TB-REP was a multipartner project that covered 11 countries in eastern Europe and central Asia including Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. The project aimed to prevent TB and drug-resistant TB, and to improve TB treatment outcomes through a health systems strengthening approach, by increasing political commitment and implementing people-centred models of care. TB-REP also sought to foster the fundamental transformation of health service delivery and financing mechanisms through alignment with financial reforms.
Through their participation in TB-REP, several countries made their TB service delivery more people-centred by adopting improved health financing mechanisms as well as new approaches to planning human resources.
- TB-REP developed a blueprint of policy options that presented a design for a people-centred model of TB prevention and care. This model focuses on meeting the health needs and expectations of people throughout their life-course through a strong primary health care system and community.
- Using the blueprint, countries participating in the project took different approaches depending on the status of their overall health systems and transformation agenda. At the beginning of the project in 2016, less than half (45%) of the participating countries had adopted key policies on health system strengthening and TB; for people-centred TB prevention and care, this percentage had grown to more than 73% in 2017 – an increase of nearly 50%.
- Armenia, Kazakhstan, Kyrgyzstan, the Republic of Moldova and Uzbekistan introduced people-centred national TB policies and will enhance their health systems through strengthening three functions. A few participating countries did not introduce formal policies for a people-centred model of TB care in 2017, but are strengthening TB services and taking steps to improve their model of TB care to make them more ambulatory-based.
- The average duration of hospital stay and hospitalization rates, which are indirect measures of the people-centredness of care, decreased overall. To this end, some countries developed and implemented roadmaps, several of which were endorsed by their governments.
Key challenges ahead
The achievements made through TB-REP are threatened by the decline of external donor support faced by most participating countries. This comes at a time when their health systems and services are not fully prepared for such a transition. Reduced support can affect health system sustainability and the expansion of people-centred TB services, which require resources beyond those needed to address technical issues, such as the implementation of the recently updated WHO treatment policy for multidrug-resistant TB and national health system reform.
TB-REP 2.0 will help countries to better understand and address the challenges and opportunities they may encounter during the transition process. This includes an understanding of how health system strengthening can help them in transitioning from support from the Global Fund to Fight AIDS, Tuberculosis and Malaria to sustainable and efficient TB services, as well as in securing access to medicines and medical products.
As with the TB-REP, TB-REP 2.0 partners will provide quality technical assistance and high-level advocacy to participating countries. They will also address intersectoral and governance aspects of TB and work to strengthen linkages between them. The Global Fund will provide financial support and the project principal recipient will continue to be the Centre for Health Policies and Studies in the Republic of Moldova.