Photo Credit: Warren ZelmanPhoto Credit: Warren Zelman

This story was originally published on the SIAPS Program homepage

To be fully effective, health system strengthening projects should have sustainable impact and lay the groundwork for future progress. Here’s how SIAPS’ work supported health system reform in Ukraine.

SIAPS worked in Ukraine for four years, from 2013 through 2017. Ukraine has the most severe HIV epidemic in Eastern Europe and Central Asia and the second highest TB burden in Europe. Ukraine has the highest mortality rate from infectious diseases in the WHO/Euro region, with TB, HIV, and AIDS accounting for 90% of all deaths.

However, the country’s health system was poorly equipped to cope. Following the collapse of the Soviet Union, Ukraine inherited a centrally controlled health system that funded about half of health expenditures as of 2014. Out-of-pocket payments accounted for more than 46% of the rest, and a third of that was for medicines, which are expensive. That meant affordable medicines were out of reach for many people, as well as the medicines essential to treating these diseases.

 {Photo credit: Niranjan Konduri/MSH}While the transition to digital case management might seem to be simple, health workers in low- and middle-income countries, like Ukraine, are challenged by a lack of basic technologies.Photo credit: Niranjan Konduri/MSH

[Niranjan Konduri]Niranjan KonduriMotivated frontline health workers play a key role achieving global strategies to fight tuberculosis (TB), writes MSH Principal Technical Advisor Niranjan Konduri, of USAID's Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, for The Lancet Global Health Blog. Using the story of Irina Chaban, a Ukrainian TB doctor, as an example, Konduri highlights the challenges health workers in low- and middle-income countries must overcome while working to eradicate TB.

"While the transition to digital case management might seem to be a simple solution, [health workers like Chaban] are challenged by a lack of basic technologies that are taken for granted in higher-income countries," Konduri says.

{Photo credit: Warren Zelman}Photo credit: Warren Zelman

This blog post is a web-formatted version of the Global Health Impact newsletter: Stronger Health Systems Stop TB and Save Lives (December 2015). (View or share the email version here.) We welcome your feedback and questions in the comments or email us. On social media, use hashtag and tag .  Subscribe

Originally known as SITE-TB, Sistema TMBR is the official platform for drug resistant TB monitoring and treatment in Brazil.Originally known as SITE-TB, Sistema TMBR is the official platform for drug resistant TB monitoring and treatment in Brazil.

In the 1990s many Brazilian patients infected with tuberculosis (TB) were not being cured, despite starting treatment. Some patients stopped taking their medication, which led to the reemergence of TB. In 1993, the World Health Organization declared that TB was a global emergency. Eventually, a multi-resistant strain of TB surfaced, making it even more difficult to fight the disease.

These occurrences --- referred to as “chronic cases” --- became apparent in some Brazilian states, but health units lacked standardized management systems to treat these cases of TB.

Centro de Referência Professor Hélio Fraga (CRPHF), which is Brazil's National Tuberculosis Reference Laboratory, took control of TB surveillance in 1994. CRPHF defined a more effective treatment scheme and a national network to register and monitor the chronic cases in 1999. CRPHF builds human capacity through training and carries out operational and epidemiological studies. They also evaluate TB and other lung disease control activities and function as a Macro Regional Reference Lab.

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