The Russian Federation has an extensive tuberculosis (TB) control system which focuses on inpatient treatment and often allows long hospital stays. A large network of facilities exists to detect and treat cases, with 80,000 hospital beds reserved for TB treatment. How can the TB control system become more efficient?

The Russian Federation has the 12th highest number of new TB cases per year in the world. Although the disease declined in the 1960s, the rate of cases almost tripled in the 1990s to reach 90.7 per 100,000 people in 2000. In 2001, 9.1 hospital beds were set aside per 1,000 people, compared with 2.4 in the United Kingdom and 4.1 in the European Union. Other countries with a high TB burden largely treat infected people as outpatients.

A detailed study by the World Health Organization's (WHO) Stop TB Department, Russian Federation TB medical staff and international research institute researchers looked at the patterns of use of TB hospitals in four Russian Federation regions. They investigated what kind of patients were using the inpatient facilities in the hospitals, why they were being admitted and what scope there is for reducing the use of inpatient services. 

The study made a number of findings, including:

• About 70 percent of the patients surveyed were male, the average age was 40 and high rates of alcohol abuse (32-49 percent), disability (17-39 percent) and unemployment (27-41 percent) were recorded.  
• About a third of beds were occupied by patients who were smear-positive or culture-positive for TB, 20 percent by smear-negative and/or culture-negative patients, 20 percent by patients who no longer had TB, and about 20 percent of beds were not occupied.
• In all four regions, at least a third of beds were unoccupied or occupied by patients who did not have active TB. In two regions this figure was over 50 percent.
• If clinical and public health reasons were used as admission criteria for TB patients, less than 50 percent of patients would need to be admitted and less than 50 percent of beds would be needed. 
• When including patients with social problems, up to 81 percent of patient admissions would be justified and up to 85 percent of beds would be needed.

The study suggests that a large portion of the Russian Federation’s hospital infrastructure for TB is unnecessary if it is used strictly according to clinical and public-health criteria. However, social reasons and difficulties in accessing outpatient care account for a large portion of hospital bed use.

The implications for policy are:

• To improve the efficiency of TB control delivery, health system standards and regulations will need to be reformed to improve resource allocation and clinical care. More cost effective alternatives to hospital inpatient care are needed for managing TB patients with social problems.
• The management of staff numbers will need to be improved when managing a transition from hospital to community-based TB care, as the large number of staff employed in TB control facilities accounts for a third of total costs. 
• National and international agencies must focus on medium to long-term improvements in the health care system rather than on short-term change in TB treatment protocols.

Source(s):
‘Health-systems efficiency in the Russian Federation: tuberculosis control’, Bulletin of the World Health Organization 84(1), pages 43-51, by Katherine Floyd, Raymond Hutubessy, Yevgeniy Samyshkin, Alexei Korobitsyn, Ivan Fedorin, Gregory Volchenkov, Boris Kazeonny, Richard Coker, Francis Drobniewski, Wieslaw Jakubowiak, Margarita Shilova and Rifat A. Atun, 2006 (PDF) Full document.

Funded by: United Kingdom Department for International Development (DFID)

id21 Research Highlight: 11 September 2006

Further Information:
Professor Rifat A. Atun
Centre for Health Management
Tanaka Business School
Imperial College London
South Kensington Campus
London SW7 2AZ
England

Tel: +44 20 7594 9160
Fax: +44 20 7823 7685
Contact the contributor: r.atun@imperial.ac.uk

Stop TB Partnership, World Health Organization (WHO)

Stop TB Department, World Health Organization (WHO)

Other related links:
'The rise of tuberculosis in Russia: are hospitals to blame?'

'The views of TB control staff on health system decentralisation'

'Primary health care reform in Russia: can it succeed?'

'On the same side – public-private partnerships in TB control'

'Tuberculosis control needs strong national health services'