SHANDONG - CHINA

TB case management deskguide training in Shandong Province

In China, national policy guidelines for tuberculosis (TB) were already prepared, but these were not designed for consultation room practice. We therefore developed a TB operational guideline (desk guide) and it's training modules. This was based on national guides we've prepared and scaled-up with the TB programme and COMDIS NGO partner Association for Social Development (ASD) in Pakistan and similarly in other countries. The generic version was thoroughly adapted in a working group process in China, incorporating international and national guidelines and evidence, so as to be appropriate to the China context. This "how to do" desk guide contains details on TB identification, diagnosis, treatment, case management, patient support and treatment outcome reporting.

The desk guide was tested in two provinces of China, Guangxi and Shandong, to see whether it was useful to patients and usable by doctors. Results showed that patients had a better knowledge of TB and better treatment support, and that country TB doctors found the desk guide to be useful in their daily practice.

In April 2006, the China National TB Programme (NTP) approved the desk guide and it was shared with a number of provincial teams. Another version focussing on the "communications" between doctors and TB patients has been drafted with the NTP.

The adaptation process highlighted a number of general strategies to e considered in adapting generic guidelines into country specific ones: 1) local policy-makers and practitioners should have a leading role; 2) a systematic working process should be employed with capable staff; and 3) the guideline should be embedded within the current programmes so it is sustainable for wider scale-up.