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Human Resources for Tuberculosis Care in China: Gaps and Challenges from a Physicians’ Perspective

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Human Resources for Tuberculosis Care in China: Gaps and Challenges from a Physicians’ Perspective Human Resources for Tuberculosis Care in China: Gaps and Challenges from a Physicians’ Perspective By Lei Guo Graduate Program in Global Health Duke Kunshan University and Duke University Date:_______________________ Approved: ___________________________ Shenglan Tang, Supervisor ___________________________ Truls Ostbye ___________________________ Xiaoyun Liu Thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in the Graduate Program in Global Health in the Graduate School of Duke Kunshan University and Duke University 2018 ABSTRACT Human Resources for Tuberculosis Care in China: Gaps and Challenges from a Physicians’ Perspective By Lei Guo Graduate Program in Global Health Duke Kunshan University and Duke University Date:_______________________ Approved: ___________________________ Shenglan Tang, Supervisor ___________________________ Truls Ostbye ___________________________ Xiaoyun Liu An abstract of a thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in the Graduate Program in Global Health in the Graduate School of Duke Kunshan University and Duke University 2018 Copyright by Lei Guo 2018 Abstract The human resources for health is one of the key building blocks in tuberculosis control. As the implementer of disease control policies and medical practices, physicians are at a core position for the health of tuberculosis patients. Unfortunately, while the tuberculosis control system is under the transition to the Trinity Model nationwide, little attention was paid to this particular workforce. This study filled the gap of little information about the challenges of tuberculosis physicians by researching on the gaps and challenges of tuberculosis physicians at prefecture‐city and county level. A mixed method approach was used to collect both quantitative and qualitative data through survey and in‐depth interview with physicians, directors of clinical departments and officials at disease control agencies. The shortage of physicians, difficulty in recruitment, insufficient and inappropriate use of protective equipment, unfair compensation, and insufficient training opportunities were found as major challenges of tuberculosis physicians. A collective effort from all levels of governments, CDCs, and hospitals should be made in increasing competence, ensuring health and safety, providing fair compensation, enhancing productivity, and strengthening supportive supervision of tuberculosis physicians. iv Table of Contents Abstract ......................................................................................................................................... iv List of Tables ................................................................................................................................. ix List of Figures ................................................................................................................................ x List of Abbreviations ................................................................................................................... xi Acknowledgements .................................................................................................................. xii 1. Introduction .......................................................................................................................... 1 1.1. Tuberculosis in China ................................................................................................. 1 1.1.1. Trend of disease burden in tuberculosis .............................................................. 1 1.1.2. Tuberculosis care and control system .................................................................. 5 1.2. Human resources for health in China ..................................................................... 10 1.2.1. Overview of human resources for health .......................................................... 10 1.2.2. Human resources for tuberculosis care in the world ....................................... 11 1.2.3. Human resources for tuberculosis care in China .............................................. 13 1.3. Research purpose ....................................................................................................... 14 2. Methods ............................................................................................................................... 16 2.1. Study design ............................................................................................................... 16 2.1.1. Settings .................................................................................................................... 16 2.1.1.1. Selection criteria and process ...................................................................... 16 2.1.1.2. Study sites ...................................................................................................... 17 2.2. Data collection ............................................................................................................ 19 v 2.2.1. Quantitative data ................................................................................................... 19 2.2.1.1. Data sources .................................................................................................. 19 2.2.1.2. Sample ............................................................................................................ 19 2.2.1.3. Data collection tool ....................................................................................... 20 2.2.2. Qualitative data ..................................................................................................... 20 2.2.2.1. Data sources .................................................................................................. 20 2.2.2.2. Sample ............................................................................................................ 21 2.2.2.3. Data collection tool ....................................................................................... 21 2.2.3. Procedures .............................................................................................................. 22 2.2.4. Quality control ....................................................................................................... 22 2.3. Data management and analysis ............................................................................... 23 2.3.1. Data management ................................................................................................. 23 2.3.2. Data analysis .......................................................................................................... 24 2.3.2.1. Conceptual framework ................................................................................ 24 2.3.2.2. Quantitative analysis.................................................................................... 26 2.3.2.3. Qualitative analysis ...................................................................................... 26 2.4. Ethical consideration ................................................................................................. 26 3. Results .................................................................................................................................. 28 3.1. Characteristics of samples ........................................................................................ 28 3.2. Recruitment ................................................................................................................ 30 3.3. Support of tuberculosis physicians ......................................................................... 33 3.3.1. Supervision............................................................................................................. 33 vi 3.3.2. Compensation ........................................................................................................ 35 3.3.3. Life‐long learning .................................................................................................. 40 3.3.4. Health and safety .................................................................................................. 46 3.3.4.1. Infection protection ...................................................................................... 47 3.3.4.2. The impact of two‐child policy ................................................................... 50 3.3.4.3. Patient‐doctor relationship .......................................................................... 51 3.4. Performance of tuberculosis physicians ................................................................. 53 3.4.1. Availability ............................................................................................................. 54 3.4.2. Competence ............................................................................................................ 57 3.4.3. Productivity ........................................................................................................... 59 3.5. Quitting ....................................................................................................................... 62 4. Discussion ............................................................................................................................ 64 4.1. Gaps and challenges .................................................................................................. 64 4.1.1. Availability of tuberculosis physicians .............................................................
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