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Free Content Decentralising tuberculosis services from county tuberculosis dispensaries to township hospitals in China: an intervention study

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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 Chinaƕs poorly accessible areas, was feasible.
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Keywords: China; decentralisation; patient access; quality of care; township hospitals; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK 2: Guangxi Centre for Disease Control and Prevention, Nanning, China

Publication date: May 1, 2008

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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