Shiloh
Editor, Senior Moderator
Source: http://www.zn.kiev.ua/3000/3450/63320/
Google translation :
Institutionalized epidemic
Author: Lydia SURZHIK
June 27, 2008
In recent times it is very difficult given each step, but he could not afford to go, with the cane. And although pester the unbearable pain, eyes radiating zhiznelyubie vosmidesyatiletnego professor and wisdom. The brave struggle with illness, loved to joke and "starorezhimnoy" habit, health, kissed ladies hand. A few days before his fatigue stopped beating heart, went to the editor - has brought materials and documents to the planned publication. "Oh, now my burden has become easier ..." - smiled, taking a hand in the portfolio, and headed to the Ministry of Health to send a letter and a folder with documents rotund Minister V. Knyazevichu. Until the last days of his life professor Schutsky tirelessly worked as adviser to the National Commission on Radiation Protection in Ukraine; many years of experience with the treatment of pulmonary tuberculosis, actively participated in the development of several bills to address the epidemic of tuberculosis (TB) in Ukraine, particularly nationwide programme to combat disease TB and multi overcome tuberculosis epidemic, "On Amendments to the Law of Ukraine" On the fight against tuberculosis ", prepared a methodical manual" Protect yourself from TB ". Much hope is vested in a meeting with the minister to convey to the current leadership healthcare industry, all these developments own vision and strategies to overcome the epidemic, which has become rampant in Ukraine. Especially his concern spread himiorezistentnogo (antimikobakterialnym resistant to drugs), tuberculosis, which resist the medicine sometimes powerless. A thorough understanding of the situation, to the intransigence of bureaucracy and chinovnichey myopia prompted Professor I. Schutskogo and his colleague Professor V. Kalinu speak of a lawsuit against the Ministry of Health - on the recognition of wrongful order MOH № 610 from November 15, 2005 "On introduction in Ukraine adapted DOTS - Strategy ". The District Administrative Court of Kiev, having considered the case, the Health Ministry acknowledged the above Order illegal and unenforced (District Administrative Court ruling Kiev № 5 / 55 dated 03.04.2008 town). To defend its truth in court, Ivan had to spend too much energy ...
During the epidemic threshold
Professor Schutsky and his minded were made not so much to the recommended WHO strategy to detect and treat tuberculosis as such (DOTS - Directli Observet Treatment Short course chemotherapie - short courses of chemotherapy; "clean" DOTS strategy was developed to developing countries in Africa and Asia, where there is no TB service and medical assistance for the majority of the population is unavailable), but against the blind and irresponsible copying its introduction in Ukraine. In doing so, reflects the specificity of epidemic situation in our country, a simplistic idea of the DOTS strategy, as such, which would "quickly and cheaply" to counter the epidemic, rather led to negative consequences, in particular, accelerate the destruction ftiziatricheskoy service, reduce it further, eliminating large quantities of anti institutions and sanatoriums. Introduction to Ukraine adapted so-called DOTS strategy, according to the plaintiffs, is a primitive "clean"-DOTS strategy, which added an individual event national programme. As the analysis of the results of introducing a pilot project in the Donetsk region, nearly all statistical indicators have been much worse compared to obscheukrainskimi. Moreover, a sharp increase in incidence occurred TB: if in early 1999, the absolute number of patients stood at 3203 Rights (64.2 per 100 thousand population), at the end of the experiment in 2003 - 4653 (97,8) in 2004 . - 4525 (96,1) in 2005 - 4816 (103,4), with the most severe cases were found, neglected forms of TB, with the massive allocation multipolirezistentnyh mycobacteria tuberculosis (MBT). In another pilot region (Kiev) also saw an increase in morbidity (at 12.3%) and mortality (from 8.7% in 2001 to 12.8% in 2005 - by 100 thousand population). Despite this, the Ministry of Health under pressure from interested individuals and organizations attempting to distribute the provalny experiment to the whole country. And despite the resolution Roundtable (22.02.06 of the city) with representatives of the Verkhovna Rada, government officials and the public, which, inter alia, observed: "Cancel order of the Ministry of Health of Ukraine № 610 of 15.11.2005 d." On the introduction in Ukraine adapted DOTS strategy ?...?
In his legal action professors Schutsky and V. I. Kalina noted that the implementation of an order 610 MZ № lead "to the total destruction ftiziatricheskoy service, rapid increases in TB incidence and mortality from raising it in two or three times". Concerns professionals reasonably far.
