Table 6 Factors influencing the integration of TB services in Shanghai Changning and Guangxi Nanning
Themes | Shanghai Changning | Guangxi Nanning |
|---|---|---|
Historical context | Integration associated with the restructuring process of the public health organizations, especially the establishment of CDC Pressure from enactment of the Law for Licensing Medical Practitioners. | Integration associated with the restructuring process of the public health organizations, especially the establishment of CDC Pressure from enactment of the Law for Licensing Medical Practitioners. |
Clinical capacity | Limited capacity of the CDC staff to treat TB cases: rationale for integration | Limited capacity of the CDC staff to treat TB cases: rationale for integration |
Motivation for integration | CDC: Worried about losing "control" of services: a potential barrier | CDC: Worried about losing "profits" of services: a potential barrier |
| Â | Hospital: Strong budget commitment from health bureau may motivate providers Historical influence: already established good relationship with the CDC before integration Environmental trigger: most of the other districts in Shanghai had adopted the integrated model | Hospital: Little budget commitment from health bureau may demotivate providers, but integration perceived to improve reputation and income Historical influence: involving TB service provision since 1996 |
Resource allocation | More sustainable resource allocation system: health bureau directly allocated operational budget to designated hospital and funded TB clinical staff More patient-centered and public health orientated care: may improve the quality of integration | Funding for the designated hospital rather limited, resources reallocated from CDC to designated hospital; Tendency to hospitalize TB cases, more profit and clinical-orientated care: may affect the quality of integration |
Staffing and incentives | Attracting and maintaining skilled TB staff a challenge | Attracting and maintaining skilled TB staff a challenge |
Management coordination | Leadership mechanisms in place Personal relationships count | Leadership mechanisms in place Official coordination from the health bureau counts |
Technical exchange | Participatory and collaborative approach: may help to improve the quality of integration | Traditional training approach: may limit the quality of integration |