| I BackgroundAdministrative division is a kind of repartition and adjustment on administrative management domain in the territory of a certain country under the consideration of geography, history, economy, regime framework and responsibility fulfillment. Nowadays, the administrative division of China already starts to reveal the weakness of not advancing with the times. While the economy of a city develops to a certain stage it will break the restrictions of traditional administrative division and bring about adjustment. And when strengthening the productivity by transforming a city’s domain, the local government should rule the expanded area in an ordered and efficient way at the same time. Thus it will come with a series of difficulties like government restructuring and integration of public service sectors.Taking the combination of Pudong New Area and Nanhui District in Shanghai in2009as an example, after the State Council approved the domain adjustment, well-functioning public health planning suspended in a sudden while new planning is about to establish. During this transition period, the government should combine related institutions and personnel to continue routine administrative management and public services in order to minimize the impact of domain adjustment on residents. However, historic experiences and practical cases for public health management sectors are quite few. Therefore, it is essential to research on and conclude the combination and adjustment process of the whole public health field in these two years and to provide assumption and suggestion for unfinished integrated projects.II ObjectivesThis article aims at study the objectives, principles, path, models of public health institution integration evoked by administration division combination by taking the combination of Pudong and Nanhui as an example, taking the adjustment and re-planning of health administrative departments and public health institutions as entry point. This is to provide experience and decision-making evidence for problems of public health institution integration evoked by administration division combination, to offer suggestions for decision maker when design scheme of domain adjustment, and to add innovative research area to traditional health planning theory. This objective could be further divided into the following three parts:1. Concluding accomplished integration path, method and experience of health administration departments and affiliated public health institutions;2. Raising assumption or scheme of unfinished public health institution integration;3. Putting forward initial suggestion of new public health management models fitting in with socio-economic development of new Pudong.Ⅲ ContentsThis article intends to research on the connect and difference of definitions and objectives between health administration departments and public health service institutions; to research on the transition mechanism and process from administration sectors to service institutions caused by administration division integration by observing and analyzing the progress of government departments, health administration sector and affiliated public health institutions of Pudong and Nanhui and to explore conditions and possibilities of multiple integration models; to sort, analyze and sum up the combination path of center for disease prevention and control and to make a typicality research; to put forward assumption of integration model of communicable disease hospitals; initially explore the necessity and possibility of newly building public health center and extensive disease control of the NEW Pudong.IV MethodsLiterature Review:using administration division, administration division integration, regional health resource integration, health planning theory, administration organization, public health institution, etc. as key words, to review the main databases like Web of Science, CQVIP, CNKI and so on; to study and sort policy paper documents of national, municipal and district level; to research media report and conference material.Quantitative Research:to describe current status of research contents by analyzing yearbooks, health yearbooks, statistics manuals, health development reports, other statistical and surveying material.Qualitative Research:around integration background, transition path, finished integration plans, feelings and evaluation, experience, difficulties and advice, assumption of future development and so on, implementing respondent interview, expert consultation, field investigation; to analyze typical case research by using SWOT.V Results5.1Administration Division Adjustment and Related Challenges of Institution IntegrationSince1990s, large cities or metropolises as Beijing, Shanghai and Guangzhou have experienced a new round of administrative division adjustment. Governors in China, nowadays, decide to allocate regional domain mainly starting from the consideration of economic growth. This will cause a serious of problems and come up with lots of obstacles and difficulties. This article aims at exploring one of these challenges, i.e. the inevitable restructuring of health administration departments, public health management and service institutions after administration division adjustment. It belongs to the regional health planning area, but also differs from it. This origins from administrative orders and the established regional border is broken, featuring in:a. top down; b. aiming at adapting to regional pattern variation; c. passive; d. sudden; e. massive changes; f. massive; e. few theories and examples for reference.The process of institution integration caused by administration division adjustment would meet five fundamental problems:how to finish the whole process in a relatively pressing period; how to transit the requests of administration division adjustment into affiliated public health institution integration; what methods and path to follow; how to overcome the restriction of traditional health planning theory; how to tackle with the demand of combining public health functions to build new public health institutions.Administrative organization means the organs