Investigation report on the construction of county public health system

Investigation report on the construction of public health system in Pingluo County

In order to further improve the public health service and the ability to deal with public health emergencies in our county, safeguard the health and safety of the people, maintain social stability, and promote comprehensive, coordinated and sustainable economic and social development, according to the spirit of the relevant departments of the autonomous region, I The county arranged relevant departments to investigate and study the construction of the public health system. The investigation report is as follows:

First, the basic situation

Public health system construction

1. Organization setting:

After years of construction, the county has formed a three-level public health work network and service system with relatively complete facilities and functions. It has a staff-filled team of health professional technology and health supervision and law enforcement. There are 238 medical and health institutions at all levels in the county, including 1 county-level general hospital, 1 Chinese medicine hospital, 1 health and epidemic prevention station, 1 maternal and child health center, 16 township health centers, training center and Honghui clinic. There are 1 preventive health station, 168 village medical stations, and 47 individual and social medical institutions. Our county has not established a health supervision office, a county health and epidemic prevention station, and functions such as disease control, health supervision, information reporting, and public health incident handling. The specific health supervision and law enforcement business is undertaken by the Health and Epidemic Prevention Station under the supervision of the first and second divisions. The county's food hygiene, public health, cosmetics hygiene, school health, occupational health, drinking water hygiene, radiation health, disinfection and health, infectious disease prevention and control supervision and management work.

2. Composition of health personnel and equipment of public health institutions:

There are 817 health workers in the county. In terms of academic structure, 414 people with college education or above account for 51%; 154 people with secondary education or above, accounting for 19%; and 632 professional technicians, including those with associate titles or above. 34 people, accounting for 5.4%, 134 people with intermediate titles, accounting for 21.2%, and 464 people with junior and junior titles, accounting for 73.4%. The county health and epidemic prevention station is responsible for the health and epidemic prevention tasks of 10 townships, 128 administrative villages, 2 field mines, 62 industrial and mining enterprises, and nearly 260,800 people in the prevention, treatment, management, research and teaching. In recent years, as the undergraduate graduates of higher medical colleges have been enriched into the health supervision team, the level of supervisors has been further improved, and the age structure has been further rejuvenated. There are 62 employees in the epidemic prevention station, 48 in the compilation, 7 in self-support, 7 in temporary employment, 54 in professional and technical personnel, accounting for 86% of the total number of employees, 35 in college or above, and 12 in secondary school. Persons; 7 with senior professional titles, including 2 chief physicians, 5 deputy chief physicians, 21 intermediate titles, and 48% of professional and technical personnel. There are 20 sets of equipment of more than 10,000 yuan: low-speed refrigerating centrifuge, carbon monoxide measuring instrument, carbon dioxide measuring instrument, washing machine, urine ten-item analyzer, vertical circular steam sterilization pot, data processing machine, B-ultrasonic instrument, electrocardiograph , microscope, inverted biological microscope, biochemical analyzer, blood cell analyzer, carbon dioxide incubator, ultraviolet spectrophotometer, fluorescent spectrophotometer, ELISA spectrophotometer, atomic absorption spectrophotometer, gas chromatograph, water sampler One each.

3. Housing and other conditions:

The Health Supervision Office of the Health and Epidemic Prevention Station was built in 1974 with an area of ​​780.72 square meters. The comprehensive office building was built in 1985 with an area of ​​1,165 square meters. The new CDC building, which was built with the use of national debt funds, was put into use in October 2003. The area is 1,500 square meters, with a total investment of 1.8 million yuan. The county health and epidemic prevention station, the county hospital, the Chinese medicine hospital, and the maternal and child health center have established a “SARS” network system, and implemented “SARS” epidemic situation report and zero report system in all medical and health units throughout the county; the health and epidemic prevention station has implemented 24 hours. The epidemic duty system was established and the epidemic situation forecasting room was established. In the county hospital, the Chinese medicine hospital established a fever clinic, the county hospital established an isolation ward, set up 6 observation beds. All the medical and health units in the county have established a pre-inspection system for atypical pneumonia.

