The Global Fund in China: Multidrug-resistant tuberculosis nationwide programmatic scale-up and challenges to transition to full country ownership

Wang, Lixia; Li, Renzhong; Xu, Cheng; Zhang, Hui; Ruan, Yunzhou; Chen, Ming-Ting; Wang, Dongmei; Dirlikov, Emilio; Du, Xin; Zhao, Jian; Zhao, Yanlin; Wang, Sheng Fen; Liu, Yuhong; Li, Liang; Falzon, Dennis; Sun, Yiyuan; Wang, Yu; Schwartländer, Bernhard; Scano, Fabio

doi:10.1371/journal.pone.0177536

Cited by 21 publications

(33 citation statements)

References 12 publications

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“…China did not start to implement an effective strategy for addressing MDR-TB until the Global Fund (GF) supported China to undertake MDR-TB case finding and treatment in a small number of Chinese provinces in 2003 [37]. The GF-funded project has ended because China no longer qualifies for GF funding.…”

Section: Discussionmentioning

confidence: 99%

Current situation and progress toward the 2030 health-related Sustainable Development Goals in China: A systematic analysis

et al. 2019

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BackgroundThe Sustainable Development Goals (SDGs), adopted by all United Nations (UN) member states in 2015, established a set of bold and ambitious health-related targets to achieve by 2030. Understanding China’s progress toward these targets is critical to improving population health for its 1.4 billion people.Methods and findingsWe used estimates from the Global Burden of Disease (GBD) Study 2016, national surveys and surveillance data from China, and qualitative data. Twenty-eight of the 37 indicators included in the GBD Study 2016 were analyzed. We developed an attainment index of health-related SDGs, a scale of 0–100 based on the values of indicators. The projection model is adjusted based on the one developed by the GBD Study 2016 SDG collaborators.We found that China has achieved several health-related SDG targets, including decreasing neonatal and under-5 mortality rates and the maternal mortality ratios and reducing wasting and stunting for children. However, China may only achieve 12 out of the 28 health-related SDG targets by 2030. The number of target indicators achieved varies among provinces and municipalities. In 2016, among the seven measured health domains, China performed best in child nutrition and maternal and child health and reproductive health, with the attainment index scores of 93.0 and 91.8, respectively, followed by noncommunicable diseases (NCDs) (69.4), road injuries (63.6), infectious diseases (63.0), environmental health (62.9), and universal health coverage (UHC) (54.4). There are daunting challenges to achieve the targets for child overweight, infectious diseases, NCD risk factors, and environmental exposure factors. China will also have a formidable challenge in achieving UHC, particularly in ensuring access to essential healthcare for all and providing adequate financial protection. The attainment index of child nutrition is projected to drop to 80.5 by 2025 because of worsening child overweight. The index of NCD risk factors is projected to drop to 38.8 by 2025. Regional disparities are substantial, with eastern provinces generally performing better than central and western provinces. Sex disparities are clear, with men at higher risk of excess mortality than women. The primary limitations of this study are the limited data availability and quality for several indicators and the adoption of "business-as-usual" projection methods.ConclusionThe study found that China has made good progress in improving population health, but challenges lie ahead. China has substantially improved the health of children and women and will continue to make good progress, although geographic disparities remain a great challenge. Meanwhile, China faced challenges in NCDs, mental health, and some infectious diseases. Poor control of health risk factors and worsening environmental threats have posed difficulties in further health improvement. Meanwhile, an inefficient health system is a barrier to tackling these challenges among such a rapidly aging population. The eastern provinces are predicted to pe...

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Section: Discussionmentioning

confidence: 99%

Current situation and progress toward the 2030 health-related Sustainable Development Goals in China: A systematic analysis

et al. 2019

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“…The influential Global Fund project for MDR-TB control ended its support for operations in China on 30 June 2014 [8,12]. The absolute number of smear-positive TB patients who received DST decreased substantially in 2015 compared with 2013 and 2014.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis and treatment of MDR-TB under the national MDR-TB prevention and control programme have been established at the designated TB hospitals in the superior prefectural cities, and the basic units of the TB control programme at the county level are responsible for referring patients suspected of having MDR-TB. Considering the cost-effectiveness, insufficient laboratory facilities, and bio-safety of county TB dispensaries, MDR-TB screening was conducted only amongst five high-risk groups of TB patients under China’s MDR-TB control programme, including (1) chronic TB patients (patients who experienced multiple treatment courses but remained sputum positive) and TB patients for whom retreatment failed; (2) close contacts of MDR-TB cases who developed sputum smear-positive (SS+) TB; (3) TB patients for whom initial treatment failed; (4) relapsed and retuened TB patients; and (5) patients who remained smear-positive at the end of the third month of the initial treatment regimen [7,11,12]. …”

