Improving the Development of Public Health Emergency Preparedness and Response System via Reinforcing Primary Care in Pandemic and Non-pandemic Periods

Abstract

Background: Since the outbreak of COVID-19, the ability to manage public health emergencies in mega-cities has been put on the policy agenda, and the role of primary care in public health system is critical. Objective: To explore the status, problems and challenges of practical exploration of Shanghai's primary care in responding to COVID-19, providing policy recommendations and decision-making basis for improving the public health emergency system. Methods: From June to September 2020, a qualitative study was conducted using group interviews with administrators and healthcare professionals selected from 10 representative community health centers(CHCs) in suburban, fringe and urban areas in Shanghai's 5 districts for exploring major tasks shouldered by the CHCs, organizational structure of the CHCs, actual tasks performed by the CHCs, internal collaboration, major problems in service delivery during the pandemic, and recommendations, and with directors, as well as professionals responsible for information, healthcare management and quality control, public emergency management and infectious disease containment selected from health commissions and centers for disease control and prevention in the districts, for exploring the functions and roles of CHCs during the pandemic and their weaknesses in anti-pandemic actions, anti-pandemic supports from health commissions and centers for disease control and prevention for CHCs, and ideas about actions of primary care in pandemic and non-pandemic periods. The interviews with individuals from three kinds of affiliations were guided using different types of semi-structured outlines developed by our research team. Results: The interviews revealed that during the pandemic, the CHCs gave emergency responses to COVID-19, participated in regional collaboration for COVID-19 containment, delivered in-hospital COVID-19 screening and triage services while providing routine medical services, and continued to offer family doctor services. Four issues were found to be addressed: insufficient healthcare resources and workers, insufficient services targeting psychological influence of COVID-19, unsatisfied internal coordination and multi-departmental management, and lack of appropriate mechanisms incentivizing healthcare workers and invigorating primary care. Conclusion: In view of the challenges in fighting COVID-19 faced by primary care, it is recommended to take actions on the basis of appropriately balancing the delivery of routine primary care services and public health services, and tasks during pandemic and non-pandemic periods, and appropriately coordinating with higher level departments, as well as developing incentive programs according to the local conditions as a supplement for the government programs. Copyright © 2021 by the Chinese General Practice.