Medical treatment system:

As the leading unit of the medical treatment system, the county hospital established the Pingluo County Emergency Center in December 2002, setting up 300 beds, including 240 square meters for emergency departments, 10 observation beds, and 3 "120" ambulances. The ICU ward sets 4 beds and some basic medical ambulance equipment. The Department of Infectious Diseases set 20 beds. County Hospital of Traditional Chinese Medicine has set up 120 beds, 32 sets of beds for maternal and child health centers, and 15 beds for Yaofu Center Health Center. It has certain basic medical equipment and hospitalization ability. Other medical and health units have simple medical conditions and can only solve the basic needs of local people. medical insurance.

Second, the outstanding problems exist:

In recent years, with the rapid development of economy and society and the improvement of the health needs of the people, the development level of the county's health care industry can not fully meet the requirements of society, economy and people's people, especially in 2003-2004 SARS and other major infections. In the prevention and treatment of diseases and the relief of major disasters, a series of prominent problems in the public health undertakings of the county have been exposed:

The prevention, early warning and emergency control of public health problems lack a unified, scientific operation mechanism and management system, and the mechanism for responding to public health emergencies is still not perfect.

In the face of public health incidents that raided, in May 2003, the State Council urgently formulated and promulgated the “Emergency Regulations for Public Health Emergencies”. In order to further strengthen the leadership of the county's work in the prevention and treatment of atypical pneumonia, according to the work arrangements of the district and city party committees and governments, the county has established the Pingluo County Atypical Pneumonia Work Command, and the office is located in the Pingluo County Health Bureau. Implementing the divisional responsibility system for county-level leadership against SARS, and formulating the Emergency Treatment Plan for SARS in Pingluo County, clarifying the responsibilities of the health department and other relevant departments, and ensuring comprehensive measures against SARS. implement. The County Health Bureau has set up an emergency command center with organizations such as health quarantine, medical treatment, and logistics support. In accordance with the principle of "mainly prevention, combination of prevention and control, emergency response, combination of peacetime and warfare, block-based, bar-and-block combination, special-oriented, group-specific combination", all tasks have been successfully completed. Through the prevention and treatment of SARS, although we have accumulated a certain amount of experience in dealing with emergencies, the problems reflected in the prevention and treatment process of SARS cannot be ignored: First, some leaders do not pay attention to the prevention work of SARS. Really recognize the importance of establishing a public health mechanism. There is no long-term consideration in terms of prevention and early warning. There are thoughts of blindly fighting in emergencies. Second, some departments have mutual disharmony and mutual deduction in their work for their own interests. The third phenomenon is that some peasant people do not understand or support the decisions of the county party committee and the government, and some still hold opposing attitudes.

Public health-related infrastructure and equipment support are seriously lagging behind, rural health work is developing slowly, and the level of health technology and public health services is low.

In recent years, a kind of medical function has been strengthened throughout the country, and the functions of disease prevention, maternal and child health care, health education, health supervision and law enforcement have been weakened to varying degrees, resulting in many local county, township and village medical prevention. The health care network is incomplete. At present, although the county has formed a network of public health work and services at the county, township and village levels with relatively complete facilities and functions, the public health infrastructure work is still weak: First, most of the medical income of each medical unit is used. In order to pay employees' wages, unable to purchase medical equipment and introduce new technologies, there is widespread phenomenon that medical equipment is backward and technical conditions are poor. Second, because township hospitals are limited by housing conditions, there is no standardized infectious disease clinic, which is easy to cause. There is a medical hazard in iatrogenic infection and transmission. Third, although the county health and epidemic prevention station has built a new disease control center building, the construction funds are insufficient, with a gap of 400,000 yuan. At the same time, due to the lack of equipment supporting funds, it is impossible to equip with advanced testing equipment. The existing inspection equipment is relatively backward and cannot meet the emergency needs of current disease control and public health emergencies. Fourth, the Pingluo County hospital business housing is seriously inadequate, restricting the development of emergency services and the management of infectious diseases. The medical equipment is outdated. There are few "120" emergency systems and vehicle-mounted equipment, which can only cope with general conditions of first aid and general infection. The treatment needs of the disease does not have the conditions to cope with large-scale public health emergencies. The county hospitals have a simple clinic and isolation ward, and there are few beds. Once there are many cases of SARS, they will not be able to cope. And the county hospital issued a fever clinic, isolation ward is located in the hospital, and other patients and hospital staff members of the family area is relatively close, without isolation belt, easy to cause iatrogenic infection and spread. Fifth, the functions of county-level medical and health institutions are not clear, the functions are imperfect, the service functions are not strong, the township health centers are serious, the public health departments are not perfect or ineffective, and the village clinics only pay attention to the pursuit of economic interests and other issues; Taking the county-level medical institutions as the leader, the township hospitals as the link, and the village-level health-based three-level medical and health service system fail to play their due role and need further strengthening and development. Seventh, the county and township governments fail to give full play to their management functions and the role of the village committee. They should follow the principle of localized management, integrate the elements into blocks, and gradually form prevention, early warning at the county, township and village levels. , control and deal with integrated emergency mechanisms.

