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Objectives. To assess the improvements of the Chinese Centers for Disease Control and Prevention (CDCs) systembetween2002and 2012, and problems the system has encountered.
Methods. We obtained data from 2 national cross-sectional surveys in 2006 and 2013, including 32 provincial, 139 municipal, and 489 county-level CDCs throughout China. We performed a pre-post comparative analysis to determine trends in resource allocation and service delivery.
Results. The overall completeness of public health services significantly increased from 47.4% to 76.6%. Furthermore, the proportion of CDC staff with bachelor's or higher degrees increased from 14.6% to 32.6%, and governmental funding per CDC increased 5.3-fold (1.283-8.098 million yuan). The working area per CDC staff increased from 37.9 square meters to 63.3 square meters, and configuration rate of type A devices increased from 28.1% to 65.0%. Remaining problems included an 11.9% reduction in staff and the fact that financial investments covered only 71.1% of actual expenditures.
Conclusions. China's CDC system has progressed remarkably, enabling quicker responses to emergent epidemics. Future challenges include establishing a sustainable financing mechanism and retaining a well-educated, adequately sized public health workforce. (Am J Public Health. 2016;106:2093-2102. doi:10.2105/AJPH.2016.303508)
Between 1953 and 2001, China relied on epidemic prevention stations (EPSs) forthe majority of their public health services (PHSs) from the national to the county levels. EPSs were specifically responsible for disease control and surveillance, health supervision, health education, technical advising, and guideline provision for public health.1 During health care reform in the 2000s, the lack of capacity to respond to public health emergencies and the changing disease spectrum-and the nonseparation nature of health law enforcement-led the Chinese central government to restructure the EPS networks to provide better surveillance and guard against disease outbreaks. EPSs have gradually separated their disease control and health inspection functions and changed their names to Centers for Disease Control and Prevention (CDCs).2
Each administrative division has its own corresponding CDC2; there are 32 provincial (including the Xinjiang Production and Construction Corps), 347 municipal, and nearly 3000 county-level CDCs, which together form a 3-tiered CDC system in mainland China. To carry out the functions of health promotion and disease prevention, China's CDCs must provide 7 core PHSs and 266 activities (Appendix A, available as a supplement to the online version of this article at http://www....