Decentralising tuberculosis services from county tuberculosis dispensaries to township hospitals in China: an intervention study.
SETTING: County tuberculosis (TB) dispensaries are the basic health care unit for the provision of TB services in China. In the rural hills of the western provinces of China, however, county centres are often far from patients' homes.
OBJECTIVE: To evaluate whether decentralisation would result in improvements in patient access to TB services while maintaining the quality of the DOTS strategy.
METHODS: The present study compared TB services that were decentralised to township hospitals with two comparable control groups where township hospitals continued to routinely refer suspects to the county TB dispensaries. Training and supervision of quality control were provided. Routine TB reporting data were reviewed. A questionnaire-based survey was conducted for 171 new TB patients enrolled from 1 April 2005 to 31 July 2006.
RESULTS: Patients in the decentralised group spent less on travel and treatment for TB. The TB case notification rates increased significantly in the decentralised group, but remained unchanged in the control groups. Compared with the control groups, the decentralised group had improved treatment outcomes after 16 months. A higher quality of care was also observed in the decentralised group.
CONCLUSION: The decentralised model showed better patient access and quality of care. The study demonstrated that decentralising TB services to the township level, especially vital in China's poorly accessible areas, was feasible. [Summaries available in French and Spanish].
The International Journal of Tuberculosis and Lung Disease (2008) 12 (5) 538-547