In May 2017, Belarus kicked off preparations for its 2018 pilot project on changing financing mechanisms for tuberculosis (TB) services with a round-table consultation in Minsk and a study tour to Estonia.
At the round-table meeting on 16–17 May, representatives from 4 of the 6 oblasts (administrative regions) in Belarus shared their ideas on improving the provision of patient-oriented TB care and changing the country’s model of financing TB services. The WHO Country Office in Minsk organized the 2-day event in collaboration with the Ministry of Health; the Global Fund to Fight AIDS, Tuberculosis and Malaria; WHO/Europe; and the World Bank.
A recent study in Belarus revealed that around 70% of the national budget for TB is spent on hospital services, and recommended shifting resources towards active case-finding and ambulatory care. The assessment also showed that optimizing the current budget would help to decrease HIV-associated TB.
Participants at the meeting discussed policy options related to legal regulation, budget optimization, contracting service providers, regulation of out-of-pocket payments for ambulatory treatment, salaries for TB and primary health care workers, licensing of community-based organizations for the provision of nonmedical services, and human resources planning.
Representatives of WHO/Europe also presented the recently published “A people-centred model of TB care”.
Study tour to Estonia
A delegation from Belarus visited Estonia on 21–26 May to gain an understanding of its payment models for TB services. Estonia systematically prioritized outpatient TB care by piloting the approach in selected districts prior to rolling it out countrywide. This is often cited as an example of best practice in shifting to ambulatory TB care.
During the visit, the delegation met with representatives from relevant ministries and institutions engaged in TB care.
Next steps
Participants at the meeting and on the study tour agreed that developing a roadmap to implement a people-centred model of TB care in the pilot oblasts is an important next step. A review of national policy documents and approaches, regulations, and budgeting must support this process.