Browsing by Person "Zou, Guanyang"

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Adapting and implementing training, guidelines and treatment cards to improve primary care-based hypertension and diabetes management in a fragile context: Results of a feasibility study in Sierra Leone
(BMC, 2020-07-29) Zou, Guanyang; Witter, Sophie; Caperon, Lizzie; Walley, John; Cheedella, Kiran; Senesi, Reynold G. B.; Wurie, Haja
Background: Sierra Leone, a fragile country, is facing an increasingly significant burden of non-communicable diseases (NCDs). Facilitated by an international partnership, a project was developed to adapt and pilot desktop guidelines and other clinical support tools to strengthen primary care-based hypertension and diabetes diagnosis and management in Bombali district, Sierra Leone between 2018 and 2019. This study assesses the feasibility of the project through analysis of the processes of intervention adaptation and development, delivery of training and implementation of a care improvement package and preliminary outcomes of the intervention.
Association between health service utilisation of internal migrant children and parents' acculturation in Guangdong, China: a cross-sectional study
(BMJ Publishing Group, 2018-01-13) Peng, Bo-li; Zou, Guanyang; Chen, Wen; Lin, Yan-wei; Ling, Li
Objectives To assess the health service utilisation of internal migrant children in Guangdong, China, and to explore the association between children's health service utilisation and their parents' acculturation. Design Cross-sectional survey between April and May 2016. Setting Six society-run schools of Tianhe and Baiyun districts in Guangzhou City of China. Participants We recruited all students at grade 7 or 8 and one of their parents who resided in Guangzhou over 6 months without permanent registered residence (hukou) in Guangzhou (1161 pairs completed this survey). 258 children were ill within the past 2 weeks or during the last year. Main outcome measures The main outcome was self-reported health service utilisation. Logistic regression analysis was conducted to explore the association between children's unmet needs for outpatient or inpatient service and their parents' acculturation (categorised into high, middle and low groups). Results In total, 216 children, or 18.6% of the total subjects, were ill within the past 2 weeks and were in need of outpatient service; 94 children, or 8.1% of the total subjects, were in need of inpatient service. Among them, 17.6% and 46.8% of the migrant children had unmet needs for outpatient and inpatient services, respectively. After controlling for enabling resources and predisposing characteristics, migrant children with parents in the middle-acculturation group (adjusted OR=3.17, 95% CIs 1.2 to 8.3, P<0.05) were more likely to have an unmet outpatient need than high-acculturation or low-acculturation groups, although only statistically significant when comparing with the high-acculturation group. Stratified analysis suggested that this association could be moderated by their family economic status. Conclusions Our study suggested that the association between migrant children's health service utilisation and their parents' acculturation was complex and could be moderated by family economic status. Increasing the service utilisation among migrant children requires improving the acculturation and economic status of the parents of internal migrants.
Association between medication adherence and admission blood pressure among patients with ischemic stroke
(Wolters Kluwer, 2018-10-18) Chen, Min-Jie; Wu, Chan-Chan; Wan, Li-Hong; Zou, Guanyang; Neidlinger, Susan
Background:Poor medication adherence is one of the most important factors underlying uncontrolled blood pressure, and ensuing hypertension is the leading risk factor for stroke. However, the influence of prestroke medication nonadherence on the admission blood pressure of patients with hypertension who have had an ischemic stroke remains unclear.
