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Dr. Wenhui Mao
The Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC 27708, USA

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Journal article
Published: 10 July 2021 in International Journal for Equity in Health
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Background Health policy interventions were expected to improve access to health care delivery, provide financial risk protection, besides reducing inequities that underlie geographic and socio-economic variation in population access to health care. This article examines whether health policy interventions and accelerated health investments in India during 2004–2018 could close the gap in inequity in health care utilization and access to public subsidy by different population groups. Did the poor and socio-economically vulnerable population gain from such government initiatives, compared to the rich and affluent sections of society? And whether the intended objective of improving equity between different regions of the country been achieved during the policy initiatives? This article attempts to assess and provide robust evidence in the Indian context. Methods Employing Benefit-Incidence Analysis (BIA) framework, this paper advances earlier evidence by highlighting estimates of health care utilization, concentration and government subsidy by broader provider categories (public versus private) and across service levels (outpatient, inpatient, maternal, pre-and post-natal services). We used 2 waves of household surveys conducted by the National Sample Survey Organisation (NSSO) on health and morbidity. The period of analysis was chosen to represent policy interventions spanning 2004 (pre-policy) and 2018 (post-policy era). We present this evidence across three categories of Indian states, namely, high-focus states, high-focus north eastern states and non-focus states. Such categorization facilitates quantification of reform impact of policy level interventions across the three groups. Results Utilisation of healthcare services, except outpatient care visits, accelerated significantly in 2018 from 2004. The difference in utilisation rates between poor and rich (between poorest 20% and richest 20%) had significantly declined during the same period. As far as concentration of healthcare is concerned, the Concentrate Index (CI) underlying inpatient care in public sector fell from 0.07 in 2004 to 0.05 in 2018, implying less pro-rich distribution. The CI in relation to pre-natal, institutional delivery and postnatal services in government facilities were pro-poor both in 2004 and 2018 in all 3 groups of states. The distribution of public subsidy underscoring curative services (inpatient and outpatient) remained pro-rich in 2004 but turned less pro-rich in 2018, measured by CIs which declined sharply across all groups of states for both outpatient (from 0.21 in 2004 to 0.16 in 2018) and inpatient (from 0.24 in 2004 to 0.14 in 2018) respectively. The CI for subsidy on prenatal services declined from approximately 0.01 in 2004 to 0.12 in 2018. In respect to post-natal care, similar results were observed, implying the subsidy on prenatal and post-natal services was overwhelmingly received by poor. The CI underscoring subsidy for institutional delivery although remained positive both in 2018 and 2004, but slightly increased from 0.17 in 2004 to 0.28 in 2018. Conclusions Improvement in infrastructure and service provisioning through NHM route in the public facilities appears to have relatively benefited the poor. Yet they received a relatively smaller health subsidy than the rich when utilising inpatient and outpatient health services. Inequality continues to persist across all healthcare services in private health sector. Although the NHM remained committed to broader expansion of health care services, a singular focus on maternal and child health conditions especially in backward regions of the country has yielded desired results.

ACS Style

Sakthivel Selvaraj; Anup K. Karan; Wenhui Mao; Habib Hasan; Ipchita Bharali; Preeti Kumar; Osondu Ogbuoji; Chetana Chaudhuri. Did the poor gain from India’s health policy interventions? Evidence from benefit-incidence analysis, 2004–2018. International Journal for Equity in Health 2021, 20, 1 -15.

AMA Style

Sakthivel Selvaraj, Anup K. Karan, Wenhui Mao, Habib Hasan, Ipchita Bharali, Preeti Kumar, Osondu Ogbuoji, Chetana Chaudhuri. Did the poor gain from India’s health policy interventions? Evidence from benefit-incidence analysis, 2004–2018. International Journal for Equity in Health. 2021; 20 (1):1-15.

Chicago/Turabian Style

Sakthivel Selvaraj; Anup K. Karan; Wenhui Mao; Habib Hasan; Ipchita Bharali; Preeti Kumar; Osondu Ogbuoji; Chetana Chaudhuri. 2021. "Did the poor gain from India’s health policy interventions? Evidence from benefit-incidence analysis, 2004–2018." International Journal for Equity in Health 20, no. 1: 1-15.

Collection review
Published: 24 June 2021 in PLOS Medicine
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Wenhui Mao and coauthors discuss possible implications of the COVID-19 pandemic for health aspirations in low- and middle-income countries.

ACS Style

Wenhui Mao; Osondu Ogbuoji; David Watkins; Ipchita Bharali; Eric Nsiah-Boateng; Mohamed Mustafa Diab; Duah Dwomoh; Dean T. Jamison; Preeti Kumar; Kaci Kennedy McDade; Justice Nonvignon; Yewande Ogundeji; Fan-Gang Zeng; Armand Zimmerman; Gavin Yamey. Achieving global mortality reduction targets and universal health coverage: The impact of COVID-19. PLOS Medicine 2021, 18, e1003675 .

AMA Style

Wenhui Mao, Osondu Ogbuoji, David Watkins, Ipchita Bharali, Eric Nsiah-Boateng, Mohamed Mustafa Diab, Duah Dwomoh, Dean T. Jamison, Preeti Kumar, Kaci Kennedy McDade, Justice Nonvignon, Yewande Ogundeji, Fan-Gang Zeng, Armand Zimmerman, Gavin Yamey. Achieving global mortality reduction targets and universal health coverage: The impact of COVID-19. PLOS Medicine. 2021; 18 (6):e1003675.

Chicago/Turabian Style

Wenhui Mao; Osondu Ogbuoji; David Watkins; Ipchita Bharali; Eric Nsiah-Boateng; Mohamed Mustafa Diab; Duah Dwomoh; Dean T. Jamison; Preeti Kumar; Kaci Kennedy McDade; Justice Nonvignon; Yewande Ogundeji; Fan-Gang Zeng; Armand Zimmerman; Gavin Yamey. 2021. "Achieving global mortality reduction targets and universal health coverage: The impact of COVID-19." PLOS Medicine 18, no. 6: e1003675.

