In China, the national public health emergency response system was originally established in 2003 to address emerging respiratory infectious diseases. In response to the COVID-19 pandemic, fever clinics were instituted within Primary Healthcare Centers (PHC) to serve as a supplementary measure to the existing healthcare infrastructure during public health emergencies. The final goal is leading to the subsequent development of a more sophisticated public health emergencies medical care system.

Over the past three years, the utilization rates and visitation numbers of fever clinics have fluctuated irregularly. This study seeks to summarize the operational processes of PHC fever clinics during this period, identify existing challenges, and propose potential strategies for improvement.

A convenience sampling method was employed to select 16 PHC fever clinics, with one clinic chosen from each of the 16 districts in Shanghai. Managers of these fever clinics were invited to participate in semi-structured, in-depth interviews conducted from November 23, 2023, to June 18, 2024. The interview guide was developed by integrating insights from existing literature, government regulations, and a preliminary survey. The interviews centered on themes related to the establishment, operation, and challenges encountered by the clinics in recent years. The framework analysis method was employed to manage the qualitative data. Quantitative data were collected on the number of patients visiting fever clinics over the past three years, alongside population statistics and jurisdictional areas of each PHC. The correlation among clinic visits, population size, and population density was examined. Additionally, the SWOT framework was applied to assess the strengths, weaknesses, opportunities, and threats associated with PHC fever clinics.

Of the 16 participants interviewed, 14 individuals (87.5%) possessed either vice-high or superior professional titles, with an average professional tenure of (20.0±6.6) years. The qualitative interviews identified five distinct themes pertaining to functions, hardware configurations, operational processes, current operational challenges, and underlying influencing factors. The fever clinics were classified into urban or suburban categories according to their geographic location. Over the past three years, the mean frequency of visits to urban fever clinics had been lower compared to their suburban counterparts. The results of the SWOT analysis revealed that PHC fever clinics had established a more advanced sentinel surveillance network for the prevention and control of respiratory infectious diseases. Nonetheless, the analysis also identified shortcomings in human resources, infrastructure, and inefficiencies in the allocation and use of medical resources.

The PHC fever clinics are strategically located closer to communities, offering a more convenient and cost-effective option for patient access. Additionally, these fever clinics play a crucial role in forming a comprehensive network for the prevention and control of infectious diseases. In Shanghai, there is a notably higher demand for fever clinics situated in suburban areas. However, when compared to the standardized requirements for fever clinic settings, there are deficiencies attributed to the structural limitations of PHC facilities. Furthermore, there was a notable inefficiency in human resource allocation due to the intermittent nature of seasonal respiratory infectious disease epidemics. It is advisable to dynamically adjust the human resource management in PHC fever clinics in accordance with sentinel monitoring data and the prevailing trends of respiratory infectious disease epidemics. Supportive governmental policies and media advocacy can enhance the operational efficiency of fever clinics. The PHC has recommended active service implementation to ensure optimal utilization of these clinics.