Belarus pilot project shows the way to people-centred TB services

Anna Handoshko

Belarus is among the 9 countries in the WHO European Region with the highest burden of multidrug-resistant tuberculosis (MDR-TB). In the Brest region of south-west Belarus, the challenge of MDR-TB is well recognized by physicians and health-care authorities. Treatment for MDR-TB is long and difficult, causing financial hardship for patients, their families and for health-care systems.

Thus, in 2017, when the Belarus Ministry of Health proposed a pilot project on the reorganization of tuberculosis (TB) services to improve people-centred care, the Brest region joined without hesitation.

“In a very short time, we analysed the situation to estimate the scale of the problem and set up goals to organize TB services so they are centred around people,” Dr Svetlana Krapivina, head of the Brest regional TB dispensary, recalls.

WHO/Europe and partners provide technical support for the pilot through the Tuberculosis Regional Eastern European and Central Asian Project (TB-REP). In collaboration with partners, WHO helped organize stakeholder dialogues to address political and technical aspects of the transformation of TB services delivery.

Shifting from inpatient to outpatient care

In the current model of TB care applied in Belarus, those suffering from TB are generally hospitalized, often unnecessarily. This strains family relationships and also places a financial burden on communities. With the new model of care, hospitalization is reduced, freeing funds and human resources for other, more effective forms of treatment.

As part of this shift, 2 TB inpatient wards were closed on 1 January 2018, reducing the number of beds dedicated for the use of TB patients, from 484 to 355. The highly skilled staff from these wards moved to the outpatient service and beds formerly reserved for TB treatment were repurposed to meet other medical needs. “Available regional financing has given us an opportunity to rationally use the released funds in the outpatient service and to scale up the outpatient model of care,” explains Dr Krapivina.

Patients responding positively to people-centred care

In order to create a sustainable system, it is important to help people understand the reasons and rationale behind the reform. The main challenge, as Dr Krapivina explains, is changing attitudes towards TB treatment and patients’ understanding of the importance of adherence with treatment requirements. “We often see the same old way of thinking in our communities,” says Dr Krapivina. “But our patients are ready for changes, especially when it means reducing hospitalization.”

The future of TB services in Belarus

Since it began in early 2018, the project in the Brest region has also led to redirections of patient flows. Future plans for expanding the project include an increase in the capacity of the day care units, designed for patients who come to the TB dispensary for outpatient services, and home treatment in order to bring TB care closer to the patients. Work is already underway to ensure quality of care and minimize transport expenses for patients, which will be further crucial developments.

As part of the activities specified in the roadmap used for the transition of TB services to people-centred care, integrating services such as narcological and psychiatric support, HIV treatment and others with TB services will be one way of giving patients access to a whole range of care in one place, making it more convenient for both them and health-care workers.

Dr Krapivina is convinced that similar shifts in TB care would be welcomed in other regions of Belarus, since this type of reform is very much needed and a people-centred, outpatient model of care for TB services will bring many benefits to those suffering from TB, as well as to health systems.

Background

The pilot project in Belarus is supported by TB-REP – a regional project on strengthening health systems for effective TB and drug-resistant TB control, financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria. The project targets 11 countries in the WHO European Region, including Belarus.

In 2017, the Ministry of Health of Belarus passed a decree on “measures to improve the effectiveness of anti-tuberculosis measures” and a resolution on staff standards of medical and other employees of public health organizations that provide tuberculosis care in inpatient and outpatient settings. These decrees laid the ground for the 2018 pilot project on transforming TB services in the country. In May 2017, Belarus began preparations for its 2018 pilot project.