title: 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.
  
  
  METHODS
  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.
authors.affiliation: China Programme, COMDIS Health Services Delivery Research Consortium, University of Leeds, Shenzhen, China.|Institute for International Health and Development, Queen Margaret University, Edinburgh, UK.
authors.forename: Guanyang
authors.initials: G
authors.lastname: Zou
authors.affiliation: Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: King
authors.affiliation: Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK.
authors.forename: John
authors.initials: J
authors.lastname: Walley
authors.affiliation: Devision of Health System, Policy and Management, School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Yin
authors.affiliation: Centre for Health Policy and Management, School of Public Health, Shandong University, Jinan, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Sun
authors.affiliation: Devision of Health System, Policy and Management, School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China; xiaolinwei@cuhk.edu.hk.
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Wei
mesh_terms: D002681:China; D003299:Cooperative Behavior; D023801:Directly Observed Therapy; D014943:Global Health; D006284:Health Plan Implementation / Q000458:organization & administration* / Q000592:standards; D006739:Hospital Administration; D006801:Humans; D007407:Interviews as Topic; D036301:Qualitative Research; D012017:Referral and Consultation / Q000191:economics; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy*
keywords: collaboration; general hospitals; open systems; tuberculosis programme