On Public health in prisons
From Russian discussions

One of the main issues concerning the quality of health care given in the prison system is deciding under which authority doctors working in prisons come under, which relates to the security clearance they have in correctional facilities. For this reason, in many countries, doctors in prisons come under the administration of the Ministry of Justice. The patients’ rights are primarily guaranteed by legal system, rather than by civilian doctors. The quality of medical care offered to prisoners therefore depends on the resolution of two issues: payments between health systems (civilian and penitentiary) and the respect of patient’s rights within penitentiary system. One of the challenges is, however, that health workers in Russian prisons earn less than their civilian counterparts, which means a high turn over.

Continued treatment after a prisoner-patient is released is an issue that has sparked many inter-ministerial discussions. A full spectrum analysis with regards to the needs of such patients is also necessary.

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On the Prognosis of TB epidemiology
From Russian discussions

There are well-known strategies for controlling tuberculosis, which, when implemented in a proper way, have proved to be effective. There is therefore no cause for panic, despite the fact that there have been changes in the clinical picture of the disease over the years. Focus should be placed on the improvement of health systems in countries and the formulation of appropriate policies to ensure the most effective response to the disease.

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On Vertical vs. horizontal approaches to global health challenges
From English discussions

National planning for HSS must be done in a comprehensive manner and not just during the call for proposals or to show results. Well-needed resources should be seen to catalyze HSS as well as influence policies indirectly.

There are countries that have been able to negotiate substantial support for horizontal programming. This could be due to the availability of strong structures in their health systems, which makes it possible for them to absorb the pressure of the ‘push’ factors. The GFATM ‘angle of approach’ should remain vertical, rather than ‘push’, and requires that these nations establish structures in order to catalyze HSS where these prove to be inadequate. However, a one-size-fits-all approach to tackling HSS issues does not take into account the varied realities between countries.

Even if these structures are not yet in place on the ground, it is possible to see where countries have made substantial efforts to establish them. As the GFATM encourages these efforts, this will eventually lead to the establishment of stronger health systems. The Fund should therefore focus on monitoring and implementing vertical programmes, while demanding that countries create the enabling environment for the absorption of the funds made available.

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