Abstract: Objective To evaluate DOTS strategy implementation in rural and mountainous area in Fujian province. Methods A combined qualitative and quantitative methodology was used.Questionnaire survey was conducted to TB patients and in-depth interview was carried out among relevant persons and TB patients.The topics of the in-depth interview included case detection,treatment and management,TB control policies issued by relevant departments.The evaluation was conducted from three aspects which were governmental commitment to TB control,the process of care detection and the implementation of case supervision and management. Results The governmental commitment to TB control implemented well in the three selected counties.53.3% patients selected the village clinic/private clinic as the first time of health care seeking and only 6.9% patients selected TB dispensary in the first health care seeking.26.4% patients delayed in seeking diagnosis while 59.9% patients experienced the delay in diagnosis confirmation.94.9% of smear positive patients were visited by doctors during the treatment,but 72.9% of smear positive cases believed that it was not necessary to be observed by doctors in drug taking.And only 47.3% patients were directly observed the treatment by health care workers. Conclusion The governmental commitment could ensure the implantation of TB control.TB suspects and patients should be informed to visit TB dispensary for diagnosis.The effectiveness of referral should be improved and the delay in diagnosis confirmation should be reduced.Directly observed treatment is the key point in DOTS strategy,thus the training to the township and village doctors should be enhanced to improve their awareness of TB and at the same time medical ethical policies adapted to the situation in rural area should be developed.

Key words: Tuberculosis /prevention and control, Tuberculosis/economics, Health expenditures, Fujian province