Study On Tuberculosis Control Network And Its Implementation In Putuo District Of Shanghai

Objectives:To know about the tuberculosis control network and its effects in Putuo District and make recommendations to further improve the operation of the network and the allocation of resources by analyzing the human resources and financial input for tuberculosis control institutions and relevant problems.Methods:Questionnaire investigation including human resources status, financial input and expenditure and some performance indicators were carried out in district CDC, designated hospital and 10 community health service centers. In order to know about medical staff’s opinions about current tuberculosis management model, satisfaction degree of work, and training participation effects, questionnaire investigations were carried out within tuberculosis control staff. Questionnaire investigations were carried out between residents and migrants TB patients who had finished their treatment within a year before May 2010, in order to know about their basic information, family economic condition, tuberculosis diagnosis and treatment process, and the experiences during the process, etc. Focus group discussion or in-depth individual interviews were done between health technical workers and administrators of tuberculosis control to know how the cooperation between different health institutions, and what measures were implemented to achieve tuberculosis control. Quantitative data was entered through epidata and analyzed by SPSS 13.0. Qualitative data were live recorded, sorted out through word and analyzed by means of classified summaries.Results:All of the health institutions carried out their work respectively of finding, tracking, treating, and management of patients with tuberculosis, in which comprehensive health institutions played important role in finding cases. The coordination between district level health institutions were easily reached while the coordination between district and city-level designated hospitals didn’t go well. Those TB patients with poor economic conditions were able to get financial aid only after several communications between community doctors and different government sectors. Currently, there are 12 TB control related personnel in district level, of which 7 work part-time. The number of community TB control staff was increased from 9 in 2005 to 115 in 2009. The proportions of those staff under 35 yrs old and over 50 yrs old were both over 40%. The proportion of non-regular staff was up to 22.61%. The proportion of staff with education levels of or lower than junior college was 79.13%. The proportion of staff with primary professional title was 74.48% and 5.22% with no professional title. The satisfaction degree test showed that their general satisfaction degree of work and individual satisfaction degree of interpersonal relationship, appreciation from leaders and social status were rather high with an average score over 3.26. The satisfaction degrees of workload burden and payment were among the lowest with respective scores of 1.91 and 2.51. The difficulties of being regular staff, promotion, high burden of work and low payment influenced TB control related staff initiative to a certain extent. The financial input exclusively for TB control increased annually during the last 5 years with a growth rate of 560%. TB control expenditure per capita also increased evidently from 0.13 RMB in 2005 to 0.88 RMB in 2009. Qualitative results showed that the financial input for district designated hospitals was not enough. In community health centers, although the financial input for social public health input increased every year, the expenditure for TB control could not be clearly defined because those expenditures were input as a total package. The financial subsidies for TB cases finding and management were allocated according to standards in Shanghai and those for finding and management of migrants with TB were done according to Global Funding Project. However, both of them were considered rather low by most health personnel and the incentives were not high. The TB control work has been greatly improved. The number of new occurrence of TB cases increased gradually, and the proportion of cases and potential cases reached 90% and more. The proportion of treating active TB cases and the cure proportion of new smear-positive patients were increased annually. The satisfaction degrees of pharmaceutical types in designated hospitals, privacy protection and treatment effects of medical staff from those TB patients were quite high with all over 90%. However, their satisfaction degrees of waiting time, explanation of notes and treatment environment were relatively low, especially the satisfaction of waiting time. The satisfaction degrees of medical personnel attitude, explanation, and privacy protection were relatively high. The qualitative results showed that the reduction proportion of payment was not high and the out-of-pocket money for treatment was relatively high.Conclusions and recommendations:The TB control network, the platform for coordination between Health and other sectors, and sustainable coordination mechanism need to be further improved. In order to establish an overall society participating in TB control network, the coordination and cooperation between different sectors should be enhanced. The lack of sufficient TB control related staff, the high burden of workload and low payment definitely existed. There was an unbalanced distribution of working force between different age levels with low proportion of staff aging between 35yrs old to 50 yrs old, low education level, poor distribution of professional titles and high turnover of staff. Thus, the development plan for TB control realted staff needs to be reinforced, and policies need to be made to promote the sustainable development of human resources of TB control including encouraging graduates of other places to work in communities by including them into regular staff and easier access to professional title promotion. Through analysis, the results showed that although the financial input for TB control increased every year, it remained insufficient if designated hospitals treating TB resulting into low incentive system for medical staff. So the sustainable financial input system needs to be improved gradually especially the financial input degree into those district designated hospitals. Besides, the performance evaluation system and incentive system of TB control related staff needs to be improved in order to promote their initiative. Although the public health financial input increased every year, the definition of its application range was not clear enough and those used in TB control were far from sufficiency. Therefore, the proportion of financial input for TB control needs to be further clarified and expenditure management mechanism needs to be established gradually.