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Extensive Review of Tuberculosis Prevention, Control and Care In Extensive review of tuberculosis prevention, control and care in Kazakhstan 10–16 May 2012 ABSTRACT The notification rate of TB cases in Kazakhstan is among the highest in the WHO European Region. WHO was requested to organize a review of the Kazakh Tuberculosis Programme, which took place from 10 to 16 May 2012. The reviewers made a number of recommendations to improve the programme. The main focus should be on: expansion of the programmatic management of drug-resistant TB, introduction and roll-out of molecular diagnosis of TB and MDR-TB, expansion of ambulatory treatment of patients, and home-based care and day-care treatment including all eligible patients, particularly sputum-smear- negative patients (as well as sputum-smear-negative MDR-TB patients). Hospitalization practices need to be rationalized in order: (i) to prevent the spread of drug resistance, and (ii) to use the available resources more efficiently by reallocating the funds saved by reducing the number of hospitals to expand ambulatory treatment, social support for patients and the number of health-care providers. Examples of the involvement of civil society organizations and provision of an integrated continuum of care (transfer of released patients from prison to civilian sector) need to be expanded across the country. Keywords CONTROL DELIVERY OF HEALTH CARE NATIONAL HEALTH PROGRAMS PREVENTION PROGRAM EVALUATION TUBERCULOSIS, MULTIDRUG-RESISTANT Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website (http://www.euro.who.int/pubrequest). © World Health Organization 2014 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. CONTENTS Page Acknowledgements ........................................................................................................................ iii Abbreviations ................................................................................................................................. iv Executive summary ........................................................................................................................ vi Key achievements ................................................................................................................................. vi Key challenges ..................................................................................................................................... vii Main recommendations ..................................................................................................................... viii 1. Introduction ............................................................................................................................. 1 1.1 Process ........................................................................................................................................ 1 2. Background information .......................................................................................................... 2 1.1 Health‐care system ..................................................................................................................... 2 2.2 TB prevention, care and control ................................................................................................. 3 3. Leadership and governance ................................................................................................... 18 3.1 Strategy and policy development ............................................................................................. 18 3.2 Government and local authority commitment ......................................................................... 18 3.3 Partnership and civil society involvement ................................................................................ 19 3.4 Patient and community participation ....................................................................................... 20 3.5 Links with other health interventions and health‐sector reform ............................................. 21 3.6 Advocacy, communication and social mobilization .................................................................. 25 3.7 Operational research ................................................................................................................ 26 4. Service delivery ...................................................................................................................... 30 4.1 TB hospital capacity and activity indicators .............................................................................. 30 4.2 Prevention ................................................................................................................................. 42 4.3 Diagnosis ................................................................................................................................... 48 4.4 Treatment ................................................................................................................................. 55 4.5 Care ........................................................................................................................................... 64 4.6 Special populations ................................................................................................................... 67 5. Health workforce .................................................................................................................... 80 5.1 Main findings ............................................................................................................................ 80 5.2 Human resources for health ..................................................................................................... 82 5.3 Human resources for TB prevention, control and care ............................................................ 84 5.4 Training ..................................................................................................................................... 88 5.5 Staff development .................................................................................................................... 91 5.6 Performance assessment .......................................................................................................... 92 6. Information ............................................................................................................................ 94 6.1 Surveillance ............................................................................................................................... 94 6.2 Monitoring and evaluation ..................................................................................................... 103 7. Medical products, vaccines and technologies ..................................................................... 108 7.1 Supply/procurement/import .................................................................................................. 108 7.2 Registration ............................................................................................................................. 109 7.3 Drug availability and use ......................................................................................................... 109 7.4 Stock management ................................................................................................................. 110 8. Financing .............................................................................................................................. 110 8.1 Health sector financing and expenditure ............................................................................... 110 8.2 TB financing and expenditure ................................................................................................. 112 9. References ...........................................................................................................................
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