Description And Evaluation Study On DOTS Implementation Of Anti-TB Institutions From 12 Counties Of 6 Provinces In China

Objective:To learn about the present situation of DOTS strategy implementation of anti-tuberculosis institutions from 12 counties of 6 provinces in China,then assess the quality of DOTS implementation and analyze the possible factors that influence the DOTS strategy from suppliers side,and then provide policy implications.Method:With the 12 counties of 6 provinces in the east and minddle and west China as sample counties,qualitative study and quantitative study method were used to assess the present situation of DOTS strategy implementation,and then probe into the possible influence factors.1.Select 2 counties or districts within each province as field research spots.In the selected provinces and counties or districts,key informant interview and semi-structured questionnaire were conducted.The key informants were from decision-makers,administraters,medical staffs correlate anti-tuberculosis and the tuberculosis patients from the multi-level region.Focus group discussion and nominal focus group discussion were also launched in selected field research spots among staffs of hospital from county and township.2.Launch questionnaire investigation in anti-tuberculosis institutions at multi-level region.3.Examine the knowledge and ability of anti-tuberculosis professional staffs,including the ability of reading X-ray chest photograph and Sputum smear.Result:1.The anti-tuberculosis network of county and township level in 6 provinces was sound on the whole,but the phenomena of human resources deficiency and short of funds were still present, especially in the middle and west region of China.2.Three-tier health care network was foundation of tuberculosis prevention and control work, the relationship between part of comprehensive hospitals and professional anti-tuberculosis institutions was not smooth,and should make great efforts to use integrated the advantages of medical institutions to better the implementation of DOTS.3.The DOTS was not fully suitable for China's national conditions,we should find a better steering modes:for example,family supervision,telephone supervision,etc.4.The significance of township sputum check point should be assessed and studied further. 5.Free anti-tuberculosis drugs had high side-effect,the ancillary drugs and adjuvant therapy were relatively high cost,even more than the cost of free drugs,so that it was not conducive to the implementation of DOTS strategy.6.At present,the monitoring and information reporting system of national network is somemore burdensome,it is not conducive to carry out DOTS strategy effectively.Suggestions:1.Strengthen construct the anti-tuberculosis institutions and capacity development of human resources is the key to keep sustainable development of anti-tuberculosis.2.The matching funds of projects in poverty-stricken areas in the western China are still likely to become constraints to the implementation of DOTS strategy,so it could be considering a request for transfer payments from central government funds.3.Some monographic studies about additional sputum checking point in township hospitals should be undertaken to evaluate the effectiveness of settings.4.Give full attention to the role of all kinds of medical institutions in finding patients,and strengthen the administrative intervention,and strengthen the referral of tuberculosis patients in the current system is the key to increase the rate of patients found.5.Family support and supervision play an important role in TB control and it's conducive to the achievement of DOTS strategy objectives.6.A uniform standard is needed about the definition of the implementation of DOTS strategy, standards,ways and means of supervision in different parts of China from the national tuberculosis prevention and control center.