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

Karapet Davtyan,Maryna Piskorska,Olga Denisiuk,Seda Aghabekyan,Rony Zachariah,Hayk Davtyan,Joshua Jayaraj,Anna Tyshkevych,Azamdzhon Mirzoev,Armen Hayrapetyan

doi:10.3855/jidc.10928

Abstract

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

Highlights

In former Soviet Union countries, tuberculosis (TB) financing largely relies on a hospital-centered model
In most countries of the former Soviet Union, tuberculosis (TB) management is provided free of charge under the National TB Program (NTP)
Twenty informants were interviewed in Armenia, 20 in Tajikistan and 12 informants were interviewed in Ukraine, since saturation was reached earlier in Ukraine

Summary

Introduction

In former Soviet Union countries, tuberculosis (TB) financing largely relies on a hospital-centered model. In most countries of the former Soviet Union, tuberculosis (TB) management is provided free of charge under the National TB Program (NTP). Patients with presumptive TB are screened in specialized TB inpatient hospitals/departments or in TB outpatient departments within primary healthcare facilities. Those diagnosed with TB are admitted to hospital during the initial phase of treatment and treated on an ambulatory basis during the continuation phase. The TB hospitals receive money from the government through the NTP based on a bed/day occupancy Revenue generated through these means cover for the cost of drugs and food, and for remuneration of healthcare providers and other hospital-related expenses. Outpatient TB physicians are inclined to refer patients to the TB hospitals for diagnosis or treatment whenever it is possible as this reduces their workload on one side and supports their colleagues working in hospitals on the other side

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