Health system response to TB: learning from the Armenian experience
A study tour focussing on health system organization to make tuberculosis (TB) prevention and care more people-centred, and on financial reforms to TB services was conducted in Armenia on 18–19 December 2017.
Organized by WHO in cooperation with the Ministry of Health of Armenia and the Centre for Health Policies and Studies (PAS Centre), this inter-country exchange saw representatives from the ministries of health and finance, and the health insurance funds from Belarus, Kyrgyzstan and Moldova taking part in the tour.
One of the objectives of this initiative was to share the experience of Armenia in implementing policy measures and related new financing mechanisms, to stimulate ideas and the exchange of good practices in TB prevention and care. Presentations were given on the TB care reforms that have already been carried out, their challenges and achievements.
Participants also received presentations on current payment mechanisms, the roadmap for improving TB financing, the impact of the new financing mechanism on TB service efficiency and financial savings, as well as future steps to be taken towards establishment of an optimal model for TB services in Armenia.
The experts visited TB hospitals and outpatient care providers, and met with officials from the Ministry of Health, the National Tuberculosis Control Centre, the State Health Agency and other national stakeholders and international organizations involved in TB services.
Participants emphasized the importance of the opportunity for dialogue, interactive discussions and visits to TB facilities, as well as familiarizing themselves with the electronic software systems used in Armenia. Furthermore, they compared ongoing health system reforms, with a focus on TB prevention and care, in Belarus, Kyrgyzstan and Moldova, and highlighted lessons learned from such reforms in Armenia.
Countries included in the Tuberculosis Regional Eastern European and Central Asian Project (TB-REP) are working on the implementation of a people-centred model of TB care and strengthening health systems for improved TB prevention and care. The similarities in health systems and TB burden, as well as the shared history, of the 11 targeted countries translates into a common understanding of each other’s issues and serves as a favourable basis for action-based learning. This initiative was the first TB REP country exchange visit, and it proved effective in sharing good practices in the region.
Since 2014, Armenia has been working on health system transformation and has introduced significant changes, such as new financing mechanisms for hospital TB services and updated hospitalization and discharge criteria, in an effort to render TB prevention and care more people-centred. Changes in TB service delivery, introduced in accordance with WHO recommendations for reducing the number of unjustified hospital admissions of TB patients and the number of bed days, resulted in greater financial efficiency, allowing the allocation of resources to improving TB services and reducing potential nosocomial TB transmission.
The effectiveness of the system depends directly on outpatient settings with active screening, and strict compliance with the criteria for admission and discharge. In this regard, the Ministry of Health is working on the concept of the optimal model for TB prevention and care in Armenia, in accordance with WHO’s people-centred model of TB care.
TB-REP actively supports a comprehensive multi-component approach and addresses a series of important programmatic gaps related to health system strengthening for TB prevention and care. Weak regional and inter-country collaboration in health system strengthening and TB has been identified as one of the key gaps. TB-REP promotes such cooperation through inter-country thematic study tours and exchange visits.