Abstract
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.
Highlights
In 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
This restructuring process reflected the continuous health sector reform under the context of financial decentralization in China, including the establishment of the CDCs in early 2000. This whole process had witnessed the weakening of the clinical functions of the CDCs and redeployment of the TB control staff to the designated hospitals
The CDC staff seemed to agree with such criticism and suggested that integration could make the best of the public health strength of the CDC and the clinical strength of the hospital
Summary
In 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. 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. Integration of TB services into general health services Tuberculosis (TB) control is of great public health importance, in many low-and middleincome countries. Integration of TB services within public and private hospitals in many African countries has been achieved, this has been less successful in parts of Asia where hospitals were not included in initial plans for rapid TB service expansion [7]. In order to strengthen integration of DOTS within hospitals, a combination of strong individual commitment of health professionals, organizational supports, partnership governance, and relevant policy is required [9]
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