Chinese health foreign aid and policy: beyond medical aid
(2014-04) Zou, Guanyang; McPake, Barbara; Wei, Xiaolin
Contraceptive practices and induced abortions status among internal migrant women in Guangzhou, China: a cross-sectional study
(2015-06) Zeng, Jiazhi; Zou, Guanyang; Song, Xiaoqin; Ling, Li
Background: China is facing the unprecedented challenges of internal migration. Migrants tend to have poorer utilization of health and family planning services as compared to the local residents. Migrant women are at greater risk of induced abortions due to their poor contraceptive knowledge and attitude. This study aims to understand the contraceptive practices and history of induced abortions, explore the potential factors influencing induced abortions, and evaluate the utilization of family planning services among migrant women in Guangzhou, China. Methods: An anonymous, self-administered questionnaire survey was conducted with 1003 migrant women aged 18-49 in Guangzhou, China in 2013. A multi-stage sampling method was employed. Binary logistic regression model was used for analyzing risk factors of induced abortions. Results: Among the 1003 participants, 810 (80.8 %) reported having sex in the past 6 months, including 715 (88.3 %) married and 95 (11.7 %) unmarried. The most reported contraceptive method was male condom (44.9 %), while 8.1 % never used any contraceptive methods. Only 10.4 % reported having attained free condoms from family planning service stations (FPSSs) and 39.3 % reported having acquired contraceptive knowledge from family planning workers. Of all the participants, 417 (41.6 %) had a history of induced abortion. Of married and unmarried women, 389 (49.1 %) and 28 (14.0 %) had induced abortion respectively. Of these, 152 (36.5 %) had repeated abortions. The most reported reason for having induced abortion was failure of contraception (31.9 %), followed by nonuse of any contraceptives (21.1 %). Migrants who had induced abortion tended to be older, have household registration outside Guangdong province, receive no annual health checkup, have lower education, have urban household registration, have lived longer in Guangzhou and have children (P < 0.05). Conclusions: The prevalence rate of induced abortion, especially repeated abortions among migrant women was high in Guangzhou, China. There is an urgent need to improve the awareness of regular and appropriate use of contraceptives. The utilization of FPSSs among migrant women was reportedly low. Family planning system should be improved to provide better access for migrants and better integrated with the general health services. 2015 Zeng et al.
Developing a social mobilisation intervention for salt reduction: participatory action research in Bombali district, Sierra Leone
(BioMed Central, 2023-09-12) Cheedella, Kiran; Conteh, Peter; Zou, Guanyang; Walley, John; Kamara, Ajaratu; Wurie, Haja; Witter, Sophie
Background: High salt intake is a major risk factor for hypertension, which in turn contributes to cardiovascular diseases, the major cause of death from non communicable diseases (NCDs). Research is limited on social mobilisation interventions to tackle NCDs, including in fragile health settings such as Sierra Leone. Methods: Participatory action research methods were used to develop a social mobilisation intervention for salt reduction in Bombali District, Sierra Leone. A team of 20 local stakeholders were recruited to develop and deliver the intervention. Stakeholder workshop reports and interviews were used to record outcomes, enablers, and barriers to the intervention. Focus group discussions were used to observe knowledge, attitudes, and behaviours of community members pre- and post- the intervention. Results: Stakeholders showed enthusiasm and were well engaged in the social mobilisation process around salt reduction. They developed radio jingles, radio show talks, organised community awareness raising meetings, school sensitisation outreaches, and door to door engagements. Stakeholders reported benefiting personally through developing their own skills and confidence in communication and felt positive about their role in educating their community. The interventions led to reported increased awareness of risks of high salt intake and NCDs, resulting in a reduction of salt use in the community, leading to perceived health gains. However, salt reduction was also met with some resistance due to social factors. Local community structures were also reactivated to work on the interventions and connect the community to the local health facility, which saw an increase in patients having their blood pressure checked. The comparison villages also experienced an increase in awareness and perceived reductions in salt intake behaviours. This was as messages had cascaded via the radio and initial focus group discussions. The social mobilisation stakeholders also agreed on future activities that could continue at no or low cost. Conclusion: Social mobilisation interventions can provide low-cost strategies to tackle NCDs in fragile settings such as Sierra Leone through the utilisation of community structures. However, more research is required to ascertain the key enablers for replicability and if such successes can be sustained over a longer follow up period.
Health service seeking behavior among migrant workers in small and medium-sized enterprises in Guangdong, China: Does family migration matter?
(Hindawi, 2018-11-21) Dang, Yuewen; Zou, Guanyang; Peng, Boli; Ling, Li; Wand, Handan
Objective. This study aims to understand the health service seeking behavior of migrant workers and explore its association with their living status (i.e., living with family members or not), in Guangdong, China. Methods. This was a cross-sectional survey conducted with 912 migrant workers in 2012 using a structured questionnaire adapted from the National Health Service Survey. Data were analyzed using the multivariable logistic regression. Results. Of all migrant workers, 58% lived with at least one family member in the host city. Most of the respondents rated their health status being “very good or good” (58%). Fifty-four percent of the respondents reported having at least one disease in the past 12 months. Sixty-two percent of those who reported at least one disease visited doctors in the past 12 months. Of these, 22% returned to their hometown for medical treatment. Logistic regression showed that migrant workers living with families rated themselves as having better health status (P<0.05) but had more diseases (P>0.05) and had higher doctor visitation rate than those living with alone (58% vs. 66%, P<0.05). Conclusion. The Andersen health service utilization model helps to understand the health seeking behavior of the migrant workers in the host cities. Migrant workers living with family members were positively associated with self-rated health status and health service seeking behavior in small and medium-sized enterprises. Our findings suggest the importance of the assistance programs and social support to improve seeking of healthcare services among migrant groups, especially those who live alone in the host cities.