Corrected proof
Published: 04 May 2021 in Health Policy and Planning
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In the coming years, about a dozen middle-income countries are excepted to transition out of development assistance for health (DAH) based on their economic growth. This anticipated loss of external funds at a time when there is a need for accelerated progress towards universal health coverage (UHC) is a source of concern. Evaluating country readiness for transition towards country ownership of health programmes is a crucial step in making progress towards UHC. We used in-depth interviews to explore: (1) the preparedness of the Nigerian health system to transition out of DAH, (2) transition policies and strategies that are in place in Nigeria, (3) the road map for the implementation of these policies and (4) challenges and recommendations for making progress on such policies. We applied Vogus and Graff’s expanded transition readiness framework within the Nigerian context to synthesize preparedness plans, gaps, challenges and stakeholders’ recommendations for sustaining the gains of donor-funded programmes and reaching UHC. Some steps have been taken to integrate and institutionalize service delivery processes toward sustainable immunization and responsive primary healthcare in line with UHC. There are ongoing discussions on integrating human immunodeficiency virus (HIV) services with other services and the possibility of covering HIV services under the National Health Insurance Scheme (NHIS). We identified more transition preparedness plans within immunization programme compared with HIV programme. However, we identified gaps in all the nine components of the framework that must be filled to be able to sustain gains and make significant progress towards country ownership and UHC. Nigeria needs to focus on building the overall health system by identifying systematic gaps instead of continuing to invest in parallel programmes. Programmes need to be consolidated within the overall health system, health financing priorities and policies. A comprehensive and functional structure will provide continuity even in the event of decreasing external funds or donor exits.

ACS Style

Uche Shalom Obi; Osondu Ogbuoji; Wenhui Mao; Minahil Shahid; Obinna Onwujekwe; Gavin Yamey. Progress in the face of cuts: a qualitative Nigerian case study of maintaining progress towards universal health coverage after losing donor assistance. Health Policy and Planning 2021, 36, 1045 -1057.

AMA Style

Uche Shalom Obi, Osondu Ogbuoji, Wenhui Mao, Minahil Shahid, Obinna Onwujekwe, Gavin Yamey. Progress in the face of cuts: a qualitative Nigerian case study of maintaining progress towards universal health coverage after losing donor assistance. Health Policy and Planning. 2021; 36 (7):1045-1057.

Chicago/Turabian Style

Uche Shalom Obi; Osondu Ogbuoji; Wenhui Mao; Minahil Shahid; Obinna Onwujekwe; Gavin Yamey. 2021. "Progress in the face of cuts: a qualitative Nigerian case study of maintaining progress towards universal health coverage after losing donor assistance." Health Policy and Planning 36, no. 7: 1045-1057.

Original research
Published: 22 April 2021 in BMJ Global Health
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China has made profound progress in advancing universal health coverage (UHC) over the past two decades. New Cooperative Medical Scheme (NCMS) was initiated in 2003 to provide health insurance coverage to rural population. Its benefit packages and cost-sharing mechanism have changed significantly over time. This study aims to assess the impact of changing NCMS policies on NCMS enrollees’ service utilisation, medical financial burden and equity between 2003 and 2013. Data are from China National Health Services Survey (NHSS) which is conducted every 5 years. We used the subsample of NHSS that were enrolled in NCMS in 2003, 2008 and 2013. From 2003 to 2013, we found increased service utilisation and an elimination of inequity in service utilisation with respect to income. Contradicting prior findings of increasing financial burden after the NCMS implementation, we identified significant protective effect of NCMS against financial risks, and a reduction in percentage of households with high medical expenditure in the middle-income and high-income quintiles. The rural residents from the low-income groups have high financial risk, therefore, should be the priority target for future reforms. In pursuit of UHC globally, many countries struggle to provide good coverage to the disadvantaged rural population and balance between the competing priorities of various UHC dimensions. Our trend analysis revealed China’s two-stage approach with NCMS reform that first focused on expanding population coverage, then on service coverage and financial risk protection. This path could potentially be replicated in other middle-income and low-income countries to pave the way for UHC.

ACS Style

Yaoguang Zhang; Di Dong; Ling Xu; Zhiwen Miao; Wenhui Mao; Frank Sloan; Shenglan Tang. Ten-year impacts of China’s rural health scheme: lessons for universal health coverage. BMJ Global Health 2021, 6, e003714 .

AMA Style

Yaoguang Zhang, Di Dong, Ling Xu, Zhiwen Miao, Wenhui Mao, Frank Sloan, Shenglan Tang. Ten-year impacts of China’s rural health scheme: lessons for universal health coverage. BMJ Global Health. 2021; 6 (4):e003714.

Chicago/Turabian Style

Yaoguang Zhang; Di Dong; Ling Xu; Zhiwen Miao; Wenhui Mao; Frank Sloan; Shenglan Tang. 2021. "Ten-year impacts of China’s rural health scheme: lessons for universal health coverage." BMJ Global Health 6, no. 4: e003714.

Journal article
Published: 21 April 2021 in Infectious Diseases of Poverty
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Background The China National Health Commission-Gates TB Project Phase III implemented a comprehensive TB control model including multiple interventions to address the burden of drug-resistant TB (DRTB). This study aims to evaluate the quality of DRTB clinical services and assess the financial burden of DRTB patients during the intervention period. Methods A mixed-methods approach was used to evaluate the effectiveness of interventions in the three project provinces: Zhejiang, Jilin and Ningxia Hui Autonomous Region. The quantitative data included de-identified DRTB registry data during 2015–2018 in project provinces from China CDC, medical records of DRTB patients registered in 2018 (n = 106) from designated hospitals, and a structured DRTB patient survey in six sample prefectures in 2019. The quality of clinical services was evaluated using seven indicators across patient screening, diagnosis and treatment. Logistic regression was conducted to explore factors associated with the extremely high financial burden. Semi-structured in-depth interviews with policymakers and focus group discussions with physicians and DRTB patients were conducted to understand the interventions implemented and their impacts. Results The percentage of bacterially confirmed patients taking a drug susceptibility test (DST) increased significantly between 2015 and 2018: from 57.4 to 93.6% in Zhejiang, 12.5 to 86.5% in Jilin, and 29.7 to 91.4% in Ningxia. The treatment enrollment rate among diagnosed DRTB patients also increased significantly and varied from 73 to 82% in the three provinces in 2018. Over 90% of patients in Zhejiang and Jilin and 75% in Ningxia remained in treatment by the end of the first six months’ treatment. Among all survey respondents 77.5% incurred extremely high financial burden of treatment. Qualitative results showed that interventions on promoting rapid DST technologies and patient referral were successfully implemented, but the new financing policies for reducing patients’ financial burden were not implemented as planned. Conclusions The quality of DRTB related clinical services has been significantly improved following the comprehensive interventions, while the financial burden of DRTB patients remains high due to the delay in implementing financing policies. Stronger political commitment and leadership are required for multi-channel financing to provide additional financial support to DRTB patients.

ACS Style

Wei-Xi Jiang; Zhi-Peng Li; Qi Zhao; Meng-Qiu Gao; Qian Long; Wei-Bing Wang; Fei Huang; Ni Wang; Sheng-Lan Tang. Impacts of a comprehensive tuberculosis control model on the quality of clinical services and the financial burden of treatment for patients with drug-resistant tuberculosis in China: a mixed-methods evaluation. Infectious Diseases of Poverty 2021, 10, 1 -13.

