Progress in tuberculosis control and the evolving public-health system in China

Abstract

China has the world's second largest tuberculosis epidemic, but progress in tuberculosis control was slow during the 1990s. Detection of tuberculosis had stagnated at around 30% of the estimated total of new cases, and multidrug-resistant tuberculosis was a major problem. These signs of inadequate tuberculosis control can be linked to a malfunctioning health system. The spread of severe acute respiratory syndrome (SARS) in 2003, brought to light substantial weaknesses in the country's public-health system. After the SARS epidemic was brought under control, the government increased its commitment and leadership to tackle public-health problems and, among other efforts, increased public-health funding, revised laws that concerned the control of infectious diseases, implemented the world's largest internet-based disease reporting system, and started a programme to rebuild local public-health facilities. These measures contributed to acceleration in efforts to control tuberculosis. By 2005, the detection of cases of tuberculosis had increased to 80% of the estimated total new cases, permitting China to achieve the 2005 global tuberculosis control targets. At the same time, specific efforts to improve tuberculosis control also contributed to strengthening of the public-health system. We examine how the strengthening of a disease control programme and the public-health system worked together to achieve a desired health outcome.

Figure 1

Progress of tuberculosis control in China, 1991–2005 Trends in the estimated proportion of all new smear-positive tuberculosis cases detected (pink bars), the proportion of new smear-positive cases successfully treated (green bars), and the proportion of counties implementing the WHO-recommended DOTS strategy (green shaded area) from 1991 to 2005 in China.

Figure 2

Funding for China's national tuberculosis control programme, 2001–2005 Local government funds include operational cost and staff salaries from provincial level down to county level; loan funding is from the World Bank; the Global Fund to fight AIDS, Tuberculosis and Malaria has two projects that are operational; other grants are from the Japanese government, the Damien Foundation Belgium, and the Canadian International Development Agency.