Health service utilisation of rural-to-urban migrants in Guangzhou, China: does employment status matter?
(Wiley, 2016-11-17) Song, Xiaolei; Zou, Guanyang; Chen, Wen; Han, Siqi; Zou, Xia; Ling, Li
Objective: To describe the self-reported health status and service utilisation of employed, retired and unemployed migrants in Guangzhou, a megacity in southern China. Methods: A cross-sectional study adapted from the National Health Service Survey was conducted between September and December in 2014. Based on the distribution of occupation of migrants, multistage sampling was used to recruit individuals. Logistic regression was applied to explore the factors influencing their service utilisation. Results: Of 2906 respondents, 76.6% were employed, 9.2% retired and 14.2% unemployed. Only 8.1% reported having an illness in the previous 2 weeks, and 6.5% reported having been hospitalised in the previous year. Employed migrants had the lowest recent physician consultation rate (3.4%) and the lowest annual hospitalisation rate (4.5%) (P < 0.05); unemployed migrants had the highest rates (6.8% and 14.5% respectively, P < 0.05). Retired migrants were more likely to return to their hometown for health care (8.6%) than employed (1.5%) and unemployed migrants (3.4%) (P < 0.05). After adjusting for age and gender, employment status remained significant in explaining the recent two-week treatment-seeking behaviour of migrants (P < 0.05). Conclusion: Disparity of service utilisation continues to be a problem for migrants due to the poor health awareness, lack of time and inconvenience of medical insurance reimbursement. Employed migrants make the least use of health services. 2016 John Wiley & Sons Ltd
Health-related quality of life and its correlates among chinese migrants in small-and medium-sized enterprises in two cities of Guangdong
(2014-01) Lu, L.; Zou, Guanyang; Zeng, Z.; Han, L.; Guo, Y.; Ling, L.
Objectives: To explore the relationship between health-related quality of life (HRQOL) status and associated factors among rural-to-urban migrants in China. Methods: A cross-sectional survey was conducted with 856 rural-to-urban migrants working at small-and medium-size enterprises (SMEs) in Shenzhen and Zhongshan City in 2012. Andersen's behavioral model was used as a theoretical framework to exam the relationships among factors affecting HRQOL. Analysis was performed using structural equation modeling (SEM). Results: Workers with statutory working hours, higher wages and less migrant experience had higher HRQOL scores. Need (contracting a disease in the past two weeks and perception of needing health service) had the greatest total effect on HRQOL (_ =20.78), followed by enabling (labor contract, insurance purchase, income, physical examination during work and training) (_ = 0.40), predisposing (age, family separation, education) (_ = 0.22) and health practices and use of health service (physical exercise weekly, health check-up and use of protective equipments) (_ =20.20). Conclusions: Priority should be given to satisfy the needs of migrant workers, and improve the enabling resources.
Learning from implementation of a COVID case management desk guide and training: a pilot study in Sierra Leone
(BioMed Central, 2023-09-25) Witter, Sophie; Zou, Guanyang; Cheedella, Kiran; Walley, John; Wurie, Haja
Background: When the COVID pandemic hit the world, there was need for applied guides and training materials to support frontline health care staff to manage patients effectively and safely and to educate themselves and communities. This article reports on the development and piloting of such a set of materials in Sierra Leone, which were based on international evidence but adapted to the local context. Reflecting on this experience, including community and health system barriers and enablers, is important to prepare for future regional shocks. Methods: This study, in Bombali district in 2020, piloted user-friendly COVID guides for frontline health workers (the intervention), which was evaluated using facility checklists (pre and post training), routine data analysis and 32 key informant interviews. Results: Key informants at district, hospital and community health centre levels identified gains from the training and desk guides, including improved diagnosis, triaging, infection prevention and management of patients. They also reported greater confidence to share messages on protection with colleagues and community members, which was needed to encourage continued use of essential services during the pandemic. However, important barriers were also revealed, including the lack of testing facilities, which reduced the sense of urgency, as few cases were identified. Actions based on the Ebola experience, such as setting up testing and isolation centres, which the community avoided, were not appropriate to COVID. Stigma and fear were important factors, although these were reduced with outreach activities. Supplies of essential medicines and personal protective equipment were also lacking. Conclusion: This pilot study demonstrated the relevance and importance of guides adapted to the context, which were able to improve the confidence of health staff to manage their own and the community’s fears in the face of a new pandemic and improve their skills. Previous epidemics, particularly Ebola, complicated this by both creating structures that could be revitalised but also assumptions and behaviours that were not adapted to the new disease. Our study documents positive adaptations and resilience by health staff but also chronic system weaknesses (particularly for medicines, supplies and equipment) which must be urgently addressed before the next shock arrives.