According to the statistics, the number of TB patients in Ukraine annually increases by 38-40 thousand people. In 2007, the incidence (according to the analytical-statistical handbook MZ "Tuberculosis in Ukraine") stood at 79.8 per 100 thousand and death rate - 22.6, whereas, for example, in such European countries as Germany, the figures equal, respectively, 8.00 and 1.00 in Italy - 7.00 and 1.00; Finland - 9.00 and 1.00; France - 12.00 and 1.00; USA - 5.00 and 0 , 52. According to the Institute phthisiology and pulmonology, to date in Ukraine about 90% of the adult population are carriers of the Office. In 2007, for the first time in the past ten years, the incidence of all forms of active tuberculosis in rural areas has exceeded that of urban residents.
In recent years, more and more recorded cases of loss of sensitivity to antimikobakterialnym mycobacteria tuberculosis drugs. To date himiorezistentnosti primary frequency is around 20% and secondary - 75%. Nearly 10% of patients, who first diagnosed tuberculosis, there multidrug resistance to TB drugs (TAP), that is to treat such patients virtually nothing. This situation, according to phthisiology, largely born irregular supply of medicines, lack of standardized treatment regimens, as well as rapid growth in the incidence of TB, in particular with multidrug-resistant to drugs, in places of detention. Each year in the penitentiary system of Ukraine, there are up to 12000 prisoners, the active form of TB patients. The rate of incidence of TB in prisons in about 50-70 times higher than the comparable figure among the civilian population. Correctional institutions have become rassadnik infection, from which it offset on the territory of Ukraine.
On the threatening situation with TB doctors raise the alarm-phthisiology, and show no concern about policy. Our penetrate the leading AIDS (although aware that the acquired immunodeficiency syndrome often die of tuberculosis), substitution therapy for drug addicts, a side vaccination against measles and rubella, while more than ten years we have raging epidemic of TB, which annually causes more than ten thousand lives - on the mortality rate from tuberculosis Ukraine ranks first in Europe!
Moreover, how would occasionally threatened us nor the threats of various epidemics, even pandemics (avian influenza, SARS - SARS, etc.), now the most common infectious disease that kills in the world, more people than from all infectious and parasitic diseases combined, is tuberculosis. In doing so, the highest rate of TB morbidity and mortality from him - among HIV-infected and AIDS patients.
As is known, since 1993, WHO declared that tuberculosis is a global threat. After a relatively brief period of stability in Eastern Europe and the former Soviet Union, the post opening and clinical application of anti-TB drugs, suffered a collapse of utopian hopes for the elimination of this insidious disease.
In Ukraine the situation with tuberculosis began to cause concern doctors since 1990. In 1993 I held a congress phthisiology pulmonology and Ukraine, where scientists and clinicians-doctors noted the negative trends in epidpokazatelyah. Congress sent the appropriate treatment the president, Cabinet Ministers and the Verkhovna Rada. Experts warned: if the government does not take decisive action, the situation is and will continue to deteriorate. However, no reply had been received and has already happened in two years what the doctors warned: irresistible invasion hordes sticks so-called Koch exceeded the epidemic threshold. Since then, all we are in the zone of high risk for tuberculosis.
According to the Health Ministry, now accounting for dispansernom is 585110 people. Incidentally, in 2000 they numbered 660820. Strangely, is not it? While the epidemic situation has developed all these years in the ascending (see chart), the MOH statistics, there is the opposite trend. Interestingly, which disappeared nearly one hundred thousand patients who previously were on dispansernom accounting? Cured or ...? Maybe contingent joined those who generally turned attention away from anti agencies? How many of them - nobody knows no dopodlinno. However, experts estimated, the number of patients may reach a million, because of medical statistics do not enter a person without a certain place of residence, illegal migrants and some other categories of the population, in particular, released from prison. In Ukraine has still not created a single roster of TB patients, so no one owns reliable information on how many people actually have suffered from tuberculosis infection.
But even the existing official statistics sufficient to the level of incidence of TB Ukraine took second place in Europe, second only to Russia this indicator. In 16 countries (of 61) of the European region, WHO tuberculosis recognized the situation critical. Here is the list: the Russian Federation, Ukraine, Romania, Uzbekistan, Kazakhstan, Belarus, Kyrgyzstan, Tajikistan, Moldova, Azerbaijan, Turkmenistan, Lithuania, Georgia, Latvia, Armenia, Estonia.