AMA Style

Wei-Xi Jiang, Zhi-Peng Li, Qi Zhao, Meng-Qiu Gao, Qian Long, Wei-Bing Wang, Fei Huang, Ni Wang, Sheng-Lan Tang. Impacts of a comprehensive tuberculosis control model on the quality of clinical services and the financial burden of treatment for patients with drug-resistant tuberculosis in China: a mixed-methods evaluation. Infectious Diseases of Poverty. 2021; 10 (1):1-13.

Chicago/Turabian Style

Wei-Xi Jiang; Zhi-Peng Li; Qi Zhao; Meng-Qiu Gao; Qian Long; Wei-Bing Wang; Fei Huang; Ni Wang; Sheng-Lan Tang. 2021. "Impacts of a comprehensive tuberculosis control model on the quality of clinical services and the financial burden of treatment for patients with drug-resistant tuberculosis in China: a mixed-methods evaluation." Infectious Diseases of Poverty 10, no. 1: 1-13.

Journal article
Published: 01 March 2021 in The Lancet Global Health
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ACS Style

Paige Kleidermacher; Wenhui Mao; Gavin Yamey; Kaci Kennedy McDade. Estimating Chinese foreign health aid: an analysis of AidData's Global Chinese Official Finance dataset. The Lancet Global Health 2021, 9, S26 .

AMA Style

Paige Kleidermacher, Wenhui Mao, Gavin Yamey, Kaci Kennedy McDade. Estimating Chinese foreign health aid: an analysis of AidData's Global Chinese Official Finance dataset. The Lancet Global Health. 2021; 9 ():S26.

Chicago/Turabian Style

Paige Kleidermacher; Wenhui Mao; Gavin Yamey; Kaci Kennedy McDade. 2021. "Estimating Chinese foreign health aid: an analysis of AidData's Global Chinese Official Finance dataset." The Lancet Global Health 9, no. : S26.

Journal article
Published: 19 January 2021 in Infectious Diseases of Poverty
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Background The detection of drug-resistant tuberculosis (DR-TB) is a major health concern in China. We aim to summarize interventions related to the screening and detection of DR-TB in Jiangsu Province, analyse their impact, and highlight policy implications for improving the prevention and control of DR-TB. Methods We selected six prefectures from south, central and north Jiangsu Province. We reviewed policy documents between 2008 and 2019, and extracted routine TB patient registration data from the TB Information Management System (TBIMS) between 2013 and 2019. We used the High-quality Health System Framework to structure the analysis. We performed statistical analysis and logistic regression to assess the impact of different policy interventions on DR-TB detection. Results Three prefectures in Jiangsu introduced DR-TB related interventions between 2008 and 2010 in partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) and the Bill & Melinda Gates Foundation (Gates Foundation). By 2017, all prefectures in Jiangsu had implemented provincial level DR-TB policies, such as use of rapid molecular tests (RMT), and expanded drug susceptibility testing (DST) for populations at risk of DR-TB. The percentage of pulmonary TB cases confirmed by bacteriology increased from 30.0% in 2013 to over 50.0% in all prefectures by 2019, indicating that the implementation of new diagnostics has provided more sensitive testing results than the traditional smear microscopy. At the same time, the proportion of bacteriologically confirmed cases tested for drug resistance has increased substantially, indicating that the intervention of expanding the coverage of DST has reached more of the population at risk of DR-TB. Prefectures that implemented interventions with support from the Global Fund and the Gates Foundation had better detection performance of DR-TB patiens compared to those did not receive external support. However, the disparities in DR-TB detection across prefectures significantly narrowed after the implementation of provincial DR-TB polices. Conclusions The introduction of new diagnostics, including RMT, have improved the detection of DR-TB. Prefectures that received support from the Global Fund and the Gates Foundation had better detection of DR-TB. Additionally, the implementation of provincial DR-TB polices led to improvements in the detection of DR-TB across all prefectures.

ACS Style

Xiao-Yan Ding; Wen-Hui Mao; Wei Lu; Hao Yu; Qiao Liu; Peng Lu; Hui Jiang; Xing Zhang; Feng Lu; Jie Xu; Chong-Qiao Zhong; Jin-Liu Hu; Wei-Xi Jiang; Lei Guo; Sheng-Lan Tang; Li-Mei Zhu. Impact of multiple policy interventions on the screening and diagnosis of drug-resistant tuberculosis patients: a cascade analysis on six prefectures in China. Infectious Diseases of Poverty 2021, 10, 1 -10.

AMA Style

Xiao-Yan Ding, Wen-Hui Mao, Wei Lu, Hao Yu, Qiao Liu, Peng Lu, Hui Jiang, Xing Zhang, Feng Lu, Jie Xu, Chong-Qiao Zhong, Jin-Liu Hu, Wei-Xi Jiang, Lei Guo, Sheng-Lan Tang, Li-Mei Zhu. Impact of multiple policy interventions on the screening and diagnosis of drug-resistant tuberculosis patients: a cascade analysis on six prefectures in China. Infectious Diseases of Poverty. 2021; 10 (1):1-10.

Chicago/Turabian Style

Xiao-Yan Ding; Wen-Hui Mao; Wei Lu; Hao Yu; Qiao Liu; Peng Lu; Hui Jiang; Xing Zhang; Feng Lu; Jie Xu; Chong-Qiao Zhong; Jin-Liu Hu; Wei-Xi Jiang; Lei Guo; Sheng-Lan Tang; Li-Mei Zhu. 2021. "Impact of multiple policy interventions on the screening and diagnosis of drug-resistant tuberculosis patients: a cascade analysis on six prefectures in China." Infectious Diseases of Poverty 10, no. 1: 1-10.

