Table 6.

Systems-based mapping of implementation barriers and recommendations for sustaining the “Xinjiang Model”

System domain	Main barriers identified	Operational implications	Actionable recommendations
Health workforce	Workforce fragility, limited professional capacity, high workload, staff turnover	Reduced quality and continuity of screening, follow-up, referral coordination, and patient management	Establish minimum staffing arrangements for TB prevention and control teams; provide workload-based compensation; strengthen continuous professional training
Health financing	Gaps in nutrition support, screening reimbursement, and residual out-of-pocket costs	Financial pressure on patients and institutions; weakened treatment adherence and service uptake	Adjust nutrition subsidy standards; reimburse screening for persons with presumptive TB and close contacts; reduce residual out-of-pocket costs
Service delivery	Pressure on universal health check-ups; referral delays; difficulties in sputum collection and follow-through	Reduced screening quality, delayed diagnosis, delayed treatment initiation, and interrupted continuity of care	Standardize referral timelines; strengthen feedback between screening sites and designated TB hospitals; improve sputum collection guidance; optimize screening workflows
Patient-centered support	Physical and psychological vulnerability	Interrupted treatment and poor continuity of care	Integrate psychosocial support, family involvement, and practical assistance into community-based follow-up
Governance	Policy misalignment and lack of detailed operational guidance for some components of the model	Inconsistent implementation across settings and difficulty sustaining some program components	Develop clearer operational protocols, accountability mechanisms, and routine monitoring requirements