Tuberculosis control and surveillance in changing health reform in the Czech Republic

In the Czech Republic a centralized, governmentally budgeted and vertically structured health system has been reformed to a liberalized health system with fragmentation of organisation, responsibilities and funding after 1989. Tuberculosis (TB) control and TB surveillance followed the general health system reform and implementation of liberalized health insurance system. In the liberalized health system the feasibility and accessibility of methods of TB control rather improved. In contrary to that TB surveillance in the liberalized system suffered bu absence of vertical mechanisms ensuring the completeness and validity of data collected in a centralised notification system (recording and reporting system). The rate of control notification dropped up to 50%. TB surveillance was therefore supplemented in 1996 by vertically oriented mechanisms of the hygienic (public health) service. TB consultants were appointed at regional and mostly also on district level as part-time jobs of the hygienic service and entitled to supervise all notifications from the given region (district), particularly what regards completeness of bacteriological data. As a consequence complete and reliable reports on epidemiological situation are issued and an assessment of antituberculous chemotherapy of new TB cases is made by a regional cohort analysis starting 1st quarter 1998. TB situation in the Czech republic is regarded as stable, being under control, with a decreasing trend of bacteriologically confirmed TB cases and increasing trend of bacteriologically not confirmed pulmonary TB. The TB is slowly shifting to high risk groups of population.