In 2022, tuberculosis (TB) was responsible for 1.3 million deaths worldwide.[1] Prior to the COVID-19 pandemic and the Ukraine conflict, Poland experienced a 6 percent annual decrease in TB rates, with an incidence rate of 15 cases per 100 000 people in 2019.[2] In 2020, Poland reported 3,388 TB cases, including 38 cases of multidrug-resistant TB (MDR-TB).[3] However, the number of TB cases in Poland increased to 4,314 by 2022, including 126 cases of drug-resistant TB (DR-TB), following the arrival of Ukrainian refugees, among whom TB is more prevalent.[4] Of the estimated 230 Ukrainian refugees with DR-TB in Poland, only 46 were undergoing treatment.[5] Factors such as differences in healthcare systems, language barriers, TB-related stigma, and prolonged hospitalizations have hindered refugees, especially single parents, from seeking medical help.[6] In response to these challenges and the constraints of a hospital-centric approach that lacked outpatient treatment for DR-TB, Poland adopted a patient-centred model. This shift introduced a new home-based, oral treatment regimen recommended by WHO, which is particularly beneficial for DR-TB patients. This change has not only addressed the needs arising from the refugee crisis, but also facilitated quicker diagnosis and treatment, and improved treatment adherence for all patients. This work contributes to strengthening capacity and health system resilience and integrating essential health care services into primary health care, all part of the national health response. It is a strong example of implementing “Delivering United Action for Better Health – a strategy for collaboration between the WHO Regional Office for Europe and Member States in the WHO European Region,” through mobilizing WHO’s skill, knowledge and expertise to improve health outcomes for all.

“The project highlights the bold action and commitment of the Polish health authorities in undertaking new measures to treat this old disease. We expect the new model to result in better treatment outcomes, saving more lives and reducing suffering.”

- Dr Nino Berdzuli, WHO Representative to Poland and Special Envoy for the Ukraine Emergency Response in refugee-hosting countries

How did Poland, with the support of WHO, achieve this?

TB, a treatable and curable disease, requires timely and accurate diagnosis for effective management, as well as continuous access to medication. In Poland, TB treatment is free for both citizens and refugees. To improve access to treatment, Poland aimed to shift towards a patient-centred approach, allowing foreign nationals and Ukrainian refugees to receive recommended treatment at home, reducing the need for hospital stays, and tackling associated stigma.

In June 2022, WHO formed a multiagency partnership to support Ukrainian refugees and provide innovative TB treatment solutions in Poland. This collaboration included the Polish Institute of Tuberculosis and Lung Diseases, the Polish Respiratory Society, Doctors without Borders (MSF), the Governmental Strategic Reserves Agency, and the health ministries of Poland and Ukraine.

WHO promoted information exchange between the Ukrainian National TB Program and the Polish Institute of Tuberculosis and Lung Diseases, to enhance TB knowledge and coordination. WHO also provided technical support in drafting policy documents and establishing Poland’s National TB Consilium. This clinical consultation body has transformed clinical decision-making for complex TB cases, ensuring personalized care based on the latest scientific evidence.

WHO also donated previously scarce DR-TB treatment drugs including bedaquiline, delamanid and clofazimine in Poland. for a total of almost US$ 190,000, to be use for home therapy. By investing over US$ 660 000 in TB laboratory equipment and supplies, including acquiring GeneXpert testing machines, WHO significantly enhanced the capabilities of 14 TB laboratories. Additionally, the upgrade extended to the National Reference Laboratory for whole-genome sequencing of TB, used to predict drug resistance in order to guide DR-TB treatment and management.

^{A WHO expert discusses TB diagnosis with a laboratory technician at the laboratory of the Tuberculosis and Lung Diseases Treatment Unit at the Kuyavian-Pomeranian Pulmonology Centre in Bydgoszcz.}
Photo credit: WHO/Aleksander Binek

Capacity building through training sessions, funded and led by WHO technical experts, commenced in January 2023. These sessions sought to train medical specialists and health managers in utilizing new drugs and implementing patient-centred care models, according to WHO guidelines.

In Jaroszowiec, 39 km northwest of Kraków, which has become a refuge for many Ukrainians fleeing the war, a local hospital specializing in lung diseases became a pioneer in the new patient-centred care model.[7] This model proved effective for new and ongoing patients and served as a benchmark for other medical facilities treating patients with TB. Patients are monitored remotely through daily video calls where a medical professional observes them taking their medication correctly. The inclusion of video-supported outpatient treatment has modernized TB care, improving accessibility and continuity.

“To ensure adherence, patients are monitored remotely through daily video calls where a medical professional observes them taking their medication correctly. Being treated at home allows them to continue their work schedule, maintain social connections and live a regular life with minimal disruption. This is essential for the patients, especially refugees who are single mothers with nobody else to look after their children for months if they were to be hospitalized.”

- Dr Ivanna Mazur, Ukrainian pulmonologist and refugee from Ternopil who works for the Polish health system at the hospital

Overall, Poland’s approach has led to quicker TB diagnosis and treatment, better adherence, and improved outcomes, using innovative methods such as video-supported outpatient care. This progress showcases the evolution of the healthcare system in addressing patient needs, underpinned by international cooperation and a commitment to universal healthcare.