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Reforming China’s Rural Health System
Table 7.1
Key Weaknesses in the Public Health System
Activities
Issues and weaknesses
Monitor and analyze health status and health problems of population to guide policy and program development
• Poor data quality from administrative systems • Information gaps for important population groups (e.g., floating population) and health problems (e.g., NCDs) • Data inadequately analyzed, and findings and analysis not effectively communicated to policy makers and other stakeholders at different levels • Disconnect between priority health problems and investment in services that actually address those problems • Poor data quality: delays, under- and misreporting, limited coverage (effective coverage of surveillance often limited to urban centers and some township capitals) • Limited data sharing across institutions and levels of government, and persistent problems in reporting standards, communication systems, and cross-agency coordination • Limited and fragmented technical capacity in surveillance, field epidemiology, and laboratory testing, resulting in weak capacity in early recognition of suspect cases and notification of authorities • Weak cross-sector coordination for emergency planning • No system or mechanism for emergency projection or alert, and lack of simulations or drills • Local health promotion and education activities not always closely linked with County Framework for Health Education and Promotion Plan developed by the MOH; very little focus on NCDs • Lack of local systematic assessment of needs and opportunities for health promotion and education • Access to many preventive health care services restricted to urban areas, and poor coverage of many interventions in rural and remote areas • Preventive and screening services not always free of charge
Disease surveillance, case detection and investigation, and preparation for and management of disease outbreaks and other public health disasters
Health promotion and education
Preventive medical services
Design and enforcement • Emphasis on administrative licensing rather than health of public health legislainspections and law enforcement tion and regulations and • Tendency to focus on larger and profitable firms/industries in other health protection public health inspection and licensing activities, rather than on measures high-risk ones • Limited work to protect communities against environmental health risks at township and village level; insufficient incentives for THCs and village clinics to contribute to health protection efforts Sources: Claeson, Wang, and Hu 2004 and Koplan et al. 2005.