NCTB - CHINA

Incentives for TB patients and providers project evaluation Shanxi Province, China.

Summary

This COMDIS study examined the incentives of a Fidelis project, or Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB, in China's Shanxi province.

Fidelis was implemented in Shanxi's 50 counties during the period November 2004 to October 2005. The project hoped to address the lack of motivation among health workers and the often lengthy distance that patients travel to reach health centres, both possible barriers to TB control. Poor patients were given incentives of US$1 for transport for their visit to the health centres while doctors were given referral and supervision incentives.

The COMDIS study found there was a lack of tools to determine the economic status of patients and also to publicise the incentives. Furthermore, patients were unaware of the types of incentives available and had considered the amount to be insufficient. The patients, too, faced a huge financial burden and a long delay in getting their TB treated.

The researchers stated that it is better if the countries' health system and any issues concerning the TB programme are addressed before implementing financial incentives. Their findings suggested that the existing financial incentives will not be effective unless they are built in a well-functioning health system and TB programme. In fact, they suggested that the financial incentives may end up causing problems rather than solving them. The researchers also recommended that the operational issues of incentives be field-tested before they are introduced on a large scale.