"After dragging on for almost two years, I finally saw the stitches and needles in a hurry to get a certificate on this year's National Day", Chen Jiayue of the Huacao Community Public Health Center in Minhang District, Shanghai, said of a post-90s female colleague, because she needed to be on standby during the anti-epidemic period, she was engaged but had no time to return to her hometown to handle the formalities.
The COVID-19 outbreak at the end of 2019. In the following two years of continuous epidemic, Chen Jiayue's workload doubled, and staying up all night became a common thing, which is also the epitome of many grass-roots disease control personnel across the country.
The reason for this is not only the shortage of manpower - Hang Wenquan, director of the Shanghai Minhang District Health Commission, pointed out that taking the relevant work of the isolation point as an example, compared with catering, security and other projects, public health services are the only part that cannot be purchased from third parties.
He Dandan, head of the Comprehensive Office of the Disease Control Department of the Minhang District Health Commission, has a deep feeling about this: sampling, circulation, transfer, understanding of virus strains, research and judgment of the epidemic situation and even the choice of prevention and control measures, each link needs a solid professional foundation and timely knowledge update.
Every major outbreak is an examination and honing of the public health workforce. SARS 19 years ago was a short encounter to test this team, and the new crown epidemic that lasted for more than two years was a protracted battle to hone this team. The continuous "iteration" of virus transmission has put forward new requirements for the cultivation of public health talents and provided new opportunities.
"Eight Points of Health" learned that under the guidance of the National Health Commission, the Ministry of Education, and the National Bureau of Disease Control and Prevention, the "Public Health Talent Improvement Project" jointly planned by the National Health Commission Cadre Training Center (Party School), the National Health Commission Talent Exchange Service Center, the National Health Commission Capacity Building and Continuing Education Center, the Chinese Preventive Medicine Association, the China Teacher Development Foundation, the Chinese Welfare Foundation, the Beijing Medical Reward Foundation, the China Health Promotion Foundation and other institutions, jointly planned by Tencent It has been officially launched a few days ago.
The five sub-projects of the project cover major groups of the disease control system such as chief experts, young elites, clinicians, managers, and rural doctors, and systematically help to strengthen the team of public health talents and enhance the scientific research and practice capabilities of public health through the establishment of new curriculum systems and the strengthening of practical training, with a view to supporting local decision-making wisdom in the face of changes in the epidemic.
Researcher Feng Zijian, secretary general of the Chinese Preventive Medicine Association, pointed out that the ability of various localities to judge the epidemic situation is the most core part of the current public health talent training.
Always recruiting
From 2016 to 2021, Minhang District recruited 65 disease control personnel; coincidentally, the number of disease control personnel who retired and resigned during the same period also happened to be 65. Behind the increase in various public health work brought about by the development of urban areas and the zero growth of personnel is the de facto dilemma of the disease control system.
It's not a question of money in the first place. As a "model student" of the reform of the grass-roots medical and health system, Minhang District has gradually increased the per capita public health expenditure of about 80 yuan at the beginning of the "Thirteenth Five-Year Plan" to 115 yuan, and then according to the relevant requirements of Shanghai Municipality, the treatment and clinical treatment of public health personnel have been pulled together, and the salaries of disease control system personnel are not lower than the level of medical institutions at the same level, an increase of nearly 20% in the past three years.
△ The picture is from People's Vision
But Hang Wenquan especially understands those "deserters": in the past, people who engaged in public health led everyone to "eliminate the four harms", from time to time to go down to check food hygiene, campus hygiene, etc., it can be said that they are one with the public; now in addition to pregnant women, the elderly, chronic disease patients and other key service groups, there is almost no sense of existence in other people, let alone a sense of achievement, it is difficult to retain people on the grounds of career.
The talent problem has become a major problem. He Dandan introduced that according to the requirements of the construction of the Shanghai Municipal Disease Control System, the number of minhang District Compilation Office is 392 people, but the maximum number is less than 200. Although the number of applicants from first-class colleges and universities is small, some of the job seekers who come to the household registration or stable work cannot understand the Shanghai dialect, and it is difficult to communicate with local residents in the early stage; in addition, there are few male students, and female students are inconvenienced or ineffective in tasks such as continuous overnight circulation, sampling, and transfer.
Even so, the number of people in the Shanghai CDC professional system is still higher than in other places, and there are 800 or 900 people in the Municipal Center for Disease Control and Prevention. The number of provincial disease control personnel in most parts of the country is only 300 to 400 people, and the slow progress of public health talent construction is a common phenomenon. Xu Peihai, director of the Cadre Training Center of the National Health Commission and vice president of the Party School, revealed that in the past 10 years, the personnel of health care institutions, research centers, blood collection and supply institutions set up by various public health institutions have increased to varying degrees, while the personnel of the CDC and health supervision institutions have declined year by year, of which the CDC has decreased by 77,000 in the past 9 years.
