Tuberculosis control in Samara Oblast, Russia: institutional and regulatory environment
OBJECTIVE: To identify and evaluate institutional and regulatory influences as well as incentives and disincentives that might be amenable to change in the promotion of the DOTS strategy.
DESIGN: Multidisciplinary situational analysis through in-depth interviews of stakeholders and review of official federal and oblast documents.
RESULTS: Interpretation of traditional notification data is complex because classification and reporting systems differ from World Health Organization principles. Regulations governing financing encourage lengthy hospitalisations and interventions, and provide few incentives to shift policy to ambulatory care.
CONCLUSION: Accurate comparability of epidemiological trends and programmatic successes requires equivalent classification and reporting systems. If the DOTS strategy is to be sustainable, changes to financing systems will be needed.
Document Type: Regular Paper
Affiliations: 1: Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK 2: Department of Microbiology and Infection, King's College, Denmark Hill, London, UK 3: Centre for Health Management, The Business School, Imperial College London, South Kensington Campus, London, UK 4: Samara Oblast Health Department, Samara, Russia 5: GUIN (Glavnoe Upravlenie Ispolneniia Nakasanii), Samara, Russia
Publication date: October 1, 2003
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