After every major epidemic, there will always be a lot of reflection, which is the reason for the continuous progress of mankind, also known as learning from a pit. After SARS in 2003, China’s disease prevention and control system was given an opportunity to upgrade: a nationwide unified network direct reporting system for infectious diseases was established, and a case of "unexplained" pneumonia was specially designed in order to avoid the failure of reporting some diseases that have not been clearly defined for the time being; Established the Emergency Regulations for Public Health Emergencies, which stipulated a four-level emergency response mechanism; In many places, the health and epidemic prevention stations were renamed as centers for disease prevention and control, which clarified the establishment standards and improved the administrative level of the units … However, at the end of last year, the sudden COVID-19 epidemic gave us a real test of the achievements of the disease control system construction in the past 17 years, and the results were not satisfactory, exposing many problems.
What are the main problems?
(1) The direct reporting system of epidemic situation, which has been built with huge investment, is not running smoothly.
(B) In the cry of strengthening the construction of disease control system, the number of disease control professionals has decreased compared with 2003. According to the Statistical Bulletin on the Development of Health Care in China in 2019, there are 188,000 people in the Center for Disease Control and Prevention, including 140,000 health technicians, which are 20,000 and 19,000 fewer than in 2003 respectively.
(C) CDC system, people floating, brain drain accelerated. In June, 2019, at a seminar held in the State Council Development Research Center, Ceng Guang, chief epidemiologist of China Center for Disease Control and Prevention, said: Due to various problems accumulated for a long time and the further decline in income due to recent policy reasons, people in the disease control system are floating and the brain drain is accelerating. In the past three years, there have been as many as 100 young and middle-aged backbones lost from the National Center for Disease Control and Prevention alone, and the brain drain from disease control institutions in some places may be more serious.
(4) The number of disease control institutions has decreased, and some places have even merged disease control institutions in the name of reform. In 2003, there were 3,584 national centers for disease control and prevention (epidemic prevention stations), and by the end of 2019, there were only 3,403 centers, a decrease of 181. In July 2018, Liaoning Province issued the red-headed document "Optimization and Integration Plan of Provincial Public Welfare Institutions", which reorganized and integrated the provincial and municipal disease control and health supervision departments. After the integration, only provincial disease control remained, and disease control and health supervision institutions below the provincial level were integrated and will no longer exist.
(5) The county-level CDC is beset with "diseases" and its business development is stagnant and retrogressive. Professional and technical personnel are in short supply, and there is a serious shortage of staff; Aging infrastructure and insufficient investment; The channel of working funds is single; Lack of incentive and restraint performance appraisal system, lack of enthusiasm for disease control cadres.
Reform is imperative! How to change it?
Gao Fu suggested.
According to the report of China Youth Daily on May 27th, Gao Fu, director of China Center for Disease Control and Prevention, who attended the third session of the 13th Chinese People’s Political Consultative Conference, called for speeding up the reform of the disease control system. He proposed to strengthen the core competence of disease control institutions and improve their "professional voice".
He said that the new pneumonia epidemic has exposed the shortcomings of China’s major epidemic prevention and control system and public health system construction. As the main force of epidemic prevention and control, CDC has not fully played its role in early warning and monitoring, epidemiological investigation, and the proposal and implementation of prevention and control measures, and is faced with problems such as insufficient capacity, professional voice can not meet the requirements of modern disease prevention and control management and the increasingly diverse needs of the masses. The existing problems include: the CDC’s "unequal power and responsibility", the responsibility to put forward prevention and control strategies, the lack of decision-making power and discourse power to deal with the epidemic, and the "disconnection between administrative decision-making and technical strategies", and the CDC experts can only exercise the right of suggestion and cannot participate in decision-making; There is only a relationship of guidance and guidance between the superior and the subordinate disease control institutions, which makes it difficult to form an effective joint force in dealing with the epidemic situation. The division of labor and cooperation mechanism between disease prevention and control institutions and medical institutions is not perfect.