Statistics from 2018 show that nearly half of the CDCs in the country have a staff loss, with an average loss of 3.46 people per institution; among them, the provincial level is the most prominent: more than 2/3 of the institutions have a loss of personnel, with an average loss of 11.36 people per institution.
After the outbreak of COVID-19, the problem of manpower tension has been further highlighted. In the case of Min, the 25 staff of the Huacao Community Public Health Center have been implementing a 24-hour rotational scheduling system, of which 15 are emergency personnel, ensuring that 2 people are on duty at any time. In addition to their daily work, their tasks in epidemic prevention and control include on-site sealing and sampling, epidemiological investigation of positive personnel close contacts, and support for medical institutions.
"When there is a situation, almost all the staff are mobilized," Chen Jiayue said, often in the first half of the night in the community to seal the control of the building, the second half of the night to go to the hospital to support, toss a night and the next morning as usual to get up the spirit to work. According to the rhythm of virus transmission and mutation, this year the scope of screening has been expanded to sub-close people, and the vaccination work outlets have also been deployed to the community, the workload has increased exponentially, and sometimes she simply sleeps in the office.
"To engage in public health, there must be a 'net' above and a 'foot' below", Hang Wenquan said, there is less manpower and no one does anything, and the corresponding data accumulation is also affected, which will further weaken public health work, which is a problem that we are facing urgently need to be solved.
Upgrade skill packs
Once this year, because of the sudden escalation of the epidemic, more people needed to be transferred to quarantine. In Chen Jiayue's jurisdiction, a woman with two children is adamant that she refuses to leave her home, on the grounds that she thinks the quarantined hotel is even more unsafe. According to the working practice of the extraordinary period, after the positive case was confirmed, it was verified and reported at all levels, and the news was conveyed to the community in the evening, and they immediately rushed to the woman's home, connected by telephone across the door, repeatedly explained the policy, introduced protective measures, and still failed to convince her until 12 o'clock at night, and the staff had to stay at her door for a night. Chen Jiayue had never thought before that she would have to "chat" to engage in disease control.
In fact, the requirements for talents in public health work have been keeping pace with the times, and the epidemic has only highlighted this point. According to statistics, in the past two years, various basic and applied research papers on the new crown virus have produced 400,000 to 500,000 papers, and these huge numbers of international academic papers have been published in English.
△ The launching ceremony of the 2021 "Public Health Talent Improvement Project"
"How can our public health system sort out, interpret, evaluate, and absorb these new studies, findings, and new data to improve understanding of disease and improve our response accordingly?" Researcher Feng Zijian, secretary general of the Chinese Preventive Medicine Association, believes that the monitoring and early warning of the epidemic and the formulation of immediate and long-term response strategies require a strong professional team, and we are lacking in terms of numbers and professional capabilities.
Take the basic skill of public health practitioners - epidemiological investigation, ask about the recent itinerary, with whom to contact these basic information, high school students can do a simple training; the "gold content" of this work lies in the reasonable program design, accurately collect the exposure history and contact history of relevant personnel, while conducting high-quality analysis of on-site investigation and data obtained, so as to reveal the characteristics of the epidemic - what risk appears, how high the risk is, which place is high risk, which place is low risk." This kind of judgment is at the heart of the CDC role," he added.
Every grassroots prevention and control decision at the local level should not be underestimated, and they are the first line of defense against the epidemic. Hang Wenquan told Eight Points Of Health: The first large-scale centralized isolation point in Shanghai during the new crown epidemic was first established in Minhang District on February 26, 2020. At that time, 19 confirmed cases were found in the whole district, including home infections. At that time, he immediately decided to requisition the hotel for centralized isolation, and used a special car to pick up two close contacts from other places overnight, stopping the spread of the epidemic in time.
Professor Zhang Wenhong of the Department of Infectious Diseases of Huashan Hospital affiliated to Fudan University once said that accurate anti-epidemic is like catching rats in a porcelain shop. Obviously, the more professional the research, the more it can get the full trust of the local government emergency command management, and the more accurate the government decision-making is, there is no need for a comprehensive blockade or a national nucleic acid test, and only the screening of specific groups of people in certain specific areas can be done.
The construction of a new era of team building
The SARS epidemic in 2003 is regarded as the starting point of a new round of public health system construction in China, the most important of which is undoubtedly people. The professional development of public health talents is different from that of clinical medical talents, in addition to clinical basic medicine, public health majors also have their own specialized courses, and vocational training is also different. According to the "Eight Points of Health" understanding, among the more than 3,000 colleges and universities in China, there are only more than 80 public health and preventive medicine majors or colleges, and only about 10,000 people are trained for bachelor's and master's degrees in public health every year, and there is a lack of application-oriented talents, which is far from meeting the needs.
