SHANGHAI - CHINA

TB care incentives-enablers to complete treatment by rural migrants in Shanghai study

Migrants pose a major challenge to tuberculosis (TB) control in developed and developing countries including China, where the reported new migrant TB cases in Shanghai increased by 9.4% each year from 1998 to 2005.

This COMDIS study aimed to understand the challenges of TB care from the perspective of migrant TB patients under the new era of free TB treatment, and to generate policy recommendations for TB control in migrant populations in China and other similar settings.

The study revealed that the health system problems caused substantial barriers for migrant patients accessing TB care. Migrants were not covered by medical and unemployment insurance, and the profit driven operation style of public general hospitals resulted in high patient costs and long delays of migrant patients prior to their TB diagnosis. The free treatment policy has little, if any, effect in reducing migrant patient financial stress.

Recommendations following the COMDIS study focus on containing the profit-driven behaviour of general public hospitals in order to reduce patient costs and shorten diagnostic delays. It is also crucial to provide social welfare to migrants, including cost of living subsidies for poor migrant TB patients.

Following this study, COMDIS is now working with the Shanghai Centre for Disease Control to pilot providing cost of living subsidies to poor migrant TB patients in one district of Shanghai.