The administrative functions of disease prevention and control are decentralized. The disease prevention, control and emergency functions of the national health administrative department are scattered in many departments, such as disease prevention and control bureau, medical management and emergency office. There is a lot of interference in the details of prevention and control, and there is no comprehensive coordination. According to Gao Fu, from 2010 to 2018, the total number of CDC staff at all levels in China decreased by 3.9%, among which the number of professional technicians mainly practicing doctors decreased by 10.8%.
In terms of funds, the share of medical and health expenditure of CDC decreased from 2.9% to 2.4%. He stressed that the key to the reform of the disease prevention and control system "is not whether it has administrative power, but that the technical work is not subject to administrative intervention and maintains its independent technology and authority." To this end, he suggested clarifying the responsibilities of the administrative department and the technical department.
According to the law, CDC has the right to formulate and publish prevention and control strategies and technical plans, and is responsible for monitoring, investigating, handling, early warning and evaluating the epidemic situation. He suggested, "Give the CDC decision-making power in the field of professional affairs and reduce the micro-management and direct management of the CDC by the health administrative department. Explore the establishment of a mechanism for reporting public health work and major issues directly to the leaders in charge of the government, and directly release epidemic information with the authorization of the government. " In addition, he suggested strengthening the awareness and ability of coordination, strengthening the management of higher-level disease control institutions to lower-level disease control institutions, implementing vertical business management of major public health service projects under the jurisdiction of the central government, and strengthening the national disease control system. On the afternoon of June 2nd, General Secretary of the Supreme Leader presided over a symposium of experts and scholars and delivered an important speech. He emphasized that the disease prevention and control system is an important guarantee for protecting people’s health, ensuring public health safety and maintaining economic and social stability. We should base ourselves on more accurate and effective prevention, and intensify reform in rationalizing the system and mechanism, clarifying the functional orientation, and improving professional ability.
It is necessary to establish a stable investment mechanism for public health undertakings, improve the basic conditions for disease prevention and control, and improve public health services.
It is necessary to optimize and improve the function setting of disease prevention and control institutions and establish a division of labor and cooperation mechanism linked up and down.
It is necessary to strengthen the capacity building of national disease prevention and control institutions and strengthen their technology, ability and talent reserve. It is necessary to improve the linkage mechanism between disease control institutions and urban and rural communities, strengthen the disease prevention responsibilities of township hospitals and community health service centers, and consolidate the grassroots foundation of joint prevention and control.
It is necessary to innovate the coordination mechanism of medical care and prevention, and establish a mechanism of mutual restriction between personnel communication, information communication, resources communication and supervision and supervision.
It is necessary to strengthen the construction of disease control talent team, establish a talent training and use mechanism that adapts to the modern disease control system, and stabilize the grassroots disease control team.
It is necessary to build a number of high-level public health colleges and focus on cultivating talents who can solve practical problems such as pathogen identification, epidemic situation research and transmission law research, on-site epidemiological investigation and laboratory testing.
It is imperative to strengthen the ability of early monitoring and early warning, improve the monitoring system of infectious diseases and public health emergencies, improve the monitoring mechanism of unexplained diseases and abnormal health events, improve the sensitivity and accuracy of evaluation and monitoring, establish a multi-point trigger mechanism of intelligent early warning, improve the multi-channel monitoring and early warning mechanism, and improve the ability of real-time analysis and centralized judgment.
It is necessary to strengthen the construction of laboratory testing network and improve the ability of infectious disease detection. It is necessary to establish a collaborative monitoring mechanism between public health institutions and medical institutions, give play to the role of grass-roots sentinel, and achieve early detection, early reporting and early disposal.
It is necessary to improve the response plan system for public health emergencies, set up health emergency teams by classification, and cover the fields of situation judgment, epidemiological investigation, medical treatment, laboratory testing, community guidance, and material deployment. It is necessary to strengthen the knowledge reserve and training exercises of grassroots health personnel and enhance the ability of pre-disposal. It is necessary to carry out in-depth publicity and education on health emergency knowledge, and improve the people’s awareness of public health emergencies and their ability to prevent self-help and mutual aid.