The shortage of funds limits the wide and effective implementation of public health, especially preventive health care.

In recent years, with the development of the economy and social progress, the field of public health services has been continuously expanded. In addition to good planning immunization and tuberculosis prevention and control, county health and epidemic prevention stations have also carried out chronic disease prevention and control, AIDS prevention and treatment, health education and health. A series of special work such as law enforcement supervision, public health incident handling, occupational disease supervision, etc., and the funds required for these projects are not included in the county budget. At the same time, due to the increase in workload, the demand for various types of professional and technical personnel has increased. However, the county finances have implemented an increase in the number of people, and the policy of self-supporting and self-supporting has led to the phenomenon that medical units lack talents but cannot afford talents. The lack of investment in business funds and the shortage of talents have limited the development of public health in our county. As the hub of the tertiary medical preventive health care network, the township health center shoulders the specific work of public health services and undertakes a large number of preventive and health care tasks. Many of the jobs are free of charge. In recent years, due to the relatively tight financial budget of the county, the funds allocated to the township hospitals are only 60% of the employee's file salary, which is equivalent to 30% to 40% of the total wages of the employees, and the business income cannot make up for the shortfall of the employees' wages. Low wages, coupled with poor living conditions and working conditions, have caused serious brain drain in township health centers, directly affecting the quality of rural health work.

Third, future work ideas and work tasks

Establish and improve emergency response mechanisms for public health emergencies

1. Establish a unified command and organization system for emergency public health emergencies throughout the county. Establish a leading group for emergency response to public health emergencies, responsible for the unified leadership of major emergencies in the county, clarifying the duties and tasks of relevant departments and townships, and forming a monitoring and early warning of public health emergencies based on the coordination of health departments and coordination of departments and towns. And the emergency response linkage mechanism to provide organizational guarantee for the effective handling of emergencies. The health department should also set up a corresponding command and coordination organization to be responsible for the prevention and control of medical and health units and the emergency treatment, implement a scientific division of labor, be responsible for grading, and establish and improve the organization and management system.

2. Establish a unified early warning and reporting system for public health emergencies. The county health bureau will be the center, the county-level disease control, medical and supervision institutions will rely on the technology, and the public health incident monitoring report and early warning network extended by the township medical and health institutions will further standardize the monitoring, reporting and division of labor coordination system. .

3. Establish and improve emergency early warning mechanisms for public health emergencies. Further integrate emergency plans for SARS, bird flu prevention, food hygiene and safety, occupational poisoning, major disasters and other public health emergencies, and revise and improve various emergency prevention and control measures in accordance with the provisions of the Emergency Regulations on Public Health Emergencies Scientific division of labor, strict responsibility, and gradually establish an emergency response system for public health emergencies covering urban and rural areas, with comprehensive functions, responsiveness, and coordinated operation, including medical treatment, disease prevention and control, and health law enforcement supervision.

