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Optimizing Investments in Belarus’ Tuberculosis Response Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized © International Bank for Reconstruction and Development / The World Bank 1818 H Street NW, Washington DC 20433 Internet: www.worldbank.org; Telephone: 202 473 1000 This work is a product of The World Bank and its contractor vendor, Optima Consortium of Decision Sciences. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of the Executive Directors of The World Bank or other partner institutions or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Nothing herein shall constitute or be considered to be a limitation upon or waiver of the privileges and immunities of The World Bank, all of which are specifically reserved. Rights and Permissions This work is available under the Creative Commons Attribution 3.0 Unported licence (CC BY 3.0) http://creativecommons.org/licences/by/3.0. Under the Creative Commons Attribution license, you are free to copy, distribute and adapt this work, including for commercial purposes, under the following conditions: Attribution – Please cite the work as follows: The World Bank. 2017. Optimizing Investments in Belarus’ Tuberculosis Response. Washington DC: World Bank. License: Creative Commons Attribution CC BY 3.0 Translations – If you create a translation of this work, please add the following disclaimer along with the attribution: This translation was not created by The World Bank and should not be considered an official World Bank translation. The World Bank shall not be liable for any content or error in its translation. All queries on rights and licenses should be addressed to the Office of the Publisher, The World Bank, 1818 H Street NW, Washington DC, 20433, USA; fax: 202-522-2625; email: [email protected]. Cover image source: iStock Photo Library/Theo Hawkins OPTIMIZING INVESTMENTS IN BELARUS’ TUBERCULOSIS RESPONSE Republic Scientific and Practice Centre for Pulmonology and Tuberculosis authors: Alena Skrahina and Dzmitry Klimuk Republican Scietntific Practice Center for Medical Technologies authors: Inna Nekrasova World Bank authors: Clemens Benedikt, Feng Zhao, and Nicole Fraser Burnet Institute Melbourne authors: Sarah Jarvis, David Kedziora and Azfar Hussain University College London authors: Gerard Abou Jaoude, Lara Gosce, Hassan Haghparast Bidgoli, Jolene Skordis-Worrall This page is for collation purposes. CONTENTS Key Messages ................................................................................................................................................................ xiii Executive Summary ...................................................................................................................................................... xv TB epidemic situation and response ..................................................................................................................... xv Alternative TB response scenarios ........................................................................................................................ xv Optimized allocations ................................................................................................................................................ xvi Conclusions and recommendations ................................................................................................................... xvii 1. Introduction: Why Allocative Efficiency Analysis Now? ......................................................... 1 1.1 Necessity for allocative efficiency ......................................................................................................... 1 1.2 Tuberculosis in the context of overall disease burden ................................................................ 2 1.3 Financing of TB in the context of health care financing .............................................................. 2 1.4 Financing of the TB response in Belarus ........................................................................................... 4 2. What Are the Key Questions and which Methods Were Used to Answer Them? ........... 7 2.1 Optima Model ................................................................................................................................................ 7 2.2 Analytical framework ................................................................................................................................ 8 2.3 National targets and how they were translated into Optima ................................................ 10 2.4 Limitations of the analyses ................................................................................................................... 11 3. What Are the Current Trends in the TB Epidemic? ................................................................ 13 3.1 Summary of key national data on the status of the TB epidemic ......................................... 13 3.2 Epidemic trends estimated in Optima ............................................................................................. 17 4. What Are the Impacts of Current Tuberculosis Spending? ................................................. 25 4.1 Focus of current TB programs in Belarus ...................................................................................... 25 4.2 Without TB programs, TB incidence and deaths would rise substantially ...................... 26 5. What Will Be the Impact of Different Program Implementation Scenarios? ................ 29 5.1 Scenario group 1: Scaling up coverage of key diagnostic and treatment interventions .............................................................................................................................................. 29 5.2 Scenario group 2: Shifting from in-patient to out-patient modalities of TB treatment.......................................................................................................................................... 32 5.3 Scenario group 3: Enhanced drug regimens and coverage of XDR-TB treatment ........ 35 5.4 Scenario group 4: Efficient screening and diagnosis of active TB ....................................... 39 iii iv Contents 6. What Might Be Gained from Optimized Allocation of Currently Available Funding? ............................................................................................................................. 42 6.1 Optimized allocation of resources to minimize incidence, prevalence and deaths .................................................................................................................................................... 42 6.2 Optimized allocation of resources to minimize the prevalence of MDR- and XDR-TB .................................................................................................................................... 47 6.3 Will optimized allocations of current resources achieve national and global targets? ................................................................................................................................... 48 7. Conclusions and Recommendations ............................................................................................ 52 Bibliography ................................................................................................................................................... 71 APPENDIXES A Technical Summary of Optima ........................................................................................................... 56 B Fitting process for Optima-TB in Belarus ........................................................................................ 59 C Key data inputs into the model .......................................................................................................... 65 D Additional Results Not Included in the Body of the Report ........................................................ 69 E Glossary ................................................................................................................................................... 70 FIGURES ES.1 Current allocation of TB resources and optimized allocations to minimize TB incidence, prevalence and deaths........................................................................ xvi 1.1 Health expenditure in Belarus compared to regional and global averages (2014) ...... 4 1.2 Belarus: TB spending by year and source of financing, US$ (%) .......................................... 4 1.3 Belarus: TB spending by source of financing and thematic focus, 2015 (%) .................. 5 3.1 TB treatment cascade and treatment cohort cascades ........................................................... 16 3.2 Trends in the estimated number of people with active TB in the general population in Belarus by age group (2000-16) ......................................................................... 17 3.3 Trends in the estimated number of people aged 15-64 with active TB in Belarus by drug resistance type (2000-16) ................................................................................. 18 3.4 Trends in the estimated number of people with active TB in Belarus, all ages and sub-populations (2004-16)
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