Belarus - UNDP partnership for strengthening the National TB system: Review of the National Tuberculosis Programme
Belarus is a top-priority country for prevention and control of MDR-TB, recently documented at the highest levels in the world. Since 2007 UNDP Belarus is implementing the TB grants of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM).
In recent years, Belarus has revised its national tuberculosis policies and guidelines according to international recommendations. This was done with the support of the TB grants received from GFATM. In consideration of the revised TB policies and guidelines and the need to evaluate their implementation in the light of the high rates of MDR-TB, in June 2011 Ministry of Health of Belarus decided to undertake an external review of the National TB Programme.
- UNDP Project financed by the Global Fund: Introducing the Stop TB Strategy in Belarus with a particular focus on taking measures to combat multidrug resistant tuberculosis (MDR-TB).
- Start date 1 January 2011. End date: 31 December 2015.
The review took place with the participation of 11 international (WHO, UNDP, GFATM) and nine national experts visiting Minsk city and the three regions of Minsk, Homiel and Viciebsk.
According to the latest surveys, one third of newly diagnosed TB patients and two thirds of those returning for treatment have MDR-TB. Many of them have extensively drug-resistant tuberculosis (XDR-TB). These are the highest rates ever documented in the world. Applying the above rates, the actual number of MDR-TB cases is significantly higher than previously estimated. Similarly, more equipment and consumables will be needed for early detection and treatment (laboratory and anti-TB drugs). The national currency devaluation in 2011 made imported equipment and consumables even more expensive than before.
The review members were impressed with the significant progress made by the National TB Programme in recent years. The leadership and dedication of its staff made it possible to update national policies and guidelines, implement and monitor them. The commitment to the DOTS Strategy that the Government of Belarus made in 2005 has been translated into effective action that can be used as an example for other MDR-TB high-burden countries in the Region.
A number of technical aspects in the National TB Programme need to be further improved, of which National TB Programme management is already aware and which it is addressing. For many of them, renewed Ministry of Health support is essential. MDR-TB patients should be diagnosed earlier so that the most appropriate treatment and infection control measures can be decided.
Noninfectious TB patients are treated in hospitals unnecessarily, causing a significant financial burden for the health system, and affecting the quality of life of many patients without medical or public health justification. In addition, the number of TB patients involuntarily isolated and treated is a major concern of the review members.
The review team analysed the relevant documents available (publications, mission reports, etc.), conducted site visits (of relevant institutions and facilities) and interviews (with policymakers, health providers and beneficiaries, general population, main national and international partners) at national level as well as in four areas selected for their epidemiological status and geographical distribution: Minsk city, Minsk oblast (region), Homiel oblast and Viciebsk oblast.
The following areas of the National TB Programme were assessed and revised:
- Case-finding and diagnosis
- Treatment and case management
- Childhood TB
- HIV-related TB
- Drug-resistant TB
- TB control in prisons
- Other vulnerable populations and social determinant
- Infection control
- Management of medicines and other commodities
- Monitoring and evaluation
- Human resources development
- Operational research
- Ethics and human rights
- Advocacy, communication and social mobilization
- Health system and TB control
In the final report the experts have provided both general recommendation for improvement TB-related activities of the healthcare system and specific recommendations for improvement of each of the abovementioned TB areas.
The main findings and recommendations of the review were conveyed to the First Deputy Minister of Health. As part of the debriefing, the review team invited the Ministry of Health to apply to the GFATM Round 11 for a TB grant (at that time, the call for applications had not yet been cancelled) and proposed specific action for this process, as already discussed with international partners.
The areas identified as recommended for improvement are the grounds for the Government consideration for the National TB Programme development. Some of the recommended changes have been already introduced in the National TB Programme, others are planned to be put in practice and used for strategic planning of the TB activities by the Ministry of Health.
When in 2013 the Country Coordinating Mechanism of Belarus, and UNDP as the Principal Recipient, were invited by GFATM to submit the Proposal for funding the Phase 2 of the current TB grant, while reviewing the submitted proposals for funding and taking its decisions for funding the proposed activities, the GFATM will be considering the recommendations, areas for improvement and needs assessment stated in the Review of the National Tuberculosis Programme of Belarus.