title: Ambulatory tuberculosis treatment in post-Semashko health care systems needs supportive financing mechanisms.
abstract: The tuberculosis (TB) control strategy in the Republic of Karakalpakstan, Uzbekistan, is being changed to decentralised out-patient care for most TB patients by the Government of Uzbekistan, in collaboration with the international medical humanitarian organisation Médecins Sans Frontières. Ambulatory treatment of both drug-susceptible and drug-resistant TB from the first day of treatment has been recommended since 2011. Out-patient treatment of TB from the beginning of treatment was previously prohibited. However, the current Uzbek health financing system, which evolved from the Soviet Semashko model, offers incentives that work against the adoption of ambulatory TB treatment. Based on the 'Comprehensive TB Care for All' programme implemented in Karakalpakstan, we describe how existing policies for the allocation of health funds complicate the scale-up of ambulatory-based management of TB.
authors.affiliation: Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Kohler
authors.affiliation: Department of Health Management, Evidence-based Medicine Centre, Tashkent Institute of Postgraduate Medical Education, Tashkent.
authors.forename: D A
authors.initials: DA
authors.lastname: Asadov
authors.affiliation: Médecins Sans Frontières, Nukus and Tashkent.
authors.forename: A
authors.initials: A
authors.lastname: Bründer
authors.affiliation: Médecins Sans Frontières, Nukus and Tashkent.
authors.forename: S
authors.initials: S
authors.lastname: Healy
authors.affiliation: Tashkent Paediatric Medical Institute, Nukus Branch, Nukus, Uzbekistan.
authors.forename: A K
authors.initials: AK
authors.lastname: Khamraev
authors.affiliation: Médecins Sans Frontières, Nukus and Tashkent.
authors.forename: N
authors.initials: N
authors.lastname: Sergeeva
authors.affiliation: Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Tinnemann
mesh_terms: D000553:Ambulatory Care / Q000191:economics* / Q000331:legislation & jurisprudence / Q000458:organization & administration; D002017:Budgets / Q000331:legislation & jurisprudence; D003266:Continuity of Patient Care / Q000191:economics / Q000331:legislation & jurisprudence; D003695:Delivery of Health Care / Q000191:economics* / Q000331:legislation & jurisprudence / Q000458:organization & administration; D005380:Financing, Government / Q000191:economics* / Q000331:legislation & jurisprudence / Q000458:organization & administration; D033161:Government Regulation; D017048:Health Care Costs / Q000331:legislation & jurisprudence; D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence; D006291:Health Policy / Q000191:economics* / Q000331:legislation & jurisprudence; D006801:Humans; D017146:Models, Organizational; D011050:Policy Making; D014376:Tuberculosis / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D014610:Uzbekistan