Successful Tuberculosis Control Program in China Incorporates Results-Based Financing (RBF)

With more than one million new cases each year, it is the second largest epidemic in the world, behind only India. Poverty helps to spread TB, and TB reinforces poverty, sickening the poor especially in their adult (i.e., most productive) years. Their incapacitation and death are tragedies in themselves but they also contribute to the impoverishment of families, and impact the country as a whole. It is estimated that high-burden countries in Asia suffer from productivity loss due to TB of 4 to 7 percent of GDP per year.¹ But a national TB program incorporating performance incentives has turned the tide on the epidemic.   
 
A national tuberculosis program was established in 1981, and though some progress was made, “the program was plagued by poor treatment compliance, a deficient network of diagnostic laboratories, and an inadequate system of reporting and evaluating cases.”² Thus, in 1990, TB was still the leading cause of death among adults (360,000 died of TB that year alone).
 
One year later, China embarked on a 10-year Infectious and Endemic Disease Control (IEDC) project to curb the TB epidemic. In partnership with the World Bank and the World Health Organization (WHO), the Chinese government implemented DOTS (Directly Observed Treatment, Short-course) in 13 provinces that account for roughly half of the Chinese population.  DOTS, the internationally recommended approach for the diagnosis and treatment of tuberculosis, requires the supervision of a TB patient’s treatment by an independent observer to ensure treatment is taken regularly, usually over a six-month period. DOTS has been proven to be extremely cost-effective at reducing incidence of TB in high-burden settings.