SHANDONG - CHINA

TB sputum collection/microscopy centres evaluation in Shandong

In order to increase case identification rate the Ministry of Health issued a policy to establish sputum collecting centres (SCC) at 1/3 of township hospitals across China. Following this, the Shandong Provincial Health Bureau issued a similar local requirement in Nov 2004. The governments have allocated the required resources to township hospitals to build SCCs. Until May 2005, Shandong had set up 550 SCCs and identified 985 sputum positive patients. Unfortunately, the policy was given without operational details, such as whether the SCCs do the diagnosis, or what should be done if sputum smears are negative. Neither did the policy specify the training needs of outpatient doctors in the township hospitals regarding referral of chronic coughing patients for sputum checks. This cross-sectional study was therefore aimed at describing the performance of SCCs in Shandong based on their social-economic factors (such as geography, population, transportation and GDP) and the performance at their respective county dispensaries; to identify problems and lessons learnt from SCCs; to explore the criteria of establishing SCCs and the operational issues to achieve good SSC performance. This research documented the current performance at their respective county dispensaries in 4 counties of Shandong province and identified the existing problems and good lessons. From sampled county data on basic social-economic indicators, the number of SCCs, the distance from a SCC to the county TB dispensary and patient approximate transportation time was collected. Performance outcomes of each SCC (the number of sputum smears checked and sputum positive patients identified) were collected for years 2005 and 2006. Information from the local TB staff was collected about their respective SCCs performance. From population estimates, TB suspects identified in the SCCs and the county TB dispensaries were compared to evaluate whether the intervention (SCCs) can improve accessibility and reduce TB suspects. The project has provided insights to improve the ongoing national policy, hence improving TB services to 900 million rural people. This research was a foundation to examine the national policy of setting up SCCs at the township level.