Barriers to hospital and tuberculosis programme collaboration in China: context matters
Abstract
Background: In many developing countries,
programmes for ‘diseases of social importance’, such
as tuberculosis (TB), have traditionally been organised as
vertical services. In most of China, general hospitals are
required to report and refer suspected TB cases to the TB
programme for standardised diagnosis and treatment. General
hospitals are the major contacts of health services for the TB
patients. Despite the implementation of
public–public/private mix, directly observed treatment,
short-course, TB reporting and referral still remain a
challenge.
Objective: This study
aims to identify barriers to the collaboration between the TB
programme and general hospitals in China.
Design:
This is a qualitative study conducted in two purposefully
selected counties in China: one in Zhejiang, a more affluent
eastern province, and another in Guangxi, a poorer southwest
province. Sixteen in-depth interviews were conducted and
triangulated with document review and field notes. An open
systems perspective, which views organisations as social
systems, was adopted.
Results: The
most perceived problem appeared to be untimely reporting and
referral associated with non-standardised prescriptions and
hospitalisation by the general hospitals. These problems could
be due to the financial incentives of the general hospitals,
poor supervision from the TB programme to general hospitals, and
lack of technical support from the TB programme to the general
hospitals. However, contextual factors, such as different
funding natures of different organisations, the prevalent
medical and relationship cultures, and limited TB funding, could
constrain the processes of collaboration between the TB
programme and the general hospitals.
Conclusions:
The challenges in the TB programme and general hospital
collaboration are rooted in the context. Improving collaboration
should reduce the potential mistrust of the two organisations by
aligning their interests, improving training, and improving
supervision of TB control in the hospitals. In particular,
effective regulatory mechanisms are crucial to alleviate the
negative impact of the contextual factors and ensure smooth
collaboration.
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Source:
Global Health Action
