Qulitative Analysis Of Exiting Barriers In Anti-tb Healthcare Utility And Effects Of Pro-poor Interventions Among Vulnerable Groups Of China

Aims Qualitative interviews with stakeholders were applied to identify factors influencing vulnerable groups in receiving anti-TB care, and to address effects and exiting problems in anti-TB pro-poor interventions, then provide suggestions for national policy makers.Methods Data collection was mainly through qualitative interviews and associated with second-hand materials collection. In-depth interviews and key informant interviews were used in this study. Thematic framework was applied to do data analysis. Maxqda software was applied to do data management such as coding; Microsoft word was used to do charting, comparisons and summaries.Results Through interviews and material summary, it was found that (1)There's few pro-poor interventions targeted on vulnerable groups, and most anti-TB programmes were under the guide of NTP and provided more money to western poor areas. Most of the Current effect evaluations were comprehensive and integrating assessments to general populations in one area, and there's little evaluation about certain intervention. It's difficult to do scientific and strict effect evaluation to certain interventions because there were always dozens of different interventions or comprehensive intervention in one area. Few initiatives targeted on vulnerable groups experienced many difficulties in the process of implementation and it's hard to receive positive effect and widely promotion. (2) Most vulnerable TB patients and suspects were in poor awareness of TB disease and national TB policies, and among the few who stated they knew about TB policy, and most of them just know"free"but didn't know"what"or"which"were for free. Village doctors know little about national and local TB policies except"TB patients should be controlled in TB dispensaries". (3) Most vulnerable patients stated that the biggest worry was from financial: one patient with interruption treatment said she had no money to continue treatment; another patient said he'd go to costal areas hunt for a job when his symptoms relieved;…Stigma influenced patients'family and social life: old patients were isolated by other family members; young patients have difficulties to find jobs or mates; some patients even avoided or rejected TB healthcare workers'management because they're afraid of being known by others that they've got TB. (4) Many key informants and patients stated that assistance from government's current policy was limited: costs such as tests, liver protection drugs or transportation fees were hard to undertake especially for the vulnerable. Many patients showed their gratitude and satisfaction to TB healthcare workers'human care such as home visit with rice, edible oil, and so on. (5) Heavy TB epidemic burden caused heavy workload burden to primary TB healthcare workers in western China, there's primary TB doctor said that subsidy fees for supervising one patient to complete the course of treatment was too few to support their work. Most of the primary TB healthcare workers were graduated from secondary technical schools and lack of sufficient clinical or professional ability to meet the work demand. Some key informants and TB patients stated that there're general hospitals detaining TB patients for treatment instead of referring them to TB dispensaries for convergence-case-management.Conclusions At present, there's few interventions as well as relevant evaluations targeted on vulnerable groups in China. Poverty is the most important barrier for vulnerable groups to get TB healthcare. It influences effective TB control extensively through various and complicated mechanisms such as transportation and migration movement. TB Healthcare utilizers and village doctors were in poor awareness of TB knowledge and policy. Information unequal situation between patients and doctors was one of the barriers influencing efficient TB healthcare utilizations. Health education about TB knowledge and relevant policy needs to be strengthened. Current national TB policy provided vulnerable groups with limited assistance which shared only little about the whole TB medical expenses. Quantity and quality of Human resources in primary TB healthcare centres needs to be strengthened. Convergence case management needs to be strengthened to avoid deliberate provider delay in General hospitals. There's still funding gap in national TB control with the help of international programmes, solutions should be made to guarantee sustainable development of our national TB control and management.