Original research
Published: 13 January 2021 in BMJ Global Health
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BackgroundGhana’s shift from low-income to middle-income status will make it ineligible to receive concessional aid in the future. While transition may be a reflection of positive changes in a country, such as economic development or health progress, a loss of support from donor agencies could have negative impacts on health system performance and population health. We aimed to identify key challenges and opportunities that Ghana will face in dealing with aid transition, specifically from the point of view of country-level stakeholders.MethodsWe conducted key informant interviews with 18 stakeholders from the government, civil society organisations and donor agencies in Ghana using a semistructured interview guide. We performed directed content analysis of the interview transcripts to identify key themes related to anticipated challenges and opportunities that might result from donor transitions.ResultsOverall, stakeholders identified challenges more frequently than opportunities. All stakeholders interviewed believe that Ghana will face substantial challenges due to donor transitions. Challenges include difficulty filling financial gaps left by donors, the shifting of national priorities away from the health sector, lack of human resources for health, interrupted care for beneficiaries of donor-funded health programmes, neglect of vulnerable populations and loss of the accountability mechanisms that are linked with donor financing. However, stakeholders also identified key opportunities that transitions might present, including efficiency gains, increased self-determination and self-sufficiency, enhanced capacity to leverage domestic resources and improved revenue mobilisation.ConclusionStakeholders in Ghana believe transitioning away from aid for health presents both challenges and opportunities. The challenges could be addressed by conducting a transition readiness assessment, identifying health sector priorities, developing a transition plan with a budget to continue critical health programmes and mobilising greater political commitment to health. The loss of aid could be turned into an opportunity to integrate vertical programmes into a more comprehensive health system.

ACS Style

Wenhui Mao; Kaci Kennedy McDade; Hanna E Huffstetler; Joseph Dodoo; Daniel Nana Yaw Abankwah; Nathaniel Coleman; Judy Riviere; Jiaqi Zhang; Justice Nonvignon; Ipchita Bharali; Shashika Bandara; Osondu Ogbuoji; Gavin Yamey. Transitioning from donor aid for health: perspectives of national stakeholders in Ghana. BMJ Global Health 2021, 6, e003896 .

AMA Style

Wenhui Mao, Kaci Kennedy McDade, Hanna E Huffstetler, Joseph Dodoo, Daniel Nana Yaw Abankwah, Nathaniel Coleman, Judy Riviere, Jiaqi Zhang, Justice Nonvignon, Ipchita Bharali, Shashika Bandara, Osondu Ogbuoji, Gavin Yamey. Transitioning from donor aid for health: perspectives of national stakeholders in Ghana. BMJ Global Health. 2021; 6 (1):e003896.

Chicago/Turabian Style

Wenhui Mao; Kaci Kennedy McDade; Hanna E Huffstetler; Joseph Dodoo; Daniel Nana Yaw Abankwah; Nathaniel Coleman; Judy Riviere; Jiaqi Zhang; Justice Nonvignon; Ipchita Bharali; Shashika Bandara; Osondu Ogbuoji; Gavin Yamey. 2021. "Transitioning from donor aid for health: perspectives of national stakeholders in Ghana." BMJ Global Health 6, no. 1: e003896.

Preprint content
Published: 15 December 2020
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IntroductionDrug-resistant tuberculosis (DRTB) has become a critical challenge to ending TB efforts worldwide. To help address the burden in China, the China National Health Commission-Gates TB Project Phase III implemented a comprehensive TB control model which includes multiple interventions to improve the quality of clinical services and reduce the financial burden for DRTB patients.MethodsA mixed-methods approach was used to evaluate the effectiveness of interventions. The quantitative data included three sources: de-identified DRTB registered data from 2015-2018 in project provinces, medical records of DRTB patients registered in 2018 (n=106), and a structured DRTB patient survey in six sample prefectures. The quality of clinical services was evaluated using seven indicators across patient screening, diagnosis and treatment. Logistic regression was conducted to explore factors associated with the extremely high financial burden (defined as out-of-pocket medical expenditure in the first six months of treatment over 30% of annual household income). Key informant interviews with policymakers and focus group discussions with physicians and DRTB patients were conducted to understand the interventions implemented and their impacts.ResultsThe percentage of bacterially confirmed patients taking a drug susceptibility test (DST) increased significantly between 2015 and 2018: from 57.4% to 93.6% in Zhejiang, 12.5% to 86.5% in Jilin, and 29.7% to 91.4% in Ningxia. The treatment enrollment rate among diagnosed DRTB patients also increased significantly and varied from 73% to 82% in the three provinces in 2018. Over 90% of patients in Zhejiang and Jilin and 75% in Ningxia remained in treatment by the end of the first six months’ treatment. Among all survey respondents 77.5% incurred extremely high financial burden of treatment. Qualitative results showed that interventions on promoting rapid DST technologies and patient referral were successfully implemented, but the new financing policies for reducing patients’ financial burden were not implemented as planned.ConclusionsThe quality of DRTB related clinical services has been significantly improved following the comprehensive interventions, while the financial burden of DRTB patients remains high due to the delay in implementing financing policies. Stronger political commitment and leadership are required for multi-channel financing to provide additional financial support to DRTB patients.

ACS Style

Weixi Jiang; Zhipeng Li; Qi Zhao; Mengqiu Gao; Qian Long; Weibing Wang; Fei Huang; Ni Wang; Shenglan Tang. Impacts of a Comprehensive TB Control Model on the Quality of Clinical Services and the Financial Burden of Treatment for Patients with Drug-resistant Tuberculosis in China: A Mixed-methods Evaluation. 2020, 1 .

AMA Style

Weixi Jiang, Zhipeng Li, Qi Zhao, Mengqiu Gao, Qian Long, Weibing Wang, Fei Huang, Ni Wang, Shenglan Tang. Impacts of a Comprehensive TB Control Model on the Quality of Clinical Services and the Financial Burden of Treatment for Patients with Drug-resistant Tuberculosis in China: A Mixed-methods Evaluation. . 2020; ():1.

Chicago/Turabian Style

Weixi Jiang; Zhipeng Li; Qi Zhao; Mengqiu Gao; Qian Long; Weibing Wang; Fei Huang; Ni Wang; Shenglan Tang. 2020. "Impacts of a Comprehensive TB Control Model on the Quality of Clinical Services and the Financial Burden of Treatment for Patients with Drug-resistant Tuberculosis in China: A Mixed-methods Evaluation." , no. : 1.

Journal article
Published: 25 November 2020 in BMC Public Health
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Background China and Vietnam have made impressive progress towards universal health coverage (UHC) through government-led health insurance reforms. We compared the different pathways used to achieve UHC, to identify the lessons other countries can learn from China and Vietnam. Methods This was a mixed method study which included a literature review, in-depth interviews and secondary data analysis. We conducted a literature search in English and Chinese databases, and reviewed policy documents from internal contacts. We conducted semi-structured interviews with 16 policy makers, government bureaucrats, health insurance scholars in China and Vietnam. Secondary data was collected from National Health Statistics Reports, Health Insurance Statistical Reports and National Health Household Surveys carried out in both countries. We used population insurance coverage, insurance policies, reimbursement rates, number of households experiencing catastrophic heath expenditure (CHE) and incidence of impoverishment due to health expenditure (IHE) to measure the World Health Organization’s three dimensions of UHC: population coverage, service coverage, and financial coverage. Results China has increased population coverage through strong political commitment and extensive government financial subsidies to expand coverage. Vietnam expanded population coverage gradually, by prioritizing the poor and the near-poor in an incremental way. In China, insurance service packages varied across regions and schemes and were greatly determined by financial contributions, resulting in limited service coverage in less developed areas. Vietnam focused on providing a comprehensive and universal service packages for all enrollees thereby approaching UHC in a more equitable manner. CHE rate decreased in Vietnam but increased in China between 2003 and 2008. While Vietnam has decreased the CHE gap between urban and rural populations, China suffers from persistent disparities among population income levels and geographic location. CHE and CHE rates were still high in lower income groups. Conclusion Political commitment, sustainable financial sources and administrative capacity are strong driving factors in achieving UHC through health insurance reform. Health insurance schemes need to consider covering essential health services for all beneficiaries and providing government subsidies for vulnerable populations’ in order to help achieve health for all.

ACS Style

Wenhui Mao; Yuchen Tang; Tra Tran; Michelle Pender; Phuong Nguyen Khanh; Shenglan Tang. Advancing universal health coverage in China and Vietnam: lessons for other countries. BMC Public Health 2020, 20, 1 -9.

AMA Style

Wenhui Mao, Yuchen Tang, Tra Tran, Michelle Pender, Phuong Nguyen Khanh, Shenglan Tang. Advancing universal health coverage in China and Vietnam: lessons for other countries. BMC Public Health. 2020; 20 (1):1-9.

Chicago/Turabian Style

Wenhui Mao; Yuchen Tang; Tra Tran; Michelle Pender; Phuong Nguyen Khanh; Shenglan Tang. 2020. "Advancing universal health coverage in China and Vietnam: lessons for other countries." BMC Public Health 20, no. 1: 1-9.

Preprint content
Published: 07 October 2020
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Background The detection of drug resistant tuberculosis (DR-TB) is a major concern in China. China has implemented multiple DR-TB interventions in partnership with development partners and via domestic policy reforms. We aim to summarize the interventions related to the screening and detection of DR-TB in Jiangsu Province, analyse their impact, and highlight policy implications for the prevention and control of DR-TB.Methods We selected six prefectures across Jiangsu Province, a relatively developed area in China with a long history of collaboration with development partners and provincial policy reforms. We collected policy documents between 2008 and 2019, and extracted routine TB patient registration data from the TB Information Management System (TBIMS) between 2013 and 2019. We used the High-quality Health System Framework to guide the analysis. We performed statistical analysis on the percentage of pulmonary TB cases confirmed by bacteriology, percentage of bacteriologically confirmed TB patients tested for drug susceptibility by prefecture and by year. We used logistic regression models on TB cases confirmed by bacteriology and bacteriologically confirmed TB patients tested for drug susceptibility to further assess the impact of different policy interventions. Results Our study found that three prefectures in Jiangsu introduced DR-TB related interventions between 2008 and 2010 in partnership with the Global Fund and the Bill and Melinda Gates Foundation. By 2017, all prefectures in Jiangsu had implemented provincial level DR-TB policies, such as increases in human resources for health, use of rapid molecular tests (RMT), expanded drug susceptibility testing (DST) for populations at risk of DR-TB, and allocation of funds specifically targeting DR-TB. With the use of RMT, the diagnostic process of DR-TB was optimized and the testing time shortened. The percentage of pulmonary TB cases confirmed by bacteriology increased from around 30% to over 50% between 2013 and 2019, indicating that the implementation of new diagnostics, including RMT, have provided more sensitive testing results than the traditional smear microscopy. At the same time, the proportion of bacteriologically confirmed cases tested for drug resistance has increased substantially, indicating that the intervention of expanding the coverage of DST has reached more of the population at risk of DR-TB. Prefectures that implemented interventions with the Global Fund and the Bill and Melinda Gates Foundation had better performance in detecting DR-TB patients. The disparities in detecting DR-TB among prefectures significantly narrowed after the implementation of provincial DR-TB polices. Conclusions The introduction of new diagnostics, including RMT, have improved the detection of DR-TB. Prefectures implementing interventions with the Global Fund and the Gates Foundation had better detection of DR-TB even after the end of the partnership. Additionally, the implementation of provincial DR-TB polices led to improvements in the detection of DR-TB across all regions.

ACS Style

Xiaoyan Ding; Wenhui Mao; Wei Lu; Hao Yu; Qiao Liu; Peng Lu; Hui Jiang; Xing Zhang; Feng Lu; Jie Xu; Chongqiao Zhong; Jinliu Hu; Weixi Jiang; Lei Guo; Shenglan Tang; Limei Zhu. Impact of Multiple Policy Interventions on the Screening and Diagnosis of Drug-Resistant Tuberculosis Patients: Cascade Analysis on 6 Cities from Eastern China. 2020, 1 .

AMA Style

Xiaoyan Ding, Wenhui Mao, Wei Lu, Hao Yu, Qiao Liu, Peng Lu, Hui Jiang, Xing Zhang, Feng Lu, Jie Xu, Chongqiao Zhong, Jinliu Hu, Weixi Jiang, Lei Guo, Shenglan Tang, Limei Zhu. Impact of Multiple Policy Interventions on the Screening and Diagnosis of Drug-Resistant Tuberculosis Patients: Cascade Analysis on 6 Cities from Eastern China. . 2020; ():1.

Chicago/Turabian Style

Xiaoyan Ding; Wenhui Mao; Wei Lu; Hao Yu; Qiao Liu; Peng Lu; Hui Jiang; Xing Zhang; Feng Lu; Jie Xu; Chongqiao Zhong; Jinliu Hu; Weixi Jiang; Lei Guo; Shenglan Tang; Limei Zhu. 2020. "Impact of Multiple Policy Interventions on the Screening and Diagnosis of Drug-Resistant Tuberculosis Patients: Cascade Analysis on 6 Cities from Eastern China." , no. : 1.

