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Centrul pentru politici și analize în sănătate

Advancing People-Centered Quality TB Care – From the New Model of Care Towards Improving DR-TB

Stop, look back and pursue the tasks with renewed forces

Stop, look back and pursue the tasks with renewed forces

7/23/2018 5:00 PM
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The TB-REP project, aiming to decrease the burden of TB disease and halt the spread of drug resistance in the 11 EECA countries by increasing political commitment and translating evidence into the implementation of patient centered TB models of care, has reached past its midpoint*. What has been achieved by now? Have the countries covered by the project managed to accomplish the planned changes? What else can be done in the time remaining, so that the ideas and concepts laid down in the project come into life, and the residents of the participating countries could feel positive changes in the work of anti-tuberculosis services with regard to the attitude of the medical personnel, in particular, and society, as a whole, towards the TB patients and their families? The mid-term review of the project implementation, covering the period from January 2016 to October 31, 2017, was called upon to answer these and other questions.

The working group that developed the review, reached the following conclusions:

  • The project, as envisaged, takes into account the needs and requirements of the beneficiary countries and complements and expands the national TB control programs and GF grants. As the donor funding in the region decreases, the importance of TB-REP becomes even more relevant. Due to the project, a number of health system problems that hampered the improvement of TB treatment and prevention in the region have been identified and addressed using innovative models of TB care.
  •  Due to the project, the TB communities of almost every participating country have been actively participating in the transformation of both TB services and healthcare systems. TB affected people are no longer silent, they are involved in the process of taking critical decisions related to TB control; they no longer feel embarrassed about their illness and are increasingly involved in public outreach activities and advocacy work aimed at changing the current situation in the treatment of TB.
  •  The interest in the field of TB control among civil society organizations has been increasing. Although many of them see their role only in public awareness and patient supporting activities, their participation in shaping the health care policies and in the development and improvement of anti-tuberculosis services is growing.
  • The project has become a catalyst in bringing together key partners whose contribution has been paramount to the effective strengthening of TB control and TB care system reform in participating countries and also has allowed to share experience among professionals involved in ongoing or planned TB service reforms in the countries of the region. They began to approach TB control problems and patient care comprehensively building on the achievements of other countries. The project has contributed to the understanding of the health system and fostering of positive relations between ministries of health, ministries of finance and/or health services purchasers.
  • Due to regular work with the leadership of the participating countries and to high-level meetings, it was possible to ensure that the issues related to the incidence and spread of TB and disease control were constantly included on political agendas, and the urgency of health care reform is practically recognized in all 11 countries.

Of course, many processes have just begun. The participating countries were (and are) in different socio-economic conditions. Traditions in the health sector, in general, and anti-tuberculosis services, in particular, have been strong for years. But compared to 2015, which preceded the outset of the project, it was possible to save 17% of the regional budget for TB care. This result is achieved due to a decrease in the average length of hospitalization and the transfer of patients from inpatient to outpatient treatment. And while saving money is not the main goal of the project, it cannot be disregarded.

Undoubtedly, a three-year period for a project aimed at developing and implementing complex systemic reforms, that should lead to reduced number of beds, the transition to the outpatient model of care, the shift in funding sources and implementation of innovative and effective payment mechanisms for health workers, is too short. Only the first steps have been taken, and they have been different in different countries, and to ensure the continuous funding, it is necessary to make every effort, for the time remaining, in order to achieve, if not the most ambitious, then the most significant of the goals. This will not only prove the feasibility of the project to the donors, but will also enable the participating countries to enjoy the success of the changes, understand their meaning and significance, and thereby continue to be active supporters and advocates of the reforms.

The team that conducted the project mid-term review positively assessed the carried out activities and proposed a number of recommendations that will contribute to its successful completion. For the full text of the review, see here.

* TB-REP is a regional TB control project funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria and implemented by the Center for Health Policies and Studies of the Republic of Moldova (the principal recipient) and the WHO Regional Office for Europe (the technical lead agency), in 
collaboration with partners, namely TB Europe Coalition (through Alliance for Public Health Ukraine), Stop TB Partnership, and technical expertise of London School of Economics and Political Science, European Respiratory Society, London School of Hygiene and Tropical Medicine. The project was launched in January 2016.


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