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Table 6 Factors influencing the integration of TB services in Shanghai Changning and Guangxi Nanning

From: Factors influencing integration of TB services in general hospitals in two regions of China: a qualitative study

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
  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