Institutional architecture of the rehabilitation care system in Ukraine

The rehabilitation care system in Ukraine operates under the simultaneous influence of armed conflict, health-care reform and targeted institutional development of rehabilitation. Objective: to perform a structural and functional analysis of the institutional architecture of the rehabilitation care system in Ukraine. Materials and methods. A systems approach was applied, including analysis of legal and regulatory documents, statistical data from the Ministry of Health and the National Health Service of Ukraine for 2021–2024, a sociological survey (n=2450), Delphi expert survey (n=32) and network analysis of institutional interactions. Results. Five sectors of the institutional landscape were systematized: state, municipal, private, civil society and international. Limited availability of early, outpatient and community-based rehabilitation, workforce and financial deficits, information gaps and fragmented patient pathways were identified. Five clusters of systemic dysfunctions were established: institutional fragmentation, regulatory gaps, resource insufficiency, information asymmetry and coordination failure. Conclusions. Institutional fragmentation is the root cause of systemic inefficiency. Addressing it requires intersectoral coordination, unified ICF-based standards, development of outpatient and community-based rehabilitation, case management and systematic monitoring of rehabilitation outcomes.