which possessing legal administrative power, representing the nation to conduct administrative management activities and exercise administrative power in the name of itself. In China, it refers to the central and local people’s governments and their functional departments. Health administrative department means the sector responsible for medical and healthcare administration affairs in governments of every level. It is in charge of making medical and health laws, regulations and policies, instructing, managing and supervising the operation of affiliated institutions, etc. Specific law enforcement, business function and service provision are carried out by subordinate units.Public health institution has a broad definition, which has generalized wording and narrow meaning. Public health institutions in this article means health administrative departments and specialized public health institutions representing health administration sector to perform public health functions and provide services for residents, including CDC, health inspection institute, maternal child health institution, etc.5.2Case Study of Pudong New AreaIn2011, the permanent resident population is5.175million, among which floating resident population is2.146million and registered population is2.785million. There are13sub-districts and25towns.Pudong New Area was called Chuangsha. The central government declared to develop and open Shanghai Pudong in April1990. Shanghai Pudong New Area was established in1992. The People’s Government of Pudong New Area was founded in August2000. The State Council approved to implement comprehensive reform in Pudong in June2005. And in April2009, the State Council decided to combine the whole Nanhui District into Pudong New Area. The integration started from May2009, establishing the new party committee in July2009and finishing the process in August2009.In2011, the average life expectancy of registered population was82.62,80.26of male and84.96of female. The maternal mortality was4.93per100thousand and the infant mortality was2.71per thousand. There are1074medical and health institutions of every grade and every kind,12850authorized beds,15374open beds and a total of24439health personnel.In September2009, after the combination of Pudong and Nanhui, health administration departments took the lead in integrating and Pudong New Area Health Bureau (Population and Family Planning Commission). The organization Commission issued documents in November2009to appoint leaders and set the organization structure of the bureau. Till May2012, professional stations which undertake government responsibilities and bear instructive functions have finished integrated or adjustment, sorted management and operation schemes, and keep or reasonably replenish branches, such as CDC, health inspection institute, medical emergency center, maternal and child health institution, dental and eye disease prevention institute.Case Study of Pudong CDC Integration ProcessCase Study of Integration Model Design of Pudong Communicable Disease Hospitals Case Study of Establishing Pudong New Area Public Health CenterVI Discussion6.1Principles of Public Health Institutions Integration after Administration Division AdjustmentFormer health plans are broken as administration division adjusting. Public health institutions should focus on efficient linkage and transition in function, personnel, reaction, service and so on according to different specialized area. According to regional health planning patterns, each district-level government health sector sets one and only one headquarter of every professional station, but could establish dependant branches to carry out localized management. Institutions mainly performing clinical treatment functions would maintain former status. Layout of community health centers would comply with municipal policies. Principles of public health institution integration after administration division adjustment include: rapid reaction, steady transition, tacit linkage, practical and usage of IT technologies.6.2Conclude Integration Models of Public Health Institutions after Administration Division AdjustmentHealth administration departments:The integration of health administration departments is mainly conducted following administrative order of the government in charge. Health sector itself need to focus on sorting and combine positions and personnel, and linking with affiliated institutions.Prevention-function public health institutions:After the combination of health administration departments, prevention-function professional stations should take the lead in integrating. Basically this would comply with the rule of setting one headquarter in one district. Health administration departments first decide combination strategy, appoint leaders, raise integration requirements and make explicit the new name of the institutions. New institution leaders set and implementing internal integration scheme under the instruction of health administration departments.It is hard for a professional station headquarter to make its service cover all sub-districts and towns after combination. Therefore, dependent branches are established whose business is managed by professional status like interior divisions.Prevention-treatment public health institutions:Their health care function equals treatment function. Integration path is similar to the aforementioned type. However, the integration should agree with practical conditions and right time. No matter which type, according to the experience of Pudong New Are, personnel integration is the most troublesome but most important problem. Government departments, especially health administration sectors should consider it as a key problem when making integration plans.Treatment-function public health institutions:Institutions focusing on clinic treatment function and subordinated by prevention function could remain its original status temporally, because their main responsibility is to satisfy medical treatment demand of a certain area or specific population. Whether integration or replenishing depends on practical needs. |
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