Application of the Buxton-Hanney Payback Framework to Department of War Sponsored Research on the Ukrainian Health and Trauma System Following the Russian Invasion, 2022-2025

Abstract Background In response to the February 2022 Russian invasion of Ukraine’s, international aid and foreign investment from the U.S. Government and regional allies flowed into the country. As part of this support, the Department of War (DoW) has supported multiple research initiatives aimed at strengthening Ukrainian healthcare, further advancing the objectives of the U.S.-Ukraine partnership. Given the scope of U.S. involvement, a thorough investigation into the outcomes of this critical research was essential to ensure accountability and improve resource allocation. Materials and Methods To gauge the impact of these investments, the Center for Health Services Research at the Uniformed Services University of the Health Sciences conducted a Buxton-Hanney Payback Framework assessment, which systematically identifies the outcomes generated by these projects. From January 2025 to April 2025, the research team employed snowball sampling and grey literature review to identify principal investigators involved in DoW-funded Ukrainian health research. The team conducted virtual consultations to collect outcome data pertaining to the framework’s domains, which were catalogued into a structured data collection instrument. Results The team identified 7 DoW-funded projects dedicated to Ukraine’s health and trauma system. These projects yielded a total of 80 outcomes across the Buxton-Hanney framework domains, revealing a broad spectrum of impacts. These included academic knowledge outputs through publications and workforce training; policy-level contributions for healthcare; direct health benefits; and economic returns driven by workforce resilience and expansion of business operations. Conclusions Identified outcomes underscore the strategic value of sustained investment in military healthcare research. Investments not only support allies but also provide crucial lessons that can strengthen healthcare delivery for the U.S. Military, particularly in dynamic and conflict-affected environments. Even in their early stages, projects demonstrated immediate value by providing real-time insights that advance the partnership’s objectives. Furthermore, this assessment advocates for the utilization of the Buxton-Hanney Framework as a standardized tool for assessing the outcomes and impacts for programs within the DoW.