Elsevier

Health Policy

Volume 72, Issue 1, April 2005, Pages 93-104
Health Policy

What lessons can de drawn from tuberculosis (TB) Control in China in the 1990s?: An analysis from a health system perspective

https://doi.org/10.1016/j.healthpol.2004.06.009Get rights and content

Abstract

China has made a significant achievement in tackling the TB epidemic over the last decade, due largely to the implementation of directly-observed treatment strategy (DOT). The cure rate of TB cases reached more than 90% for registered TB patients. However, the case detection rate has, unfortunately, been very low (some 30%). Using available information, this paper identifies four main problems facing TB control in China, these are, low case finding, a substantial proportion of TB patients failing to complete standardised treatment, increased proportion of MDR TB patients, and lack of effective TB control among “floating populations”. The paper also analyses the possible causes of these problems associated with socio-economic barriers in care seeking, ineffectiveness of TB services, particularly in poor areas, lack of co-operation between health facilities, and weakness of political and financial commitments of local governments to TB control. The paper ends with the discussion of opportunities and challenges facing TB control and makes recommendations for further actions and research.

Section snippets

Background

China is faced with a serious epidemic of tuberculosis. There are over 5 million people with active TB and it is the leading infectious cause of mortality, resulting in 130,000 deaths annually. According to the nationwide TB epidemiological survey in 2000, about 550 million Chinese people are infected with Mycobacterium tuberculosis, of which 10% may develop TB clinically during their lives. Although, there are effective preventive measures available to stop these infected people from

Reform of health care system and analysis of its impact on service delivery

From the foundation of the People’s Republic of China to the economic reform launched in the late 1970s, the Chinese Communist Party and its government placed health care as one of its top priorities. Over the first three decades of the new People’s Republic, the provision of basic health care, particularly in relation to the control of infectious diseases, such as sexually transmitted disease (STD) and TB, was high on the government agenda. In the rural areas of China, a so-called three-tier

Achievements in TB control over the 1990s

There have been several significant achievements in TB control observed in China over the past decade. The IEDC project jointly funded by the World Bank and the Chinese government, and the MoH supported TB control project, have been an impetus leading TB control. A number of key achievements made in tackling the TB epidemic are as follows:

According to the official figures, the IEDC project provided some 9 million TB suspects with free diagnostic services. In the project county areas, about 2

Problems jeopardising effective TB control and their causes

There are a number of problems that have affected the effectiveness of TB control in China over the past decade. The first is a low case detection (case-finding) rate. As a whole, the case detection rate in China was probably around 30%, according to the 2000 survey3

Opportunities and challenges for next decade

TB control and prevention has in recent years been a top priority for the Chinese government with the support of many international organisations. After the completion of the IEDC project, the World Bank, working with the Department for International Development, UK, has helped the Chinese government to develop a new large TB control project with over US$ 200 million, covering 16 provinces (most of which are poor provinces) and almost half of the Chinese population. In 2002, the Global Fund

Suggestions and recommendations

This section offers some recommendations on developing more robust TB control measures and on the areas for further research towards effective TB control in China. Each recommendation is presented in order of priority.

The expansion of DOTS implementation to the whole country should be put as a top priority in the years to come, since the benefits of successful DOTS implementation in many parts of China have been demonstrated over the past decade. Particular efforts should be made to improve and

Acknowledgements

The authors of the paper would like to express their sincere appreciation to many people, particularly Zhao Fengzeng, Wang Lixia, Wang Xuejing, Zhou Jiqian, Gong Youlong, Meng Qingyue, Li Renzhong, Zhang Tuohong, Zhan Shaokang, Jiang Xiwen and Daniel Chin who have generously spent their valuable time to discuss issues and problems related to TB control in China, and shared their TB-related research materials and experiences with us. Comments from Rachel Tolhurst, Wang Xuejing and others are

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