Changes Of Material Resources And Equity In County-Level CDCs In Shandong Province Before And After The COVID-19 Pandemic

BackgroundCounty-level Centers for Disease Control and Prevention(CDCs)play a leading role in China’s CDC system and are also the core professional agencies for handling sudden public health emergencies.Material resources are an important component of health resources and provide an essential guarantee for CDCs to provide public health services and fulfill their public functions.During the process of preventing and controlling the COVID-19 pandemic,material resources played a fundamental role.However,material resources are limited,and how to distribute them more fairly has become a prerequisite for CDCs to provide better public health services.Therefore,this paper aims to investigate and evaluate the material resource status of county-level CDCs in Shandong Province before and after the COVID-19 pandemic(i.e.,in 2019 and 2021),reveal the problems and shortcomings in resource allocation,and provide references for more reasonable resource allocation.ObjectiveTo analyze the changes in material resource allocation of county-level CDCs in 2019 and 2021,including the total fixed assets,total building area,lab tailored house area,as well as it’s equipment.Using a method of agglomeration degree analysis,we aim to evaluate the fairness of material resource allocation and explore changes in fairness.Based on the research results,corresponding policy recommendations will be proposed to allocate resources more reasonably and improve the level of health services.MethodsThis study used a stratified random sampling method to select a total of 84 county-level CDCs in 8 cities in the eastern,central,and western regions of Shandong Province in August 2022.The survey questionnaire was developed by the research team based on the "Shandong Provincial Yearbook of Disease Prevention and Control" and the "Instruction for Lab Construction of Provincial,Municipal and County-level CDC ".The questionnaire covered general information,the total fixed assets,building area,and lab tailored area in 2019 and 2021,and the configuration of Class A,B,and C laboratory equipment.EXCEL was used to establish a database for data analysis..Descriptive statistical analysis was performed on the material resources of the sampled CDCs in 2019 and 2021,and changes between the two years were examined.Agglomeration analysis was used to evaluate the fairness of material resource allocation in the two years and analyze changes in fairness between them.Results1.Allocation of Material Resources:(1)Total Fixed Assets:the average total fixed assets increased from 12.43 million yuan to 19.21 million yuan,with a growth rate of 54.61%.(2)Total Building Area and Lab Tailored Area:the average total building area in 2021 was 3813.42 m2,with an average increase of 390.82 m2,while the average lab tailored area was 3813.42 m2,with an average increase of 176.32 m2.Both increased by 11.42%and 14.19%,respectively.(3)Laboratory Equipment:the overall availability rate of type A equipment reached 87.18%in 2021,an increase of 6.65 percentage points.The availability rate of type B equipment was 65.92%,an increase of 8.82 percentage points,while that of type C equipment was 35.66%,an increase of 5.73 percentage points.2.Compliance with standards in resource allocation:(1)Proportion of lab tailored area:Overall,the average proportion of lab tailored area met the standard before and after the Covid-19 outbreak,with both exceeding the national requirement of 35%.In 2019,44 disease control centers met the standard,with a compliance rate of 52.38%.By 2021,this number had increased to 52,with a compliance rate of 61.90%,an increase of 9.52 percentage points.(2)Number of Class A laboratory equipment:Overall,the average number of Class A equipment in 2019 was 54.38,with a compliance rate of 89.15%,which did not meet the national standard of over 90%for equipment allocation.However,by 2021,this had increased to 68,reaching the standard.In 2019,41 disease control centers had a compliance rate of over 90%,with a compliance rate of 48.81%.By 2021,this number had increased to 55,with a compliance rate of 65.48%,an increase of 16.6 7 percentage points.(3)Compliance with both standards:In 2019,a total of 25 disease control centers met both standards,accounting for 29.76%of all centers.By 2021,this number had increased to 35,an increase of 10 centers,and the proportion had risen by 11.90 percentage points to 41.67%.3.Fairness and changes in the allocation of material resources:(1)Fixed asset value:The fairness in the central region is relatively good,with both the HRAD and HRAD/PAD higher than 1 before and after the pandemic,while in the eastern and western regions,both are lower than 1 and have a declining trend after the pandemic,indicating a decrease in fairness.(2)Total building area and lab tailored area:The fairness in the central region is relatively good.After the pandemic,the HRAD in the western region increased from 0.903 to 1.009,and the HRAD/PAD increased from 0.983 to 1.129,achieving a transition from relatively unfair to relatively fair.However,both HRAD and HRAD/PAD in the eastern region are lower than 1,with a declining trend,indicating a decrease in fairness.(3)Laboratory equipment:The ABC-class equipment allocation in the eastern region is relatively fair,while the HRAD/PAD of B-class equipment in the western region was higher than 1 in 2021,achieving a relatively fair allocation according to the population size.However,there is a trend towards more unfair allocation of C-class equipment in that region.Although the HRAD and HRAD/PAD of other items did not exceed 1,they are gradually approaching 1,indicating an improvement in the trend of unfair allocation.Conclusions(1)The total quantity and attainment rate of physical resources have increased after the epidemic,but still fall short of the requirements;(2)The configuration of laboratory equipment is relatively complete but unevenly distributed;(3)There are differences in the increment of physical resource allocation among regions before and after the epidemic;(4)There are differences in fairness within and between regions;(5)The fairness in the western region has improved significantly,but it is a low level of relative fairness;(6)Fairness in allocation according to population size is better than that according to geographic area.Suggestions:(1)Continuously increase investment in underprivileged regional disease control centers and accelerate the process of standardization construction;(2)Facilitating Comprehensive Enhancement of Laboratory Instrument and Equipment Configuration;(3)Developing Differentiated Policy Measures Based on Regional Characteristics and Needs;(4)Strengthen resource allocation optimization to promote coordinated development within regions.(5)Actively promote information technology construction and deepen communication and cooperation.