Health systems and new models of TB prevention and care

Tuberculosis (TB) prevention and care are complex and require coordinated actions across all levels of a country’s health system. However, in the context of the post-Soviet era, the economic downturn and more dynamic and unpredictable movements of people – both within countries and across borders – national health systems in the Region face increasing challenges.

In addition, the overall reduction of external donor funding for TB as countries generally become wealthier can increase the fragility of national health systems. In many countries, TB and especially multidrug- and extensively drug-resistant TB (M/XDR-TB) may be indications of partial health systems failure.

Aligning financing mechanisms for TB and human resources

The lack of sustainable human resources and sound health financing mechanisms presents significant challenges at all levels of M/XDR-TB prevention, control and care. Countries are in particular need of specialized human resources to manage cases of M/XDR-TB in children and adults, to deliver adequate services for case detection and to scale-up diagnostic and laboratory capacity. Many are also struggling to provide sustainable health financing, effective people-centred models of care and adequate human resources developments in rapidly changing environments.

Models of TB care need to be in line with the most up-to-date WHO recommendations and national clinical protocols, but they also need to take into account how countries provide these clinical protocols (that is, in which setting, at which facility level and by which type of health-care worker). This can vary considerably in different country contexts and according to the financing of service provision, care, the health-care workers who provide the care and the facilities themselves. As changes to any of these variables can affect one or more of the others, each requires careful assessment.

WHO/Europe supports countries in implementing effective and efficient TB service delivery systems towards universal health coverage, and more integrated models of care that are outpatient-oriented, have sustainable financing and feature well-aligned payment mechanisms. WHO/Europe also seeks increased political commitment to transform health systems to end TB through regional cooperation and the sharing of evidence.