Mingkuan Fan,1,2 Yushu Liu,1 Kui Liu,1,3 Canyou Zhang,1,4 Yuhong Li,1,4 Xiaoqiu Liu,1,4 Hui Zhang,1,4 Jun Cheng1,4 

1National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China; 2Medical College of Xiangyang Polytechnic, Xiangyang, Hubei, People’s Republic of China; 3Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, People’s Republic of China; 4National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China

Correspondence: Hui Zhang, National Center for Tuberculosis Control and Prevention & National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, No. 155 Changbai Road, Changping District, Beijing, 102206, People’s Republic of China, Tel +86-10-58900516, Email zhanghui@chinacdc.cn Jun Cheng, National Center for Tuberculosis Control and Prevention & National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, No. 155 Changbai Road, Changping District, Beijing, 102206, People’s Republic of China, Tel +86-10-58900516, Email chengjun@chinacdc.cn

Purpose: Understanding the resilience of tuberculosis healthcare services (TB-HSs) is crucial for the targeted reinforcement of weak links and mitigation of the impact of public health emergencies (PHEs). However, assessment systems in this domain are lacking. This study aims to construct a resilience assessment index system (RAIS) for TB-HSs in China.
Methods: The following four-step design process was conducted: 1) establishing the RAIS index pool based on a literature review, 2) designing an initial RAIS for TB-HSs following Donabedian’s “structure-process-outcome” framework through expert meetings; 3) employing a two-round Delphi survey to obtain a consensus on the RAIS; and 4) using the analytic hierarchy process to quantify the weight of each indicator included in the final RAIS.
Results: The expert panel (n=26) had 100.0% and 96.2% response rates in the first and second Delphi rounds, respectively. The expert authority coefficients for the two rounds were 0.908 and 0.906. Both rounds showed high levels of expert coordination (P< 0.001). The final RAIS comprising three first-grade, nine second-grade, and 39 third-grade indicators. Our findings reveal that tuberculosis service provision/utilization tops the first-grade indicators, weighing 49.05%. Among the second-grade indicators, service outcomes (20.79%) and patient treatment (20.67%) were the top-weighted. Of the third-grade indicators, the treatment discontinuation proportion (10.29%) and the treatment coverage rate in confirmed TB patients (8.90%), were critical components in evaluating the resilience of TB-HSs.
Conclusion: This study developed a unified hierarchical resilience assessment index system for TB-HSs in China. Further research is required to validate and improve our results. The study’s findings could help develop strategies that benefit public health.

Keywords: tuberculosis, health system, resilience, evaluation, delphi method