Before the end of May, the provincial disease control bureaus were listed in place, and then what？ The reform of disease control system has a long way to go!

foreword

It has been more than three years since the outbreak of the COVID-19 epidemic; It has been two years since the establishment of the National CDC in May 2021.

Before May, there was little news about the establishment and promotion of provincial disease control bureaus, and the overall work progress was very slow. However, in May this year, especially in the recent period, under the pressure and urging of the relevant state departments, many provinces put up the brands of the disease prevention and control bureaus of their respective provinces, autonomous regions and municipalities directly under the Central Government before the deadline.

This series of actions and information gives us the feeling that "the brand should be hung out first, and the requirements of this time node should be completed before deadline. As for the three-set plan, internal organization, specific work and other contents, let’s wait for the next node to talk about it slowly. As for the reform of the disease control system, who knows?"

挂个牌子也许是疾控局成立，或者说疾控体系改革最简单的内容了，可是然后呢？疾控体系改革就结束了？疾控体系改革就这些吗？

当然不是，疾控体系改革任重道远，道阻且长，目前疾控体系改革尚没有看到太多的实质性进展，疾控局的成立只是个开始。

疾控体系改革必须以解决其存在的4个主要问题——能力不强、机制不活、动力不足、防治不紧密为导向。这是一个艰难的过程，我们只能在不断的探索和实践中寻找最适合我们的那条疾病预防控制的健康之路。

01、国家疾控局成立过程 　

我们首先把时间拨回新冠疫情发生后的第一个全国两会，2020年全国两会。

2020年5月24日下午，中共中央总书记、国家主席、中央军委主席最高领袖在参加十三届全国人大三次会议湖北代表团审议时强调，防范化解重大疫情和突发公共卫生风险，事关国家安全和发展，事关社会政治大局稳定。要坚持整体谋划、系统重塑、全面提升，改革疾病预防控制体系，提升疫情监测预警和应急响应能力，健全重大疫情救治体系，完善公共卫生应急法律法规，深入开展爱国卫生运动，着力从体制机制层面理顺关系、强化责任。

In the context of the COVID-19 epidemic, on April 28th, 2021, the State Council appointed and dismissed national staff, and appointed Wang Hesheng, deputy director of the National Health and Wellness Commission, as the director of the National Bureau of Disease Control and Prevention. Subsequently, the National CDC was established, and it took nearly a year before the "three-set plan" of the National CDC was released.

Established by listing:On May 13th, 2021, the National Bureau for Disease Control and Prevention was officially listed, which belongs to the deputy ministerial level managed by National Health Commission. It will be responsible for formulating policies for the prevention and control of infectious diseases and public health supervision, guiding the construction of disease prevention and control system, planning and guiding the construction of epidemic monitoring and early warning system, guiding the construction of scientific research system for disease control, public health supervision and management, and supervision of infectious diseases, which means that the functions of disease control institutions have changed from simply preventing and controlling diseases to comprehensively maintaining and promoting the health of the whole population.

The "three-set plan" was announced:On February 16th, 2022, China Organization Network published the Provisions on the Functional Allocation, Internal Structure and Staffing of the National Bureau for Disease Control and Prevention and the Notice of the General Office of the State Council, the General Office of the Central Committee of the CPC on Adjusting the Functional Allocation, Internal Structure and Staffing of the National Health and Wellness Committee on February 16th, making it clear that the National Bureau for Disease Control and Prevention is a national bureau under the management of the National Health and Wellness Committee and is a vice-ministerial unit. At the same time, it stipulates the function allocation, internal structure and staffing of the National Bureau for Disease Control and Prevention, and adjusts the internal structure of the National Health and Wellness Committee.

It only took more than three months for the national medical insurance bureau to go from listing to "three decisions"And in the "transition period" of more than three months, we also made high-profile actions: centralized collection of anticancer drugs and medical insurance access negotiations, management of medicines and medical behaviors, and investigation of management of high-value medical consumables, which frequently caused waves in the industry, and we can’t wait for the announcement of the three-set plan to start the reform process.

The overall progress of the National CDC is in sharp contrast with it:It has been nearly nine months since the listing of the National CDC to the announcement of the final plan, and in these nine months, except for the addition of a deputy director, there is almost no official action of any institution.

02、Establishment process of provincial disease control bureaus 　

At the beginning of the establishment of the National Bureau of Disease Control and Prevention, Fujian Province took the lead in announcing the overall framework for the establishment of provincial, municipal and county disease control bureaus: "Systematically promote the reform of the province’s disease control and prevention system; Establish a provincial-level disease prevention and control bureau, and set up municipal and county-level disease prevention and control bureaus based on the health and health departments at the same level. " In August 2021, Fujian Provincial Bureau of Disease Control and Prevention (to be established) was unveiled in Fuzhou.

In addition, there was almost no progress in the provinces. Until this May, due to various factors, the "deadline" was finally determined.The provincial disease control bureaus are required to complete the listing before the end of May.. Ever since, almost every day, provinces have announced the listing of CDC, and the listing of CDC in various places has accelerated.

