完善公共卫生防疫体系建设:基于基层卫生“平战”防疫视角

Improving the Development of Public Health Emergency Preparedness and Response System via Reinforcing Primary Care in Pandemic and Non-pandemic Periods

背景新型冠状病毒肺炎疫情发生之后,特大城市公共卫生突发事件的治理能力被提上政策议程,而基层卫生作为公共卫生体系的“网底”所发挥的作用十分关键。目的探索上海市基层卫生在应对新型冠状病毒肺炎疫情防控中的实践并剖析当前存在的问题与困境,为完善公共卫生应急体系提供政策建议与决策依据。方法本研究于2020年6—9月选取上海市具有代表性的郊区、城区与城郊结合地带,采用小组座谈形式调查了5个区10家社区卫生服务中心,以及相应卫生健康委员会与疾病防控部门。访谈工具为自行设计的半结构式访谈大纲,社区卫生服务中心的访谈内容主要包括疫情防控期间承接的主要任务、组织架构、实际工作内容、内部协同、主要问题与建议等,相应卫生健康委员会与疾病防控部门的访谈内容主要包括社区卫生服务中心在疫情防控中的主要职能与实际作用、暴露的“短板”、卫生健康委员会/疾病预防控制中心如何予以支持及如何“平战结合”。结果上海市基层卫生在公共卫生疫情防控中主要发挥了疫情应急响应、区域联防联控,院内分诊筛查、保障基本医疗,借力新型冠状病毒肺炎疫情、做实签约服务的功能,存在物资与人力资源不足、心理防疫能力不足、内部协同与多部门管理不足、激励机制与活力不足四大问题。结论针对当前基层卫生在公共卫生疫情防控中的困境,建议从四个方面理顺关系,即理顺基本医疗与公共卫生关系、理顺平时与疫情应急响应期的关系、理顺社区与上级部门关系、理顺政府与市场关系。

Background Since the outbreak of COVID-19,the ability to manage public health emergencies in mega-cities has been put on the policy agenda,and the role of primary care in public health system is critical.Objective To explore the status,problems and challenges of practical exploration of Shanghai's primary care in responding to COVID-19,providing policy recommendations and decision-making basis for improving the public health emergency system.Methods From June to September 2020,a qualitative study was conducted using group interviews with administrators and healthcare professionals selected from 10 representative community health centers(CHCs)in suburban,fringe and urban areas in Shanghai's 5 districts for exploring major tasks shouldered by the CHCs,organizational structure of the CHCs,actual tasks performed by the CHCs,internal collaboration,major problems in service delivery during the pandemic,and recommendations,and with directors,as well as professionals responsible for information,healthcare management and quality control,public emergency management and infectious disease containment selected from health commissions and centers for disease control and prevention in the districts,for exploring the functions and roles of CHCs during the pandemic and their weaknesses in anti-pandemic actions,anti-pandemic supports from health commissions and centers for disease control and prevention for CHCs,and ideas about actions of primary care in pandemic and non-pandemic periods.The interviews with individuals from three kinds of affiliations were guided using different types of semi-structured outlines developed by our research team.Results The interviews revealed that during the pandemic,the CHCs gave emergency responses to COVID-19,participated in regional collaboration for COVID-19 containment,delivered in-hospital COVID-19 screening and triage services while providing routine medical services,and continued to offer family doctor services.Four issues were found to be addressed:insufficient healthcare resources and workers,insufficient services targeting psychological influence of COVID-19,unsatisfied internal coordination and multi-departmental management,and lack of appropriate mechanisms incentivizing healthcare workers and invigorating primary care.Conclusion In view of the challenges in fighting COVID-19 faced by primary care,it is recommended to take actions on the basis of appropriately balancing the delivery of routine primary care services and public health services,and tasks during pandemic and non-pandemic periods,and appropriately coordinating with higher level departments,as well as developing incentive programs according to the local conditions as a supplement for the government programs.