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Filtering by Category: Article

Drug-resistant tuberculosis control in China: progress and challenges

Future Health Systems

Long Q, Qu Y, and Lucas H (2016) Drug-resistant tuberculosis control in China: progress and challenges, Infect Dis Poverty. 2016; 5: 9. doi: 10.1186/s40249-016-0103-3


Background: China has the second highest caseload of multidrug-resistant tuberculosis (MDR-TB) in the world. In 2009, the Chinese government agreed to draw up a plan for MDR-TB prevention and control in the context of a comprehensive health system reform launched in the same year.

Discussion: China is facing high prevalence rates of drug-resistant TB and MDR-TB. MDR-TB disproportionally affects the poor rural population and the highest rates are in less developed regions largely due to interrupted and/or inappropriate TB treatment. Most households with an affected member suffer a heavy financial burden because of a combination of treatment and other related costs. The influential Global Fund programme for MDR-TB control in China provides technical and financial support for MDR-TB diagnosis and treatment. However, this programme has a fixed timeline and cannot provide a long term solution. In 2009, the Bill and Melinda Gates Foundation, in cooperation with the National Health and Family Planning Commission of China, started to develop innovative approaches to TB/MDR-TB management and case-based payment mechanisms for treatment, alongside increased health insurance benefits for patients, in order to contain medical costs and reduce financial barriers to treatment. Although these efforts appear to be in the right direction, they may not be sufficient unless (a) domestic sources are mobilized to raise funding for TB/MDR-TB prevention and control and (b) appropriate incentives are given to both health facilities and their care providers.

Summary: Along with the on-going Chinese health system reform, sustained government financing and social health protection schemes will be critical to ensure universal access to appropriate TB treatment in order to reduce risk of developing MDR-TB and systematic MDR-TB treatment and management.

Disparity in reimbursement for tuberculosis care among different health insurance schemes: evidence from three counties in central China

Future Health Systems

Pan Y, Chen S, Chen M, Zhang P, Long Q, Xiang L, and Lucas H (2016) Disparity in reimbursement for tuberculosis care among different health insurance schemes: evidence from three counties in central China, Infect Dis Poverty. 2016; 5: 7. doi: 10.1186/s40249-016-0102-4

Health inequity is an important issue all around the world. The Chinese basic medical security system comprises three major insurance schemes, namely the Urban Employee Basic Medical Insurance (UEBMI), the Urban Resident Basic Medical Insurance (URBMI), and the New Cooperative Medical Scheme (NCMS). Little research has been conducted to look into the disparity in payments among the health insurance schemes in China. In this study, the authors aimed to evaluate the disparity in reimbursements for tuberculosis (TB) care among the abovementioned health insurance schemes.

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Factors that determine catastrophic expenditure for tuberculosis care: a patient survey in China

Future Health Systems

Zhou C, Long Q, Chen J, Xiang L, Li Q, Tang S, Huang F, Sun Q, and Lucas H (2016) Factors that determine catastrophic expenditure for tuberculosis care: a patient survey in China, Infect Dis Poverty. 2016; 5: 6. doi:  10.1186/s40249-016-0100-6

Tuberculosis (TB) often causes catastrophic economic effects on both the individual suffering the disease and their households. A number of studies have analyzed patient and household expenditure on TB care, but there does not appear to be any that have assessed the incidence, intensity and determinants of catastrophic health expenditure (CHE) relating to TB care in China. That will be the objective of this paper.

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Non-medical financial burden in tuberculosis care: a cross-sectional survey in rural China

Future Health Systems

Li Q, Jiang W, Wang Q, Shen Y, Gao J, Sato KD, Long Q, and Lucas H (2016) Non-medical financial burden in tuberculosis care: a cross-sectional survey in rural China, Infect Dis Poverty. 2016; 5: 5. doi:  10.1186/s40249-016-0101-5

Treatment of tuberculosis (TB) in China is partially covered by national programs and health insurance schemes, though TB patients often face considerable medical expenditures. For some, especially those from poorer households, non-medical costs, such as transport, accommodation, and nutritional supplementation may be a substantial additional burden. In this article the authors aim to evaluate these non-medical costs induced by seeking TB care using data from a large scale cross-sectional survey.


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Do academic knowledge brokers exist? Using social network analysis to explore academic research-to-policy networks from six schools of public health in Kenya

Future Health Systems

The potential for academic research institutions to facilitate knowledge exchange and influence evidence-informed decision-making has been gaining ground. Schools of public health (SPHs) may play a key knowledge brokering role—serving as agencies of and for development. Understanding academic-policymaker networks can facilitate the enhancement of links between policymakers and academic faculty at SPHs, as well as assist in identifying academic knowledge brokers (KBs). Using a census approach, the authors administered a sociometric survey to academic faculty across six SPHs in Kenya to construct academic-policymaker networks.

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Community Participation in Health Systems Research: A Systematic Review

Future Health Systems

George AS, Mehra V, Scott K, Sriram V (2015) Community Participation in Health Systems Research: A Systematic Review Assessing the State of Research, the Nature of Interventions Involved and the Features of Engagement with Communities. PLoS ONE 10(10): e0141091. doi:10.1371/journal.pone.0141091

Community participation is a major principle of people centered health systems, with considerable research highlighting its intrinsic value and strategic importance. Existing reviews largely focus on the effectiveness of community participation with less attention to how community participation is supported in health systems intervention research.

This systematic review explores the extent, nature and quality of community participation in health systems intervention research in low- and middle-income countries.

It concludes that despite positive examples, community participation in health systems interventions was variable, with few being truly community directed. Future research should more thoroughly engage with community participation theory, recognize the power relations inherent in community participation, and be more realistic as to how much communities can participate and cognisant of who decides that.

Honouring the Value of People in Public Health

Future Health Systems

Complex and dynamic public health problems require a different approach: an emphasis on the value of people. People who own the problem can anticipate the most likely social obstacles to its resolution, and their participation is essential to maintain an evolving strategy that can institutionalize an approach to the problem.

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Potential of Performance Based Payment

Future Health Systems

In Bangladesh the rates of maternal mortality have not reduced appreciably over the past decade. Although many of these deaths could be prevented by providing safe motherhood services through skilled birth attendants, equitable access to these services for the poor remains a problem. This article illustrates how a performance based payment scheme can decrease this inequity and provide lessons for future programs.
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Health dynamics, innovation and the slow race to make technology work for the poor

Future Health Systems

The “race to universal fixes” for health anddevelopment problems is valuable. It is an important counter to innovation approaches aimed simply at a race to the top inthe global economy, assuming that health and poverty-relatedproblems will be solved by trickle down. Yet as this article argues, it risks missing the finishing line if a complementary– and slower – race is not pursued. This “slow race”emphasizes pathways to tackling ill-health and disease whichare specific to diverse and dynamic local contexts; createshybrids between local and external knowledge andperspectives for appropriate solutions; recognizes thattechnological fixes are not enough and that social, culturaland institutional dimensions are key, requiring a systemsapproach to health and innovation, and embraces uncertaintyand unpredictable change through adaptation and learning.
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