Opportunities and challenges for delivering non-communicable disease management and services in fragile and post-conflict settings: Perceptions of policy-makers and health providers in Sierra Leone
(BMC, 2020-01-06) Witter, Sophie; Zou, Guanyang; Diaconu, Karin; Senesi, Reynold G. B.; Idriss, Ayesha; Walley, John; Wurie, Haja
Background: The growing burden of non-communicable diseases in low- and middle-income countries presents substantive challenges for health systems. This is also the case in fragile, post-conflict and post-Ebola Sierra Leone, where NCDs represent an increasingly significant disease burden (around 30% of adult men and women have raised blood pressure). To date, documentation of health system challenges and opportunities for NCD prevention and control is limited in such settings. This paper aims to identify opportunities and challenges in provision of NCD prevention and care and highlight lessons for Sierra Leone and other fragile states in the battle against the growing NCD epidemic.
Patient care pathways under the model of integrating tuberculosis service with general hospitals in China
(Blackwell Publishing Ltd, 2013-10) Wei, X.; Yin, J.; Zou, Guanyang
Objective: To report care pathways of tuberculosis (TB) patients under the integrated model, where TB clinical service is provided by a general hospital instead of the TB dispensary, with the aim of providing policy recommendations for TB care reforms in China. Methods: Six counties implementing the integrated model were randomly selected, and 50 TB patients in each county participated in a questionnaire survey. Results: Of the 301 participants, 82 visited only the TB designated hospital. A patient visited a median of two health providers in total. The median external provider delay and internal provider delay were 1 and 0 day, respectively. The median out-of-pocket medical costs were US$379 in total; US$293 in the TB units and US$0 in other health units in the TB designated hospital. Logistic regression analyses suggested that patients who visited the primary care facilities first tended to have longer external delays (OR = 5.71) than patients who visited the other hospitals (OR = 10.16). Conclusion: The integrated model is promising as it reported relatively fewer patient pathways and shorter delays than the dispensary model. However, the integrated model did not reduce patient out-of-pocket costs. 2013 John Wiley & Sons Ltd.
Perceived challenges in delivering comprehensive care for patients following stroke: A qualitative study of stroke care providers in Guangdong Province, China
(Taylor & Francis, 2020-04-28) Wu, Chanchan; Zou, Guanyang; Chen, Minjie; Wan, Lihong; Kielmann, Karina; McCormack, Brendan
Purpose: To understand the challenges in delivering comprehensive care for patients recovering from stroke.
