On the 6th and 7th August, TBEC ran the first National Dialogue for the Development of Partner Cooperation to End TB in Belarus.

What does this long title actually mean? And what actually happened during the course of these two days in Minsk?

Daniel Kasnitsky (TBEC Capacity Building Manager), Paul Sommerfeld (TBEC Board Member) stand with two participants outside during the National Dialogue in BelarusDuring the two days, the 45 participants discussed how to organise people centred TB care in cooperation between civil society and how to introduce mechanisms for social contracting of TB care. The participants included: experts, key decision makers, people living with TB, representatives of civil society, two deputies from the Belorussian national assembly, three directors from state-level health departments, head of TB services, international experts, and journalists. The event was organised under the auspices of the regional TB Rep 2.0 programme. However, the thing that truly differentiated this from other events was that people living with TB participated on equal grounds with doctors and healthcare organisers. We would even go as far as to say that genuine dialogue took place – almost everyone who needed to be there was able to participate.

What was discussed at the National Dialogue?

One of the key questions during the meeting was regarding the development of cooperation between TB services and societal organisations in order to strengthen support for people receiving treatment for TB and ensuring adherence to their treatment course. The pilot project in Brest oblast regarding the move towards a people-centred system of TB care (under the auspices of the TB Rep 1.0 project) demonstrated that the effectiveness of such a transition and showed that it could be expanded to cover other regions of Belarus. However, in order to attain sustainable results, a social contracting mechanism is needed for TB that allows community groups to receive funding in order to encourage early diagnosis and adherence to treatment among high-risk groups, two areas that civil society organisations can most effectively support the work of TB services.

Five speakers, including TBEC Board Member Paul Sommerfeld, sit at presenters table during the National Dialogue in BelarusDeputy Minister for Health and Head Medical Officer Natalia Zhukova called for “the immediate and widespread introduction of state social order for the provision of TB help and the clarification of the role of community organisations in the improvement of adherence to TB treatment, oriented towards patients’ needs”. It was key that members of regional health departments attended the National Dialogue in Belarus as they will soon be directly involved in the allocation of funding for local civil society organisations.

 

 

 

Barriers to Ambulatory Treatment

The recent analysis of barriers to ambulatory treatment conducted by the Country Coordinating Mechanism (CCM) identified three main factors:

  • Patients not informed about their right to access ambulatory treatment
  • Very few people know about video-controlled treatment as an app for mobile phones
  • Social insecurity

Participants in the National Dialogue in Belarus spent two days developing recommendations to overcome barriers to access to people-centred ambulatory care in the context of state social order on TB. The recommendations for concrete steps to overcome the identified barriers:

  • Develop an algorithm to support patients with TB in need of financial support through the provision of transport vouchers/compensation of transport in the course of ambulatory treatment as necessary;
  • Create and support a working group on TB with the involvement of the CCM, government organisations, NGOs, patient groups;
  • Create a Social Committee under the auspices of the Belarussian Ministry of Health;
  • Initiate and support regular meetings of the Committee for Demographic Security, whose agenda will include questions related to the realisation of the HIV and TB programmes;
  • Develop and approve guidelines from the Ministry of Health of Belarus on the training of medical personnel in TB services (nurses, TB doctors) in selected aspects of psychology (psychology of addition, the diagnosis of depression, etc);
  • Create a mechanism for quality appraisal medical-social services in relation to TB and HIV provided by community organisations;
  • Introduce changes to the law on healthcare and secondary legislation in order to formalise the understand of “ambulatory treatment under the control of medical personnel” and “the treatment of co-morbidity”;
  • Prepare an order from the Ministry of Health regulating fieldwork by multidisciplinary medical teams for the clinical support of patients with TB that live in distant regions of the country.

These recommendations have been included in the “Plan for the Sustainable Response and Transition to State Funding for HIV/AIDS and TB prevention, treatment, care and support programmes in the Republic of Belarus from 2019-2021”, which will be received as the official document for the Ministry of Health. Its aim is to move to state funding for prevention, treatment, care and support services for TB and HIV, which are currently financed by Global Fund grants.

Results

As a result of the National Dialogue, the Civil Society Platform on TB was created , the technical coordination of which will be managed by the state organisation “Let’s defeat TB together”.

All the participants of the National Dialogue in Belarus stand around a conference tableThe National Dialogue has raised high expectations from everyone who took part and now we will need a great deal of coordination and to go beyond our comfort zones in order to work together and recognise our partners’ strengths and unique approaches.

“It is surprising, but indeed true, that you [the TBEC facilitators] had to come from far away, so that we were able to sit down together and discuss everything normally” – the head of the department of pulmonology and pthisiology in the Scientific-Practice Centre of the Republic praised the event.

As a regional organisation, TBEC sits outside relationships at the national level and this gives us the freedom to create an open discussion between civil society, medical workers, and directors of health systems. We regularly act in this role across the countries of the WHO European Region.

You can download the agenda for the National Dialogue here.

Acknowledgements

I would like to particularly than the following people, without whom the National Dialogue would not have been able to take place and whose professionalism and kindness I will always value:

Viacheslav Grankov, WHO Programme Coordinator for Infectious Diseases in the Republic of Belarus

Nataliia Krishtafovich, Board Member for the organisation “Let’s Defeat TB Together”

Anna Tkacheva, Coordinator for the organisation “Let’s Defeat TB Together”

Dmitrii Pinevich, Deputy for the Ministry of Health in Belarus

Nataliia Zhukovaia, Deputy for the Ministry of Health in Belarus

Gennadii Gurevich, Director of the Scientific Practical Centre of the Republic for Pulmonology and Pthisiology

Elena Skriaginaia, Deputy Director for Scientific Work, Scientific Practical Centre of the Republic for Pulmonology and Pthisiology

Viktoriia Kralko, Scientific Practical Centre of the Republic for Pulmonology and Pthisiology

Zhanna Saprikinaia, Scientific Practical Centre of the Republic for Pulmonology and Pthisiology

Tatiana Makarevich, Head of the Grant Management Department of the Global Fund for the Republican Scientific Practical Center for Medical Technologies, Informatization, Management and Health Economics

Oleg Eremin, Member for the Coordinating Committee of the Organisation “BelNetAntiAIDS”

Stela Bivol, Director for the PAS Centre, Moldova

Also, thanks to all the experts and speakers at the National Dialogue for your valuable time and expertise, which you spent in order to support the speedy resolution of the problem of TB in Belarus

And with a doubt to my co-organiser Paul Sommerfeld, co-chair of the TBEC Board, whose wisdom and charm ensure that any discussion becomes constructive, and to Anna Medvedenko, the Administrative Officer for TBEC, who thought everything through and ensured that we always had good working conditions.

By Daniel Kashnitsky, Capacity Building Manager for TBEC


flag_yellow_low

This webpage is the product of an activity that has received funding under an operating grant from the European Union’s Health Programme (2014-2020).

The content of this webpage represents the views of the author only and is his/her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains.