Study On Evaluation And Strategies Of Response Capacity In Center For Disease Prevention And Control

Objectives1. To explore the current situation and problems of response capacity of Center for Disease Prevention and Control (CDC) and public health staff, and then provide some related evidences for the construction of emergency system in China.2. To improve the strategies and measures of increasing the capacity of emergency response to CDC and public health staff, and then provide some policy suggestions for CDC's sustainable development in China.3. To provide technical support for emergency preparedness training project's successfully implementation through develop training program, evaluate training effectiveness, and then explore a feasible and effective training mode in China.MethodsLiterature reviewing, census, semi-structured interview, questionnaire and empirical study were used to assess preparedness and response capacity for public health emergency in Hubei province.1. The current situation and problems of public health emergency were analyzed by literature reviewing and retrospective investigation.2. The 98 CDC participated in this census in Hubei province. The response capacity of personnel from 10 CDC was investigated by questionnaire and semi-structured interview, and the related factors were analyzed by Logistic regression. The qualitation and quantitation study methods were applied including questionnaire and semi-structured interview.3. The empirical study was used in this research. 315 public health staff from 98 CDC of Hubei province participated in the emergency training in 2005. There were 78 participants from the class June, 119 from the class of August, and 118 from the class of October. Thirteen participants did not complete their training because of some unrelated factors with the training, and were not part of the evaluation (N=302, 95.87% response rate). Twenty-one public health leaders from Health department of Hubei, Henan, Hunan, Jiangxi, and Anhui, participated in the leadership training program in 2006, and the response rate was 100%. The training programs were evaluated by anonymous questionnaire and semi-structured interviews at pre-training, immediately post-training and 12-month after training (Follow-up).Results1. There were 8371 staff in 98 CDC of Hubei Province, and 2729 staff were emergency personnel with 32.60%. The age structure was fusiform, and most of personnel belong to 35~44 age group (34.33%). A majority of personnel qualification were associate degree or secondary school diploma with 80.57%. People with middle-level professional title were 44.86%, and preventative medicine personnel were only one-fifth (19.44%). Distribution of average quality score of personnel were imbalance in different CDC, and the average quality score of personnel in province CDC are 1.12 times than that in city CDC and 1.39 times than that in county CDC. At the same time, the average quality score of personnel of enrolling in CDC was lower than the average quality score of resignation's personnel within last three years.2. The survey results of response capacity of public health emergency indicated that 100% agency developed the monitoring scheme, but there had a low level of understanding due to lack of effective methods to promote learning. Although all of CDC could carry out the analysis of monitoring data, the capacity and methods were not satisfied to the demand of prediction and precaution. The results of research about laboratory showed that the performance of detection could not fit with the actual requirement of public health emergency response because of the deficiency of instrumentation and management. According to the research results of emergency material and fund, we found the every government gave great importance to public health emergencies after SARS, but there were not enough response material and fund which could not satisfy the practical work needs. For example, only eighty percent CDC designated the specialized department in charge of emergency material and emergency fund, and the majority of CDC (74.49%) had not enough fund to response to the public health emergency.3. The results of investigation about training and continuing education showed that only twenty-five percent of CDC carried out the requirement research to emergency training, and sixty percent of CDC developed the measures about training effectiveness evaluation. Meanwhile, the majority of public health personnel indicated that emergency training and emergency drilling were scientific and feasible way to improve the response capacity. 4. The response capacity of personnel has been promoted after crisis of SARS in CDC. However, the disposition of personnel and response capacity regarding public health emergency did not always satisfy with the requirement of current situation. Factors influencing on the response capacity regarding public health emergency might include: levels of work (OR=3.61), standard of culture (OR=2.69), major of graduation (OR=2.90), department of work (OR=2.07), length of training's time (OR=2.16) and levels of training (OR=4.12).5. The emergency training improved the knowledge levels and increased attitudinal and behavioral intentions scores regarding emergency preparedness. The results of post-test showed that the emergency knowledge and self-assessment scores of participants increased significantly as compared with pre-test(P<0.05), The results of the follow-up measure showed that the emergency knowledge and self-assessment scores of participants declined slightly as compared with post-test levels (P>0.05). However, there was a significant increase as compared with pre-test (P<0.05). Moreover, more than eighty percent of participants reported that the training process and resources were scientific and feasible.Conclusions1. Public health emergency has not obtained enough support from government, especially fund investment.2. The response capacity regarding public health emergency was difficult to adapt to the current needs for disease prevention and control. For example, personnel composition, professional title, educational background and major of graduation did not always satisfy with the requirement of current situation. At the same time, there was a brain drain for personnel movement at this stage for center of disease prevention and control.3. The monitoring system regarding public health emergency is not perfect, and the analysis capacity of monitoring data did not always satisfy with the requirement of predict and precaution.4. There had no enough instrumentation in CDC, and the performance of disease control and public health emergency response were restricted by the poor detectivity.5. The capacity of logistical support was poor. The reserve, management and dispatching regarding emergency material and fund did not satisfy with the need of practical work.6. The emergency preparedness capability could be improved by emergency training, and the emergency training model was effective and feasible in improving the emergency preparedness capability of public health personnel. Suggestions1. Government and relevant departments should implement the responsibilities of disease prevention and control, and perfect the ensure mechanism of emergency material and fund.2. Center of disease prevention and control should improve the personnel system reform and improve human resources allocation, and then increase the capacity of public health emergency response.3. Disease surveillance system and emergency plans should be improved to strengthen the performance of prediction and precaution.4. Government and relevant departments should purchase laboratory apparatus and equipment, and optimize human resources allocation, and then improve the performance of measure and analysis.5. The emergency material and fund should be reserved, and the regulatory regime should be improved at present in order to enhance the emergency ensure capacity.6. Develop and improve the emergency training model, and strengthen emergency preparedness training for public health staff, and then increase the performance of public health emergency response.Innovation and ApplicationThis research not only carried out the present study, but also developed the empirical study according to the related strategies and suggestions. The emergency preparedness training model for public health staff in CDC was developed according to the research results, and it was spread in China. Meanwhile, the study and research results were referenced by State Council and the Ministry of Health when they developed the project of emergency management training from 2006 to 2010.