TB CONTROL POLICIES IN EUROPEAN COUNTRIES: INTERNATIONAL STANDARDS AND LOCAL PRACTICE OF THEIR IMPLEMENTATION
BACKGROUND. Ukraine belongs to countries with high level of tuberculosis (TB) incidence. Despite measures implemented by the state and non-governmental organizations (NGOs), the situation with the spread of TB stays alarming. MATERIAL AND METHODS. Analysis of legal acts, international standards, national reports and other official documents related to TB control was carried out for such countries as the UK, the Netherlands, Moldova, Romania, and Ukraine. RESULTS. All the European countries under consideration are running the DOTS approach (DOTS Directly Observed Treatment Short-Course), recommended by the WHO. The Netherlands and the UK have been using this approach for a long time (since 1970); and in the Netherlands resources are mobilized by the government and NGOs working both on the national and international levels. In Romania, Moldova, and Ukraine DOTS approach is not widely used and is implemented mostly in an adapted form. All the selected countries have national plans for TB control with clearly defined goals and ways to achieve them. However, while implementing TB control policy local features are taken into account: in the UK national policy is adjusted for implementation at the local level, in Moldova there are some local programs of TB control. The UK has introduce case managers for each patient with TB, Romania has the special managers to implement the national TB control program. Ukraine is characterized with fragmentary funding of TB control, lack of coordination mechanisms for the NGOs using international funds, which endangers the overall achievement of the policy goal. Ukraine's legislation contains provisions that interfere with implementation of current strategies to strengthen the health system in general and to improve TB control in particular. Currently, such local features as population mobility, poor coordination of TB control, inadequate attention to spread of TB among HIV-infected, drug resistance inhibit the implementation of internationally recognized standards for TB control in Ukraine. CONCLUSIONS. To adjust the Ukrainian TB control policies according to the European standards, it is needed to review the existing regulatory frameworks, to overcome the perception of HIV and TB as problems, which belong to different services, to strengthen management of TB control, and to implement the transparent financial mechanisms.