Tuberculosis in China
High prevalence of Tuberculosis is a critical public health problem in china. The country records more than 1.4 million new cases and approximately 150,000 deaths related to tuberculosis. An estimated 4.7 million prevalent cases of tuberculosis were reported across the whole of china; this was by the year 2000. This problem is said to be most prevalent in rural china and areas that are severely affected by poverty. The residents of these areas cannot afford adequate TB services. The availability, affordability and receipt of care declines, as the socio-economic position declines. The problem of high tuberculosis in china started in early 1990s and has been rising gradually over the years.
Status of Tuberculosis
Currently, china accounts for 50 percent of multidrug resistant tuberculosis cases in the world. This health threat results from interrupted and incomplete treatment of tuberculosis. The interruptions are caused by the lack of adequate drugs to treat tuberculosis and access to these services is privileged to a few, as most of the infected cannot afford medical care. This continues to be a challenge in treatment and control of the disease as it is spreading at an alarming rate. The infected re continuously infecting their loved ones at home, thus worsening the situation of trying to control the disease.
Other problems of tuberculosis in china today are high mortality of the disease, high incidence of the disease nationwide and high incidence of infections of pulmonary tuberculosis cases especially in northwest china (Allegra, 2008). These problems have been escalating since the country declared tuberculosis a national disaster in the 1990s; this has forced the government to take steadfast measures in efforts of controlling tuberculosis and its effects on the country’s growth.
In response to the seriousness of the tuberculosis problem in china, the Chinese government has had to formulate measures to curb this problem. One of its earliest measures came to being when the government implemented two major control projects in the 1990s. This was recommended by the World Health Organization’s ‘Directly Observed Therapy Short course’. The funding for this project was provided by the World Bank for the first year of the project’s running, and the Chinese government provided funding for the second running of the project.
By 1997, 50percent of the country’s population had been covered with the projects, and by the year 2000, more than 75 percent of the country had been covered. Concentration and emphasis was put on the areas with the highest rate of tuberculosis. This dedication of the government and the World Bank was the first step towards ridding china of the deadly disease. Results from the project showed 96.8 percent treatment success rate and 53 percent reduction in the death rate related to tuberculosis (Spielgelburg, 2007).
The Chinese Ministry of Health revealed that 63.8 percent of tuberculosis patients in china are currently between the ages of 15 and 50 years, representing at least 350million people in the workforce and an annual GDP loss of over $2 billion. This has highly affected the economic growth of the country. The state council has, therefore, taken measures to stress that the country needs to meet its national targets. Indeed, tuberculosis has been listed as one of the priority diseases that need to be controlled in the country’s eleventh five-year program for economic and social development for 2006-2010 (Freeman, Lu, 2009).
The law dictates obligatory reporting for diseases in class A and B; this is expected to improve the reporting of tuberculosis substantially, since diseases in these classes are considered highly contagious and dangerous. However, the government still finds it difficult to deal with several local authorities that tend to conceal information on this disease for fear of censure. The problem of corruption, cover-ups and misreporting among local officials has raised concerns over the country’s political determination to fight infectious diseases.
On a brighter note, there are reports of several localities that are liaising with the government to try to implement the fight against infectious diseases, which includes tuberculosis. These authorities are providing the government with the required information, and this is done on time to save lives. They are also trying to encourage their counterparts, who are still hiding this crucial information from the government to own up and take responsibility for the lives of the people in their regions (Freeman, Lu, 2009).
The Chinese government has also increased its allocation of funding on tuberculosis programs. The government started by allocating $5.4 million a year to fund free tuberculosis examinations and treatments. This funding has been progressively increasing and has played a vital role in helping to launch a comprehensive containment initiative, which was aimed at free screening and drugs for all tuberculosis patients. In the interim, there has been an increase in funding from the international community. It is reported that the total funding for tuberculosis control in china grew from $20 million in 2001 to $100 million in 2005.
At the Fourth ‘Stop TB Advisory Group’ meeting of the World Health Organization held in Manila in November 2003, china set out a plan of action in 2004-2005. According to the plan, emphasis was given to strengthen human resource capacity, improve laboratory diagnosis, strengthen program management, increase case detention, and maintain high case detention rate. The targets for this program were achieved. The fight against tuberculosis requires partnership and participation, regional, international cooperation and collaboration among the affected countries and the concerned international organizations.
The World Health Organization governs and organizes health activities and offers technical support to international countries. In its biannual budget, is has allocated substantial amounts of money to the Chinese tuberculosis programs, to which it offered recommendations. These programs started running in 1990 when tuberculosis was first detected in china. The World Health Organization has been on the forefront in helping China to curb the disease and improve the lives of the infected and affected people from poor provinces.
The World Bank has also played a major role in ensuring the fight against the prevalence of tuberculosis in china has been successful. Most of the funding for tuberculosis treatments and screening has come from the World Bank. The Chinese government in collaboration with the World Bank has been able to reach the areas that need the most attention but could not access health care facilities and services. This has improved the quality of service provision in the health care system.