It is expected that at the request of relevant departments, the "three-set plan" of the disease control bureaus in cities, counties and districts throughout the province and the disease control bureaus may also be set within 2 months.

03、The ideas and responsibilities of setting up the CDC have been basically clear. 　

Country:The National Bureau for Disease Control and Prevention was established. The National Bureau for Disease Control and Prevention is a national bureau managed by the National Health and Wellness Committee, with 170 administrative staff at the deputy ministerial level. There are 1 director, 4 deputy directors and 32 deputy directors. There are 10 departments, including comprehensive department, planning, finance and regulation department, monitoring and early warning department, emergency response department, infectious disease prevention and control department, health and immunization planning department, comprehensive supervision department I, comprehensive supervision department II, science, technology, education and international cooperation department (Hong Kong, Macao and Taiwan office) and government party committee (personnel department).

Provincial level:According to the central model, the provincial CDC is established, which is generally the deputy department level with different offices, and the director of the CDC is also the deputy director of the Health and Health Commission.

Cities and counties:Under normal circumstances, there is a CDC in the Health and Health Commission, and the director of the CDC is also the deputy director of the Health and Health Commission at the same level.

From the perspective of responsibilities, the main responsibilities of the provincial CDC include:To organize the formulation of draft regulations, policies, plans and standards for the prevention and control of infectious diseases and public health supervision; Leading the professional work of disease control institutions at all levels in the province, organizing the implementation of the national immunization program, overall planning and supervising the disease control work of infectious disease medical institutions and other medical institutions; Planning and guiding the construction of an epidemic monitoring and early warning system for infectious diseases, and being responsible for the work related to the epidemic response of infectious diseases; Cooperate to guide the construction of scientific research system for disease control; Responsible for the prevention and control of infectious diseases, environmental sanitation, school sanitation, public place sanitation, drinking water sanitation supervision and management, occupational hygiene and radiation hygiene supervision.

Judging from the public information, the positions of "chief officers" of provincial CDC can be roughly divided into two categories:In some areas, the former responsible comrades of the Provincial Center for Disease Control and Prevention were promoted to the director of the Bureau of Disease Control and entered the party group of the Provincial Health and Wellness Committee, and in some areas, the responsible comrades of the Provincial Health and Wellness Committee who were in charge of disease control and prevention were held.

04、There is not much substantial progress in the reform of disease control system. 　

At least for now, there is no substantial progress in the reform of the disease control system.

The listing of CDC has little to do with the main problems of China’s centers for disease control and prevention at present. The establishment of CDC is to sort out the disease prevention and control system to a greater extent, or even to reorganize and adjust the functions within the health care system.There is still a lot of room for efforts to meet the requirements of "persisting in overall planning, reshaping the system, comprehensively improving and reforming the disease prevention and control system".

However, the establishment of the CDC can be regarded as the beginning of the reform of the CDC system. Straightening out the system and mechanism, clarifying the functional orientation, speeding up the reform of the CDC institutions at the provincial, municipal and county levels, solving the main problems existing in the CDC system, and speeding up the improvement of the CDC system have become the next key tasks and tasks put forward by all localities.

At the same time, we can also see that even if there is not much substantive content, it is more about the adjustment and adequacy of departmental functions. The establishment process of the National CDC and local CDC has been slow and difficult, and the reform of the entire CDC system can be imagined.

05、Four key issues in the reform of disease control system 　

Many people inside and outside the industry have said that China’s disease control system has problems such as low treatment and serious brain drain, but in the final analysis,At present, there are four main problems in the prevention and control system of physical diseases in China: weak ability, inflexible mechanism, insufficient motivation and loose prevention and control.

Therefore, in order to make substantial progress in the reform of disease control system, we must start with these four main problems.

1, the ability is not strong

Question:

The ability is not strong, and we don’t have to admit that the ability of disease control system is not strong, especially in some districts and counties, the overall ability is generally not strong, and the personal ability is generally weak.

Because of insufficient preparation or because of the positioning and treatment of grassroots disease control, it is impossible to recruit highly educated talents, resulting in fewer grassroots disease control personnel and fewer professional business personnel, which leads to poor overall ability. Secondly, from the perspective of personal ability, many people’s business ability is also relatively general. A CDC with strong ability is often one or two people, and then more tasks can only be pressed on the shoulders of these two people, resulting inCapable people are busier and don’t get much, and those who can’t are more idle and more chaotic..

Ideas:

The disease control system should have a set of assessment and evaluation mechanism in line with its own reality, which must be operable, and then be assessed regularly. Of course, it needs to be clear,This assessment is not only for the staff of the CDC, but also for every link of the CDC system.From the staff of community health service centers to the staff of medical institutions who are responsible for the online reporting of infectious diseases and the corresponding responsibilities of public health, from the staff of CDC to the staff of CDC, the staff of CDC should be assessed accordingly.

The assessment content should include the completion of the government’s public health functions and public welfare tasks undertaken by disease control institutions at all levels, the completion of the guidance and supervision tasks undertaken by regional medical institutions, and the improvement of residents’ health indicators in the jurisdiction. At the same time, it is necessary to strengthen the application of assessment results, and take the assessment results as an important basis for the appointment and dismissal of personnel, the evaluation of the first, the total salary and the approval of reward performance in CDC, and link them with the performance, further study and promotion of CDC staff.

