| BackgroundIn the public health emergence response to SARS and bird flu, many problems of the disease control system and human resource allocation have been exposed in these years. The system and human resource couldn't adapt to the demands of disease control and emergence response in current and future situation. Strengthening disease control system has become an important work for Chinese government to research and dissolve. County level Centers for Disease Control and Prevention (CDC) in middle and west China are the emphasis work. With the construction of infrastructure, it is especial important for county CDCs to allocate the limited human resource on the base of the essential functions definition in middle and west China. Our research is one Operational Research of WB/Foreign donation SARS and Other Infectious Diseases Response Program (MOH). We selected three provinces, Jiangxi, Yunnan and Qinghai as study sites in middle and west China.Research Objectives1. To investigate the present situation of disease control services at county level CDCs especially in the poor counties of three provinces in middle and west china.2. To investigate and evaluate the present situation of human resources at county level CDCs especially poor counties of three provinces in middle and west china.3. To evaluate the emergency response demand and capability at county level CDCs especially in the poor counties.4. To define the basic functions, work categories and items of poor county CDCs in middle and west china.5. To analyze the factors which influence the allocation of human resource in middle and west china.6. To set the minimal standard of human resource allocation for CDCs in poor counties in middle and west china. 7. To put forward relevant policy suggestions and reformation tasks for improving the human resource.Research MethodsQuantitative study methods (including literatures, documents and routine statistic data collection, questionnaire investigation for CDCs) , qualitative study methods (including in-depth interview, focus group discussion and nominal group discuss ) and Delphi method are used together to collect data. Difference analysis and multi-factor statistical methods are applied to analyze and interpret the data. Statistical description and estimation were applied to analyze the quantitative data; Framework approach to code, categorize, interpret the qualitative data and set the multiple regression model for human reseource allocation standard. Oration and tables were used to express opinions and expectations of the interviewers.Research findings1. Comparing the social economic and health indexes, the investigated three provinces and counties are representative. The results of questionnaire investigation indicate that most of human allocation indexes have difference between three provinces. The situation of Qinghai province is relatively worse than the others. There is no much difference between national, provincial poor county and normal county.2. Though all of sample CDCs provided pay-for-service in different degree, more than half were unbalanced and got into debt, especially in the poor counties. It is the only choice for CDC to provide paid-service. It could partly maintain the survival of CDC but it would affect the service quality and the performance of the basic function ultimately. The equity and accessibility of disease prevention and contorl will get more frustration.3. There was difference between numbers of total staff and health-tech staffs per 10,000 persons, age proportion, education proportion, professional training background proportion of health-tech staffs, and, ways of staffs reducing in different type of county CDCs.4. Health-tech professionals were insufficient while non-professionals were overstaffed. The structure of the health-tech staff is unreasonable, such as the age gap, too many non-professionals, technical secondary school, clinic and pharmacy staff. The performance of them was hard to meet the basic functions of CDC and there was no deposit of human resource in county CDCs. The quality study of the six sample counties shows that after the epidemic station separating, the personnel structure got worse. At some poor counties, CDCs were forced to accept the non—professionals, which deteriorates the unseasonable structure.5. The finance input shortage is a very important and longstanding influencing factor in human resource allocation of county CDC. Basically the poor county finance is olny mouth-feeding budget which result in economy compensation shortage and restrict the CDC manning scale. There is a lack of proper interior institution management mechanism, staff enrolling standard and performance evaluation. The personnel reformation and institution reformation is just at the beginning and it is a trudge and short of motivity. It should be cognizant of the necessity, long-lasting and difficulty for in-depth reformation and needs the time, social and policy supporting.6. Lacking outlay, the training for CDCs and town hospital health workers was mainly made through the meeting or one-pass-to-ten. It maybe has some pushing effect on fulfilling tasks, but it is very difficult for health workers to improve their ability building and performance with such training mode lack of deepness and extent.7. All of the sample counties have established the public health emergency response lead team and network. But the manpower, financial and material resources are insufficiency and the emergency response ability is limited. It is difficult to guarantee the effective response when facing the emergency such as SARS.8. 