Wand Koch laws do not write
Given that an epidemic of tuberculosis in Ukraine on criteria registered with the WHO in 1995, the first reaction to an adequate level of state leadership came only a few years, when the Cabinet of Ministers adopted a decree "On comprehensive measures to combat tuberculosis" (1999). In 2000, the Verkhovna Rada adopted the Law of Ukraine "On protect the population from infectious diseases", and the president signed a decree "On urgent measures to combat tuberculosis". Since 2001, started centralized procurement tender antimikobakterialnyh drugs, in some medical institutions have digital fluorography. It would seem, off the ice - the power finally realized that tuberculosis is a national threat.
In recent years, Ukraine established legal and regulatory framework aimed at overcoming the epidemic of this dangerous social disease - the list of relevant laws, presidential decrees, orders and orders KM MOH took a few pages printed font. Moreover - a national program to counter tuberculosis in 2007-2011. Verkhovna Rada approved the law. However, despite a solid legislative and regulatory framework, any tangible progress in overcoming the epidemic has not yet been observed. One of the doctors on this occasion ironically remarked deskat, Wand Koch lives of its laws, and it "sneeze" on programs and laws passed by the Verkhovna Rada.
"The fact is that in this program the main method of diagnosis of TB is defined timely laboratory diagnosis of TB using" smear sputum microscopy method ", which detects TB bacilli only at 30-40%. It is also to bring the number of identified using a method called TB cases among the first cases, up to 50%. Bacteriological method (seeding) reveals MBT up to 70-80%, and together with rentgenoflyuorografiey - up to 90%. That is, the program offers the least effective method of diagnosing TB. WHO in 2006 introduced a new strategy ( "Stop-TB Strategy"), in which bacteriological method for identifying TB is a major. -- And further: - The National Programme ... and annex "The goals and activities for 2007 - 2011's. to overcome tuberculosis epidemic "set out like theses CPSU Central Committee ... There are no deadlines, most activities are not mentioned funding. Only six of 30 - ty urgent action is defined indicative level of funding, only one - of the first, and most did not specify how the recommended measures would be financed. This is - fertile ground for manual control and use of financing the state budget for other purposes ", - this view was of Professor I. Schutsky.
Specialists point-phthisiology well as other serious shortcomings. Financing programs are not provided a separate line item in the State budget and included in the budget program "Providing medical measures to combat tuberculosis, AIDS prevention and treatment, treatment of cancer patients". In doing so, budgetary costs provided for 2008, grouped under the same classification codes, in particular, the purchase of test-systems, medicines, medical supplies and medical equipment. That is not funded activities nationwide program, but only individual purchases within the stipulated costs.
Very concerned phthisiology existing order, to be precise - disorder, in providing anti-drugs agencies. Thus, in particular, funding anti-TB drugs procurement in 2008 in the cost of Ukraine's state budget provided for only the second half. Thus, the necessary medicines can get to health facilities in the best case in August. In doing so, none of the officials is not responsible for what causes such erroneous practices - in fact breaks in the treatment of certain patient Drug entail the development of resistant (sometimes deadly) form of tuberculosis. Incidentally, this problem - himiorezistentnogo TB - specialists not in vain called Man.
-- Each year, TB drugs delivered to hospitals late in the second half of the year - said the deputy director of the Institute of phthisiology and pulmonology them. F. Yanovskogo professor Vasily Melnik. -- This leads to the fact that treatment was suspended ... In such a situation, we create a reserve of prohibited drugs, albeit at the request of WHO, we need to have an annual reserve TAP. But our bureaucratic system is unwavering.
-- And while Ukraine TAP buys five times more expensive compared to world prices. Why does it happen?
-- When WHO experts examined, at what price we bought the drugs were very surprised. For example, rifampicin almost five-fold, other drugs in three to four times more expensive than world prices. WHO publishes a compendium, which is the price of all TAP (as a guide). A Ukraine buys on those prices, which actually set firmachi.
-- And what producers?
-- Manufacturer mainly Indian ...
-- Is domestic farmindustriya does not produce anti-TB drugs?
