Task shifting of HIV/AIDS case management to Community Health Service Centers in urban China: a qualitative policy analysis

Ma, Fuchang; Lv, Fan; Xu, Peng; Zhang, Dapeng; Meng, Sining; Ju, Lahong; Jiang, Huihui; Ma, Liping; Sun, Jiangping; Wu, Zunyou

doi:10.1186/s12913-015-0924-y

Table 2 Context and process analysis on task shifting of HIV/AIDS case management services to CHSCs

From: Task shifting of HIV/AIDS case management to Community Health Service Centers in urban China: a qualitative policy analysis

Element	Description	Evidence
Context
1. Situational factors	• A nationwide public health delivery system had been established defining CHSCs as the primary care institutions.	• Over 33 000 CHSCs and a total of about 300 000 trained employees around the country by 2010.
1. Situational factors	• A large number of well-trained community doctors.	• An average of 100 CHSCs in each selected city.
2. Structural factors	• The number of PLWHA is increasing.	• The estimated and the reported number of PLWHA is continuously increasing in 2007, 2009 and 2011 in China.
2. Structural factors	• The workload for HIV/AIDS prevention is expanding in CDCs.
3. Technical factors	• CHSCs provide comprehensive medical and public health services including HIV/AIDS prevention and control.	• CHSCs serve as gate-keeper of health care delivery system in China.
3. Technical factors	• The expansion of ART program in the country;	• Free ART became available for AIDS patients who were rural residents or urban residents with no health insurance since 2004.
4. Cultural factors	• The anti-discrimination campaign and human rights protection for PLWHA create supportive and legal environment for HIV/AIDS case management services in CHSCs.	• Issuance of the “Regulations on HIV/AIDS Prevention and Treatment” by the State Council in 2006.
4. Cultural factors		•The “Zero discrimination” goal and campaign in the society.
Process
1. Agenda setting	• CHSCs need to participate in HIV/AIDS preventive services.	• China’s second Action Plan for the Containment and Control Of HIV/AIDS (2006–2010) by the State Council in 2006.
2. Policy development	• CHSCs need to assist upper level health institutions in HIV/AIDS health education and case management services.	• National Regulations on Basic Public Health Care by Ministry of Health in 2011.
	• CHSCs work as platform of China’s HIV/AIDS Care System.	• China’s Action Plan for the Containment and Control of HIV/AIDS (2011–2015) by the State Council in 2011.
	• Expansion the coverage of ART.
	• HIV/AIDS case management services were included in the annual assessment of the basic public health services in three cities.	• The regulations or assessment announcements for community health service in Guangzhou, Nanjing and Changsha in 2012.
3. Implementation	• A pilot program integrating HIV/AIDS case management with routine health services in 42 CHSCs of eight cities (Beijing, Shanghai, Chongqing, Harbin, Nanjing, Hangzhou, Changsha and Guangzhou) was implemented from 2011 to 2013.	• China-Gates Foundation HIV Cooperation Program.
3. Implementation		• 77.6 % (1046/1348) of PLWHA have been receiving health management services in pilot CHSCs by the end of 2012 according to the program report.

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