Improving payment mechanisms to support a new delivery model for TB care in Romania (2017)

In July 2015, the WHO Regional Office for Europe signed an agreement with the Romanian Angel Appeal Foundation, principal recipient of the current tuberculosis (TB) grant of the Global Fund to Fight AIDS, Tuberculosis and Malaria, for technical assistance which included the development of a new delivery model of TB care that is financially sustainable and enhances people-centred integrated/coordinated services.

This work was conducted in coordination with the Ministry of Health and the Romanian Angel Appeal by a small group of WHO external consultants and staff who visited the country in October 2015 and April and December 2016. The group developed a revised list of tasks for the different levels of care (pulmonology services in hospitals and outpatient dispensaries, family medicine practices, communities) and identified their new payment methods.

This model diverges significantly from the current hospital paradigm and is expected to improve the quality of TB services, their cost-effectiveness and financial sustainability. It will require both field-testing in order to fine tune the way it works and a strong political commitment for its countrywide roll-out. Other countries aiming to introduce universal coverage of their TB services may be inspired by this report.