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China Advances Battle Against Tuberculosis

March 23, 2010

  • Largest tuberculosis control project ever conducted prevents 770,000 deaths, 20 million infections across 16 provinces in China.
  • Focus on directly observed treatment, poorer regions of China critical to success.
  • China considers how TB lessons apply to public health strategy in Africa.

March  23, 2010--China’s commitment to curbing one of the world’s most persistent infectious threats—tuberculosis (TB)-- has paid off in lives saved, a stronger national TB strategy and a model that could help nations struggling with the same burden half a world away, in Africa.

This month, the World Bank-supported China Tuberculosis Control Project—the largest TB control effort ever conducted—concludes its eight-year run with impressive results: 770,000 deaths and 20 million TB infections averted.

The project, covering a remarkable 668 million Chinese, provided access to effective TB control services in 16 provinces. It made significant progress against what remains a major public health problem in China, which, together with India, comprises 40 percent of the world’s TB burden. China reports more than 1 million new TB cases per year, and the disease contributes to a cycle of poverty by hitting adults in their most productive years, thereby incapacitating the family breadwinner.

Directly Observed Treatment, Focus on Poor

In implementing the project, Chinese government and partner health experts used the World Health Organization-recommended Directly Observed Treatment, short-course strategy (known as “DOTS”). The regimen involves not just finding and curing infectious TB patients, but ensuring—through direct observation—that they take the full, six-month treatment to prevent drug resistance. Patients were also offered free care.

DOTS allows TB patients return to their families and their place of work sooner, and thus resume a normal and productive life. Through this approach, the project achieved 100% DOTS coverage, 77% case detection and a 92% cure rate for detected TB smear-positive patients.

These results exceeded initially designed targets and allowed the project to meet its objectives early, in the third year. “This was one of the most successful TB projects ever seen,” said Jack Langenbrunner, World Bank Lead Economist for Health in East Asia. “Other countries have fought TB protocols, but the Chinese weren’t held back. They accepted DOTS immediately and scaled it up.”

A Chinese Ministry of Health evaluation of the project noted that the focus on Western and poorer regions of China was critical to bolstering the national TB strategy.

“The pro-poor policy and financial support guaranteed the availability of funds, pharmaceuticals, instruments and equipment, giving a spur to TB prevention and control in these areas,” the report stated. “The encouraging progress made in these areas in turn galvanized TB efforts in developed and non-poverty areas, therefore promoting balanced development of TB services across the nation.”

The achievements of China’s TB project are also seen as a giant step toward meeting the Millennium Development Goals for infectious disease. 

“Because it’s such a large country, if China makes efforts to reduce its own burden of TB, this will have a big impact on the global achievement of targets to reduce TB infections worldwide,” said Adrian Davis, head of the U.K. Department for International Development’s (DFID) North and East Asia office.

The China TB project—integrated from its inception into China’s overall national TB control program—was financed through a $104 million loan from the World Bank; a $37 million grant from DFID; a $14 million grant from Japan; and $124 million in government counterpart funding. Other major international partners included the Bill and Melinda Gates Foundation, the World Health Organization, KNCV Tuberculosis Foundation (Netherlands) and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

According to Jim Adams, Bank Vice President for East Asia and Pacific, the project’s unusual financing mix—blending grant and loan—has emerged in recent years as an effective way to mobilize capital for global disease prevention.  This approach helped the project win the Bank President’s Award for Excellence in 2004.

Lessons for Africa?

As an outgrowth of China’s successful collaboration with the Bank on TB and other health projects, the Ministry of Health commissioned three papers co-authored by Bank and Chinese academic experts to examine the nation’s comparative advantage in implementing public health programs, as well as lessons learned from the Bank’s health work in Africa, where China has long invested in infrastructure.

The papers, presented at a December 2009 roundtable meeting in China, will be published as a special issue of the World Health Organization Bulletin later this year. They will help the Chinese government rethink its health strategy in Africa, with a view to expanding from building hospitals and providing equipment to applying Chinese public health innovations to disease prevention and treatment programs.

“China’s experience shows that where there is broad and lasting political commitment and consistent emphasis on preventive measures and basic curative care, large improvements in health outcomes can be achieved,” concluded one of the papers.