8 essential public health functions, 21 work cata40 work categories of poor county CDCs within coming 5 years were identified by nominal group discussion and Delphi method. At present national poor county CDCs are only coping with the routine work. It has little chance for them to develop the chronic disease prevention, health information system building and management, health risk factor surveillance and health education. In fact, 116 sample county CDCs assessed by themselves that they have fulfilled 64%-69% of 8 basic functions. The experts evaluated that the CDCs had fulfilled 40-50% of 8 basic functions and work categories. If according the latest defined basic function, work categories and items, their human resource couldn't meet the present and future demand of disease control service and emergency response.9. 116 county CDCs in 3 provinces all expect to reduce the proportion of heath staff without professionals or title, improve the proportion of heath-tech staff with professional training background and titles, to change a majority of technical secondary school background staff in county CDCs.10. Quality and quantity studies show that there are various factors to influence the human resource allocation of county CDCs. The factors includes not only the population, social economic development level, square, geographic features, traffic condition, CDC health-tech staff quality, the operation of basic rural preventive and medical service network, but also the institution and personnel reformation. So it is not proper to allocate the human resource only by population.11. The following equation can be a reference to guide the human resource allocation of county CDC: Y= 1.67 +2.5×10-6×square—011×the number of township health centers in each township + 4.38×10-3xpopulation + 0.0169xthe vehicle number of CDC+0.0156×the number of computers connected to internet of CDC—0.14×the proportion of junior college staffs—0.12×the proportion of staffs with major of public health—0.081×located in tableland12. At present with many unsure factors during public health system reformation and disease control framework adjusting, it is temporary for the definition of basic functions and the human resource allocation standard of county CDCs. Meanwhile it is not suitable to predict for too long time. It needs supporting and premise to apply the human resource allocation standard proposed by this research.Suggestions1. Government at all levels should pay highly attention to the public health system and CDC construction, and strengthen their financial support to public health sector and CDC. Establish a reasonable responsibility-sharing and money-raising mechanism. In its process to a socialistic market economy, government should allocate human resource reasonably and buy the special package of disease prevention control services and public health services according to identified basic CDCs functions and public health need.2. Government should in-depth reform human resource management system gradually. With strengthening the government macro-adjustment, county CDC should be entitled with more power and establish more rigid regulations about enrolling staffs. To set up the competing, supervising and promoting mechanism and form into good circulation. Establish health professionals center to manage newly engaged professionals as an agent and give help to the duty-off persons providing information. Strengthen the outlay to ameliorate the quality and stucture of the personnel by various position training.3. In next several years, county CDC should perform its own function round and well, and it is necessary that supervision should be intensified, which is one premise of getting the permission of providing paid service on health care and disease control.4. It needs to define the functions and work purview of public health related institutions for stressing on the corporation together. Strengthening the instruction and management of the township-village two-tier network of preventive services as well as county CDC.5. With strengthening the public health emergency response lead team and network, it needs to establish a emergency response and routine management mechanism. The manpower, financial and material resources should be sufficiency; the fund should account in the county finance budget, and there need input from the higher government for the poor areas.6. It should be identied the essential fuctions, work categories and items in different social economic areas and periods. Concerning the essential functions of county CDC and the requirement of emergence response in the middle and west regions, it is necessary to improve the proportion of heath-tech staff with professional training background as well as increasing laboratorial and administrative staff moderately. Guarantee the construction and development of the township-village two-tier network of preventive services as well as county CDC. Guarantee the accessibility and feasibility of disease control service.7. There should be some changes to the long term mode of identifying the CDC's manning scale according only to population. The human resource allocation standard, which is proposed by the research with its application premise, can be a reference to governments, in particular for those in the middle and west regions. One of the preconditions to realize the reasonable human resource allocation is to reform the human resource management system. County CDC should be entitled with more power and establish more rigid regulations about enrolling staffs. Currently, the predicted staff number of the standard can be set as the lowest limit of CDC's staffs. Given that CDCs perform their functions sounder and better, CDCs' staff number can be set to the upper boundary of the standard.
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