Special Issue:Primary Health Governance
Health co-prosperity is the conceptual interpretation and application extension of the logic of common prosperity in the field of health. Building a digital collaborative health governance model between Chinese and western medicine based on the advantages of digital reform is the "Zhejiang Model" of health co-prosperity and helps to achieve the goal of high-quality full life cycle medical and health services. This article is based on the collection of relevant policies on the digital collaboration between Chinese and western medicine during the construction of the Common Prosperity Demonstration Zone in China and Zhejiang Province. It elaborates on the definition and connotation of health co-prosperity, and selects the digital Chinese and western coordinated health governance model of provincial, grassroots platforms, and medical institutions in Zhejiang Province as a specific case to explain the theme and path of the system design logic, grassroots platform logic, and institutional service logic of health co-prosperity, to provide reference and suggestions for the innovative construction and optimization of the collaborative health governance model between Chinese and western medicine.
Traditional Chinese medicine (TCM) is an important part of Chinese traditional culture. It's also an important health resource, economic resource, technological resource, cultural resource and ecological resource in our country. The international development of TCM is an important part of the inheritance and innovation of TCM. In the global traditional medicine system, Indian traditional medicine is the most influential. Development status, international development strategies and impact of Indian traditional medicine are greatly comparable with those of TCM. From the perspective of international development, this paper compared TCM and Indian traditional medicine from seven aspects: service delivery, health workforce, production capacity of traditional medicines, financial allocation for health system and health insurance policy, health governance, product export situation and target markets, international development and influence. It aimed to learn from the successful experience of the international development of Indian traditional medicine, and provide reference for the international development of TCM. In order to actively promote the international development of TCM, make important contributions to deepening the cultural identity of TCM overseas and promote the participation of TCM in global health governance.
Primary health governance is a crucial part of the national health governance system and plays a key role in achieving universal health. However, primary health governance currently faces many challenges. The Expert Consensus on Primary Health Governance is led by the Public Health Security and Health Professional Committee of the Public Safety Science and Technology Society, in collaboration with experts from multiple disciplines. The aim of this consensus is to integrate evidence-based scientific evidence, practical wisdom, and experience from multidisciplinary experts in primary health-related fields. This consensus addresses the connotations, significance, objectives, basic principles, system construction elements, capacity building elements, institutional elements, and technical means of primary health governance. It provides scientific, systematic, and operable consensus opinions and suggestions to enhance the level of primary health governance, standardize primary health governance practices, promote the equalization of primary health services, strengthen the cultivation of primary health governance talents, and drive innovation in health governance. This will provide scientific basis and recommendations to support the realization of the "Healthy China 2030".
在"健康海南"建设背景下,本报告聚焦"十四五"中期海南省卫生健康发展现状与未来方向,分别探讨精神障碍治理、中医药健康产业、现代化卫生健康治理体系以及科技与人才支撑能力面临的挑战和发展机遇,并提出相应的策略与建议。首篇文章应对海南省高发的精神卫生问题,强调数字化治理平台在解决精神卫生问题和支持自贸港建设中的关键作用。第二篇详细分析了中医药在健康产业中的战略地位和发展瓶颈,建议充分利用海南省丰富的中医药资源,推动产业向高质量发展。第三篇从现代化治理角度出发,强调顶层设计和协同机制优化对提升治理效能的重要性。最后一篇聚焦于科技和人才支撑能力,通过SWOT分析提出了推动卫生健康事业跨越式发展的关键策略。综上,四个报告在逻辑上相互补充,形成了一个多维度、多层次的研究框架,全面展示了海南省在"健康海南"建设中的创新实践与未来展望。为政策制定者和决策者提供了重要的参考和指导,助力海南省在未来进一步提升健康水平和治理能力,实现卫生健康事业的跨越式发展。
In China, the governance of public health by the public health committee, a grassroots mass autonomous organization, is a new approach managing public health services in primary care. Many regions are exploring governance models of public health by the public health committee, aiming to make it a key hub to realize the vertical connection and horizontal linkage grid management of grassroots communities.
To analyze the policy documents related to the construction of local public health committees of various regions in China using policy document analysis, so as to provide a reference for improving the primary-level public health governance system and governance capacity.
In March 2022, we searched policy documents related to the construction of public health committees on the official websites of the local governments and health commissions of eight sample regions (Beijing, Guangdong, Chongqing, Shandong, Anhui, Guizhou, Gansu, and Ningxia Hui Autonomous Region) in which village (residential) public health committees have been constructed using "public health committee" as the key search term. Through literature review and policy document analysis, an analytical framework for the governance system of the public health committee was constructed. Nvivo 11 Plus was used for word frequency and coding analyses of the included policy literature.