Renaming non-communicable diseases [Letter]
(2017-07-01) Zou, Guanyang; Decoster, Kristof; McPake, Barbara; Witter, Sophie
Results of a cluster randomized controlled trial to promote the use of respiratory protective equipment among migrant workers exposed to organic solvents in small and medium-sized enterprises
(MDPI, 2019-08-31) Chen, Wen; Li, Tongyang; Zou, Guanyang; Renzaho, Andre M. N.; Li, Xudong; Shi, Leiyu; Ling, Li
Background: Existing evidence shows an urgent need to improve respiratory protective equipment (RPE) use, and more so among migrant workers in small and medium-sized enterprises (SMEs). The study aimed to assess the effectiveness of a behavioral intervention in promoting the appropriate use of RPE among internal migrant workers (IMWs) exposed to organic solvents in SMEs. Methods: A cluster randomized controlled trial was conducted among 1211 IMWs from 60 SMEs in Baiyun district in Guangzhou, China. SMEs were deemed eligible if organic solvents were constantly used in the production process and provided workers with RPE. There were 60 SMEs randomized to three interventions on a 1:1:1 ratio, namely a top-down intervention (TDI), a comprehensive intervention, and a control group which did not receive any intervention. IMWs in the comprehensive intervention received a module encompassing three intervention activities: An occupational health education and training component (lectures and leaflets/posters), an mHealth component in the form of messages illustrative pictures and short videos, and a peer education component. The TDI incorporated two intervention activities, namely the mHealth and occupational health education and training components. The primary outcome was the self-reported appropriate RPE use among IMWs, defined as using an appropriate RPE against organic solvents at all times during the last week before measurement. Secondary outcomes included IMWs’ occupational health knowledge, attitude towards RPE use, and participation in occupational health check-ups. Data were collected and assessed at baseline, and three and six months of the intervention. Generalized linear mixed models were performed to evaluate the effectiveness of the trial. Results: Between 3 August 2015 and 29 January 2016, 20 SMEs with 368 IMWs, 20 SMEs with 390 IMWs, and 20 SMEs with 453 IMWs were assigned to the comprehensive intervention, the TDI, and the control group, respectively. At three months, there were no significant differences in the primary and secondary outcomes among the three groups. At six months, IMWs in both intervention groups were more likely to appropriately use RPE than the control group (comprehensive intervention: Adjusted odds ratio: 2.99, 95% CI: 1.75–5.10, p < 0.001; TDI: 1.91, 95% CI: 1.17–3.11, and p = 0.009). Additionally, compared with the control group, the comprehensive intervention also improved all three secondary outcomes. Conclusions: Both comprehensive and top-down interventions were effective in promoting the appropriate use of RPE among IMWs in SMEs. The comprehensive intervention also enhanced IMWs’ occupational health knowledge, attitude, and practice. Trial registration: ChiCTR-IOR-15006929. Registered on 15 August 2015.
Rural-urban health seeking behaviours for non-communicable diseases in Sierra Leone
(BMJ, 2020-03-02) Idriss, Ayesha; Diaconu, Karin; Zou, Guanyang; Senesi, Reynold G. B.; Wurie, Haja; Witter, Sophie
Introduction Non-communicable diseases (NCDs) are the leading cause of mortality globally. In Africa, they are expected to increase by 25% by 2030. However, very little is known about community perceptions of risk factors and factors influencing health-seeking behaviour, especially in fragile settings. Understanding these is critical to effectively address this epidemic, especially in low-resource settings.
Self-reported illnesses and service utilisation among migrants working in small-to medium sized enterprises in Guangdong, China
(Science Direct, 2015-07) Zou, Guanyang; Zeng, Z.; Chen, Wen; Ling, Li
Objectives: As one of the most vulnerable populations in China, many migrants work in the small-to-medium-sized enterprises (SMEs). This study aims to describe the self-reported illnesses and service utilization of the migrants working in the SMEs in Pearl River Delta Areas (PRDA) of Guangdong province, China. Study design: Cross-sectional survey. Methods: We interviewed 856 migrants working in the SMEs of different manufacturing industries in 2012. Descriptive analysis was employed to report self-reported illnesses and service utilisation among migrants in the last two weeks and in the last year. Statistical tests such as 2 test were used to explore factors influencing their service utilisation. Results: In the last two weeks, 91(11%) of the respondents reported having any illness. The most reported illness was respiratory problem (69%), while 9.9%, 7.7% and 13% reported having digestive, skin and other problems respectively. The most important symptom was cough (39%). Thirty-seven percent of the respondents who reported any illness had visited health facilities. The lower income group were more likely to visit health facilities than the higher income group (P=0.006). The most reported reason for not visiting health facilities was 'feeling not serious' (65%). In the last year, 13% reported having respiratory problems and 7.8% reported accidental injuries. Less than 3% received hospitalization care. The proportion of those without hospitalization to those who should have been hospitalized was 31%. Conclusion: Underuse of the health service among migrants working in the SMEs could be associated with the 'healthy migrant' effect. However, when assessed among the ill migrants in the SMEs, the utilisation rate was still low mainly due to their poor health awareness. Improving their risk perception and integration of occupational and general health service is crucial to improve the health conditions and utilisation of service among migrants in the SMES. 2015 The Royal Society for Public Health.
