Supporting primary health care led preventive screening through community-embedded health access points in Ukraine

Ensuring timely, affordable access to preventive screening and early detection of noncommunicable diseases (NCDs) is essential for resilient primary health care (PHC), yet coverage remains uneven in rural and hard-to-reach communities in Ukraine. Long-standing barriers related to distance, transport and limited local services have been made worse since 2022 by a full-scale war. To operationalize the national policy and strengthen local health services access, the Support TB Control Efforts in Ukraine project supported Health Access Points (HAPs) using a community-embedded model to decentralize screening and reinforce referral pathways to PHC.

HAPs were operationalized in medical facilities, and at community venues, i.e., libraries, employment offices, social service centers. Screening offered to all adults included blood pressure, glucose, cholesterol, cancer risk assessment (breast, cervical, prostate, colorectal), immunization status, and depression. Health workers collected data using standardized registers and aggregated it monthly for descriptive analysis.

Between December 2023 and June 2025, 234 HAPs were operationalized across 13 hromadas in 11 oblasts. A total of 92,018 screening records were included, 75.8% from primary visits and 24.2% from secondary visits. Most attendees (83.2%) were aged 40 years or older, while 16.8% were aged 18-39 years, demonstrating uptake beyond the nationally prioritized 40 years and older age group. Nearly all attendees (98.0%) had their blood pressure taken, and 7.7% (95% CI: 7.5-7.9%) of these had hypertension. Among people who received depression screening, 7.2% (95% CI: 7.0-7.4%) were referred for further evaluation. Cancer risk assessments indicated substantial needs for referral: 21.8% after breast cancer screening, 24.1% after cervical cancer screening, and 23.2% after prostate cancer screening. Immunization checks identified gaps requiring referral for a tetanus and diphtheria booster for 15.1% (95% CI: 14.9-15.4%) of those screened.

The HAP model demonstrated a feasible and scalable approach to expand preventive screening as an extension of PHC with referral closer to communities during wartime, including for adults younger than 40 years. Embedding services in community venues provide people and especially internally displaced persons with impactful, time-effective, gender-sensitive and age-responsive integrated quality health services, for communicable and noncommunicable diseases as well as strengthen the prevention services in conflict-affected settings.