Abstract
BackgroundThere could be various stakeholders who influencing multidrug-resistant tuberculosis (MDR-TB) policy development and implementation, yet their attributes and roles remain unclear in practice. This study aimed to identify key stakeholders in the process of policy-making for MDR-TB control and prevention and to analyse the attributes and relationships of the stakeholders, providing evidence for further policy research on MDR-TB control.MethodsThis study was conducted from October 2018 to March 2019 and applied the stakeholder analysis guidelines and domestic stakeholder analysis. An initial candidate stakeholder list was developed by policy scanning. Ten experts were invited to identify these candidate stakeholders. The major attribute of these stakeholders were analysed using the Michell scoring method. Based on these results, the intertwined relationships among groups of stakeholders were analysed and mapped through a systematic scan of the policy and literature on MDR-TB control, as well as information obtained from the interviews.ResultsA list of 21 types of candidate stakeholders was developed after a literature review and policy scanning, of which 11 received 100% approval. After expert evaluation and identification (the total expert authority was 0.80), 19 categories of stakeholders were approved and included in the stakeholder analysis. We categorized all of the stakeholders into three groups: (i) definitive stakeholders who are mainly involved in administrative departments and the Provincial Center for Disease Control and Prevention (CDC); (ii) expectant stakeholders who are mainly involved with MDR-TB patients, clinical departments of TB hospitals at different levels, community health care facilities, prefectural CDC and charity organizations; and (iii) latent stakeholders who mainly involved family members and neighbours of MDR-TB patients and TB related products manufacturers. Government departments and higher-level CDCs have strong decision-making power in developing MDR-TB control policies whereas the recommendations from service providers and the concerns of patients should be considered.ConclusionsThe MDR-TB prevention system was a multistakeholder cooperation system that was mainly led by government stakeholders. Enhancing communications with front-line service providers and patients on their unmet needs and evidence-based suggestions would highly benefit policy-making of MDR-TB prevention and control.Graphical abstract
Highlights
There could be various stakeholders who influencing multidrug-resistant tuberculosis (MDR-TB) policy development and implementation, yet their attributes and roles remain unclear in practice
Identified stakeholders of MDR‐TB prevention and treatment A total of 152 studies and 120 policy documents related to MDR-TB prevention and treatment were collected and reviewed
According to the experts’ opinion, all the candidate stakeholders were approved, with a total of 17 candidate stakeholder categories receiving over 90% approval, including 11 categories receiving 100% approval. 4 candidate stakeholders had approval rates between 80 and 90%
Summary
There could be various stakeholders who influencing multidrug-resistant tuberculosis (MDR-TB) policy development and implementation, yet their attributes and roles remain unclear in practice. Multidrug-resistant tuberculosis (MDR-TB) refers to a type of TB that is resistant to two of the most effective first-line drugs: rifampicin and isoniazid [1]. According to a global TB report, MDR-TB continues to be a public health crisis [4]. It was estimated that there were 66 000 MDR-TB/RR (rifampicin-resistant)-TB patients per year in China and the estimated proportions of TB cases with MDR/RR-TB in newly diagnosed and previously treated TB cases were 7.1% and 23% in 2019, respectively [4]. The epidemic of drug-resistant tuberculosis is still a major threat to public health in China [4]
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