Section: Introductionmentioning

confidence: 99%

“…Under the national MDR-TB prevention and control programme, county TB dispensaries are responsible for drug resistance risk assessment, sputum smear testing and bacterial culture [12]. Sputum samples from suspected MDR-TB cases, i.e.…”

Section: Introductionmentioning

confidence: 99%

“…Sputum samples from suspected MDR-TB cases, i.e. the five high-risk groups, are transferred to laboratories of high-level, prefectural designated MDR-TB hospitals for strain identification and DST [12]. Although MDR-TB screening amongst high-risk patients is reasonable and necessary in regions with a high prevalence of drug-resistant TB, this selective screening strategy might reduce the detection rate of MDR-TB cases.…”

Section: Introductionmentioning

confidence: 99%

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High-risk screening and detection of multidrug-resistant tuberculosis in two prefectures of China: a drug susceptibility surveillance-based secondary data analysis

Yang

Zhou

Ning

et al. 2018

Global Health Action

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Background: In China, less than one-fifth of multidrug-resistant tuberculosis (MDR-TB) cases are detected. MDR-TB screening is conducted amongst the following five high-risk groups of TB patients: chronic cases, close contacts of MDR-TB patients, patients with treatment failure, relapsed and returned patients, and smear-positive patients at the end of the third month of initial treatment. Objective: To estimate the possibility of detecting MDR-TB cases if only the high-risk screening strategy is applied in China. Methods: A secondary analysis was applied to the surveillance-based longitudinal data of all sputum smear-positive TB patients in Prefecture E and Prefecture W of China from 2013 to 2015. The population attributable risk (PAR) was estimated using odds ratios for five risk factors/predictors and exposure proportions amongst all MDR-TB cases. Results: A total of 3513 TB patients (2807 from Prefecture E and 706 from Prefecture W) were included. Males accounted for 77.91% (2737/3513) of the patients. The average age was 52.5 ± 20.0 years old. Overall, 40.34% (71/176) of MDR-TB patients were from the five high-risk groups during the three-year study period. The detected proportion of MDR-TB cases using the high-risk screening strategy was significantly higher in Prefecture E than in Prefecture W. The PAR% for all five risk factors/predictors was 43.4% (95% CI: 24.6–61.7%), 49.9% (95% CI: 31.3–67.0%), and 30.3% (95% CI: 12.9–50.1%) in Prefecture E and 36.6% (95% CI: 10.4–64.5%), 13.3% (95% CI: −1.7–39.7%), and −82.5% (95% CI: −117.5–−11.2%) in Prefecture W in 2013, 2014, and 2015, respectively. The PAR% for the five specific risk factors/predictors ranged from 0.4% (95% CI: −0.2–4.8%) to 21.0% (95% CI: 13.1–30.0%) in these two prefectures. Conclusion: In general, a high-risk screening strategy would miss more than half of the MDR-TB patients because they do not belong to the five high-risk groups.

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Health Financing Reforms for Moving towards Universal Health Coverage in the Western Pacific Region

Chu

Kwon

Cowley

2019

Health Systems & Reform

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This article provides an overview of health financing reforms across countries in the Western Pacific Region as progress is made toward universal health coverage (UHC). Moving toward UHC requires a strong health system with sustainable financing, which countries strive to achieve through various approaches appropriate to their country contexts. Great efforts have been made by financing reforms through resource mobilization, risk pooling, resource allocation, and strategic purchasing. Overall governance of health financing systems has improved within the context of service delivery and budget reforms. But there are still challenges and ongoing needs to continue expanding health financing mechanisms equitably and efficiently, improving stewardship and accountability, strengthening the transition to domestic financing, and enabling evidence-informed priority setting and benefits design processes. Asian countries are rapidly developing and moving to more prepaid financing mechanisms with government subsidies to reduce relatively high out-of-pocket expenses, while facing implementation challenges in the governance and expansion of social health insurance. The Pacific island countries, on the other hand, face stagnating economic growth and rely on government financing, with some countries receiving significant external funding, making it important to have strong stewardship and public financing systems in place. The way forward calls for continuing to strengthen the evidence generation and monitoring function to assess country progress, reorienting primary health care as the foundation of the health sector to ensure that continuity of care is affordable and accountable, and leveraging the private sector to contribute to an equitable and efficient health system.

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The Global Fund in China: Multidrug-resistant tuberculosis nationwide programmatic scale-up and challenges to transition to full country ownership

Cited by 21 publications

References 12 publications

Current situation and progress toward the 2030 health-related Sustainable Development Goals in China: A systematic analysis

Current situation and progress toward the 2030 health-related Sustainable Development Goals in China: A systematic analysis

High-risk screening and detection of multidrug-resistant tuberculosis in two prefectures of China: a drug susceptibility surveillance-based secondary data analysis

Health Financing Reforms for Moving towards Universal Health Coverage in the Western Pacific Region

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