title: Evaluating the impact of decentralising tuberculosis microscopy services to rural township hospitals in Gansu Province, China.
abstract: BACKGROUND
  In 2004, the Ministry of Health issued the policy of decentralising microscopy services (MCs) to one third of all township hospitals in China. The study was conducted in Gansu Province, a poor western one in China. Ganzhou was one county in Gansu Province. Ganzhou County was identified as a unique case of further decentralisation of tuberculosis (TB) treatment services in township hospitals. The study evaluated the impact of the MC policy on providers and patients in Gansu Province. The second objective was to assess the unique case of Ganzhou County compared with other counties in the province.
  
  
  METHODS
  Both quantitative and qualitative methods were used. All 523 MCs in the province completed an institutional survey regarding their performance. Four counties were selected for in-depth investigation, where 169 TB suspects were randomly selected from the MC and county TB dispensary registers for questionnaire surveys. Informant interviews were conducted with 38 health staff at the township and county levels in the four counties.
  
  
  RESULTS
  Gansu established MCs in 39% of its township hospitals. From January 2006 to June 2007, 8% of MCs identified more than 10 TB sputum smear positive patients while 54% did not find any. MCs identified 1546 TB sputum smear positive patients, accounting for 9% of the total in the province. The throughputs of MCs in Ganzhou County were eight times of those in other counties. Interviews identified several barriers to implement the MC policy, such as inadequate health financing, low laboratory capacity, lack of human resources, poor treatment and management capacities, and lack of supervisions from county TB dispensaries.
  
  
  CONCLUSIONS
  Microscopy centre throughputs were generally low in Gansu Province, and the contribution of MCs to TB case detection was insignificant taking account the number of MCs established. As a unique case of full decentralisation of TB service, Ganzhou County presented better results. However, standards and quality of TB care needed to be improved. The MC policy needs to be reviewed in light of evidence from this study.
authors.affiliation: School of Public Health and Primary Care, Chinese University of Hong Kong, 2/F School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Wei
authors.forename: Guanyang
authors.initials: G
authors.lastname: Zou
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.forename: Renzhong
authors.initials: R
authors.lastname: Li
authors.forename: John D
authors.initials: JD
authors.lastname: Walley
authors.forename: Shiwen
authors.initials: S
authors.lastname: Jiang
authors.forename: Jia
authors.initials: J
authors.lastname: Yin
authors.forename: Shuigao
authors.initials: S
authors.lastname: Jin
authors.forename: You
authors.initials: Y
authors.lastname: Li
authors.forename: Qiang
authors.initials: Q
authors.lastname: Sun
authors.forename: James N
authors.initials: JN
authors.lastname: Newell
authors.forename: Sian
authors.initials: S
authors.lastname: Griffiths
authors.forename: Lixia
authors.initials: L
authors.lastname: Wang
mesh_terms: D002681:China; D005069:Evaluation Studies as Topic; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D007753:Laboratories / Q000458:organization & administration; D008297:Male; D008853:Microscopy / Q000706:statistics & numerical data*; D008875:Middle Aged; D011057:Politics; D019035:Rural Health Services / Q000458:organization & administration*; D012923:Social Class; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000175:diagnosis*