The ‘United States Agency for International Development’ tuberculosis team has provided technical support and input to the Chinese community based TB control programs. It also builds relationships with other partners to in their bid to curb the spread if tuberculosis. This is done through training programs offered to medical staff in china to create awareness of tuberculosis and provide sufficient information about treatments. Their tuberculosis team also monitors very closely the progress of these programs to enhance growth and efficiency (Mercurio, 2007).
The ‘International Union Against Tuberculosis and Lung Disease’, in collaboration with the World Health Organization, has started a program initiated at ending stigma against patients suffering from tuberculosis. It has been noted that TB patients are highly discriminated against by being called undeserving names. This has brought about slower rates of improvement in terms of surviving the disease. They would also like affected countries to start using the word ‘prevention and care’ in place of ‘control’ because they believe it is a more appropriate word.
Effects of Measures
The measures taken by the Chinese government and the international bodies will definitely address the problem of tuberculosis. The large-scale tuberculosis programs are already making tremendous progress in reaching the worst affected areas of china’s rural provinces. One of these programs is the ‘Directly Observed Therapy Strategy’. Prevalence has greatly dropped, thanks to the introduction and proper implementation of these programs. These prevalence results indicate remarkable achievements in tuberculosis control, in china.
China’s well-organized public health system is due to the dedicated leadership in government and adequate resource allocation, efficient information system and decentralized tuberculosis control systems. The TB units in the country are present in approximately 80 percent of the regions, and this has contributed to the treatment success rate of about 96 percent. It also offers subsidized services to its affected patients according to their socio-economic condition or what kind of insurance scheme the patient has and special case management approaches in the hospitals.
Affective partnerships and effective use of funds and resources have served a corner stone for the success of the fight against tuberculosis in China. These partnerships and collaborations help to ease the burden on the government to deal with the pandemic on its own. The government, together with local and international organizations, has worked in synchrony to fight the losses that come with the disease, especially in terms of economic effects, which have been huge considering the standing of China in the world market.
The partnerships of the organizations amongst themselves are also a stepping-stone in the progress of dealing with the pandemic that has been tuberculosis in china. This has been a gradual but steady development since the early 1990s, as different local and international organizations are working together to fight tuberculosis in china’s worst affected regions. This just cause has attracted more organizations from all over the world to join china in curbing tuberculosis and in turn strengthen the relationship between china and international governments.
The efforts of the government to ensure that all cases are reported have not been in vain. The previous cases of local authorities hiding information on the prevalence of tuberculosis in their areas are being dealt with by the relevant government bodies. There has been an increase in transparency amongst the different authorities on reporting. The attempts of the government to encourage their authorities have seen major improvements in the fight against the spread if tuberculosis in china. This improvement will provide for efficiency in terms of service provision in the affected areas.
Because the Ministry of Health listed tuberculosis as a priority disease, this means that it will be considered among the first when it comes to allocation of funds. Some of the worst affected areas in china are the rural areas and provinces with the highest levels of poverty. Through priority funding, the health centers in such areas will be able to receive the drugs and equipment they need. This measure will see the prevalence rate reduce even further.
The governments’ investments are receiving funding, which is a big boost to their efforts in combating the disease that is tuberculosis. China is the world’s fastest growing economy and was recently declared the world’s richest economy. This fact alone means that the country has the capacity to source for funding given by its international ties and connections. This has seen its tuberculosis prevalence rate remarkably reduce over the years.
The plan of action that was launched by the country in 2003 to enhance human resource capacity changed the course of the problem. This was because there was increased awareness creation among the doctors, nurses and hospital staff about preventive measures that needed to be taken when caring for patients suffering from tuberculosis. This was due to its alarming rate of infection, and because it is highly contagious. After creating awareness among the hospital staff, these staff members will take the information to the affected areas to those who are caring for the TB patients at home.
Tuberculosis has been claiming millions of lives of the Chinese people for many years. It is reported that the number is fluctuating given by a number of reasons. Despite the fact that ‘DOTS’ achieved good performance in the last decade, affordable tuberculosis services are still problematic in some rural areas in the country. The declining socio-economic position is also contributing to the decline of affordability and care. This highlights the current shortcomings of the national tuberculosis control program in china and the challenges it faces if it is to reach all segments of the country, especially the most affected parts. The Chinese government still has more to do to ensure that the poor access TB-related services, even in areas where the DOTS strategy has been fully implemented.
Allegra, E. P. (2008). Avian influenza research progress. New York: Nova Biomedical Books.Freeman, C., & Boynton, X. L. (2009). China’s capacity to manage infectious diseases: Global implications ; a report of the CSIS Freeman chair in China studies. Washington, D.C: Center for Strategic and International Studies.
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Mercurio, B. (2007). Resolving the Public Health Crisis in the Developing World: Problems and Barriers of Access to Essential Medicines. Northwestern University Journal of International Human Rights, 5(1), 1-80.
Spielgelburg, D. D. (2007). New topics in tuberculosis research. New York: Nova Science Publishers.