Journal article
Published: 09 July 2020 in BMC Health Services Research
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China’s rapidly aging population has led to many challenges related to the health care delivery and financing. Since 2007, the Urban Residents Basic Medical Insurance (URBMI) program has provided financial protection for older adults living in urban areas not already covered by other health insurance schemes. We conducted a national level assessment on this population’s health needs and health service utilization. Records for 9646 individuals over the age of 60 were extracted for analysis from two National Health Service Surveys conducted in 2008 and 2013. Multiple regression models were used to examine associations between socioeconomic factors, health needs and health service utilization while controlling for demographic characteristics and survey year. Self-reported illness, especially non-communicable diseases (NCDs) increased significantly between 2008 and 2013 regardless of insurance enrollment, age group or income level. In 2013, over 75% of individuals reported at least one NCD. Outpatient services decreased for the uninsured but increased for those with insurance. Middle- and high-income groups with insurance experienced a higher increase in outpatient visits and hospital admissions than the low-income group. Forgone hospital admissions (defined as an admission indicated by a doctor but which was declined or not followed through by the patient) decreased. However, over 20% of individuals had to forgo necessary hospital admissions, and 40% of these cases were due to financial barriers. Outpatient visits and hospital admissions increased between 2008 and 2013, and insured individuals utilized more services than those without insurance. After the implementation of URBMI, health service utilization increased and forgone hospital admissions decreased, indicating the program helped to improve access to health services. However, there was still a marked difference in utilization among different income groups, with the high-income group experiencing the greatest increase. This factor calls for further attention to be given to issues related to equity. Prevalence of self-reported NCDs greatly increased among the study population between 2008 and 2013, suggesting that health insurance programs need to ensure they cover sufficient support for the treatment and prevention of NCDs.

ACS Style

Wenhui Mao; Yaoguang Zhang; Ling Xu; Zhiwen Miao; Di Dong; Shenglan Tang. Does health insurance impact health service utilization among older adults in urban China? A nationwide cross-sectional study. BMC Health Services Research 2020, 20, 1 -9.

AMA Style

Wenhui Mao, Yaoguang Zhang, Ling Xu, Zhiwen Miao, Di Dong, Shenglan Tang. Does health insurance impact health service utilization among older adults in urban China? A nationwide cross-sectional study. BMC Health Services Research. 2020; 20 (1):1-9.

Chicago/Turabian Style

Wenhui Mao; Yaoguang Zhang; Ling Xu; Zhiwen Miao; Di Dong; Shenglan Tang. 2020. "Does health insurance impact health service utilization among older adults in urban China? A nationwide cross-sectional study." BMC Health Services Research 20, no. 1: 1-9.

Journal article
Published: 08 July 2020 in Bulletin of the World Health Organization
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On 21 January 2020, the city of Taizhou, China, reported its first imported coronavirus disease 2019 (COVID-19) case and subsequently the number of cases rapidly increased. To organize the emergency responses, the government of Taizhou established on 23 January 2020 novel headquarters for prevention and control of the COVID-19 outbreak, by coordinating different governmental agencies. People at high risk of acquiring COVID-19, as well as probable and confirmed cases, were identified and quarantined. The government closed public venues and limited gatherings. The Taizhou Health Commission shared information about identified COVID-19 patients and probable cases with affected agencies. To timely track and manage close contacts of confirmed cases, Taizhou Center for Disease Control and Prevention did epidemiological investigations. Medical institutions or local centers for disease control and prevention reported confirmed cases to the national Center for Disease Control and Prevention. Taizhou, a city in Zhejiang province with about 6 million residents, reported 18 confirmed COVID-2019 cases by 23 January 2020, which ranked it third globally in number of cases after Wuhan and Xiaogan cities in the Hubei province. In total, 146 confirmed cases (85 cases imported and 61 cases through community transmission) and no deaths due to COVID-19 had been reported in Taizhou by 1 June 2020. Between 16 February and 1 June 2020, no confirmed case had been reported. Identifying and managing imported cases and people at risk for infection, timely information sharing, limiting gatherings and ensuring collaborations between different agencies were important in controlling COVID-19.

ACS Style

Haijiang Lin; Congcong Guo; Yafei Hu; Hongbiao Liang; Weiwei Shen; Wenhui Mao; Na He. COVID-19 control strategies in Taizhou city, China. Bulletin of the World Health Organization 2020, 98, 632 -637.

AMA Style

Haijiang Lin, Congcong Guo, Yafei Hu, Hongbiao Liang, Weiwei Shen, Wenhui Mao, Na He. COVID-19 control strategies in Taizhou city, China. Bulletin of the World Health Organization. 2020; 98 (9):632-637.

Chicago/Turabian Style

Haijiang Lin; Congcong Guo; Yafei Hu; Hongbiao Liang; Weiwei Shen; Wenhui Mao; Na He. 2020. "COVID-19 control strategies in Taizhou city, China." Bulletin of the World Health Organization 98, no. 9: 632-637.

Analysis
Published: 30 June 2020 in BMJ Global Health
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China has the highest number of hepatitis B and C cases globally. Despite remarkable achievements, China faces daunting challenges in achieving international targets for hepatitis elimination. As part of a large-scale project assessing China’s progress in achieving health-related Sustainable Development Goals using quantitative, qualitative data and mathematical modelling, this paper summarises the achievements, gaps and challenges, and proposes options for actions for hepatitis B and C control. China has made substantial progress in controlling chronic viral hepatitis. The four most successful strategies have been: (1) hepatitis B virus childhood immunisation; (2) prevention of mother-to-child transmission; (3) full coverage of nucleic acid amplification testing in blood stations and (4) effective financing strategies to support treatment. However, the total number of deaths due to hepatitis B and C is estimated to increase from 434 724 in 2017 to 527 829 in 2030 if there is no implementation of tailored interventions. Many health system barriers, including a fragmented governance system, insufficient funding, inadequate service coverage, unstandardised treatment and flawed information systems, have compromised the effective control of hepatitis B and C in China. We suggest five strategic priority actions to help eliminate hepatitis B and C in China: (1) restructure the viral hepatitis control governance system; (2) optimise health resource allocation and improve funding efficiency; (3) improve access to and the quality of the health benefits package, especially for high-risk groups; (4) strengthen information systems to obtain high-quality hepatitis epidemiological data; (5) increase investment in viral hepatitis research and development.

ACS Style

Shu Chen; Wenhui Mao; Lei Guo; Jiahui Zhang; Shenglan Tang. Combating hepatitis B and C by 2030: achievements, gaps, and options for actions in China. BMJ Global Health 2020, 5, e002306 .

AMA Style

Shu Chen, Wenhui Mao, Lei Guo, Jiahui Zhang, Shenglan Tang. Combating hepatitis B and C by 2030: achievements, gaps, and options for actions in China. BMJ Global Health. 2020; 5 (6):e002306.

Chicago/Turabian Style

Shu Chen; Wenhui Mao; Lei Guo; Jiahui Zhang; Shenglan Tang. 2020. "Combating hepatitis B and C by 2030: achievements, gaps, and options for actions in China." BMJ Global Health 5, no. 6: e002306.

Journal article
Published: 01 April 2020 in The Lancet Global Health
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Ipchita Bharali; Wenhui Mao; Hanna Huffstetler; Annahl Hoole; Prasadini Perera; Osondu Ogbuoji. Perspectives on transitions away from donor assistance for health: a discrete choices experiment in Sri Lanka. The Lancet Global Health 2020, 8, S25 .

