Tuberculosis control in Samara Oblast, Russia: institutional and regulatory environment.
METHODS
Tuberculosis control programme in Samara Oblast, Russia, funded in part by the government of the United Kingdom.


OBJECTIVE
To identify and evaluate institutional and regulatory influences as well as incentives and disincentives that might be amenable to change in the promotion of the DOTS strategy.


METHODS
Multidisciplinary situational analysis through in-depth interviews of stakeholders and review of official federal and oblast documents.


RESULTS
Interpretation of traditional notification data is complex because classification and reporting systems differ from World Health Organization principles. Regulations governing financing encourage lengthy hospitalisations and interventions, and provide few incentives to shift policy to ambulatory care.


CONCLUSIONS
Accurate comparability of epidemiological trends and programmatic successes requires equivalent classification and reporting systems. If the DOTS strategy is to be sustainable, changes to financing systems will be needed.
Coker
R J
RJ
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK. richard.coker@lshtm.ac.uk
Dimitrova
B
B
Drobniewski
F
F
Samyshkin
Y
Y
Balabanova
Y
Y
Kuznetsov
S
S
Fedorin
I
I
Melentsiev
A
A
Marchenko
G
G
Zakharova
S
S
Atun
R
R
D035082:Federal Government; D006296:Health Services; D006801:Humans; D011635:Public Health Administration; D012426:Russia / Q000453:epidemiology; D014376:Tuberculosis / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000401:mortality