title: Why financial incentives did not reach the poor tuberculosis patients? A qualitative study of a Fidelis funded project in Shanxi, China.
abstract: BACKGROUND
  A project implemented in 50 counties of Shanxi province provided incentives to poor TB patients for their first trip to tuberculosis (TB) dispensaries. Incentives were also given to doctors for referring and supervising TB patients. A previous quantitative evaluation identified no improvement on TB case detection and management. This qualitative study was then conducted to explore reasons for project failure.
  
  
  OBJECTIVE
  To understand how the incentives were distributed to and viewed by their recipients and the implications for TB and health systems.
  
  
  METHODS
  Qualitative in-depth interviews were conducted with 32 TB patients, 13 village doctors, 12 village leaders, 8 TB doctors and 8 TB programme managers.
  
  
  RESULTS
  The study revealed a lack of operational tools on how to evaluate patients' economic status and how to publicise the incentives. As a result, patients did not know the level of incentives in advance and regarded the amount as inadequate. Patients faced a huge financial burden and a long delay in treating TB, dwarfing the benefits of travel incentives. The referral and case supervision incentives were not implemented. Doctors did not receive any referral and supervision incentives in addition to those already existing.
  
  
  CONCLUSIONS
  Strategies to address health system and TB programme issues should be implemented before or alongside financial incentives. Operational details and tools for any intervention should be developed, field-tested and revised prior to wide-scale use.
authors.affiliation: Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK. x.wei@leeds.ac.uk
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Wei
authors.forename: John
authors.initials: J
authors.lastname: Walley
authors.forename: Jin
authors.initials: J
authors.lastname: Zhao
authors.forename: Hongyan
authors.initials: H
authors.lastname: Yao
authors.forename: Jianjun
authors.initials: J
authors.lastname: Liu
authors.forename: James
authors.initials: J
authors.lastname: Newell
mesh_terms: D002681:China; D006801:Humans; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D011203:Poverty; D036301:Qualitative Research; D012052:Reimbursement, Incentive; D014376:Tuberculosis / Q000191:economics / Q000517:prevention & control / Q000628:therapy*