Elsevier

Health Policy

Volume 73, Issue 1, July 2005, Pages 104-123
Health Policy

The management for tuberculosis control in Greater London in comparison with that in Osaka City: lessons for improvement of TB control management in Osaka City urban setting

https://doi.org/10.1016/j.healthpol.2004.11.006Get rights and content

Abstract

The tuberculosis (TB) notification in Osaka City has been persistently high compared with other urban areas in Japan. Although the TB notification in Greater London has kept much lower level compared with that in Osaka City, it has been also persistently high compared with other urban areas in the UK. Nonetheless, the contexts of the two cities relating TB control programme as well as the epidemiological situation greatly vary; there must be some lessons to be learnt from each other to improve each TB control programme to tackle against TB more effectively. Comparing the epidemiological situation of TB in both cities, it is obvious that Osaka City suffers TB more than Greater London in terms of the TB notification rate. Concerning the context of the TB control programme, Osaka City has centralised approach with strong local government commitment; Greater London, on the other hand, has an approach that is greatly fragmented but coordinated through voluntary TB Networks. This paper aims to draw some constructive and practical lessons from Greater London TB control management for further improvement of Osaka City TB control management through literature review and interview to health professionals.

TB epidemiology in Greater London shows distinct features in the extent of TB in new entrants and TB co-infected with HIV in comparison with those in Osaka City. TB epidemiology in Osaka City is to a great extent specifically related to homeless people whereas in Greater London, this relationship occurs to a lesser extent. Both areas have relatively high TB-notification rates compared with national figures, and they have “TB hot spots” where remarkably high TB-notification rates exist.

TB control in Greater London is characterised with decentralised and devolved services to local government health authorities supplemented with co-ordinating bodies across sectors as well as across Greater London. Sector-wide TB Network as well as London TB Group (LTBG) and London TB Nurses Network are major key functioning bodies to involve relevant professionals as wide as possible. The specialist TB nurses play key roles for TB case management across Greater London, while in Osaka City, TB control is characterised with strong leadership and commitment of Osaka City Government for the TB control programme. The Osaka City Public Health Centre (PHC) takes initiatives to expand “Cohort Analysis and Case Management Conferences” at each of the 24 Ward Health and Welfare Centres as well as “DOTS Conferences” at hospitals for improvement of case management by physicians and nurses at hospitals as well as by the health centre staff. Public health nurses (PHNs) play very important roles for TB case management as frontline in Osaka City.

Comparing the TB control in both cities, the following suggested recommendations are made to both cities for further improvement. Four suggested recommendations to Osaka City are: more resource re-allocation to community-based TB care than to hospital-based TB care should be done; Cohort Analysis and Case Management Conferences should be strengthened through involving more multi-disciplinary sectors; specialist TB PHN at each of the 24 Ward Health and Welfare Centres should be assigned in order to concentrate more on TB control activities; and accessibility to laboratory data such as drug susceptibility test for health centre staff should be improved. Two suggested recommendations to Greater London are: screening for TB high-risk group like homeless people should be strengthened, and regular sector-wide multi-disciplinary case conferences for proper case management should be strengthened.

Section snippets

Objectives

This paper aims to derive some lessons mainly for Osaka City for management change and organisational development learnt from the experiences in Greater London through describing the TB epidemiology, the organisational structure of TB control in the two cities focusing on the care of the high-risk groups for TB.

Introduction and background

Tuberculosis (TB) is still one of the leading causes of death in adults, and it is the largest killer as a single infectious agent in the world [1]. Taking this serious situation into account, WHO declared a global TB emergency in 1993 [2]. Though TB affects mainly people in the developing countries, it also affects people in the developed world. It has been recognised as one of the re-emerging infectious diseases in many developed countries [3]. In the U.S.A., for instance, as in many European

Method and measurements

This is a descriptive and comparative epidemiological review regarding TB control management in the two cities, Greater London in England and Osaka City in Japan, through published and unpublished literature review as well as interviews with health professionals.1

Population and homeless

Population of Greater London by Census 2001 indicates 7.2 million comprised of 3.5 million males and 3.7 million females [16]. It is estimated that there are homeless people, who live in the street as rough sleepers or live in temporary housing such as hostels, cheap bed and breakfast accommodation, and shelters, ranging from 100,000 to 237,000 in Greater London [17]. Greater London is also well renowned by the high unemployment rate [12]. Besides, over 85% of the UK's asylum seekers and

Discussion

The comparison of health care systems in efficiency and equity between different areas such as countries or cities or clinical institutions is not straightforward to do because of its complexity [121]. Some trials to compare the health care systems between countries have been achieved aside from methodological proposals [122], [123], [124], [125], [126], [127], [128], [129], [130], [131], [132], [133], which derived some arguments on their methodologies and implications [134], [135], [136]. The

Acknowledgements

We would like to extend special thanks to all interviewees whom we had interviewed to derive their wonderful expertise for illustrating the TB control in Greater London. We would like to thank Mr. Joe Rowan and Mr. Hideki Tomita who gave helpful suggestions to the draft of this paper. We are also very grateful to the anonymous reviewers to make constructive comments and suggestions on this draft paper.

This study is partly funded by the emerging and re-emerging infectious diseases research

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