March 22, 2002—The World Bank yesterday agreed to finance an expansion of China's national tuberculosis control efforts to reach more of the country's poor population. Despite remarkable improvements in overall health status in the past decades, China's health services remain inadequate and there are great regional disparities in access. A significant proportion of the country's population still lacks satisfactory basic health care, and services, such as diagnosis and treatment of tuberculosis (TB), are often unaffordable for many poor communities. 

The $104 million loan will allow China to treat hundreds of thousands of people  suffering from infectious TB and support a sustainable work program for the country's strengthened National TB Control Program.

The UK Department for International Development (DFID) has played a key role, and worked closely with the World Bank, World Health Organization (WHO), and the Government of China in designing this program of support for the expansion of China's TB control efforts. DFID is providing a £ 28.3 million grant to enable the Bank loan to be on-lent to the provinces at a concessional rate. 

The World Bank has helped China since 1990 to expand effective TB control  services to many of its  largest cities and the majority of its provinces. Its first major project was the World Bank-financed Infectious and Endemic Disease Control (IEDC) Project, approved in December 1991 and covers 13 of China's 31 provinces. The TB Control program under the IEDC Project has been cited by the WHO as one of the most successful TB control interventions in the world, with patient cure rates surpassing 90 percent. 

Research has also shown that this application of the WHO-recommended TB control approach, DOTS, (Directly Observed Treatment, Short Course) in China has been associated with at least a 46 percent reduction in the expected TB deaths in the counties covered.  However, many of the gains of these efforts would have been lost if the government did not provide adequate resources to continue and expand the program after Bank financing concludes in mid-2002.

"Over and above this new project, the Chinese government has announced major initiatives to get TB under control nationally, including a pledge to significantly increase central funding of local TB control programs," says Jagadish Upadhyay, the project team leader in the World Bank's East Asia and the Pacific Human Development Sector. "This new loan will help expand free access to high quality TB care in the poorest regions of China, ensure that the national program gets sustainable funding, and helps to adopt a nationwide approach to tackling TB control in China."

Tuberculosis is the leading infectious cause of death in China, with more than 400 million infected people, and with 1.3 million new cases and 150,000 TB deaths each year. The rate of TB in poor rural areas is nearly three times higher than in economically developed urban areas, a difference attributed to poor living conditions, underlying health and nutritional status, not enough money to pay for health care, inadequate access to health services, and lack of knowledge about TB.

As poverty helps to spreads the TB, the disease also contributes to the cycle of poverty for many Chinese.  The largest group affected by TB are adults in their most productive years, and their incapacitation and death contribute to the impoverishment of families. Physical disease and economic hardship form a self-perpetuating vicious cycle.

The new infusion of World Bank finance to aid the fight against TB comes as the percentage of government funds used for public health services has fallen markedly, while charges and user fees have become increasingly common as sources of income for health care workers and facilities.  External support has been critical for public health performance in China over the last decade.

Rapid economic growth and the country's large mobile workforce, to name just a few factors, have brought new health problems, including a major increase in chronic diseases, the spread of HIV infection, and re-emergence of sexually transmitted diseases. Currently, more than 600,000 people are estimated to be infected with HIV in China, a number that is certain to increase. Overall, a third of those with HIV/AIDS will die from TB as an opportunistic infection. By pursuing HIV prevention and by implementing an effective TB control program, China can minimize the impact of HIV-associated TB and improve the care of those with HIV/AIDS.

Useful Links: Click here to read the full press release. Click here for more on the World Bank's TB work, click here and here for more on WHO and the Stop TB Partnership.