-- We have released all TAP and even the first row of the second. We have repeatedly questioned the state order. For example, to transfer budget funds farmpredpriyatiyam, produces isoniazid, rifampicin and others TAP, and they would provide them with medical institutions. But this arrangement does not suit many, and it is understandable why ... Recently, at a meeting in Ivano-Frankivsk again raised this serious problem. Representatives from different regions provided funds for the TAP (in the form of grants) - on the ground better know that and how much you want to buy. But at the Ministry of Health is not a question, arguing its position that, deskat will abuse ...
How many State allocates funds for the programme to combat tuberculosis? According to information provided by the MOH, in 2007 on the implementation of the national programme Ministry has been allocated 200 million 181.8 thousand UAH. Half of this amount (100 million hryvnas.) Was spent on the purchase of equipment. At 99 million 32.8 thousand UAH. anti-TB drugs purchased, at 1 million 149 thousand UAH. tuberculin purchased. Overall costs of the program execution has improved significantly, believe in the ministry. Compared with the year 2006 funding increased by almost half. Last year, all agencies have been provided with anti-TAP to the budget in full. At the same time, the MOH must recognize that logistics anti institutions leaves much to be desired. In many cases facilities are not designed to treat patients and do not meet sanitary standards legislation. Not all agencies TB service is local Sewage-treatment plants. Only in some institutions have anti-secession boksirovannye himiorezistentnogo to treat tuberculosis. Now many such patients die at home. In doing so, provided extremely virulence, aggressive TB bacilli, which leads to infection of others.
The Ministry of Health does not know where to Share five million? ..
According to specialists, annual losses from tuberculosis epidemic in Ukraine on two and a half billion UAH. In the future the situation will depend on the level of economic development, welfare and education of our people (up to 85% of all causes), the availability of health and completeness of the anti-medical activities (15%).
Regarding public awareness of tuberculosis, it is clearly insufficient to protect themselves and their loved ones from the risk of infection.
"A study conducted in Kiev, Donetsk and other cities, showed that 70% of the population has virtually no representation, that is tuberculosis. What's not surprising - today there are no effective sanitation and educational tools that could convey to people is very important for them information. Advising people - the weak link, which is not funded, - considers the Chief Coordinator of Kiev L. Turchenko. -- Doctors also common practice, unfortunately, not always know what the early symptoms of TB. We have had a big information campaign among health care workers directly involved in identifying and treating TB. For medical care is often treated those who are already in the midst of disease - now in Kiev find infected every second with bakteriovydeleniyami. Incidentally, before this campaign revealed only isolated cases ".
A significant drawback acting nationwide program to counter tuberculosis doctors believe the lack of spending on public awareness about the dangers of TB. To date, this is not provided for a penny. Interestingly, at informational meetings on HIV / AIDS in 2008
The Ministry of Health has allocated some four million hryvnias (in addition, three million 750 thousand hryvnias gives the World Bank).
On the issue of the "ZN" what is preventive work on the proliferation of socially dangerous infections, but funds allocated to this, the Committee to counter HIV / AIDS and other socially dangerous diseases MOH responded quite evasive, providing brief information. It can be found in particular that last year "was carried out considerable work to ensure the implementation of awareness programmes, interactive forms of work to gain knowledge and life skills to reduce the vulnerability to infection of tuberculosis". The following are actual figures on the number of press publications (over 1020 articles), features on radio and television. (Interestingly, include whether the article in the Health Ministry reporting?) Of the help provided can be concluded that prevention activities in 2008 will be aimed primarily at information campaign on HIV / AIDS. In the first half of this year, the MOH has planned to develop and submit to the Cabinet a draft decree "On a national strategy mediaraboty of HIV / AIDS".
During the meeting with the committee chaired by Professor V. Petrenko asked, as the Ministry ordered five million hryvnias, which have been severed in 2007 on preventive and educational work. Vasily Ivanovich said that won a tender from domestic firms, has made videos, although their quality is that shameful display. "That was the end of the year, it was necessary to use those funds. Mediabratiya receptive to this is not very good faith ", - summarized V. Petrenko.
-- Representatives of some social organizations consider that a commercial structure on the media summit on HIV / AIDS in the capital beautiful hotel just went and budgetary money.
-- I think we sort things ...
With regard to "explain", there is great doubt. It is clear only that dispose of funds allocated to the implementation of government programmes, MOH officials should not in its sole discretion, but under the vigilant control of the supervisory board, composed of civic organizations, media representatives and other interested parties. Maybe with this and should start countering the epidemic? Otherwise, stick Koch will continue to dictate to us their laws.
