CASE 3: Controlling tuberculosis in China

Health Condition: Tuberculosis ranks as the third leading cause of disease and disability among adults in the world, and nearly one-third of the world's population is infected with the tuberculosis bacillus. Of these cases, more than 9 million people become sick with TB when their immune system is weakened and 1.76 million die each year. In China, tuberculosis is the leading cause of death from infectious disease among adults. Every year, 1.4 million people develop active TB. In 1990, 360,000 people in China died from the disease.

Intervention or Program: In 1991, China revitalized its ineffective tuberculosis program and launched the 10-year Infectious and Endemic Disease Control project to curb its TB epidemic in 13 of its 31 mainland provinces. The program adopted the WHO-recommended TB control strategy, DOTS, through which trained health workers watched patients take their treatment at local TB county dispensaries. Information on each treatment was sent to the county TB dispensary, and treatment outcomes were sent in quarterly reports to the National Tuberculosis Project Office.

Impact: China achieved a 95 percent cure rate for new cases within two years of adopting DOTS, and a cure rate of 90 percent for those who had previously undergone unsuccessful treatment. The number of people with TB declined by over 37 percent in project areas between 1990 and 2000, and 30,000 TB deaths have been prevented each year. More than 1.5 million patients have been treated, leading to the elimination of 836,000 cases of pulmonary TB.

Cost and Cost-Effectiveness: The program cost $130 million in total. The World Bank and the WHO estimated that success­ful treatment was achieved at less than $100 per person. One healthy life was saved for an estimated $15 to $20, with an economic rate of return of $60 for each dollar invested. The World Bank ranks DOTS as one of the most cost-effective of all health interventions.