Changing Control Strategies And Management System For Schistosomiasis In China

Through literature reviewing, typical survey, experts consulting, focused group discussion and symposiums, this project aims to review the experiences and lessons of schistosomiasis control in China in different economic systems and history stages. At the same time, to retrospect the function of different policies, administrative patterns, financial support and technological progresses under different background. Through describing the developing progress and trend of the schistosomiasis control policy, and by comparing the demand of the institutes and human resources in different stages, and the effect of schistosomiasis control with different strategies, we analyzed the chances and challenges in the present anti-schistosomiasis system, and being the alarm of SARS, the government try to rebuilt and perfect the public health system, we must grasp the opportunity to reform anti-schistosomiasis system and try to control schistosomiasis.Under the planned economic system, the target of anti-schistosomiasis is eliminating schistosomiasis. The prevention and cure policy is "motivate the whole party, everyone should take part in the widely preventive and curing action", the main purpose of the integrate measures was eliminating snail. Now, we accumulated lots of experiences that suitable to the planned economic system. Such as strengthen the governmental and CCP's leadership, which will ensure the project of eliminating schistosomiasis, and the people is the main force etc. But in this stage the political meaning had been overemphasized while the complication and long-term of schitosoniasis and ecological effect had been not paid more attention.In the middle of 1980, China began to reform the economical system. And within this phase, the concept and strategy of diseases control had been introduced to the schistosomiasis control projects, and the strategy turned to focus in curing patients, and try to eliminate snail in the important areas, health education was gradually carried out. Because the policy and administrative model held the line, however, the side effect emerged, such as the resources collocated unreasonable, measures can't be actualized, management default and the task unimplemented, etc. The new administrative system was called to be established and improved.With the development of economic system, the anti-schistosomiasis institutes and human resources changed. In the stage of planned economy, the integrated administrative model of anti-schistosomiasis had been founded. Until the middle of 1980, there were 260 anti-schistosomiasisinstitutes distributing in the counties and higher lever all around the country, and 1620 in the communities, the whole staff come up to 16000, unincluding the many amateurs, about 10 persons in each group.Along with the political reform, the anti-schistosomiasis model changed too. But the function of the institutes didn't change with it. So lots of problems came forth. Such as the workers aggregating from the basic line to the upper ones, and the number of administrators increased, while the operating workers decreased. On one hand, the burden of anti-schistosomiasis system was going up, and on the other hand, the conflict between the powers increased, hindering the further schistosomiasis control.After entering 21 century, because the frequent floods in the endemic regions and the quick transmigration among people and livestock within counties, the prevalence increases again; the snail area enlarges, and the risk of people and livestock infection increases, the number of cases keeps high, the new infected regions increase, and the schistosomiasis is spreading from the rural to the urban, the task of schistosomiasis control is still arduous in china.Now the problems of the schistosomiasis control in China are: 1) social and economical problems: the importance of schistosomiasis control had not been recognized by some local governments. Short of financial support to anti-schistosomiasis, the anti-schistosomiasis institute and the staff do not adapt to the new demand of schistosomiasis control, and the researches can't meet the anti-schistosomiasis work, too. 2) biologic and environmental problems: there are too many hosts of schistosome and many transmission ways of schistosomiasis, so it is very difficult to control schistosomiasis with single measure. The natural and environmental factors relevant to schistosomiasis are complicated, which will enhance the difficulty of controlling. And the other risk factors are: the large irrigation program; return the plowland to lake; South-to-North Water Transfer; the warmer climate; and the floods etc.After surveying on the administrative model and human resources in anti-schistosomiasis facility, we found that:There are many problems of human resource existing in the schistosomiasis control system. Such as too many older workers, the present staff's average age is 42.5, the lower educational level and title of technical post of the workers, most of them is the primary technician; lower income, which lower than the standard of the national basic salary level, most of the workers' income is about 5000 to 10000 yuan per year. Too few chances of training, some of the workers never obtain anytraining. In the recently five years, the number of the workers joined in the anti-schistosomiasis system larger than that of removing from the system. But the title of technical post of the new workers lower than the removers, 53.60 percent of the new workers without any technical title, and 51.61 percent of them just graduated from the technical secondary schools. Because lots of the high quality workers remove from the anti-schistosomiasis system, the whole anti-schistosomiasis system do not adapt to the new demand of schistosomiasis control.The sizes of some anti-schistosomiasis institutes in counties are too large. Although there are many workers financed by the institutes, few workers take part in the anti-schistosomiasis program. At the same time, being the lower income, lots of high quality workers remove from the institutes. Effected by the market economy, many anti-schistosomiasis workers do not pay attention to the prevention anymore, while focus on how to make money by treating patients and so on. Because some local governments neglected the importance of anti-schistosomiasis work, and short of the financial support, and the World Bank providing loan project ended, the institutes lacks for resources to make money, in addition, the unprofessional and low quality worker swarmed into the institutes several years ago, the financial burden of the anti-schistosomiasis institute become heavier and heavier. The income of many anti-schistosomiasis institutes fewer than payout, some of them even can't sustain the workers daily life. So the anti-schistosomiasis institutes try to compensate the money shortage from curing. But it was restricted by the rural policy such as "fee become tax", and gave birth to many side effects. In addition, the working efficiency, technological innovation and the attraction of the anti-schistosomiasis system became lower and lower.The reform of anti-schistosomiasis system is urgently now. should it join in the CDC system or retain the present framework? Someone suggested that the anti-schistosomiasis system should, along with the chance of health system reforming, "better troops and simpler administration", enhance the efficiency of prevention, cure and inspection, increase the income of the workers, and strengthen to train the employee, etc. The anti-schistosomiasis institutes should try to obtain the reasonable financial support and establish the proper salary system. At present, the acceptable model is that split the schistosomiasis control into prevention and cure, the schistosomiasis cure administrated by the hospital system, while the prevention belong to the public health system, financing by the government it totally. Anti-schistosomiasis institutes should unite with the CDC.As a word, the main conclusions of this project including: 1) the situation of the schistosomiasis control changed; 2) the start and end point of the schistosomiasis control strategy lies in human, which is the first of all; 3) planning the anti-schistosomiasis comprehensively, and divide the task into different parts for different stages and then accomplish it; 4) emphasizing the importance, adjusting measures to local conditions, integrating prevention and cure and making progress steadily; 5) enlarging and consolidate the effect of the schistosomiasis control; 6) preventing and curing according to the law; 7) increasing the financial support; 8) harmonizing diseases controlling, social economic development and environment protection; 9) optimizing the health resources allocation; 10) establishing the sustainable development mechanism of the anti-schistosomiasis; 11) schistosomiasis control must depend on the science and technical progress and social development...