Study On Human Resources For TB Control In Seven Project Districts In Shanghai

Background:China is still one of the 22 countries with highest burden of TB diseases and one of the 27 countries with heavy burden of MDR as well. From 2001 to 2009, the number of tuberculosis (TB) cases in the whole country ranked first in infectious diseases, the number of MDR case in newly-infectious TB patients is about 120 thousands each year.In order to reduce and prevent chronic infectious and multiple drug-resistant TB cases, TB prevention organizations from the state to county were established and TB patients were requested to refer to local TB dispensary.TB control work in Shanghai was in the top in China, but in 1990's, with TB resurged with a vengeance, Epidemic situation in Shanghai was also serious. For the population increaseing, urbanization, aging population, TB control in Shanghai faced challenges. In 1998, according to the principle of prevention centralizition, network unity, institution integration, comprehensive management, the TB dispensary in Shanghai was reformed and the new disease control model was implemented.Human resources may affect the quality of the TB control work directly. While it might not be paid more attention comparing the financing by government officers or institution administrators. As the further development of TB control, it is necessary and urgent to improve the human resources for TB control.Objectives:To describe the current situation of human resource for TB control, to analyze the problems of allocaton, to explore the factors affecting human resources, and to provide evidences to improve the allocation of human resources for TB control in seven project districts under the new TB control model in Shanghai. Methods:1. Literature Review:Relevant literatures were collected, reviewed and summarized.2. Policy documents Review: Relevant policy documents of 7 project districts were collected and reviewed. Using Excel software to describe personnel information.3. Quantitative study: Investigation TB Human Resources situation and job satisfaction of staff were carried out applying questionnaires. Using Excel to analyse personnel education background, professional and title structure; using SPSS 13.0 to describe and anylyse characteristics and satisfaction of staff.4. Qualitative study:In-depth interviews were organized with policy makers, administrators of related institutions and health providers. The Framework Analysis was used.Key findings:Treatment and prevention were both emphased in the new TB model in Shanghai, which is differed from the general model practising in China. Staff was allocated according to the organization's function.The number of staff for TB control in Shanghai increased steadily, from 306 in 2005 to 637 in 2009, but with reference to the Chinese TB control planning and implementation guideline (Edition 2008), staff is still insufficient.The staff was relative younger, aged from 25-34 accounted for 34.3%; aged from 35-44 accounted for 21.7%; quality of the staff was constantly enhanced, bachelor degree and above, accounted for 36.5%.TB is a major public health disease, but there was no specific prevention position in most designated hospital because of ignorision by their leaders. In Designated hospital, doctor position in TB outpatient department was unattractive, because of fewer patients that may lead to less clinic practice and may result in promotion difficulty. In Community Health Service Centers(CHSC), the prevention posts also lack of attraction for heavy workload and lower income.Training projects, such as lectures, seminars, job site supervision, meeting, advanced study, were carried out, which were in various content and forms. Through various training, new technologies and new methods were popularized and the staff quality was improved, but focused training need to be emphasizeed. In the meanwhile, personnel training in CHSC generally were carried out by the staff who in charge of TB management in CHSC, but their professional skills, understanding ability might influence the training effect.To mobilize staff enthusiasm, organizations generally given the TB staff the average income of clinic departments, higher than the administrative departments, which reflected certain policy tilt. But in designated hospitals and CHSC, doctors in TB department still had less income than the physician working in the department of respiratory or internal medicine. Meanwhile, the TB projects increased all kinds of subsidies, which was above the national level, but still dit not match the Shanghai economic level.Staff performance appraisal had strengthened step by step and the staffs working enthusiasm was inspired. But there were some problems on the index in performance appraisal.TB staff had higher risk in infecting tuberculosis than other health staff. Staff in department of outpatient in designated hospital had higher risk because the higher frequencies contacts with TB patients. In CHSC, staff had higher risk because they did not take any protective measures. Generally, the job satisfaction was good. It is needed to consider the workload and payment.Recommendations:1. Optimalise allocation standards for TB staff under the new TB control network2. Ensure the sustainability of TB staff, particularly doctors in deparment of outpatient in designated hospitals and doctors working on TB prevention in CHSC.3. Evaluation of training demand and training effects should be launched, focus training should be strengthened.4. The incentive mechanism should be enhanced, the level of motivation should be improved;5. Staff performance appraisal system should be improved.