Evaluation On Public Health Emergency Capability Of County-Level CDCs

SignificancesThe public health emergency capability has a great impact on the security of people’s life and property, which could influence our country’s economic development and social stability. In recent years, all kinds of public health emergencies have occurred frequently, and the unexpected events with universal harm and diverse causes put forward a serious challenge to the disposal of public health emergency. The government has focused on improving public health emergency capability.Since SARS (Severe Acute Respiratory Syndrome) broke out, there have been some improved aspects of public health emergency capability, such as the command system, the plan system and the monitoring network. However, the early warning mechanism lagging, emergency supplies shortages, and inadequate funding were still restricting the development of public health emergency capability in our country. So how to evaluate and promote the public health emergency capability comprehensively and define the main influential factors had great realistic significance.The County-Level Centers for Disease Control and Prevention (CDCs) are the basis of the disease control and prevention system in our country and directly responsible for the disposal of public health emergency, which play an important role in the emergency network. Thus the evaluation and optimization of its public health emergency capability are particularly important.For the research on public health emergency capability, the current system review found that: although a lot of studies and established some mature evaluation tools had already been undertaken by many foreign scholars, they could not be directly applied because of the specialties of China; domestic scholars’studies were still limited to a specific aspect of public health emergency ability and lack of comprehensive views from institutional level or social level.Therefore, this study aimed to develop the indicator system suitable for the evaluation of public health emergency capability from both the macro level and the micro level, by which a comprehensive evaluation public health emergency capability of County-Level CDCs would be conducted to identify the existing problems and defects. And finally, through the analysis of the operation law and key control factors, the optimal strategies and measures would be put forward to improve the public health emergency capability.Materials and MethodsDevelop the evaluation indicator system applying literature review and expert reasoning, guided by System Theory and "Structure-process-outcome" principle.Survey the public health emergency capability of County-Level CDCs in the whole country, and the effective recovery rate was88.0%.Know the status quo of the public health emergency capability of County-Level CDCs by applying criterion gap analysis and comparing with that of2005.Find the operation rule and key points by factor analysis, correlation analysis, regression analysis and structure equation model and put forward the optimization strategy advice.Results1. The evaluation indicator system of public health emergency capabilityGuided by System Theory and "Structure-process-outcome" principle, applying literature review and expert reasoning, the evaluation indicator system of public health emergency capability was developed, which was made up of39indexes and3aspects-"resources allocation","capacity building" and "function fulfillment".2. The status quo of public health emergency capability of county-Level CDCs(1) In2010, the complete degree of public health emergency organization structure in County-Level CDCs was good (81.9%) overall, but the rate of building the think tank and special agency were still low,51.7%and59.2%respectively.(2) In2010, the average number of public health emergency staffs in County-Level CDCs was21, increasing9.3%compared to2005. For quality structure, the degree level of most emergency staffs was college degree or the technical secondary degree, and the bachelor degree or above was only24.2%. Just5.9%of the staffs had senior professional title, and the staffs who had no title personnel professional accounted for17.3%.(3) The personnel expenditure and official expenses per staff in2010were32,000Yuan and15,000Yuan, which has increased by60.0%and50.0%respectively. But the proportion of the government financial investment accounting for basic institution spending was only53.3%, thus the government investment remained inadequate.(4) The standardizing rate of equipment configuration was61.6%in average in2010, which was far away from90%, and only8.4%of the County-Level CDCs have met the standard. That is to say, equipment configuration hasn’t met the demand of public health emergency yet.(5)The contingency plan drawing-up system has been established. In2010, the mean integrity rate of contingency plan drawing-up system was89.1%, but there still was a certain gap between with100%because of a relatively low rate in the western region which was79.7%.(6) The stockpile of public health emergency supplies and items was not adequate. In2010the average adequate rate of public health emergency stockpiles was only32.7%in County-Level CDCs; the proportion of County-Level CDCs met the standard of90%was only1.1%, and. even none in the western region.(7) Public health emergency drill should be strengthened. In2010, the mean times of emergency drill for infectious disease control were1.09,0.28for disaster prevention, and0.30for other emergency drill. And the average index for drill was0.78, even just0.64in the western region, which was far away from the standard of0.90.(8) In2010, about68.4%of County-Level CDCs conducted the routine monitoring projects monthly, compared to16.7%of which weekly. The timely reporting rate was as high as94.8%in average, and85.3%of the County-Level CDCs have met the standard.(9) The disposal of public health emergency reached the standard. In2010the reasonable disposal index of public health emergency was0.89in average, far above the standard of0.70.3. The key points of public health emergency capability of county-Level CDCsPublic health emergency capability of County-Level CDCs followed the operation law of "structure-process-outcome" principle:the specific system structure through the specific service process output corresponding results.Factor analysis showed that the correlation coefficients among resources allocation, capacity building and function fulfillment were0.501and0.440respectively. Structure equation model results showed that the path coefficients among resources allocation, capacity building and function fulfillment were0.75and0.64. All of these suggested that, to improve public health emergency ability, the reasonable resources allocation was the prerequisite. Regression analysis results suggested that the personnel quantity, human comprehensive quality, funds, equipment configuration and the structure could improve public health emergency ability as the critical control points.4. The strategies and advices to improve the public health emergency capability(1) To establish a long-term investment mechanism and improve the investment efficiency, in order to ensure sufficient financial resources and funding support.(2) To strengthen the personnel training of public health emergency and improve human resources management, talent introduction mechanism and personnel quality structure.(3) To optimize laboratory equipment allocation, strengthen the equipment investment and establish scientific operation mechanism in order to ensure the quantity and quality.(4) To increase the rate of building the think tank and special emergency agencies, identify the responsibilities and procedures and complete the emergency organization framework.(5) To increase the investment of emergency stockpiles, establish comprehensive coordination mechanism, and improve the supply, supervision, allocation and distribution.(6) To change the public health emergency management from the passive defense to active response, constantly improve the contingency plan drawing-up system, and actively develop drilling and monitoring.Explorations(1) Developed the evaluation indicator system guided by "Structure-process-outcome" principle and System theory, which filled the blank of the related research.(2) Firstly Evaluated the status quo of the public health emergency capability of county-Level CDCs, which provided reference data and research foundation for the subsequent research.(3) Found the operation rule and key points by factor analysis, correlation analysis, regression analysis and structure equation model and put forward the optimization strategy advice(4) Aapplied structure equation model (SEM) in the field of public health emergency capability to find out the complex influence factors for the first time.