Abstract
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. This was a retrospective cross-sectional study using nationwide programme data and survey data collected from healthcare facilities. 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%). 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.
Highlights
In efforts to reach the 2020 Tuberculosis targets, the World Health Organization (WHO) advocates for an outpatient, people-centered model of TB care
In efforts to reach the 2020 90-(90)-90 targets, the World Health Organization (WHO) continues to advocate for a people-centered model of care based in outpatient settings rather than inpatient [5]
TB diagnosis and care is universally available through outpatient and inpatient services in compliance with the Directly Observed Treatment Short course (DOTS) strategy and TB management follows WHO guidelines
Summary
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. Outpatient facilities continue to be financed through per-capita mechanism, resulting in high number of referrals and draining resources. In efforts to reach the 2020 90-(90)-90 targets, the World Health Organization (WHO) continues to advocate for a people-centered model of care based in outpatient settings rather than inpatient [5]. Continuous reforms have led to a dramatic decrease in TB notification in recent years, TB remains a major public health issue in Armenia. In 2017, the notification rate of TB in Armenia was approximately 29 per 100,000 population, compared to 47 in 2013, and TB mortality rates for the same period were 1.8 per 100,000 population, compared to 1.6 in 2013 which could be partly attributed to the rise in the number of drug-resistant (DR) and the extensively drug-resistant (XDR) forms of TB which pose a serious public health and social challenges for the country [6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