Google translation :
Institutionalized epidemic
Author: Lydia SURZHIK
June 27, 2008
In recent times it is very difficult given each step, but he could not afford to go, with the cane. And although pester the unbearable pain, eyes radiating zhiznelyubie vosmidesyatiletnego professor and wisdom. The brave struggle with illness, loved to joke and "starorezhimnoy" habit, health, kissed ladies hand. A few days before his fatigue stopped beating heart, went to the editor - has brought materials and documents to the planned publication. "Oh, now my burden has become easier ..." - smiled, taking a hand in the portfolio, and headed to the Ministry of Health to send a letter and a folder with documents rotund Minister V. Knyazevichu. Until the last days of his life professor Schutsky tirelessly worked as adviser to the National Commission on Radiation Protection in Ukraine; many years of experience with the treatment of pulmonary tuberculosis, actively participated in the development of several bills to address the epidemic of tuberculosis (TB) in Ukraine, particularly nationwide programme to combat disease TB and multi overcome tuberculosis epidemic, "On Amendments to the Law of Ukraine" On the fight against tuberculosis ", prepared a methodical manual" Protect yourself from TB ". Much hope is vested in a meeting with the minister to convey to the current leadership healthcare industry, all these developments own vision and strategies to overcome the epidemic, which has become rampant in Ukraine. Especially his concern spread himiorezistentnogo (antimikobakterialnym resistant to drugs), tuberculosis, which resist the medicine sometimes powerless. A thorough understanding of the situation, to the intransigence of bureaucracy and chinovnichey myopia prompted Professor I. Schutskogo and his colleague Professor V. Kalinu speak of a lawsuit against the Ministry of Health - on the recognition of wrongful order MOH № 610 from November 15, 2005 "On introduction in Ukraine adapted DOTS - Strategy ". The District Administrative Court of Kiev, having considered the case, the Health Ministry acknowledged the above Order illegal and unenforced (District Administrative Court ruling Kiev № 5 / 55 dated 03.04.2008 town). To defend its truth in court, Ivan had to spend too much energy ...
During the epidemic threshold
Professor Schutsky and his minded were made not so much to the recommended WHO strategy to detect and treat tuberculosis as such (DOTS - Directli Observet Treatment Short course chemotherapie - short courses of chemotherapy; "clean" DOTS strategy was developed to developing countries in Africa and Asia, where there is no TB service and medical assistance for the majority of the population is unavailable), but against the blind and irresponsible copying its introduction in Ukraine. In doing so, reflects the specificity of epidemic situation in our country, a simplistic idea of the DOTS strategy, as such, which would "quickly and cheaply" to counter the epidemic, rather led to negative consequences, in particular, accelerate the destruction ftiziatricheskoy service, reduce it further, eliminating large quantities of anti institutions and sanatoriums. Introduction to Ukraine adapted so-called DOTS strategy, according to the plaintiffs, is a primitive "clean"-DOTS strategy, which added an individual event national programme. As the analysis of the results of introducing a pilot project in the Donetsk region, nearly all statistical indicators have been much worse compared to obscheukrainskimi. Moreover, a sharp increase in incidence occurred TB: if in early 1999, the absolute number of patients stood at 3203 Rights (64.2 per 100 thousand population), at the end of the experiment in 2003 - 4653 (97,8) in 2004 . - 4525 (96,1) in 2005 - 4816 (103,4), with the most severe cases were found, neglected forms of TB, with the massive allocation multipolirezistentnyh mycobacteria tuberculosis (MBT). In another pilot region (Kiev) also saw an increase in morbidity (at 12.3%) and mortality (from 8.7% in 2001 to 12.8% in 2005 - by 100 thousand population). Despite this, the Ministry of Health under pressure from interested individuals and organizations attempting to distribute the provalny experiment to the whole country. And despite the resolution Roundtable (22.02.06 of the city) with representatives of the Verkhovna Rada, government officials and the public, which, inter alia, observed: "Cancel order of the Ministry of Health of Ukraine № 610 of 15.11.2005 d." On the introduction in Ukraine adapted DOTS strategy ?...?
In his legal action professors Schutsky and V. I. Kalina noted that the implementation of an order 610 MZ № lead "to the total destruction ftiziatricheskoy service, rapid increases in TB incidence and mortality from raising it in two or three times". Concerns professionals reasonably far.