Understanding prescribing behaviour of Tuberculosis doctors in the context of integrated service delivery: a case study of two designated hospitals of Zhejiang province, China
(2018) Zou, Guanyang
There is on-going debate regarding if and how integrated service delivery might affect quality of care for infectious diseases traditionally delivered through vertical programmes. In China, tuberculosis (TB) care has recently been integrated into ‘designated’ public hospitals at the county level. However, the integration initiative has caused concerns among hospital providers about cost recovery for poorly funded public hospitals. These concerns are partially reflected in the prescription of non-standardized, non-free auxiliary treatment for TB patients, which increases patients’ financial burden and compromises quality of care. This study applies Complex Adaptive Systems (CAS) thinking to understand providers’ prescribing behaviour in the context of integrated service delivery in TB designated hospitals in Zhejiang province, China. A case study approach was applied to research conducted in two designated hospitals, where the TB clinic was subsidized through local government or the hospital respectively. This study started with a retrospective review of 340 medical charts of uncomplicated TB patients. Informed by the results of this review, 47 semi-structured interviews were conducted with health officials, public health officers, and hospital staff members such as managers and TB clinicians, radiologists, laboratory staff and nurses. The working environment of the TB health workers was also observed. A thematic approach was used to formulate the initial coding frame, as guided by the conceptual framework. Hospital-based integrated TB care is highly medicalised due to strong medical culture and values associated with the integrated care. In both hospitals, non-standardised, non-free prescription of drugs and interventions for uncomplicated TB is common, with no consistent patterns for the two hospitals. This can also be attributed to lack of clear guidelines, weak doctor-patient relationship and hidden financial incentives of TB doctors. Staff motivation is low due to the perceived poor opportunities for professional development in TB work, the perceived gap in salaries as compared to other clinical staff, and the limited provision of risk protection measures for TB health workers. Welfare of TB health workers, who generate limited income for hospitals, is accorded low priority. Professional differences and tension between public health and medical professionals remain the biggest barrier to ensuring clinical governance for TB control in the hospitals. This study suggests that non-standardised prescribing behaviour is a dynamic response to the systemic conditions generated by the current model of integrated service delivery in the designated hospitals in China. Delivering free and standardised integrated TB care in the designated hospitals is challenging in the context of highly fragmented disease control and clinical structures and market-orientated health services. Using CAS thinking has helped to shift attention from a functional analysis of the health systems ‘building blocks’ and their mechanical interactions towards a more dynamic way of examining emergence, feedback loops, adaptation and relationship management in the study of integrating a public health function (TB care) within a hospital setting. The study will inform the on-going discussion of strengthening the quality of integrated service delivery model in China and public-private mix for TB control in other similar contexts.
‘You say you are a TB doctor, but actually, you do not have any power’: health worker (de)motivation in the context of integrated, hospital-based tuberculosis care in eastern China
(BioMed Central, 2022-06-23) Zou, Guanyang; McPake, Barbara; Kielmann, Karina
Abstract: Background: In China, tuberculosis (TB) care, traditionally provided through the Centre for Disease Control (CDC), has been integrated into ‘designated’ public hospitals at County level, with hospital staff taking on delivery of TB services supported by CDC staff. Little is known about the impact of this initiative on the hospital-based health workers who were delegated to manage TB. Drawing on a case study of two TB ‘designated’ hospitals in Zhejiang province, we explored factors influencing hospital-based health workers’ motivation in the context of integrated TB service delivery. Methods: We conducted 47 in-depth interviews with health officials, TB/hospital managers, clinicians, radiologists, laboratory staff and nurses involved in the integrated model of hospital-based TB care. Thematic analysis was used to develop and refine themes, code the data and assist in interpretation. Results: Health workers tasked with TB care in ‘designated’ hospitals perceived their professional status to be low, related to their assessment of TB treatment as lacking need for professional skills, their limited opportunities for professional development, and the social stigma surrounding TB. In both sites, the integrated TB clinics were under-staffed: health workers providing TB care reported heavy workloads, and expressed dissatisfaction with a perceived gap in their salaries compared with other clinical staff. In both sites, health workers were concerned about poor infection control and weak risk management assessment systems. Conclusions: Inadequate attention to workforce issues for TB control in China, specifically the professional status, welfare, and development as well as incentivization of infectious disease control workers has contributed to dissatisfaction and consequently poor motivation to serve TB patients within the integrated model of TB care. It is important to address the failure to motivate health workers and maximize public good-oriented TB service provision through improved government funding and attention to the professional welfare of health workers providing TB care in hospitals.