Tuberculosis care services in Armenia: What has changed since the 2014 reform?

  • Hratchia Lylozian National Tuberculosis Control Center of the Ministry of Health, Yerevan, Armenia
  • Hayk Davtyan “Tuberculosis Research and Prevention Center” NGO, Yerevan, Armenia
  • Garry Aslanyan Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization (WHO), Geneva, Switzerland
  • Karapet Davtyan “Tuberculosis Research and Prevention Center” NGO, Yerevan, Armenia
  • Lisle S Hites The University of Alabama at Birmingham, Birmingham, AL, United States
Keywords: Tuberculosis, Health reform, Financing, Armenia, Operational Research, SORT IT

Abstract

Introduction: In efforts to reach the 2020 Tuberculosis targets, the WHO advocates for an outpatient, people-centered model of TB care. To this end, the TB care system in Armenia underwent structural and financing reforms in 2014. Financing mechanism for inpatient TB facilities was changed from a fee per bed/day to a mixed type of financing that includes fixed and variable costs eliminating incentives for unnecessary and extended hospitalizations. Unfortunately, outpatient facilities continue to be financed through per-capita mechanism, resulting in high number of referrals and draining resources. This study aimed to assess the implementation of these reforms within the Armenian TB care system.

Methodology: This was a retrospective cross-sectional study using nationwide programme data and survey data collected from healthcare facilities.

Results: In 2017 a total of 901 TB patients were registered in outpatient facilities. Only 7.6% of total TB cases were diagnosed in outpatient facilities and 30.9% of the presumptive TB cases were referred to inpatient facilities. The number of hospitalizations was reduced by 76% from 2013 to 2017. The average duration of stay reduced as well from 55+ days to 37 days. However, the proportion of smear negative TB patients remains high among all hospitalized patients (63.8%).

Conclusions: Overall, the reform has been successful, however unnecessary hospitalizations persist. Our results indicate there a need to go upstream for a structural and financial reform of the outpatient sector to complete Armenia’s TB healthcare reform and improve both patient outcomes and efficient use of system resources.

Published
2019-05-16
How to Cite
1.
Lylozian H, Davtyan H, Aslanyan G, Davtyan K, Hites LS (2019) Tuberculosis care services in Armenia: What has changed since the 2014 reform?. J Infect Dev Ctries 13:016S-021S. doi: 10.3855/jidc.11288
Section
The Armenian SORT IT Course