According to the statistics, the number of TB patients in Ukraine annually increases by 38-40 thousand people. In 2007, the incidence (according to the analytical-statistical handbook MZ "Tuberculosis in Ukraine") stood at 79.8 per 100 thousand and death rate - 22.6, whereas, for example, in such European countries as Germany, the figures equal, respectively, 8.00 and 1.00 in Italy - 7.00 and 1.00; Finland - 9.00 and 1.00; France - 12.00 and 1.00; USA - 5.00 and 0 , 52. According to the Institute phthisiology and pulmonology, to date in Ukraine about 90% of the adult population are carriers of the Office. In 2007, for the first time in the past ten years, the incidence of all forms of active tuberculosis in rural areas has exceeded that of urban residents.
In recent years, more and more recorded cases of loss of sensitivity to antimikobakterialnym mycobacteria tuberculosis drugs. To date himiorezistentnosti primary frequency is around 20% and secondary - 75%. Nearly 10% of patients, who first diagnosed tuberculosis, there multidrug resistance to TB drugs (TAP), that is to treat such patients virtually nothing. This situation, according to phthisiology, largely born irregular supply of medicines, lack of standardized treatment regimens, as well as rapid growth in the incidence of TB, in particular with multidrug-resistant to drugs, in places of detention. Each year in the penitentiary system of Ukraine, there are up to 12000 prisoners, the active form of TB patients. The rate of incidence of TB in prisons in about 50-70 times higher than the comparable figure among the civilian population. Correctional institutions have become rassadnik infection, from which it offset on the territory of Ukraine.
On the threatening situation with TB doctors raise the alarm-phthisiology, and show no concern about policy. Our penetrate the leading AIDS (although aware that the acquired immunodeficiency syndrome often die of tuberculosis), substitution therapy for drug addicts, a side vaccination against measles and rubella, while more than ten years we have raging epidemic of TB, which annually causes more than ten thousand lives - on the mortality rate from tuberculosis Ukraine ranks first in Europe!
Moreover, how would occasionally threatened us nor the threats of various epidemics, even pandemics (avian influenza, SARS - SARS, etc.), now the most common infectious disease that kills in the world, more people than from all infectious and parasitic diseases combined, is tuberculosis. In doing so, the highest rate of TB morbidity and mortality from him - among HIV-infected and AIDS patients.
As is known, since 1993, WHO declared that tuberculosis is a global threat. After a relatively brief period of stability in Eastern Europe and the former Soviet Union, the post opening and clinical application of anti-TB drugs, suffered a collapse of utopian hopes for the elimination of this insidious disease.
In Ukraine the situation with tuberculosis began to cause concern doctors since 1990. In 1993 I held a congress phthisiology pulmonology and Ukraine, where scientists and clinicians-doctors noted the negative trends in epidpokazatelyah. Congress sent the appropriate treatment the president, Cabinet Ministers and the Verkhovna Rada. Experts warned: if the government does not take decisive action, the situation is and will continue to deteriorate. However, no reply had been received and has already happened in two years what the doctors warned: irresistible invasion hordes sticks so-called Koch exceeded the epidemic threshold. Since then, all we are in the zone of high risk for tuberculosis.
According to the Health Ministry, now accounting for dispansernom is 585110 people. Incidentally, in 2000 they numbered 660820. Strangely, is not it? While the epidemic situation has developed all these years in the ascending (see chart), the MOH statistics, there is the opposite trend. Interestingly, which disappeared nearly one hundred thousand patients who previously were on dispansernom accounting? Cured or ...? Maybe contingent joined those who generally turned attention away from anti agencies? How many of them - nobody knows no dopodlinno. However, experts estimated, the number of patients may reach a million, because of medical statistics do not enter a person without a certain place of residence, illegal migrants and some other categories of the population, in particular, released from prison. In Ukraine has still not created a single roster of TB patients, so no one owns reliable information on how many people actually have suffered from tuberculosis infection.
But even the existing official statistics sufficient to the level of incidence of TB Ukraine took second place in Europe, second only to Russia this indicator. In 16 countries (of 61) of the European region, WHO tuberculosis recognized the situation critical. Here is the list: the Russian Federation, Ukraine, Romania, Uzbekistan, Kazakhstan, Belarus, Kyrgyzstan, Tajikistan, Moldova, Azerbaijan, Turkmenistan, Lithuania, Georgia, Latvia, Armenia, Estonia.
