[EQ] Restructuring Regional Health Systems In Russia

WB Knowledge Briefs:

Restructuring Regional Health Systems In Russia

Patricio V. Marquez, Lead Health Specialist, Human Development Sector Unit of the Europe and Central Asia Region of the World Bank.
Nadezdha Lebedeva, Former HRIP Project Director, Russian Health Care Foundation.
October 2010

Available online at : http://bit.ly/cpOQ6d

"…..The delivery of health services in Russia is a federal, regional and municipal responsibility, carried out in accordance with federal and regional regulations and funded through multiple sources (for example, the federal budget and transfers, regional budgets, and health insurance). The reform of regional health systems is a major challenge for the country.

From 2003-2008, the World Bank supported the MOHSD's Health Reform Implementation Project (HRIP) which restructured the health systems in two pilot regions southeast of Moscow: the Chuvash Republic and Voronezh (with 1.28 and 2.27 million population, respectively), at a total cost of US$ 41 million. The Chuvash Ministry of Health and the Voronezh Department of Health managed the implementation of the reforms…."

"….A crititical lesson from the experience is that successful reforms require holistic and well-sequenced approaches, based on detailed plans for investment in institutional and human resource development. Partial reforms produce imbalances. In both regions, reducing the numbers of hospital beds made it necessary to increase service delivery capacity at the primary care, specialized ambulatory, and long term care facility levels by redesigning the process of care through adoption of new disease management protocols, introduction of modern medical equipment to improve the diagnosis and treatment of patients, development of information systems to coordinate the flow of data and information across levels of care and within facilities, training of personnel, and resource allocation mechanisms that link payments to performance.

Battle Against Tuberculosis: Some Gains in Russia

Patricio V. Marquez, Lead Health Specialist, Human Development Sector Unit of the Europe and Central Asia Region of the World Bank.
Wieslaw Jakubowiak, Former Coordinator, WHO Stop TB Program in Russia.
Dmitry D.Pashkevich, Acting Coordinator, WHO Stop TB Program in Russia.
Vladimir A. Grechukha, Former Project Director, Russian Health Care Foundation.
October 2010

Available online: http://bit.ly/aa1zby

Lessons learned:
The establishment of high level and thematic working groups for policy setting and coordination and the participation of key stakeholders in the implementation of project activities were crucial to securing ownership of new approaches and sustaining activities and gains.
A clear division of responsibilities among international agencies helped harmonize cooperation and maximize their impact in supporting the implementation of the national program.
Modernization of the public health laboratory network and improved knowledge and skills of health personnel were essential to facilitate adoption of new guidelines for TB and HIV control, and scale up treatment.
The spread of drug-resistant TB (about 15% of new cases in 2009) and HIV/AIDS are a serious challenge to effective TB control in Russia. The provision of social support services (for example, free transportation between the home of the patient and the health center, food supplementation, etc.) and compliance by patients to the treatment regime is needed to prevent treatment interruptions and defaults during ambulatory treatment, particularly among the unemployed, homeless, alcoholics, and former prisoners. TB/HIV co-infection is also a growing problem among vulnerable population groups (for example, injecting drug users), demanding improved prevention and treatment efforts.
The strengthening of case registration and reporting systems, and improved technical capacity at different levels of the health system to monitor and evaluate TB detection and treatment outcomes using cohort data, are key institutional building blocks for improving program management and policy formulation.

 

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