Open Access Open Badges Research article

Evaluating the impact of decentralising tuberculosis microscopy services to rural township hospitals in gansu province, china

Xiaolin Wei1, Guanyang Zou2, Hui Zhang3, Renzhong Li3, John D Walley4, Shiwen Jiang3, Jia Yin2, Shuigao Jin5, You Li3, Qiang Sun6, James N Newell4, Sian Griffiths1 and Lixia Wang3*

Author Affiliations

1 School of Public Health and Primary Care, Chinese University of Hong Kong, 2/F School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong, China

2 China Office, Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK, Rm 1220, 1032 Dong Men Bei Lu, Shenzhen, 518003, China

3 China National Centre for Tuberculosis Prevention and Control, China Centre for Disease Control, 155 Changbai Road, Chang Ping District, Beijing, 102206, China

4 Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK, 101 Clarendon Rd, Leeds, LS2 9LJ, UK

5 Chief Scientist, China Centre for Disease Control, Address: 155 Changbai Road, Chang Ping District, Beijing, 102206, China

6 School of Public Health, and Centre for Health Management and Policy, Shandong University, 44, Wenhua Xi Lu, Jinan, 250012, China

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BMC Public Health 2011, 11:103  doi:10.1186/1471-2458-11-103

Published: 15 February 2011



In 2004, the Ministry of Health issued the policy of decentralising microscopy services (MCs) to one third of all township hospitals in China. The study was conducted in Gansu Province, a poor western one in China. Ganzhou was one county in Gansu Province. Ganzhou County was identified as a unique case of further decentralisation of tuberculosis (TB) treatment services in township hospitals. The study evaluated the impact of the MC policy on providers and patients in Gansu Province. The second objective was to assess the unique case of Ganzhou County compared with other counties in the province.


Both quantitative and qualitative methods were used. All 523 MCs in the province completed an institutional survey regarding their performance. Four counties were selected for in-depth investigation, where 169 TB suspects were randomly selected from the MC and county TB dispensary registers for questionnaire surveys. Informant interviews were conducted with 38 health staff at the township and county levels in the four counties.


Gansu established MCs in 39% of its township hospitals. From January 2006 to June 2007, 8% of MCs identified more than 10 TB sputum smear positive patients while 54% did not find any. MCs identified 1546 TB sputum smear positive patients, accounting for 9% of the total in the province. The throughputs of MCs in Ganzhou County were eight times of those in other counties. Interviews identified several barriers to implement the MC policy, such as inadequate health financing, low laboratory capacity, lack of human resources, poor treatment and management capacities, and lack of supervisions from county TB dispensaries.


Microscopy centre throughputs were generally low in Gansu Province, and the contribution of MCs to TB case detection was insignificant taking account the number of MCs established. As a unique case of full decentralisation of TB service, Ganzhou County presented better results. However, standards and quality of TB care needed to be improved. The MC policy needs to be reviewed in light of evidence from this study.