Feasibility Assessment and Development of a Concept Note for a Telemedicine Initiative Supporting Frontline Regions in Ukraine

**Background**

The Norwegian Red Cross (NorCross), as part of the International Red Cross and Red Crescent Movement, works to protect life and health and support people affected by conflict, crises, and other humanitarian emergencies. In Ukraine, NorCross supports the Ukrainian Red Cross Society (URCS) in delivering essential health and protection services to vulnerable populations.

The ongoing conflict continues to place significant pressure on Ukraine’s health system, particularly in frontline, hard-to-reach, and recently de-occupied areas. Damaged infrastructure, shortages of health personnel, disrupted referral pathways, medicine access barriers, and increased demand have reduced access to healthcare. These challenges particularly affect older people, persons with disabilities, internally displaced people, people with chronic conditions, and children requiring follow-up care.

In many frontline communities, access to primary and specialist healthcare remains inconsistent. Insecurity, transport limitations, financial constraints, mobility restrictions, and lack of family support can further prevent people from reaching health facilities. Consequently, patients requiring regular follow-up or specialist advice may experience delays and interruptions in care.

With Norwegian Red Cross support, URCS has established a strong humanitarian health platform through Mobile Health Units, Home Based Care, Mental Health and Psychosocial Support, Health Promotion and Disease Prevention, and community-based services. However, gaps remain in access to specialist consultations, continuity of care for chronic conditions, and referral and follow-up between community and higher-level health services.

Telemedicine could help address these gaps by extending access to qualified healthcare professionals without requiring patients or health workers to travel in unsafe or difficult conditions. It can support remote consultations, triage, referrals, follow-up, and access to specialist advice, while complementing existing URCS services.

Although several humanitarian actors have implemented or explored telemedicine initiatives, URCS has not identified an accessible and functional community-level telemedicine service in the target areas. The proposed initiative therefore seeks to assess the need and feasibility of establishing a safe, structured, and scalable telemedicine system for vulnerable populations in frontline, hard-to-reach, and underserved areas. Based on the assessment, a concept would be developed for a free service providing primary healthcare and selected specialist consultations, integrated with existing URCS health services and enabling seamless transition between remote and in-person care.

## Evaluation purpose and scope

The purpose of the assessment is to develop a concept for a potential future telemedicine project. Given the enormous number of humanitarian response activities being implemented by multiple actors and the complex operational environment in which such a project would operate, a thorough assessment of the current and future situation on the ground is required as a prerequisite.

The assessment will determine the feasibility, relevance, operational requirements, and potential added value of a telemedicine initiative designed to support frontline health posts and primary care clinics in conflict-affected areas of Ukraine. It will generate evidence to inform the development of a future telemedicine project and support decision-making on whether and how such an intervention – in a following phase – should be designed and implemented by the Ukrainian Red Cross Society (URCS) and other partners as appropriate.

Also, the assessment will evaluate the intervention's potential for sustainability and scalability, identify the conditions required for successful implementation, and explore how the initiative can be designed to strengthen and complement the national health system while addressing the needs of populations living along the conflict's frontline and hard-to-reach or underserved areas.

**General Objective:**

To assess the need, feasibility and potential value of introducing a telemedicine support system for frontline health facilities in conflict-affected areas of Ukraine and develop a concept note for a potential development and implementation of such digital health intervention\*\*.\*\*

**Specific Objectives:**

- Assess health service delivery challenges that could potentially be addressed through telemedicine.
- Identify priority clinical and operational use cases.
- Assess demand, acceptability, and perceived usefulness among health care providers and higher-level stakeholders.
- Evaluate Assess technical feasibility, including electricity and internet connectivity, hardware and software requirements, interoperability, and cybersecurity considerations.
- Assess legal, regulatory, ethical, and data protection requirements.
- Analyse operational and organisational requirements for implementation by the Ukrainian Red Cross.
- Review existing telemedicine initiatives and identify opportunities for collaboration and integration into existing health care structures.
- Elaborate a project concept for the development and implementation

**Assessment criteria:**

The assessment should evaluate the proposed telemedicine initiative against the following criteria:

**Relevance**

Extent to which the proposed intervention responds to identified health service delivery gaps and priority needs in frontline and hard-to-reach areas.

Alignment with URCS, Ministry of Health priorities, and humanitarian health response objectives.

**Added value**

Degree to which telemedicine would provide benefits beyond existing health service delivery mechanisms and telemedicine initiatives.

Potential contribution to improving access, continuity and quality of care.

**Technical feasibility**

Availability and reliability of connectivity, power supply, equipment and digital health infrastructure.

Compatibility with existing national digital health systems and interoperability requirements.

**Operational feasibility**

Availability of human resources, management structures, training capacity and support systems required for implementation and maintenance.

**Legal and ethical feasibility**

Compliance with Ukrainian regulations related to telemedicine, data protection, professional licensing and patient safety

**Sustainability**

Likelihood that the initiative can be maintained beyond initial donor support, including institutional ownership, financing and integration into existing health services.

**Scalability**

Potential for expansion to additional regions and populations without disproportionate increases in cost or complexity.

**Cost-Effectiveness**

Likely balance between required investment and expected health and operational benefits.

**Assessment domain:**

**Health System & Service Delivery Analysis**: Mapping of existing telemedicine solutions or interventions, including assessing functionality, usability, acceptability, types of frontline facilities, service packages provided, workforce composition, referral pathways, and specialist support needs.

**Telemedicine Use Case Analysis:** Evaluating potential remote clinical consultations, specialist support (cardiology, pediatrics, family medicine), case discussions, mentoring, continuing professional development, MHPSS support for providers, and triage/referral support.

**Technical Assessment:** Assessment of electricity, connectivity, digital health infrastructure, hardware availability, existing digital health platforms, interoperability requirements, and cybersecurity/information governance.

**Operational Assessment:** Evaluation of human resource requirements, governance arrangements, training needs, support/maintenance requirements, scalability considerations, and cost estimates\*\*.\*\*

**Legal and Regulatory Assessment:** Review of national telemedicine regulations, data protection requ