Evaluating the impact of decentralising tuberculosis microscopy services to rural township hospitals in Gansu Province, China
All 523 microscopy centres in the province completed an institutional survey regarding their performance
Abstract
Methods: Both quantitative and qualitative methods were used. All 523 MCs in the province completed an institutional survey regarding their performance. 4 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 4 counties.
Results: Gansu 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.
Conclusion: Microscopy 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.
This research is supported by the Department for International Development’s COMDIS-HSD Programme
Citation
Wei XiaoLin; Zou GuanYang; Hui Zhang; Li RenZhong; Walley, J.D.; Jiang ShiWen; Jia Yin; Jin ShuiGao; You Li; Qiang Sun; Newell, J.N.; Griffiths, S.; Wang LiXia. Evaluating the impact of decentralising tuberculosis microscopy services to rural township hospitals in Gansu Province, China. BMC Public Health (2011) 11 (1) 103. [DOI: 10.1186/1471-2458-11-103]