Status of implementation of recommendations for section Health system and TB control
| Recommendations | Status | Implementation | Institution responsible for implementation | Deadlines |
| Health system and TB control | ||||
| General recommendations | ||||
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1. TB control should be included in the initial design and pilot implementation of the health care reform. This is an opportunity for the NTP to test new methods of financing and service delivery which can increase the quality of inpatient and outpatient care while readjusting gaps in TB human resources. It also offers an opportunity for re-profiling TB facilities (converting beds without closing facilities). In particular, the role of TB hospitals to offer “roof and food” to patients calls for a wider discussion of this role – especially in TB hospitals − in the social support system. |
Not implemented
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MOH
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31.12.14
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2. TB indicators (output, outcome, impact) should be included in monitoring the implementation of the health care reform (see Annex 4). TB is a condition which encompasses several areas as it is often the result of socioeconomic determinants and poor access to health care. For this reason, it can be used as a proxy for monitoring the overall development and performance of the health sector. |
Not implemented
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In 2012, under the Global Fund grant, a Draft National Plan for TB/HIV Co-infection Monitoring and Assessment was developed in Ukraine for 2013-2016, which complies with WHO recommendations. This plan includes indicators of output, outcome and impact which fully reflect actual state of epidemics and efficiency of measures envisaged by the National TB Plan. However, the applicable regulations have only two indicators for “Tuberculosis” component which estimate the effectiveness of TB measures taken within general treatment network. They are represented in the Procedure on Extra Fees for Volume and Quality of Work Done Payable to Healthcare Professionals that provide primary medical assistance approved with the Decree of the Cabinet of Ministers of Ukraine dated December 30, 2013 No. 977: - performance indicator for a plan of X-ray examination within a medical risk group (90 percent and over); - indicator of specific weight of patients with acid-resistant bacteria (+) in sputum among all patients suspicious of TB or its relapse who underwent bacteriologically tested at TB laboratories of level I after seeking for medical care at primary health care facilities (from 5 to 10 percent inclusive). |
MOH
UCDC
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01.08.14
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3. Current TB legislation should be revised. Several laws and regulations have had an impact on the organization and delivery of TB services. New laws and regulations, with high relevance for TB control, are coming within the framework of the health sector reform. An overarching TB law should be developed, that can be further detailed through updated issues of a national main reference TB manual for all providers. |
Implemented
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The Law of Ukraine on fighting tuberculosis is now effective in Ukraine after being enacted in 2001 (last amendments were made in accordance with the Law No. 5460-VI dated 16.10.2012, ВВР, 2014, No. 2-3, article 41). No new laws which would regulate all TB measures have been adopted. |
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4. To improve the technical and allocative efficiency of the NTP, health interventions should be assessed for their cost–effectiveness before being translated into orders. Cost–effectiveness analysis is a sub-set of health technology assessments. To support and monitor the wider health system reform programmes, consideration should be given to setting up a semiindependent health technology analysis unit or a health policy analysis centre with the cost–effectiveness analysis of TB interventions and a master plan for TB facilities (as part of the re-profiling exercise) included in its terms of reference. |
Not implemented
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Assessment of economic effectiveness and efficient allocation of finance for measures envisaged by the National TB Program was not carried out on the national level. Under the Global Fund grant, medical and economic reasoning of structural changes within the TB facilities network in the city of Kyiv was carried out in 2012. Research findings were represented at the meeting of Kyiv Healthcare Authority and submitted to members of the city council. Based on recommendations relying on the data obtained, Kyiv facilities were re-arranged, in particular, a unified territorial medical unit in Kyiv was established and a further optimization plan was outlined. |
MOH
State Service
Regional healthcare departments
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Management of the health reform project immediately targeted at removing major reasons of the entire system inefficiency, revision of financing principles, as well as implementation of new models of assistance within the basic health care system was started in 2011 in three regions (Dnipropetrovsk, Vinnytsia and Donetsk regions). However, this reform did not cover the entire territory of Ukraine, and no new ways of financing and service provision were introduced. No TB hospitals were re-profiled or closed.