Shifting from an inpatient to outpatient centered model through transforming the TB financing in ex-Soviet countries

TB financing mechanisms

  • Karapet Davtyan National Tuberculosis Control Program, Ministry of Health, Yerevan, Armenia
  • Olga Denisiuk Alliance for Public Health, Kiev, Ukraine
  • Azamdzhon Mirzoev State Educational Establishment Institute of Postgraduate Education in Health care, Dushanbe, Tajikistan
  • Hayk Davtyan National Tuberculosis Control Program, Ministry of Health, Yerevan, Armenia
  • Seda Aghabekyan Tuberculosis Research and Prevention Center NGO, Yerevan, Armenia
  • Maryna Piskorska Alliance for Public Health, Kiev, Ukraine
  • Anna Tyshkevych Alliance for Public Health, Ukraine, Kiev, Ukraine
  • Joshua Jayaraj Tuberculosis Research and Prevention Center NGO, Yerevan, Armenia
  • Armen Hayrapetyan National Tuberculosis Control Program, Ministry of Health, Yerevan, Armenia
  • Rony Zachariah Médecins Sans Frontières, Operational Centre Brussels (LuxOR), Luxembourg city, Luxembourg
Keywords: operational research, nosocomial transmission, ambulatory TB treatment, financial reform, qualitative research, SORT IT

Abstract

Introduction: In former Soviet Union countries, tuberculosis (TB) financing largely relies on a hospital-centered model. The World Health Organization favors transformation to ambulatory treatment since it is cheaper and patient-centered. We explored policy and decision maker’s perspectives on: a) enabling factors for transformation in Armenia and b) challenges and ways forward in doing so in Ukraine and Tajikistan.

Methodology: Qualitative study of key informants from government, donors and the national TB program.

Results: 52 informants with a mean service record of 20 years were involved. Key enablers in Armenia included collaborative partnership and political will, carefully selecting an adapted financing scheme that avoided financial penalization of hospitals and health workers, and use of operational research. The operational challenges in Ukraine and Tajikistan hovered around the lack of technical capacity and guidance on “how to implement” alternative financing. Shortcomings in strategic planning, uncertainty/fear that existing hospital funding would be cut and reluctance to change were highlighted. Suggested ways forwards to change the current paradigm included country-level technical assistance, capacity building, regional exchanges and operational research.

Conclusions: the perspectives of “those who decide” on transforming TB financing have been highlighted. Taking these perspectives on-board is vital for achieving the end-TB goals.

Published
2019-05-16
How to Cite
1.
Davtyan K, Denisiuk O, Mirzoev A, Davtyan H, Aghabekyan S, Piskorska M, Tyshkevych A, Jayaraj J, Hayrapetyan A, Zachariah R (2019) Shifting from an inpatient to outpatient centered model through transforming the TB financing in ex-Soviet countries. J Infect Dev Ctries 13:002S-009S. doi: https://doi.org/10.3855/jidc.10928
Section
The Armenian SORT IT Course