Display options
Cite
Kohler S, Asadov DA, Bründer A, et al. Health system support and health system strengthening: two key facilitators to the implementation of ambulatory tuberculosis treatment in Uzbekistan. Health Econ Rev. 2016;6(1):28doi: 10.1186/s13561-016-0100-z.
Kohler, S., Asadov, D. A., Bründer, A., Healy, S., Khamraev, A. K., Sergeeva, N., & Tinnemann, P. (2016). Health system support and health system strengthening: two key facilitators to the implementation of ambulatory tuberculosis treatment in Uzbekistan. Health economics review, 6(1), 28. https://doi.org/10.1186/s13561-016-0100-z
Kohler, Stefan, et al. "Health system support and health system strengthening: two key facilitators to the implementation of ambulatory tuberculosis treatment in Uzbekistan." Health economics review vol. 6,1 (2016): 28. doi: https://doi.org/10.1186/s13561-016-0100-z
Kohler S, Asadov DA, Bründer A, Healy S, Khamraev AK, Sergeeva N, Tinnemann P. Health system support and health system strengthening: two key facilitators to the implementation of ambulatory tuberculosis treatment in Uzbekistan. Health Econ Rev. 2016 Dec;6(1):28. doi: 10.1186/s13561-016-0100-z. Epub 2016 Jul 12. PMID: 27406392; PMCID: PMC4942444.
Copy Download .nbib Format: NLM
Share it on

Health Econ Rev. 2016 Dec;6(1):28. doi: 10.1186/s13561-016-0100-z. Epub 2016 Jul 12.

Health system support and health system strengthening: two key facilitators to the implementation of ambulatory tuberculosis treatment in Uzbekistan.

Health economics review

Stefan Kohler, Damin Abdurakhimovich Asadov, Andreas Bründer, Sean Healy, Atadjan Karimovich Khamraev, Natalia Sergeeva, Peter Tinnemann

Affiliations

  1. Institute of Public Health, Heidelberg University, Heidelberg, Germany. [email protected].
  2. Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany. [email protected].
  3. Médecins Sans Frontières, Nukus and Tashkent, Uzbekistan. [email protected].
  4. Department of Health Management, Evidence-based Medicine Centre, Tashkent Institute of Postgraduate Medical Education, Tashkent, Uzbekistan.
  5. Médecins Sans Frontières, Nukus and Tashkent, Uzbekistan.
  6. Tashkent Pediatric Medical Institute, Nukus Branch, Nukus, Uzbekistan.
  7. Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.

PMID: 27406392 PMCID: PMC4942444 DOI: 10.1186/s13561-016-0100-z

Abstract

Uzbekistan inherited a hospital-based health system from the Soviet Union. We explore the health system-related challenges faced during the scale-up of ambulatory (outpatient) treatment for drug-susceptible and drug-resistant tuberculosis (TB) in Karakalpakstan in Uzbekistan. Semi-structured interviews were conducted with key informants of the TB services, the ministries of health and finance, and their TB control partners. Structural challenges and resource needs were both discussed as obstacles to the expansion of ambulatory TB treatment. Respondents stated need for revising the financing mechanisms of the TB services to incentivize referral to ambulatory TB treatment. An increased workload and need for transportation in ambulatory TB care were also pointed out by respondents, given the quickly rising outpatient numbers but per capita financing of outpatient care. Policy makers showed strong interest in good practice examples for financing ambulatory-based management of TB in comparable contexts and in guidance for revising the financing of the TB services in a way that strengthens ambulatory TB treatment. To facilitate changing the model of care, TB control strategies emphasizing ambulatory care in hospital-oriented health systems should anticipate health system support and strengthening needs, and provide a plan of action to resolve both. Addressing both types of needs may require not only involving TB control and health financing actors, but also increasing knowledge about viable and tested financing mechanisms that incentivize the adoption of new models of care for TB.

Keywords: Ambulatory care; Financing; Health system; Hospitalization; Outpatient care; Scale-up; Stakeholder perceptions; Tuberculosis; Uzbekistan

References

  1. Trop Med Int Health. 2015 Oct;20(10):1337-45 - PubMed
  2. N Engl J Med. 2008 Nov 27;359(22):2398-400 - PubMed
  3. PLoS Med. 2016 Mar 02;13(3):e1001965 - PubMed
  4. Int J Health Plann Manage. 2013 Jan-Mar;28(1):85-94 - PubMed
  5. Pneumologie. 2009 May;63(5):253-60 - PubMed
  6. Health Policy. 2005 Oct;74(2):122-32 - PubMed
  7. J Infect Dev Ctries. 2013 Mar 14;7(3):289-92 - PubMed
  8. BMC Infect Dis. 2014 Jun 17;14:333 - PubMed
  9. Int J Tuberc Lung Dis. 2014 Dec;18(12):1390-5 - PubMed
  10. Health Econ Policy Law. 2010 Apr;5(2):135-47 - PubMed
  11. Bull World Health Organ. 2013 May 1;91(5):320-1 - PubMed
  12. Eur Respir J. 2011 Sep;38(3):516-28 - PubMed
  13. PLoS One. 2016 Mar 01;11(3):e0150511 - PubMed
  14. Int J Tuberc Lung Dis. 2011 Oct;15(10):1294-300 - PubMed
  15. Euro Surveill. 2013 Oct 17;18(42):null - PubMed
  16. Eur Respir J. 2015 Jan;45(1):289-91 - PubMed
  17. Eur J Public Health. 2007 Feb;17(1):98-103 - PubMed
  18. Educ Health (Abingdon). 2003 Jul;16(2):230 - PubMed
  19. Pharmacoeconomics. 2012 Jan;30(1):63-80 - PubMed
  20. Bull World Health Organ. 2015 Feb 1;93(2):118-24 - PubMed
  21. Health Policy Plan. 2012 Jul;27(4):281-7 - PubMed
  22. Glob Health Action. 2014 Sep 16;7:24978 - PubMed
  23. Pharmacoeconomics. 2015 Sep;33(9):939-55 - PubMed
  24. Am J Trop Med Hyg. 2013 Aug;89(2):271-80 - PubMed
  25. Eur Respir J. 2014 Jun;43(6):1763-75 - PubMed

Publication Types