Academic journal article Bulletin of the World Health Organization

Engaging Hospitals to Meet Tuberculosis Control Targets in China: Using the Internet as a Tool to Put Policy into practice/Aider Les Hopitaux a Atteindre Les Cibles De Controle De la Tuberculose En Chine : Utilisation d'Internet Comme Outil De Mise En Pratique De la politique/Involucrar a Los Hospitales Para Que Cumplan Los Objetivos De Control De la Tuberculosis

Academic journal article Bulletin of the World Health Organization

Engaging Hospitals to Meet Tuberculosis Control Targets in China: Using the Internet as a Tool to Put Policy into practice/Aider Les Hopitaux a Atteindre Les Cibles De Controle De la Tuberculose En Chine : Utilisation d'Internet Comme Outil De Mise En Pratique De la politique/Involucrar a Los Hospitales Para Que Cumplan Los Objetivos De Control De la Tuberculosis

Article excerpt

Introduction

Engaging all relevant health-care providers in tuberculosis (TB) care and control through public-private and public-public mix approaches is an essential component of the World Health Organization's (WHO's) Stop TB Strategy. (1) Public-private mix implies collaboration between the public sector and private care providers for delivery of TB care and control while a public-public mix means collaboration among different public sector entities within and outside the scope of ministries of health. China has used a public-public partnership between public hospitals and TB dispensaries as one of the strategies to reach the global TB control targets. (2)

According to the 2000 National TB Prevalence Survey in China, 94% of TB suspects reportedly went to "non-TB facilities": 34% to general hospitals, 29% to township/village clinics, 22% to private clinics and 9% to traditional health clinics and other providers. (3) Only 4.3% and 1.3% consulted a TB dispensary or a TB hospital. This finding was also corroborated subsequently by a social assessment study in four provinces. (4) In 2003, the TB case detection rate in China was below the global TB control target of 70%. Two of the main strategies pursued by the Ministry of Health to improve the case detection rate were geographical expansion of DOTS (Directly Observed Treatment, Short course) strategy implementation and strengthening of the hospital-TB dispensary collaboration.

A window of opportunity opened in 2003 when China encountered a serious epidemic of severe acute respiratory syndrome. After this epidemic was brought under control, the Chinese government implemented a series of measures to strengthen its public health system. (5) One of these measures was strengthening the surveillance of communicable diseases. The law on the control of infectious diseases was also revised, making it mandatory to report communicable diseases, including TB.

The National Centre for Tuberculosis Control and Prevention used this new tool to accelerate nationwide scale-up of hospital involvement in TB control. It carried out a pilot project of the Internet-based TB reporting and referral system with the cooperation of the China country office of WHO. This project demonstrated that collaboration between hospitals and TB dispensaries was feasible and that it enhanced TB case finding. (6) Based on the evidence from the pilot project, the Ministry of Health issued an updated policy of collaboration between hospitals and TB dispensaries. The new policy stipulated that all pulmonary TB cases and suspects detected in general hospitals should be reported through the Internet and referred to TB dispensaries. The dispensaries must also trace the reported cases that fail to come to the dispensaries.

Based on data emerging from routine surveillance reports, this paper describes the processes and outcomes of collaboration between hospitals and TB dispensaries in China facilitated by the Internet-based TB reporting and management system.

Setting

The Chinese Ministry of Health has 17 departments. While control of communicable diseases is the responsibility of the Department for Disease Control, all hospitals fall under the Department of Medical Administration. The National Centre for Tuberculosis Control and Prevention under the Chinese Centre for Disease Control and Prevention provides technical support and routine management for national TB control programme implementation. This structure is replicated at provincial and prefecture levels. At the county level, most dispensaries that provide TB services are under the Centre for Disease Control and Prevention. hospitals are required to report and refer TB suspects and cases to TB dispensaries.

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Internet-based reporting

In January 2004, China launched the world's largest Internet-based National Communicable Disease Information System. The purpose of the system was to provide a common platform for health facilities including general public hospitals to use the Internet to notify 37 communicable diseases, including TB, in real-time. …

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