AMA Style

Ipchita Bharali, Wenhui Mao, Hanna Huffstetler, Annahl Hoole, Prasadini Perera, Osondu Ogbuoji. Perspectives on transitions away from donor assistance for health: a discrete choices experiment in Sri Lanka. The Lancet Global Health. 2020; 8 ():S25.

Chicago/Turabian Style

Ipchita Bharali; Wenhui Mao; Hanna Huffstetler; Annahl Hoole; Prasadini Perera; Osondu Ogbuoji. 2020. "Perspectives on transitions away from donor assistance for health: a discrete choices experiment in Sri Lanka." The Lancet Global Health 8, no. : S25.

Editorial
Published: 13 February 2020 in BMJ Global Health
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The global aid landscape is rapidly changing. So-called ‘emerging’ or ‘non-traditional’ donors (ie, those that have only recently substantially stepped up their development finance support) are pushing the boundaries of existing aid practices. Among such non-traditional donors, China stands out as a major player because of its recent high-profile commitments, like the Belt and Road Initiative, and its major role in establishing new development finance institutions, such as the Asian Infrastructure Investment Bank. Although China is often thought of as a new donor, this categorisation is somewhat misleading: China has provided aid to fellow low-income and middle-income countries for decades. However, China’s role as a major financier of and leader in global development is a relatively recent phenomenon.

ACS Style

Kaci Kennedy McDade; Wenhui Mao. Making sense of estimates of health aid from China. BMJ Global Health 2020, 5, e002261 .

AMA Style

Kaci Kennedy McDade, Wenhui Mao. Making sense of estimates of health aid from China. BMJ Global Health. 2020; 5 (2):e002261.

Chicago/Turabian Style

Kaci Kennedy McDade; Wenhui Mao. 2020. "Making sense of estimates of health aid from China." BMJ Global Health 5, no. 2: e002261.

Journal article
Published: 11 December 2019 in BMC Public Health
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Background Tuberculosis is a leading cause of death worldwide and has become a high global health priority. Accurate country level surveillance is critical to ending the pandemic. Effective routine reporting systems which track the course of the epidemic are vital in addressing TB. China, which has the third largest TB epidemic in the world and has developed a reporting system to help with the control and prevention of TB, this study examined its effectiveness in Eastern China. Methods The number of TB cases reported internally in two hospitals in Eastern China were compared to the number TB cases reported by these same hospitals in the national reporting systems in order to assess the accuracy of reporting. Qualitative data from interviews with key health officials and researcher experience using the TB reporting systems were used to identify factors affecting the accuracy of TB cases being reported in the national systems. Results This study found that over a quarter of TB cases recorded in the internal hospital records were not entered into the national TB reporting systems, leading to an under representation of national TB cases. Factors associated with underreporting included unqualified and overworked health personnel, poor supervision and accountability at local and national levels, and a complicated incohesive health information management system. Conclusions This study demonstrates that TB in Eastern China is being underreported. Given that Eastern China is a developed province, one could assume similar problems may be found in other parts of China with fewer resources as well as many low- and middle-income countries. Having an accurate account of the number of national TB cases is essential to understanding the national and global burden of the disease and in managing TB prevention and control efforts. As such, factors associated with underreporting need to be addressed in order to reduce underreporting.

ACS Style

Danju Zhou; Michelle Pender; Weixi Jiang; Wenhui Mao; Shenglan Tang. Under-reporting of TB cases and associated factors: a case study in China. BMC Public Health 2019, 19, 1 -9.

AMA Style

Danju Zhou, Michelle Pender, Weixi Jiang, Wenhui Mao, Shenglan Tang. Under-reporting of TB cases and associated factors: a case study in China. BMC Public Health. 2019; 19 (1):1-9.

Chicago/Turabian Style

Danju Zhou; Michelle Pender; Weixi Jiang; Wenhui Mao; Shenglan Tang. 2019. "Under-reporting of TB cases and associated factors: a case study in China." BMC Public Health 19, no. 1: 1-9.

Research article
Published: 19 November 2019 in PLOS Medicine
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The Sustainable Development Goals (SDGs), adopted by all United Nations (UN) member states in 2015, established a set of bold and ambitious health-related targets to achieve by 2030. Understanding China’s progress toward these targets is critical to improving population health for its 1.4 billion people. We used estimates from the Global Burden of Disease (GBD) Study 2016, national surveys and surveillance data from China, and qualitative data. Twenty-eight of the 37 indicators included in the GBD Study 2016 were analyzed. We developed an attainment index of health-related SDGs, a scale of 0–100 based on the values of indicators. The projection model is adjusted based on the one developed by the GBD Study 2016 SDG collaborators. We found that China has achieved several health-related SDG targets, including decreasing neonatal and under-5 mortality rates and the maternal mortality ratios and reducing wasting and stunting for children. However, China may only achieve 12 out of the 28 health-related SDG targets by 2030. The number of target indicators achieved varies among provinces and municipalities. In 2016, among the seven measured health domains, China performed best in child nutrition and maternal and child health and reproductive health, with the attainment index scores of 93.0 and 91.8, respectively, followed by noncommunicable diseases (NCDs) (69.4), road injuries (63.6), infectious diseases (63.0), environmental health (62.9), and universal health coverage (UHC) (54.4). There are daunting challenges to achieve the targets for child overweight, infectious diseases, NCD risk factors, and environmental exposure factors. China will also have a formidable challenge in achieving UHC, particularly in ensuring access to essential healthcare for all and providing adequate financial protection. The attainment index of child nutrition is projected to drop to 80.5 by 2025 because of worsening child overweight. The index of NCD risk factors is projected to drop to 38.8 by 2025. Regional disparities are substantial, with eastern provinces generally performing better than central and western provinces. Sex disparities are clear, with men at higher risk of excess mortality than women. The primary limitations of this study are the limited data availability and quality for several indicators and the adoption of "business-as-usual" projection methods. The study found that China has made good progress in improving population health, but challenges lie ahead. China has substantially improved the health of children and women and will continue to make good progress, although geographic disparities remain a great challenge. Meanwhile, China faced challenges in NCDs, mental health, and some infectious diseases. Poor control of health risk factors and worsening environmental threats have posed difficulties in further health improvement. Meanwhile, an inefficient health system is a barrier to tackling these challenges among such a rapidly aging population. The eastern provinces are predicted to perform better than the central and western provinces, and women are predicted to be more likely than men to achieve these targets by 2030. In order to make good progress, China must take a series of concerted actions, including more investments in public goods and services for health and redressing the intracountry inequities.

