SHANDONG UNIVERSITY- CHINA

Public Private partnership, hospitals-TB dispensaries - in China

Tuberculosis (TB) control has to engage all providers in the health system to achieve the targets of case detection and treatment success. This is because a sizable private and public health providers that are not included in the national TB DOTS programme do not fully apply standard guidelines of the DOTS programme. This problem results in substandard diagnosis and treatment of TB patients and may contribute to nurturing multi-drug resistant TB (MDR). Engaging all providers in TB control Public-Private partnership (PPP) takes many forms in different countries. In China, this includes the cooperation between the public hospitals and public TB dispensaries (public-public mix, PPM) and the involvement of village doctors (public-private) in TB control. The China national TB programme relies on the vertical management system based on TB dispensaries at four levels: national, provincial, prefecture and county. A TB dispensary is either an independent institute or a department within the local Centers for Disease Control. Most TB dispensaries have their own TB clinics providing TB diagnosis and treatment care. However, patients with TB symptoms largely use the general hospitals, township hospitals and private village doctors as their first point of entry than TB dispensaries, For the active TB patients diagnosed by the above health care providers, only 25% were reported and referred to TB dispensaries in the DOTS system. Public hospitals who treated TB patients did not use DOTS regimens and nor did they provide free diagnosis and drugs to TB patients. Public hospitals are substantially privately oriented and often over-prescribe drugs and examinations for profit.

The standard of TB reporting, referring, notification and the mechanism of collaboration between general hospital and TB dispensary was established in 2004 by the national TB control. In 2006, strengthening the collaboration between public hospitals and TB dispensaries was also implemented in 24 provinces. Different models of PPM including hospitals, TB dispensaries and community health centers are piloted to improve the situation. In all approaches, the roles of community health services, township hospitals and village doctors are to visit patient homes, trace defaulters and support patients during treatment.

This pilot study evaluates the performance and outcome of the roles of different health providers in TB control (PPM) in China, with the goal to provide policy recommendations for the future TB system development in China. It also aims to examine the different stakeholders under the PPM framework; its impact on patients and programme outcomes; and provides practical tools for China NTP to scale up the different PPM initiatives.