RESUMEN
SETTING: Afghanistan. OBJECTIVE: To describe the results of rapid expansion of the DOTS strategy in a post-conflict environment, with a focus on the experience of the Rural Expansion of Afghanistan's Community-based Healthcare (REACH) Program. RESULTS: Despite the destruction of the National Tuberculosis Program (NTP) and basic health services by war and an uncertain security situation, the NTP, with assistance from many partners and REACH, increased the number of patients receiving DOTS by 136% in 4 years (from 9261 cases in 2001 to 21851 in 2005), with an 86% treatment success rate. By focusing on rapidly expanding the number of facilities capable of providing tuberculosis (TB) diagnostic and treatment services and involving community health workers in case detection, referrals and home-based DOTS, REACH showed a 10-fold rise in the number of facilities providing TB services and a 380% increase in the number of sputum smear-positive pulmonary TB cases detected in 2 years (from 251/month in 2004 to 818/month in 2006) in 13 provinces. CONCLUSION: At the current rate of expansion, case detection and successful treatment of TB cases in Afghanistan will continue to expand rapidly. The NTP and REACH have demonstrated that expansion of TB services in Afghanistan is possible despite the challenges.
Asunto(s)
Antituberculosos/administración & dosificación , Servicios de Salud Comunitaria/estadística & datos numéricos , Terapia por Observación Directa , Tuberculosis Pulmonar/tratamiento farmacológico , Afganistán/epidemiología , Servicios de Salud Comunitaria/organización & administración , Instituciones de Salud/estadística & datos numéricos , Humanos , Servicios de Salud Rural/organización & administración , Terrorismo , Tuberculosis Pulmonar/epidemiología , GuerraRESUMEN
We aimed to provide a prioritized list of preventive, diagnostic and therapeutic procedures and their appropriate classification based on a cost-benefit analysis. Functional benchmarking was used to select a rationing model. Teams of qualified specialists working in community hospitals scored procedures from CPT according to their cost and benefit elements. The prioritized list of services model of Oregon, United States of America was selected as the functional benchmark. In contrast to its benchmark, our country's prioritized list of services is primarily designed to help the government in policy-making with the rationing of health care resources, especially for hospitals.