health Care in Europe. European Observatory on Health Care Systems. Buckingham, England: Open University Press.
Nyonator, F and J Kutzin (1999). “Health for some? The effects of user fees in the Volta Region of Ghana.” Health Policy and Planning 14(4):329-341.
Barnum, H and J Kutzin (1993). Public Hospitals in Developing Countries: Resource Use, Cost, Financing. Baltimore and London: Johns Hopkins University Press.

Published working papers and reports

Xu, K, M Aranguren Garcia, J Dupuy, N Eigo, C Indikadahena, J Kutzin, D Li, L McDonald, L Rivas, A Siroka, H Touré, E Zver (2022). Global spending on health: rising to the pandemic’s challenges. Geneva: World Health Organization.
Kutzin, J, K Fishchuk, S O’Dougherty (2022). Principles to guide health system recovery and transformation in Ukraine. Copenhagen: World Health Organization, Regional Office for Europe.
Jowett, M, J Kutzin, S Kwon, J Hsu, J Sallaku, JG Salano (2020). Assessing country health financing systems: the health financing progress matrix. Geneva: World Health Organization.
Kutzin, J, S Witter, M Jowett, D Bayarsaikhan (2017). Developing a national health financing strategy: a reference guide. Health Financing Guidance No.3. Geneva: World Health Organization.
Sparkes, S, A Durán, J Kutzin (2017). A system-wide approach to analysing efficiency across health programmes. Health Financing Guidance No.2. Geneva: World Health Organization.
Kutzin, J (1997). “Health insurance for the formal sector in Africa: yes, but…” WHO/ARA/CC/97.4. Current Concerns, ARA Paper number 14. Geneva: World Health Organization, Division of Analysis, Research and Assessment.

Blogs and podcasts

Spotlight on Universal Health Coverage: Financing UHC. 6 April 2023. The Lancet Voice podcast with Irene Agyepong and Joseph Kutzin.
Barroy, H and J Kutzin. “COVID-19 as an opportunity for PFM transformation in health.” 14 February 2022.
Barroy, H, S Gurazada, M Piatti-Fünfkirchen, J Kutzin. “No calm after the storm: retooling PFM in the health sector.” 28 May 2020.
Cashin, C and J Kutzin. “Making budgets work better to sustain progress towards UHC.” Joint Learning Network Blog. 8 April 2017.
Wagstaff, A and J Kutzin. “Health and the SDGs: out of the doldrums, heading for the rapids.” World Bank Let’s Talk Development blog. 23 March 2016.

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