Liu, Z., Newell, J., Walley, J.D., Wei, X., Li, R., Zou, G.
Background: Since 2004 the China Ministry of Health has required microscopy centres (MCs) to be set up in one third of township hospitals nationally, to improve the accessibility of sputum smear testing for tuberculosis (TB) in rural areas. The objective of this study was to assess the performance of MCs in Shandong province from both patient and provider perspectives. Methods: A survey of 245 TB suspects was conducted in 8 counties of Shandong stratified by MC performance. Seventy-two health providers and administrators were interviewed at the township and county levels. Results: General performance of MCs was poor. In 2006, the high and low performance groups checked on average 190 and 24 TB suspects, respectively. The majority of TB suspects who visited an MC did not have their sputum checked, or had it checked but without the result being recorded. TB suspects who visited an MC tended to live closer to it and have better knowledge of it than those who visited the county TB dispensary (CTD) directly. Patients with severe TB symptoms tended to go directly to the CTD. No significant difference in medical expenses before TB diagnosis or diagnostic delay was found between TB suspects who visited an MC and those who did not. Several reasons were identified: the policy tried to set up too many MCs regardless of transportation conditions; it lacked operational details; township hospitals had limited funding, qualified staff, and technical support from the CTD; and the existing referral incentive discouraged sputum checks at the MC. Conclusion: The national MC policy fell short of its goals in Shandong. Neither patients nor providers were interested in using MCs in their current form. Policy recommendations are made.
Wei, X.; Li, R.; Zou, G.; Walley, J.D.; Newell, J.; Liu, Z. Evaluating the policy of setting up microscopy centres at township hospitals in Shandong China: Experience from patients and providers. Health Policy (2010) 95 (2-3) 113-121. [DOI: 10.1016/j.healthpol.2009.11.014]