A total of 15 policy documents and 2 guidance manuals for the work of public health committees were ultimately included. Word frequency analysis showed that the five words, "hygiene" "public" "work" "committee" and "health", appeared most frequently, indicating that the selected policy literature conformed to the research theme. By using the analytical framework, the structural dimensions of the policy literature were determined, including four root nodes, namely, governance subjects, governance mechanisms, institutional guarantees, and capacity building, and 13 sub-nodes. There are 208 reference points for governance subjects, 48 reference points for governance mechanisms, 57 reference points for institutional guarantees, and 87 reference points for capacity building.
The local policy documents of the sample regions cover the contents of the four dimensions, but have different focuses. According to the framework in this study, further construction of the public health committee needs to set certain admission criteria with clear determination of rights and responsibilities for new committee members, establish an effective cooperation and communication mechanism, improve the system guarantee and provide financial and technical support.
To improve people's health via meeting their growing health needs, the "Healthy China 2030" Planning Outline highlights the concept of protective care, and actively promotes the transformation from disease-centered care to human-centered care. There is still no a standard proactive care system. We summarized the essence, development status and significance of proactive care, then based on this, explored implementation strategies and assessment system regarding proactive care management conducted by community health institutions and community medical workers. We believe that community health institutions and community medical workers play an important role in the implementation of proactive care, and improving people's awareness of proactive care and self-health management ability via integrating proactive care into health management is of great significance to improve the national health level.
Rural Physicians' Duties and Responsibilities in COVID-19 Pandemic Containment:an Empirical Study from the Perspective of Governance in Primary Care
COVID-19 pandemic containment in rural areas is the frontline for containing COVID-19 and a key part of response system for public health emergencies in China, during which rural physicians play an important role as the "gatekeeper" of rural residents' health and rural pandemic prevention and control. However, rural physicians have demonstrated some work-related problems during the COVID-19 pandemic containment, which have affected the implementation effectiveness of their duties and responsibilities.
To investigate the duties and responsibilities of rural physicians during COVID-19 pandemic containment in rural areas, and to identify the problems, then put forward relevant suggestions.
An on-site semi-structured interview using non-participant observation approach was carried out in Beijing's Huairou District from April to July, 2021. Eighteen rural physicians were selected to attend the interview as stakeholders. The interview was guided by an outline developed based on a literature review and an expert consultation, including three parts: (1) demographic characteristics (practice location, sex, age) , (2) practicing qualifications (education level, starting time of practicing, professional qualifications) , (3) involvement in COVID-19 pandemic prevention and control (awareness of the 10 instructions for COVID-19 pandemic containment in village clinics, participation in COVID-19 pandemic containment, and personal protective equipment materials for COVID-19) . The interview was continued until data saturation.
Among the 18 rural physicians, 14 (77.8%) were certified as rural physicians, 3 (16.7%) were certified as rural assistant general practitioners, 2 (11.1%) had a certificate of licensed physician and 1 (5.6%) had a certificate of licensed assistant physician. Except for one (5.6%) , the rural physicians〔17 (94.4%) 〕 indicated that they knew the 10 instructions for COVID-19 pandemic containment in the village clinic. The top three services about COVID-19 pandemic containment most frequently provided by the rural physicians were health education (94.4%) , information reporting (72.2%) and diagnosis and treatment (64.7%) , and the least provided was throat swab sampling〔only one case (5.6%) 〕. In addition, three rural physicians participated in providing other services, which included screening suspected COVID-19 cases in the village, guiding COVID-19 pandemic containment in the village, and purchasing food for villagers. Ten physicians (55.6%) indicated that personal protective equipment materials for COVID-19 were adequate, but other 8 (44.4%) expressed that such materials were inadequate during the first response phase. During the regular COVID-19 pandemic containment phase, 16 physicians (88.9%) indicated that personal protective equipment materials for COVID-19 were adequate, but other 2 (11.1%) still indicated that such materials were inadequate. The top four personal protective equipment materials for COVID-19 owned by the physicians in regular COVID-19 pandemic containment phase were 84 Disinfectant (72.2%) , ordinary disposable medical masks (66.7%) , disposable gloves (66.7%) and medical surgical masks (61.1%) , and the least owned were medical protective clothing (38.9%) and goggles (11.1%) .
Rural physicians play a necessary role in COVID-19 pandemic containment in rural areas, but the effectiveness of their services has been affected by limited personal capabilities in delivering COVID-19 pandemic containment services (including pharyngeal swab sampling) , lack of a legal right to provide home-based isolation and monitoring services, and inadequate personal protective equipment materials. Therefore, it is recommended that relevant laws and regulations should be improved to provide a legal right for rural physicians to perform their duties and responsibilities in COVID-19 pandemic containment, recruit them to the public health team of the village committee, and ensure the provision of emergency materials for village physicians to help them to realize their potential in pandemic containment.