ACS Style

Shu Chen; Lei Guo; Zhan Wang; Wenhui Mao; Yanfeng Ge; Xiaohua Ying; Jing Fang; Qian Long; Qin Liu; Hao Xiang; Chenkai Wu; Chaowei Fu; Di Dong; Jiahui Zhang; Ju Sun; Lichun Tian; Limin Wang; Maigeng Zhou; Mei Zhang; Mengcen Qian; Wei Liu; Weixi Jiang; Wenmeng Feng; Xinying Zeng; Xiyu Ding; Xun Lei; Rachel Tolhurst; Ling Xu; Haidong Wang; Faye Ziegeweid; Scott Glenn; John S. Ji; Mary Story; Gavin Yamey; Shenglan Tang. Current situation and progress toward the 2030 health-related Sustainable Development Goals in China: A systematic analysis. PLOS Medicine 2019, 16, e1002975 .

AMA Style

Shu Chen, Lei Guo, Zhan Wang, Wenhui Mao, Yanfeng Ge, Xiaohua Ying, Jing Fang, Qian Long, Qin Liu, Hao Xiang, Chenkai Wu, Chaowei Fu, Di Dong, Jiahui Zhang, Ju Sun, Lichun Tian, Limin Wang, Maigeng Zhou, Mei Zhang, Mengcen Qian, Wei Liu, Weixi Jiang, Wenmeng Feng, Xinying Zeng, Xiyu Ding, Xun Lei, Rachel Tolhurst, Ling Xu, Haidong Wang, Faye Ziegeweid, Scott Glenn, John S. Ji, Mary Story, Gavin Yamey, Shenglan Tang. Current situation and progress toward the 2030 health-related Sustainable Development Goals in China: A systematic analysis. PLOS Medicine. 2019; 16 (11):e1002975.

Chicago/Turabian Style

Shu Chen; Lei Guo; Zhan Wang; Wenhui Mao; Yanfeng Ge; Xiaohua Ying; Jing Fang; Qian Long; Qin Liu; Hao Xiang; Chenkai Wu; Chaowei Fu; Di Dong; Jiahui Zhang; Ju Sun; Lichun Tian; Limin Wang; Maigeng Zhou; Mei Zhang; Mengcen Qian; Wei Liu; Weixi Jiang; Wenmeng Feng; Xinying Zeng; Xiyu Ding; Xun Lei; Rachel Tolhurst; Ling Xu; Haidong Wang; Faye Ziegeweid; Scott Glenn; John S. Ji; Mary Story; Gavin Yamey; Shenglan Tang. 2019. "Current situation and progress toward the 2030 health-related Sustainable Development Goals in China: A systematic analysis." PLOS Medicine 16, no. 11: e1002975.

Journal article
Published: 01 October 2019 in The Lancet
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Yingyue Tang; Wenhui Mao; Shenglan Tang. Primary and secondary prevention of breast cancer in China: a scoping review. The Lancet 2019, 394, S76 .

AMA Style

Yingyue Tang, Wenhui Mao, Shenglan Tang. Primary and secondary prevention of breast cancer in China: a scoping review. The Lancet. 2019; 394 ():S76.

Chicago/Turabian Style

Yingyue Tang; Wenhui Mao; Shenglan Tang. 2019. "Primary and secondary prevention of breast cancer in China: a scoping review." The Lancet 394, no. : S76.

Journal article
Published: 01 October 2019 in The Lancet
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BackgroundThe UN Sustainable Development Goals include ending the tuberculosis epidemic globally by 2030. China is a high burden country of both drug-susceptible and multidrug-resistant tuberculosis. This study examined China's progress in meeting the tuberculosis milestones and targets laid out by the WHO End TB Strategy, and analysed key health system challenges to be overcome towards ending the tuberculosis epidemic in China.MethodsWe used estimates of tuberculosis incidence and number of tuberculosis deaths in China from the Global Burden of Disease Study 2016 to conduct current situation analysis and a projection for 2030. We also reviewed national strategy and implementation guidelines in relation to tuberculosis control in China. We conducted semi-structured qualitative interviews, including key-informant interviews with decision makers and policy implementers at national and provincial levels (n=4), and in-depth interviews with experts in tuberculosis control (n=3). Senior researchers invited participants to take part in interviews through personal contacts, and undertook the interviews after obtaining verbal consent from the participants. Thematic analysis was applied to identify themes and develop interpretations.FindingsBetween 1990 and 2016, the estimated tuberculosis incidence declined from 156 cases per 100 000 individuals to 86 cases per 100 000 individuals, and the number of tuberculosis deaths decreased from 178 515 to 40 120, in China. The tuberculosis incidence was projected to drop to 62 cases per 100 000 individuals, and the number of tuberculosis deaths to drop to 17 218 by 2030, both above the WHO 2030 targets of an 80% reduction in tuberculosis incidence (17 cases per 100 000 individuals) and a 90% reduction in the number of tuberculosis deaths (4130), compared with 2015. Of the four key informants, three said that many patients with tuberculosis, particularly multidrug-resistant tuberculosis, suffered from catastrophic payment for tuberculosis care. Qualitative interviews also revealed several key health system challenges in the access to high quality and affordable tuberculosis care, including: (1) insufficient funding and workforce for tuberculosis control; (2) difficulty in scaling up new tuberculosis and multidrug-resistant tuberculosis diagnostic tools; (3) inefficient cooperation across anti-tuberculosis health facilities; and (4) inconsistency among health insurance policies, public hospital reforms, and tuberculosis control strategies.InterpretationChina cannot meet the End TB Strategy targets by 2030, unless synergistic tuberculosis control policies and strategies can be developed and implemented, and multi-sector cooperation can be improved to enhance the delivery of tuberculosis care.FundingThe Bill & Melinda Gates Foundation (grant number OOP1148464).

ACS Style

Qian Long; Lei Guo; Weixi Jiang; Wenhui Mao; Di Dong; Shenglan Tang. Ending tuberculosis in the sustainable development era in China: what are the health system challenges? A mixed-methods study. The Lancet 2019, 394, S43 .

AMA Style

Qian Long, Lei Guo, Weixi Jiang, Wenhui Mao, Di Dong, Shenglan Tang. Ending tuberculosis in the sustainable development era in China: what are the health system challenges? A mixed-methods study. The Lancet. 2019; 394 ():S43.

Chicago/Turabian Style

Qian Long; Lei Guo; Weixi Jiang; Wenhui Mao; Di Dong; Shenglan Tang. 2019. "Ending tuberculosis in the sustainable development era in China: what are the health system challenges? A mixed-methods study." The Lancet 394, no. : S43.