上海疾病预防控制系统建设的进展与思考

Progress and strategies of Shanghai Disease Control and Prevention System

本文阐述上海市疾病预防控制系统取得的成绩,面临的挑战及应对策略。2010-2017年,上海市、区两级疾病预防控制中心(简称"上海CDC")本科以上比例分别提升了27.2%、38.1%,机构总收入分别提升了189.3%、108.0%,A类检测项目开展数分别提升了1.2%、87.7%;服务提供和防病成效显著,传染病发病水平控制在历史低位(2017年甲乙类传染病发病率为138.93/10万),免疫规划工作规范有序(常规疫苗接种率维持在99.8%以上),突发应急能力全面提升,高效应对禽流感等疫情,慢性病综合防控初见成效,建立了市、区两级疾控信息平台和覆盖全业务领域的信息标准体系。但存在专业队伍人员数量下降(市级降低了11.6%),薪酬水平不高(如慢性病防控专业人员的收入水平仅为医院的42.6%),筹资补偿机制不完善、各方协同氛围未形成等问题。未来上海CDC系统建设应结合时代要求及特大型城市发展的需求科学谋划,完善健全长效的投入机制,稳定一支高素质的公共卫生专业队伍,构建"防患于未然"的防病机制,创新"健康融万策"的协作机制。

This paper elaborates the achievements,challenges and strategies of the Shanghai Disease Prevention and Control System.Between 2010 and 2017,the proportion of staff members with bachelor′s or higher degrees at the municipal and county level centers for disease control and prevention(CDC)increased by 27.2%and 38.1%,respectively.The total institutional income increased by 189.3%and 108.0%,and the Category A testing projects increased by 1.2%and 87.7%,respectively.Significant improvements were achieved in service provision and disease prevention.The incidence of infectious diseases was at a low level,with the contagious diseases rate declining to 138.93/100000 in 2017.The Vaccine Immunization Programs were implemented well and the conventional vaccines recipients′rate was around 99.8%.The ability of the emergency response improved significantly,and the great effects of the comprehensive prevention and control of chronic diseases were achieved.A disease control information platform of Municipal and County Level CDCs have been established,which covered all business areas.Remaining problems included the decline in the number of staffs(an 11.6%reduction in Shanghai Municipal CDC),the low salary level(the income level of professionals in chronic disease prevention and control was only 42.6%of that for staff of hospitals),the imperfect financing mechanism,the absence of cooperation among departments and others.Scientific plans are expected to be made for Shanghai CDC system,which should be in accordance with the requirements of the development of megacities.The long-term investment mechanism should be established,a high-quality professional team should be retained,and a preventive and cooperative mechanism of"Health for all"should be initiated.