TUBERCULOSIS: China's tuberculosis control project benefits millions

2010-02-21 By Xinhua writer Tian Ying

BEIJING, Feb. 21 (Xinhua) -- Li Youquan, 76-year-old, from Weishui village of China's northern Hebei Province, has seen two of his brothers die of tuberculosis.
He himself diagnosed with TB in 2004, attributed his survival to a tuberculosis control project offering "free check and free treatment."
"Without this project I would have been dead years ago," Li said.
China is second only to India with 4.5 million known TB cases in 2009. WHO estimates there are approximately 1.3 million new cases every year in the country and the disease claimed 160,000 lives in 2008.
Tuberculosis disproportionately affects the poor who often cannot afford effective treatment and live in areas with inadequate sanitation. In China, 80 percent of TB patients live in the countryside.
Li's younger brother got TB in the 1980s. At that time, Li earned a monthly salary of 43 yuan (63 U.S. dollars), but just one dose of medicine cost 50 yuan.
Li borrowed 2,000 yuan from relatives and friends to help his brother, but it was soon used up. His brother died soon after.
Li is more fortunate. He has benefited from China's Tuberculosis Control Project which initiated the "free check and treatment" policy in 2002, at first in 16 pilot provinces but later was expanded nationwide.
The project which now covers 670 million people, nearly half of China's population, has prevented 770,000 deaths over the last eight years, as well as preventing 20 million people from catching TB.
The progress was reported by China's health ministry recently as the project draws to a end in March of this year.
Apart from "free check and treatment," the project also offers incentives to patients and medical personnel to raise the detection and cure rate.
The project reimburses patients' travel expenses between their home and the clinics.
Doctors get 20 yuan if they report a case. They also receive 100 to 120 yuan for each patient under their supervision.
Zhang Ben, the project manager from the Ministry of Health, said after the project concludes, measures such as free check and treatment as well as incentives to help village doctors would be carried on, but the travel subsidies would depend on the different provinces.
It was important the measures continued, as they helped promote the implementation of DOTS (directly observed therapy short course) strategy, said Zhang.
DOTS is a strategy to get patients to take drugs under the direct supervision of doctors. In some villages, doctors take drugs to patients' homes to ensure they follow the treatment plan.
Zhao Genming, a Fudan University professor in public health who led a third-party assessment of the project, thought the DOTS strategy was critical to the project's success.
As a result, the detection rate of smear positive TB (a more infectious strain of TB which could be detected through patients sputum) reached 77 percent.
Zhao said, "the financial input is also something that makes it work." Government agencies at all levels have channeled 1.472 billion yuan into the project. The funding from central government stood at 176 million yuan in 2008, almost a 40-fold increase from 2002 when the project kicked off.
The project supported by World Bank loans with grants from Britain used to finance interest on the loans, has been hailed as an innovative financial model.
However, there is still a large funding gap, both with regards to individual patients and the project at large.
Zhao Genming said that the free check and treatment policy only covered diagnosis and first-line drugs, but patients still had to pay for drugs that reduced side-effects, and liver tests, for example.
What each patients must pay out of their pockets was estimated around 2,000 yuan, Zhao remarked. "It's still a big financial burden for patients most living on an annual income of 1,500 to 2,000 yuan."
World Health Organization expert on TB, Cornelia M. Hennig, feared such a funding shortfall may hinder patients' adherence to the treatment plan.
She said suspension of medical services could result in the virus mutating into the drug-resistant strain (DRTB) which was a lot harder and more difficult to treat.
She also warned that multi-drug resistant TB, the deadliest strain killing one out of two people, was now the most serious problem for China and urgent action was needed.
Zhao Genming estimated it could take 7 to 8 years and 50,000 yuan to treat one such patient.
Drug-resistant TB is more infectious than other strains of TB. However, drugs to treat DRTB, second-line drugs, are not covered by the reimbursement scheme.
The Project's sustainability report says 2 billion yuan more is needed to fight DRTB in the 16 pilot provinces.
Despite the challenges posed by DRTB, the steps China has made to control TB have been loudly applauded by its international partners.
Jim Adams, World Bank Vice President, said China has increased its commitment to TB control over the last decade. "This determined effort has not only improved the health conditions of the Chinese population but it has also brought health security for the rest of the world."
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