Enhancing TB Control by Removing Health System Barriers

The goals of this two-year project are to demonstrate how to enhance the effectiveness and efficiency of TB control by removing China’s health system barriers and to demonstrate a new long-term equitable and sustainable model for TB control. With grant support from The Bill and Melinda Gates Foundation, this project seeks to restructure providers’ incentives and eliminate patients’ financial barriers for seeking TB treatment. Professors Hsiao and Yip are the co-principal investigators for the project, leading an interdisciplinary team of researchers and faculty members from Harvard, Oxford, Fudan, Shandong, and Ningxia Universities.

This project is closely aligned with another MDR-TB project funded jointly by the Gates Foundation and the Chinese Ministry of Health (the MOH-TB project), whereby several Chinese provinces are innovating with new technology – faster and more accurate diagnostic tests, fixed-dose combinations to treat cases, case monitoring with mobile phones, new inputs such as laboratory networks, and improved TB service delivery between hospitals and the CDC to combat MDR-TB. Our project is designed to complement these delivery-focused interventions with payment and financing interventions in order to achieve optimal TB control.

The newly established innovative incentive structure for CDC, hospitals, township health centers and practitioners is intended to reduce delayed referrals, rendering of unnecessary tests and prescription of unnecessary drugs, as well as retaining patients to earn higher income. By introducing new insurance benefit packages for TB diagnosis and treatment, our team hopes to reduce patients’ delays in seeking diagnosis, and interruption or incomplete treatment. Moreover, conditional cash transfers will be provided for the poor people to seek appropriate diagnose and complete treatment of TB.

Recognizing the essential role that education plays in achieving high-quality services and effective epidemiological control, our project delivers continuing education to providers on the correct performance of diagnostic and treatment of TB and educates patients on compliance with treatment regimens. At the same time, our team seeks to organize and engage communities in prevention and provider performance monitoring activities while increasing their awareness of TB, reducing TB-related stigma, and encouraging proper support of patients to comply with treatment.

The project relies on a solid evaluation framework that will allow a proper analysis of intervention effectiveness and the drawing of sound conclusions. The lessons learned will be disseminated continuously through a series of seminars, conferences, and meetings with policy leaders. Moreover, a final report will be submitted to relevant government partners and the Gates Foundation by year five since the inception of the project.


Below are some photographs from local clinics in Ningxia (courtesy of Yanfang Su). You can scroll through the pictures manually using the arrows or press play/pause for automatic slideshow.