All of the above, if gradually promoted and formed a set of practical things, will be very effective for the improvement of the overall system capacity, of course, this process is very difficult.

2, the mechanism is not alive

Question:

Because the disease control system is a part of the system to a large extent, this leads to many restrictions, unlike companies in a market economy, which are flexible and efficient.

Ideas:

First of all, it needs to be explained that the disease control system will never completely become a company under the market economy, which is determined by its nature. However, it is still possible to learn from each other’s strengths, and the purpose is to make the development of disease control system, especially human resources for disease control, become living water.

As implemented in some areasThe system of "chief public health expert" is a good example.The system of "chief public health experts" can be implemented for disease control at least above the municipal level, and the chief public health experts of epidemic disease, exemption from regulations, virus and disinfection are selected in a scientific and reasonable way. This is one of the measures to strengthen the construction of public health talents, provide talent guarantee for the construction of public health system, set up "chief experts" for disease control based on scientific research, talents and foreign exchanges, and build "hard power" for disease control personnel.

On March 31st, at the provincial conference on disease prevention and control system in 2023, Hao Yibin, director of Henan CDC, said:

At present, the Center for Disease Control and Prevention of Henan Province is setting up a chief expert system, which encourages senior experts with rich experience in scientific research and business management to be full-time "chief public health experts" by enjoying favorable conditions such as retaining the original administrative post treatment and special retirement and re-employment policy, empowering inter-departmental scientific research teams and providing sufficient scientific research funds.

In addition, should be established.Practice-oriented evaluation mechanism of public health talents, the implementation of classified assessment. Promote and strengthen the cooperation between disease control institutions at all levels and the college of public health in personnel training, personnel mutual employment, platform co-construction, data sharing, etc., create a demonstration base for public health personnel training in cooperation between schools and localities, and jointly cultivate applied professionals in public health.

At the same time, we should also increase the decision-making power of disease control institutions at all levels, reform the evaluation criteria of professional titles, and reasonably increase the proportion of middle and senior positions in disease control institutions. Improve the system of public health doctors, cultivate and expand the team of public health doctors, and explore giving public health doctors the right to prescribe.

3. Lack of motivation:

Question:

To put it bluntly, the disease control system is too poor and the income is too low. This is the root of many problems, because the income is low, so we can’t attract talents and can’t keep talents, so our ability is not strong; Because of the low income, more work and less work, they gradually began to muddle along and began to make no progress.

Ideas:

Tianjin CDC, Wuhan CDC, etc. have publicized the foreign services that they can charge for. For example, Tianjin CDC has launched 72 foreign technical services, which can provide a variety of health services for individuals and families, and provide entrusted testing services (23) and public health technical services (49) for the government and relevant departments, enterprises and institutions, and social organizations.

The project specifically includes the detection of water, air, food, etc.Communication and defense officeIt can provide technical support and policy consultation related to infectious disease prevention and control, theme planning activities of health science popularization day related to infectious disease prevention and control, and production of health science popularization videos.Exemption officeCan provide vaccination related policy advice and technical support, vaccination knowledge training. All these provide ideas for other disease control institutions.

The reform of disease control should explore and promote the "first-class security and second-class management" and implement it in detail.Two permits",allowing disease control institutions to break through the current wage control level of public institutions, allowing medical and health technical services to be provided on the basis of completing the approved tasks, and further stimulating the endogenous motivation of disease control institutions. While implementing the policy of full financial security, we should establish a new operating mechanism that combines security with incentives and conforms to the characteristics of disease control institutions, give them internal distribution autonomy and stimulate their operational vitality.

4, prevention and control is not close

Question:

To tell the truth, this is the most difficult to solve. Even after the establishment of the CDC, the separation between prevention and treatment may be more serious.This seems to be seen from the monitoring of the new crown infection virus.

Ideas:

For disease prevention and control, if prevention and control are to be closer,It is necessary to make clear the responsibilities that all kinds of medical institutions and medical administration departments at all levels should and must undertake in disease prevention and control.At the same time, the mechanism of personnel communication, information communication, resources communication and supervision and supervision is also established between disease control and medical care, and the disease control work is promoted to be included in the performance appraisal content of medical and health institutions.

In addition, it is necessary to establish an innovative supervision, assessment and evaluation mechanism for disease control institutions to medical institutions, and explore the establishment of a full-time and part-time disease control supervisor system in medical and health institutions to supervise the development of disease prevention and control, and urge the implementation of reporting responsibilities for infectious diseases and public health emergencies. For example, whether the infected cases in COVID-19 were reported realistically, such as whether fever of unknown origin was reported in time.

The reform of disease control system has a long way to go, and all key measures of reform and development must be supported by governments at all levels and relevant departments before they can take effect.

Everything has just begun, and China’s disease control system needs to focus on the long-term, overall planning, layout of the future, and embark on a road of public health governance with China characteristics.

write　| CDC disease control person

Proofreading　|　Gddra　

read and edit　|　Hide / Blue sea

Edit design　|　　Alice