Evaluating the policy of setting up microscopy centres at township hospitals in Shandong China: Experience from patients and providers

Zou

Zhang³

et al. 2011

BMC Public Health

Self Cite

BackgroundIn 2004, the Ministry of Health issued the policy of decentralising microscopy services (MCs) to one third of all township hospitals in China. The study was conducted in Gansu Province, a poor western one in China. Ganzhou was one county in Gansu Province. Ganzhou County was identified as a unique case of further decentralisation of tuberculosis (TB) treatment services in township hospitals. The study evaluated the impact of the MC policy on providers and patients in Gansu Province. The second objective was to assess the unique case of Ganzhou County compared with other counties in the province.MethodsBoth quantitative and qualitative methods were used. All 523 MCs in the province completed an institutional survey regarding their performance. Four counties were selected for in-depth investigation, where 169 TB suspects were randomly selected from the MC and county TB dispensary registers for questionnaire surveys. Informant interviews were conducted with 38 health staff at the township and county levels in the four counties.ResultsGansu established MCs in 39% of its township hospitals. From January 2006 to June 2007, 8% of MCs identified more than 10 TB sputum smear positive patients while 54% did not find any. MCs identified 1546 TB sputum smear positive patients, accounting for 9% of the total in the province. The throughputs of MCs in Ganzhou County were eight times of those in other counties. Interviews identified several barriers to implement the MC policy, such as inadequate health financing, low laboratory capacity, lack of human resources, poor treatment and management capacities, and lack of supervisions from county TB dispensaries.ConclusionMicroscopy centre throughputs were generally low in Gansu Province, and the contribution of MCs to TB case detection was insignificant taking account the number of MCs established. As a unique case of full decentralisation of TB service, Ganzhou County presented better results. However, standards and quality of TB care needed to be improved. The MC policy needs to be reviewed in light of evidence from this study.

“…The low throughputs of MCs may indicate an excessive number of MCs in the province. A similar problem was identified in another province implementing the same national policy [17]. …”

Section: Discussionsupporting

confidence: 55%

“…TB suspects here were defined as patients who had persistent cough for more than two weeks [7,16]. Questionnaires were developed based on a previous similar study [17] and revised by a national team. Questions included demographic information, social-economic status, knowledge regarding MCs, costs and delays to TB diagnosis.…”

Section: Methodsmentioning

confidence: 99%

Evaluating the impact of decentralising tuberculosis microscopy services to rural township hospitals in gansu province, china

Zou

Zhang³

et al. 2011

BMC Public Health

Self Cite

“…To date, a few studies in China have reported the experience of integrating TB services in the township hospitals (functioning as health centers) of Guangxi [20,21], Shandong [22,23] and Gansu provinces [24]. However, there is a lack of published evidence on the integration of TB care in the general hospitals.…”

Section: Integration Of Tb Services: From the Cdc Model To The Integrmentioning

confidence: 99%

Factors influencing integration of TB services in general hospitals in two regions of China: a qualitative study

Zou¹,

Walley

et al. 2012

BMC Health Serv Res

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BackgroundIn the majority of China, the Centre for Disease Control (CDC) at the county level provides both clinical and public health care for TB cases, with hospitals and other health facilities referring suspected TB cases to the CDC. In recent years, an integrated model has emerged, where the CDC remains the basic management unit for TB control, while a general hospital is designated to provide clinical care for TB patients. This study aims to explore the factors that influence the integration of TB services in general hospitals and generate knowledge to aid the scale-up of integration of TB services in China.MethodsThis study adopted a qualitative approach using interviews from sites in East and West China. Analysis was conducted using a thematic framework approach.ResultsThe more prosperous site in East China was more coordinated and thus had a better method of resource allocation and more patient-orientated service, compared with the poorer site in the West. The development of public health organizations appeared to influence how effectively integration occurred. An understanding from staff that hospitals had better capacity to treat TB patients than CDCs was a strong rationale for integration. However, the economic and political interests might act as a barrier to effective integration. Both sites shared the same challenges of attracting and retaining a skilled workforce for the TB services. The role of the health bureau was more directive in the Western site, while a more participatory and collaborative approach was adopted in the Eastern site.ConclusionThe process of integration identifies similarities and differences between sites in more affluent East China and poorer West China. Integration of TB services in the hospitals needs to address the challenges of stakeholder motivations and resource allocation. Effective inter-organizational collaboration could help to improve the efficiency and quality of TB service. Key words: TB control, service delivery, integration, hospitals, China.

“…In some counties, the TB programme provided US$ 0.4 to MCs per sputum slide checked. This encouraged MCs in those counties to check more slides regardless of whether they came from TB suspects (Wei et al. 2010).…”

Section: Discussionmentioning

confidence: 99%

“…Second, no guidelines were available for training outpatient doctors and laboratory technicians. A qualitative study in Shandong found that many outpatient doctors did not know how to identify TB suspects (Wei et al. 2010).…”

Section: Discussionmentioning

confidence: 99%

Implementation of the Chinese national microscopy centre policy: health facility survey in Shandong Province

Tropical Med Int Health

Zou

Zhang

et al. 2011

Self Cite

Summaryobjective In compliance with Chinese national policy, Shandong province set up microscopy centres (MCs) in one-third of all township hospitals where sputum smear microscopy is performed.We assessed the centres' performance and any factors influencing it.methods A cross-sectional, structured, facility-based questionnaire survey was conducted in 2006, collecting data from all 113 counties with established MCs as well as tuberculosis (TB) routine reporting data from the county TB dispensary.results One hundred and thirteen of 142 counties in Shandong had established 497 MCs. The centres identified 3.3% of smear-positive patients in the province. Sixty-six percentage of MCs did not identify any patients with TB; only 5% identified more than 10. Poor performance arose from low quality of staff training in township hospitals, but inappropriate geographical provision of services was the main cause of low additional case finding.conclusion The MC policy did not achieve its goal of improving TB case finding in Shandong.