Wand Koch laws do not write
Given that an epidemic of tuberculosis in Ukraine on criteria registered with the WHO in 1995, the first reaction to an adequate level of state leadership came only a few years, when the Cabinet of Ministers adopted a decree "On comprehensive measures to combat tuberculosis" (1999). In 2000, the Verkhovna Rada adopted the Law of Ukraine "On protect the population from infectious diseases", and the president signed a decree "On urgent measures to combat tuberculosis". Since 2001, started centralized procurement tender antimikobakterialnyh drugs, in some medical institutions have digital fluorography. It would seem, off the ice - the power finally realized that tuberculosis is a national threat.
In recent years, Ukraine established legal and regulatory framework aimed at overcoming the epidemic of this dangerous social disease - the list of relevant laws, presidential decrees, orders and orders KM MOH took a few pages printed font. Moreover - a national program to counter tuberculosis in 2007-2011. Verkhovna Rada approved the law. However, despite a solid legislative and regulatory framework, any tangible progress in overcoming the epidemic has not yet been observed. One of the doctors on this occasion ironically remarked deskat, Wand Koch lives of its laws, and it "sneeze" on programs and laws passed by the Verkhovna Rada.
"The fact is that in this program the main method of diagnosis of TB is defined timely laboratory diagnosis of TB using" smear sputum microscopy method ", which detects TB bacilli only at 30-40%. It is also to bring the number of identified using a method called TB cases among the first cases, up to 50%. Bacteriological method (seeding) reveals MBT up to 70-80%, and together with rentgenoflyuorografiey - up to 90%. That is, the program offers the least effective method of diagnosing TB. WHO in 2006 introduced a new strategy ( "Stop-TB Strategy"), in which bacteriological method for identifying TB is a major. -- And further: - The National Programme ... and annex "The goals and activities for 2007 - 2011's. to overcome tuberculosis epidemic "set out like theses CPSU Central Committee ... There are no deadlines, most activities are not mentioned funding. Only six of 30 - ty urgent action is defined indicative level of funding, only one - of the first, and most did not specify how the recommended measures would be financed. This is - fertile ground for manual control and use of financing the state budget for other purposes ", - this view was of Professor I. Schutsky.
Specialists point-phthisiology well as other serious shortcomings. Financing programs are not provided a separate line item in the State budget and included in the budget program "Providing medical measures to combat tuberculosis, AIDS prevention and treatment, treatment of cancer patients". In doing so, budgetary costs provided for 2008, grouped under the same classification codes, in particular, the purchase of test-systems, medicines, medical supplies and medical equipment. That is not funded activities nationwide program, but only individual purchases within the stipulated costs.
Very concerned phthisiology existing order, to be precise - disorder, in providing anti-drugs agencies. Thus, in particular, funding anti-TB drugs procurement in 2008 in the cost of Ukraine's state budget provided for only the second half. Thus, the necessary medicines can get to health facilities in the best case in August. In doing so, none of the officials is not responsible for what causes such erroneous practices - in fact breaks in the treatment of certain patient Drug entail the development of resistant (sometimes deadly) form of tuberculosis. Incidentally, this problem - himiorezistentnogo TB - specialists not in vain called Man.
-- Each year, TB drugs delivered to hospitals late in the second half of the year - said the deputy director of the Institute of phthisiology and pulmonology them. F. Yanovskogo professor Vasily Melnik. -- This leads to the fact that treatment was suspended ... In such a situation, we create a reserve of prohibited drugs, albeit at the request of WHO, we need to have an annual reserve TAP. But our bureaucratic system is unwavering.
-- And while Ukraine TAP buys five times more expensive compared to world prices. Why does it happen?
-- When WHO experts examined, at what price we bought the drugs were very surprised. For example, rifampicin almost five-fold, other drugs in three to four times more expensive than world prices. WHO publishes a compendium, which is the price of all TAP (as a guide). A Ukraine buys on those prices, which actually set firmachi.
-- And what producers?
-- Manufacturer mainly Indian ...
-- Is domestic farmindustriya does not produce anti-TB drugs?
