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The European Journal of Public Health Advance Access published online on July 12, 2006
The European Journal of Public Health, doi:10.1093/eurpub/ckl098
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© The Author 2006. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Received January 26, 2006
Accepted June 9, 2006

Article

Reform of tuberculosis control and DOTS within Russian public health systems: an ecological study

Florian M. Marx 1, Rifat A. Atun 2, Wieslaw Jakubowiak 3, Martin Mckee 1, and Richard J. Coker 1 *

1 Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
2 Centre for Health Management, The Management School, Imperial College, London, UK
3 WHO TB Control Programme in the Russian Federation, Office of the Special Representative of the WHO Director-General in Russia, Moscow, Russian Federation

* To whom correspondence should be addressed.
Richard J. Coker, E-mail: richard.coker{at}lshtm.ac.uk


  Abstract

Objectives: To investigate the association between clinical need and hospital bed supply and utilization in Russia; and, to investigate these associations in areas where traditional Russian tuberculosis health care systems exist and where the directly observed therapy-short course (DOTS) strategy has been implemented. Design: Ecological study using 2002 routine data. Main outcome measures: Hospital bed utilization and hospital admissions for patients with tuberculosis in regions that adhere to the traditional Russian method of managing tuberculosis and those where the DOTS strategy has been implemented. Results: The ratio of beds per newly notified case was 0.86. The mean duration of hospital stay per admission was 86 days for non-DOTS regions and 90 days for regions where the DOTS strategy had been implemented. The number of admissions in each region correlated closely with the number of newly registered cases and hospital beds were, on average, occupied for 325 days. In the regions where the DOTS strategy had been implemented bed occupancy was 324 days. Conclusions: Under the Russian tuberculosis control system, hospital utilization is predominantly determined by supply-side factors, namely the number of tuberculosis dedicated hospital beds, and this system extends across all regions. Implementation of the DOTS strategy in Russia has not led to fundamental structural changes in tuberculosis control systems.


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