Hong Kong's effort to enhance its public health system to fight communicable diseases moved a step forward earlier this month with the unveiling of the organisational framework of the future Centre for Health Protection (CHP) on December 18.
The centre will be headed by the Director of Health underpinned by a chief health protection controller to be appointed through posting of a suitable officer from the Department of Health.
The centre will comprise six functional branches to work on: surveillance and epidemiology, infection control, emergency response and information, public health laboratory services, public health services, and programme management and professional development.
It will be in place by mid 2004 with initial focus on two key functions �V surveillance and epidemiology together with infection control. It is envisaged that other main functions would be gradually transformed to the centre by 2005.
In general, there is general acceptance on the setting up a new CHP by the public and the professionals. Nevertheless, there are some criticisms on its independence and its relationship with the Department of Health. We would like to take this opportunity to further explain the rationale behind the institutional arrangements of the CHP as well as clear up some misunderstandings among members of the public and medical professionals.
Framework complies with SARS recommendations
Our proposed institutional framework is in line with the recommendations of the SARS Expert Committee co-chaired by Sir Cyril Chantler and Professor Sian Griffiths, both are renowned medical experts from the UK.
The Committee considered that the CHP should be set up within the Government since many of its core functions, such as collecting sensitive data from patients and contacts for medical surveillance purposes, requiring healthcare institutions to comply with directives, and international liaison, could not be performed effectively by non-government entities.
We have also made several fact-finding overseas trips to similar institutions and according to our researches, the majority of CHP-like organisations set up overseas, including those of the US, Canada, Japan, New Zealand, Singapore, Finland and the Mainland, are government agencies or government-owned entities. In fact, the popularly known US Centres for Disease Control & Prevention is placed under the Department of Health & Human Services.
Experts back Gov't proposals
The Advisory Committee on CHP, which comprises healthcare professionals in the public and private sectors, academics from four universities and a HK Jockey Club representative, has also indicated support for the organisation structure proposed by the Government.
After careful consideration of various options, we find it appropriate and logical to set up the CHP as part of the department because the latter already performs some of the basic functions of a CHP and its staff is experienced in public health matters.
The public health infrastructure and statutory authority for performing the health protection functions also exist in the department. In setting up the CHP, our objective is to build on rather than dispense with the existing strengths of the department. At the same time, we will take the opportunity to re-organise and enhance the functional elements in the department that need to be augmented or strengthened.
From a practical viewpoint, there is community expectation for the CHP to start operation as soon as possible. Given that the legal powers to perform the health protection functions are now vested in the department, having the CHP within the department is the most direct and the least disruptive implementation route.
Chief health protection controller will be appointed
There have been suggestions that the chief of the CHP should be of higher ranking. The Director of Health (a D6 post) is in fact already a high-ranking directorate in the SAR Government structure. In addition, a chief health protection controller will be appointed to oversee the operation of the CHP and make day-to-day management decisions.
We will decide on the appropriate ranking of the chief health protection controller in the light of the detailed job descriptions to be drawn up and further consultations with stakeholders concerned. We are aware of the need to pitch this officer at a sufficiently high rank given the prominent role they have to play in the fulfillment of CHP's mission.
There are also worries that the centralisation of power in the Director of Health may delay important decisions in times of disease outbreaks. In practice, most of the powers to implement public health measures for prevention or control of infectious diseases do not rest with the Director alone.
A good deal of legal powers inherent in the Quarantine & Disease Prevention Ordinance (Cap 141) e.g. powers to inspect a vessel or aircraft; powers to detain an infected person desirous of landing can be exercised by a medical & health officer or above.
Moreover, according to S.43(1) of the Interpretation & General Clauses Ordinance (Cap 1), where an ordinance confers powers or imposes duties upon a specified public officer, such public officer may delegate any other public officer to exercise such powers or perform such duties on his behalf. Such delegation allows qualified frontline staff to make rapid response to emergencies.
Command structure set up
Of course, there will be circumstances that merit a decision by the Director or even more senior officers e.g. decision to isolate and evacuate a whole residential block. For such circumstances, we have already set up a command structure to facilitate such decisions to be made. This command structure will be supported by the much-enhanced epidemiological and surveillance functions of the CHP.
There are yet some other criticisms saying that the CHP is just "old wine in a new bottle" with the Director of Health taking the command of the centre's operation. We would like to point out that the CHP will not be a "one-man show".
Its performance will largely depend on the command structure, institutional arrangements, human resources deployment, working culture and modalities for communication and collaboration with the Hospital Authority, the private healthcare sector, the universities and the wider community at large. These are the areas where we expect the CHP to make a difference compared to the current arrangements.
Indeed, the SARS outbreak in 2003 is a "wake-up call" for better integration of the existing public health systems. The proposed organisational framework of the CHP is a revamp of the functional units in the existing Department of Health set-up.
The Field Epidemiology Unit, the Communicable Disease Surveillance Unit, the Infection Control Branch, the Programme Management & Professional Development Branch and the Emergency Response & Information Branch are just examples of some of the new institutional elements. Health protection programmes will also be newly set up to pool together experts from different agencies and disciplines to tackle priority health hazards.
With the structural revamp and enrichment/integration of resources, the CHP will be able to address the inadequacies in DH's existing interface with the community, international and Mainland authorities, Hospital Authority and private hospitals/practitioners and universities. The CHP aims to eventually reap the benefits of '3R's �V real-time surveillance, rapid intervention and resolution and responsive risk communication.
Workers will mainly be Department of Health staff
Some people may doubt about the adequacy of funding to support the CHP's operation given the budgetary deficit faced by the Government. Let me make it clear upfront that the establishment and operation of the CHP will not constrained by lack of resources. Given that the CHP workforce would mainly comprise Department of Health staff, the recurrent costs of CHP are expected to be largely funded by redeployment of resources from the department.
The $500 million which the HK Jockey Club has pledged to donate for the establishment of the CHP will help meet the recurrent and capital costs for new staff and the new facilities required. We do not rule out the need to seek additional money from the centre if there is a strong case for so doing.
The inauguration of the CHP will be an epoch-making event in the public health history of Hong Kong. The proposal we announced in December marks the beginning of a detailed engineering process that will determine the final form and shape of the all-important new agency.
In the process, we will continue to consult local and overseas healthcare experts and other relevant stakeholders. With their support and contributions, we are confident the centre will stand well in meeting the challenges posed by new emerging diseases and other health hazards to our community.
(This is the full text of Mrs Yau's letter published on January 3.)