Party committees and governments at all levels should establish regular research and deployment of health and health work mechanisms such as prevention and control of major epidemics, so as to ensure clear instructions, orderly systems, smooth implementation.
Hubei exploration
On June 10th, the Seventh Plenary Session of the 11th CPC Hubei Provincial Committee was held in Wuhan. The meeting discussed the Opinions of Hubei Provincial People’s Government on Promoting the Reform of Disease Prevention and Control System and Public Health System, and decided to take the lead in domestic exploration, plan the reform of medical and health system as a whole, systematically reshape the public health system, and improve the system and mechanism of major epidemic prevention and control. Ying Yong, secretary of Hubei Provincial Party Committee, attended the meeting and delivered a speech. He pointed out that the prevention and control of the epidemic situation reflected the problems of imperfect network, unclear functions and separation of medical care and prevention in our province.
It is necessary to reform the disease control system in accordance with the unified arrangements of the CPC Central Committee. Straighten out the system and mechanism, clarify the functional orientation, and enhance the professional ability. Strengthen the administrative functions of disease control institutions, implement the responsibility of supervision and supervision, and the main person in charge of disease control institutions is also a member of the health department at the same level.
Explore and promote the "first-class security and second-class management", implement the "two permits" in detail, allow disease control institutions to break through the current wage control level of public institutions, allow medical and health technical services to be provided on the basis of completing approved tasks, and further stimulate the endogenous motivation of disease control institutions. Strengthen the construction of disease control talents. Disease control institutions should strengthen monitoring and early warning functions, and effectively strengthen the construction of hardware facilities and infectious disease detection capabilities. The coordination of medical care and prevention should be the top priority.
Try out the system of "chief public health officer" in the health department. Formulate a list of public health responsibilities, improve public health service projects, and innovate the coordination mechanism between disease control institutions and medical institutions around the establishment of a mechanism of mutual restraint between personnel communication, information communication, resources communication and supervision and supervision. It is imperative to enhance early monitoring and early warning capabilities. The premise of epidemic monitoring and early warning is that the sources of epidemic information are unblocked and data are shared openly. It is necessary to improve the monitoring system of infectious diseases and public health emergencies, and establish a multi-point trigger mechanism of intelligent early warning to achieve early detection, early reporting and early disposal.
Lao Xu suggested.
(a) the implementation of epidemic reporting according to law, reduce human intervention, give full play to the state invested heavily in the establishment of the network is said to be relatively advanced epidemic reporting system. (two) strengthen the training of disease prevention and control professionals. First of all, we should plan the disease prevention and control system and the construction of talent team from the strategic height of national long-term stability. Huang Qifan once suggested that the training of public health and epidemic prevention talents must be expanded in scale and improved in quality, and double-class universities should be encouraged to set up high-quality public health colleges, rather than only medical colleges to set up this major; Build a national key university of public health and epidemic prevention, such as "China University of Public Health", pay equal attention to teaching and scientific research, cultivate high-end public health and epidemic prevention talents for the country, and concentrate on establishing a research system and laboratory system of public health and epidemic prevention, gather high-end scientific and technological talents from all over the world, and undertake cutting-edge research work in the field of public health in China and even the world.
(3) In deepening the reform of the medical and health system, we should make overall plans for the reform of the disease control system. In particular, it should be noted that the disease control system can only be strengthened, not weakened; The talent team can only be steadily strengthened, and it cannot be floating and brain drain; The reform of disease control can only take a more professional road, establish the authority of disease control because of its specialty, and increase the right to speak in decision-making, instead of taking an administrative road. Disease prevention and control should be incorporated into the national security strategy, and an elite team that is professional, authoritative and trusted by all parties should be established, rather than an administrative grease.
(four) pay close attention to the capacity building of grassroots disease control institutions. Create the first line of defense for disease prevention and control.