1. Role of Private Village Clinics in Tuberculosis Control in Three Counties of Shandong, China Jingbo Yu 1 ; R. Paul Duncan, PhD 1 ; Qingyue Meng, PhD 2 1 College of Public Health and Health Professions, University of Florida, Gainesville, FL; 2 Center for Health Policy and Management, Shandong University, China OBJECTIVES BACKGROUND RESULTS CONCLUSIONS METHODS Since the 1990s, health policy in China has encouraged the privatization of rural health clinics. Village clinics are the major source of primary care in rural China. Before economic reform, village clinics cooperated closely with upper-level public health institutions in tuberculosis (TB) control. The performance of village clinics in TB control after privatization was unclear. In this cross-sectional case study, investigators from Shandong University conducted face-to-face interviews with doctors from 63 village clinics and 59 TB patients in three counties. Interviews were conducted in 2003. Other data sources include files of County Tuberculosis Dispensary (CTBD), and 3 focus groups among staff of each CTBD. The objective of this study is to describe the role of private village clinics in TB control (including share of first contacts, referral behaviors, and treatment management practices), and to explore factors influencing their TB care provision. 71.2 percent of rural TB patients first went to village clinics with TB symptoms. Patient delay was shorter among TB patients who initiated care in village clinics than those who first visited other institutions. Most village doctors diagnosed cold or pneumonia and gave anti-symptom and/or antibacterial treatment to suspected tuberculosis patients (STBPs) at first visit; if the symptoms weren’t relieved or became aggravated in a couple of days they would refer patients to a hospital or CTBD. Among clinics visited by STBPs, 46.5% referred STBPs to CTBDs as suggested by the TB Control Guidelines. During treatment 45.8 percent of the patients were supervised by village clinics to receive medication dosage as suggested by Guidelines. Both referral-to-CTBD rate and management practice rate were higher in Z county, where referral reward (20 yuan/TB case) and management fee (60 yuan/patient) from CTBD were guaranteed to village clinics. Private village clinics are playing an important role in referring STBPs and supervising treatment of TB patients. Economic incentives from CTBD improve the performance of private village clinics in TB control. The lesson for other countries is that a public-private partnership is feasible and effective in controlling TB. Table 1. How village clinics deal with suspected TB patients vc: village clinics S countyW countyZou countyTotalP value No. of vc% % % % Visited by suspected TB patients 43100.013100.012100.018100.0- How did they deal with TB patients 1. Anti-symptom treatment, and then 2762.8861.51083.3950.00.179 Referred patients to CTBD1227.9538.500738.90.028 Referred patients to county hospital 1432.6323.1866.7316.70.013 No reference49.300216.6211.10.392 2. Referred patients to hospitals 511.6215.400316.70.486 3. Referred patients to CTBD920.917.718.3738.90.076 4. Rejected patients24.717.718.3000.502 71.2% TB patients(59 patients ） Village clinics Township hospitals County hospitals County Tuberculosis Dispensary(CTBD) Other institutes 6.8% 5.1% 11.9% Figure 1. Where did TB patients go for health care first?