On the other hand, with the spread of the concept of healthy China, public health issues have gradually penetrated into many industry policies. Professor Meng Qingyue, dean of the School of Public Health at Peking University, believes that the public health profession has a wide mouth, and the reduction of personnel in the disease control system cannot be simply regarded as a brain drain. In the case of Peking University's School of Public Health, only 15 percent of students work after five years of undergraduate graduation, while others go on to graduate school for two years, and about 70-80 percent of the 7-year graduate students go on to pursue doctoral degrees — "it's not called going to the CDC to pursue their own majors," Meng said.
The covid-19 pandemic, which has been challenging for nearly two years, has made the task of developing public health talent even more urgent. Obviously, it is difficult for the disease control team to obtain incremental supplements in a short period of time, and people of insight have invariably thought of the improvement of stocks.
△ 2021 Public Health Talent Enhancement Project Launch Signing Ceremony
In the early stage of the outbreak of the new crown epidemic, Tencent announced the establishment of a 1.5 billion yuan "comprehensive guarantee fund for fighting the new coronavirus pneumonia epidemic", which was invested in material support, technical support, personnel care, scientific research and medical undertakings, etc. In February 2020, the Tencent team worked hard overnight to make health codes to help prevent the epidemic with numbers, with a cumulative bright code of more than 1.6 billion person-times, covering nearly 900 million people, and the cumulative number of visits exceeded 6 billion times, becoming the health code with the largest number of users and the most widely used health code.
With the rise and fall of local COVID-19 cases and the epidemic becoming a norm, Tencent is considering moving from one-time emergency donations to systemic capacity upgrades. Chen Juhong, vice president of Tencent and head of Tencent's Sustainable Social Value Division, said that the promotion of public health talents is a project related to systematic capabilities, and hopes to strengthen the professionalism of the entire team in a focused way, and can be transformed into recommendations that can be implemented for decision-making reference.
This also fits and echoes the relevant key work of the relevant departments of the National Health Commission. In June 2020, the Party School of the National Health commission undertook the topic of the Cadre and Education Bureau of the Central Organization Department and the Second Bureau of Civil Servants on the ability of the cadre team to cope with the epidemic, and joined hands with the Central Party School and Tsinghua University to organize a large-scale online questionnaire survey of 15,000 samples of disease control personnel at all levels, as well as face-to-face in-depth interviews with 151 typical anti-epidemic figures. The basic knowledge, theoretical literacy, epidemic response, ideological work, health education, science popularization and other abilities of relevant personnel were analyzed in more than 10 sub-sections.
The scientific research results of this topic were successfully translated into two training programs, one of which was the Seminar on Emergency Response Capabilities for Public Health Emergencies held by the National School of Administration of the Central Party School in November 2020 for cadres at the department and bureau level nationwide. The tutorial prepared by the Party School of the National Health and Health Commission completely simulates the response to the new crown pneumonia epidemic, and the provincial and ministerial cadres participating in the training are all front-line commanders of epidemic prevention and control, and through the time point sorting and group management exercises of the project, many people have a deeper understanding: there are so many sensitive points in the original anti-epidemic work, and the decision-making one day early and one day late, and even the firmness of decision-making, have an important impact on the results.
Xu Peihai introduced that unlike the past training, this time the textbook preparation simulates the real case, including the epidemic discovery, technical intervention, policy decisions and a complete set of processes, the lecturer made a detailed analysis of the key points in the case, and its decision-making choices, and fully discussed: As a local disease control decision-maker, what forces do you need to mobilize to make further judgments? If the research foundation is insufficient, what expert team will you use to assist in the analysis? Wait a minute.
"Such a half-day case discussion and analysis made the trainees open up," Xu Peihai said, and we prepared for two full years. With ideas, models, and specific products, a brand new project will come to fruition.
Through in-depth exchanges and communication with Tencent Public Welfare Fund, the Chinese Preventive Medicine Association and relevant research institutions, this wide-ranging and systematic public health talent improvement project came into being.
The "Public Health High-level Talents Special Project" is the first "highlight" of the entire project, with the purpose of improving the leadership of core experts in the disease control system and senior training for young professional backbones. Feng Zijian said that the project is first to solve the problem of high-level talent training, because the characteristics of public health determine that it is led, guided and driven by central-level institutions, and without a strong national center, it is impossible to have a strong grass-roots public health system.
Considering the needs of the current response to the epidemic, the training content will also focus on etiology identification, epidemic situation analysis, on-site epidemic prevention and control, etc. From the perspective of the training area, due to the intensification of the imported COVID-19 epidemic in China's border areas since 2021, such as Inner Mongolia, Yunnan, Qinghai, Xinjiang, Northeast China and other places, the disease control management cadres of these provinces and cities have become the first batch of key training targets of this training project.
According to reports, this project will also synchronously study the talent evaluation system that meets the characteristics of the public health industry, the public health talent allocation mechanism combined with rating, the public health talent flow mechanism that is integrated according to law, and the remuneration distribution mechanism for public health talents that encourages and guarantees mutual coordination. "If we cultivate talents well, we must still retain them," Feng Zijian said.