-- We have released all TAP and even the first row of the second. We have repeatedly questioned the state order. For example, to transfer budget funds farmpredpriyatiyam, produces isoniazid, rifampicin and others TAP, and they would provide them with medical institutions. But this arrangement does not suit many, and it is understandable why ... Recently, at a meeting in Ivano-Frankivsk again raised this serious problem. Representatives from different regions provided funds for the TAP (in the form of grants) - on the ground better know that and how much you want to buy. But at the Ministry of Health is not a question, arguing its position that, deskat will abuse ...
How many State allocates funds for the programme to combat tuberculosis? According to information provided by the MOH, in 2007 on the implementation of the national programme Ministry has been allocated 200 million 181.8 thousand UAH. Half of this amount (100 million hryvnas.) Was spent on the purchase of equipment. At 99 million 32.8 thousand UAH. anti-TB drugs purchased, at 1 million 149 thousand UAH. tuberculin purchased. Overall costs of the program execution has improved significantly, believe in the ministry. Compared with the year 2006 funding increased by almost half. Last year, all agencies have been provided with anti-TAP to the budget in full. At the same time, the MOH must recognize that logistics anti institutions leaves much to be desired. In many cases facilities are not designed to treat patients and do not meet sanitary standards legislation. Not all agencies TB service is local Sewage-treatment plants. Only in some institutions have anti-secession boksirovannye himiorezistentnogo to treat tuberculosis. Now many such patients die at home. In doing so, provided extremely virulence, aggressive TB bacilli, which leads to infection of others.
The Ministry of Health does not know where to Share five million? ..
According to specialists, annual losses from tuberculosis epidemic in Ukraine on two and a half billion UAH. In the future the situation will depend on the level of economic development, welfare and education of our people (up to 85% of all causes), the availability of health and completeness of the anti-medical activities (15%).
Regarding public awareness of tuberculosis, it is clearly insufficient to protect themselves and their loved ones from the risk of infection.
"A study conducted in Kiev, Donetsk and other cities, showed that 70% of the population has virtually no representation, that is tuberculosis. What's not surprising - today there are no effective sanitation and educational tools that could convey to people is very important for them information. Advising people - the weak link, which is not funded, - considers the Chief Coordinator of Kiev L. Turchenko. -- Doctors also common practice, unfortunately, not always know what the early symptoms of TB. We have had a big information campaign among health care workers directly involved in identifying and treating TB. For medical care is often treated those who are already in the midst of disease - now in Kiev find infected every second with bakteriovydeleniyami. Incidentally, before this campaign revealed only isolated cases ".
A significant drawback acting nationwide program to counter tuberculosis doctors believe the lack of spending on public awareness about the dangers of TB. To date, this is not provided for a penny. Interestingly, at informational meetings on HIV / AIDS in 2008
The Ministry of Health has allocated some four million hryvnias (in addition, three million 750 thousand hryvnias gives the World Bank).
On the issue of the "ZN" what is preventive work on the proliferation of socially dangerous infections, but funds allocated to this, the Committee to counter HIV / AIDS and other socially dangerous diseases MOH responded quite evasive, providing brief information. It can be found in particular that last year "was carried out considerable work to ensure the implementation of awareness programmes, interactive forms of work to gain knowledge and life skills to reduce the vulnerability to infection of tuberculosis". The following are actual figures on the number of press publications (over 1020 articles), features on radio and television. (Interestingly, include whether the article in the Health Ministry reporting?) Of the help provided can be concluded that prevention activities in 2008 will be aimed primarily at information campaign on HIV / AIDS. In the first half of this year, the MOH has planned to develop and submit to the Cabinet a draft decree "On a national strategy mediaraboty of HIV / AIDS".
During the meeting with the committee chaired by Professor V. Petrenko asked, as the Ministry ordered five million hryvnias, which have been severed in 2007 on preventive and educational work. Vasily Ivanovich said that won a tender from domestic firms, has made videos, although their quality is that shameful display. "That was the end of the year, it was necessary to use those funds. Mediabratiya receptive to this is not very good faith ", - summarized V. Petrenko.
-- Representatives of some social organizations consider that a commercial structure on the media summit on HIV / AIDS in the capital beautiful hotel just went and budgetary money.
-- I think we sort things ...
With regard to "explain", there is great doubt. It is clear only that dispose of funds allocated to the implementation of government programmes, MOH officials should not in its sole discretion, but under the vigilant control of the supervisory board, composed of civic organizations, media representatives and other interested parties. Maybe with this and should start countering the epidemic? Otherwise, stick Koch will continue to dictate to us their laws.