4. Establish a county public health emergency response and medical treatment team. Strengthen the business training and relevant laws and regulations training for health professionals in the county, improve the overall quality of health personnel and the awareness and emergency response capabilities of emergencies, and implement specialized intensive training and regular drills each year for the emergency treatment team. Strive to create a veritable professional emergency response team. According to the needs of emergency public health events, especially major incidents, in line with the principle of comprehensive business coverage, excellent technology, strict organization, rapid response, and coordination and efficiency, the technical backbone of each relevant business should be selected at the county-level medical and health units. To form an emergency treatment and medical rescue team, equipped with corresponding vehicles and equipment, and set up various professional emergency work groups to meet the professional needs of different types of emergencies; at the same time, set up emergency work reserve echelons in major business units to deal with major The need for subsequent processing of disaster events.

Strengthen the infrastructure of public health work, increase investment, and effectively improve the hardware conditions of public health work.

1. Actively strive for government and higher-level health departments' policies and project support, increase public health infrastructure investment, improve the installation of hardware facilities and equipment for secondary medical treatment and disease prevention and control in counties and towns, and ensure government's public health The necessary investment in work-related funds, in line with the requirements of coordinated and sustainable development, the public health investment is moderately advanced, increasing proportionately year by year, as soon as possible, the originally weak public health work has been effectively improved and strengthened.

2. The county's disease prevention and control center with advanced facilities and complete functions. It is necessary to rely on the state to increase the investment in public health construction, actively strive for the project to build a disease control center, comprehensively carry out technical equipment support and update, to meet the needs of major infectious diseases, public health, occupational health and other technical testing needs.

3. While deepening the reform of the health supervision system, strive for the support of national policy projects, build a health supervision and law enforcement command and dispatch center, equip with the necessary vehicles and facilities for supervision, enrich the health supervision and law enforcement team, and create corresponding measures to ensure the smooth development of public health and safety work. Hardware condition.

4. Accelerate the construction of infectious wards in county hospitals, actively use treasury funds, and build a high standard and high configuration in the former site of Pingluo County Hospital of Traditional Chinese Medicine in accordance with the requirements for emergency treatment of infectious diseases in the new era and the provisions of the Law on the Prevention and Control of Infectious Diseases. The infectious disease building, supporting the construction of sewage treatment, medical waste incineration and other equipment, and the transformation of the old ward of the original Chinese medicine hospital, the opening of fever clinics, intestinal clinics, hepatitis clinics and medical technology departments, at the same time through multi-funding, purchase of ventilators , monitors, X-ray machines and other equipment to strengthen the equipment for infectious wards. The newly built infectious disease building will undertake the centralized treatment and handling of major infectious diseases in the county.

5. Renovate and expand the “120” emergency center in Pingluo County, and plan to build a new business building of 1,500 square meters. Plan to establish an emergency operating room, blood purification room, emergency department, surgical ward, expansion of temporary infusion room, observation room, rescue room, Internal surgery diagnostic room and consultation room. The emergency center will add new ventilators, cardiac defibrillators, monitors, cardiac temporary pacemakers, electrocardiographs, hemodialysis equipment and ancillary equipment, operating room equipment, ambulances and vehicle rescue equipment to update existing aging equipment. . Further play the important role of emergency centers in major public health events, disasters and accidents.

6. Focus on the rural areas and strengthen the basic construction of primary health care prevention and health care. Continue to implement the “three constructions” of rural medical institutions with housing construction and basic equipment support, and strive to achieve the popularization of the new three pieces of diagnostic first aid equipment in township hospitals within 5 years; Machines, ventilators, ECG defibrillators, anesthesia machines, urine, biochemical analyzers and other equipment in the central hospitals.

7. Establish an advanced and fast information network for early warning reports of outbreaks and emergencies. On the basis of the current county-level epidemic situation to achieve direct network reporting, increase investment, strive to achieve office automation in the county's medical and health units within five years, and achieve computer networking, to build a complete and functional health management information network. Road, providing an advanced and fast information network platform for public health incident warning and command processing.