Many rural areas of China have maintained complicated administration systems for healthcare while also suffering from a shortage of qualified medical staff. Administrative officials have had little incentive to allocate a larger proportion of the government's budget to health care for practical ventures.

The healthcare system has also been divided into smaller units according to function, which fall under the administration of different government agencies. This division into children's and women's healthcare, family planning, disease control, region-based disease control, prevention of tuberculosis, and schistosomiasis control, has caused overlapping of responsibility among government agencies, which has hindered efficiency.

Another concern in rural areas is a lack of cooperation between disease control centers and hospitals. When a patient suffering from a fever is sent to hospital, the fever might be the symptom of an epidemic disease, but the hospital most often will not judge the potential danger to public health of a single case. This is neither the direct responsibility nor the specialty of hospitals. Meanwhile, China's public health administrative organizations have difficulty in spotting a major outbreak without direct access to patients. This problem was exposed during the SARS outbreak in 2003. Although ties between the two branches became closer after the SARS outbreak, communication remains weak and irregular.

Disease Control

According to the Ministry of Health and the Ministry of Finance, China is building a county-to-nation multilevel disease control information network and in villages and city communities is assigning disease control personnel.

In the wake of the SARS outbreak, China has started to place enormous emphasis on training professionals in public health emergency response, which has progressed steadily over the years. Nie Shaofa, an epidemic professor of Huazhong University of Science and Technology, believes a huge brain drain is taking place in the already low talent reservoirs of disease control organizations at all levels. He suggested that the government should nurture talent as a key measure in constructing a public health emergency system.

"It will take a comprehensive appraisal to make judgment on the effectiveness of the public health emergency system in China," said Wang Ke'an, an epidemic expert and former President of the Chinese Academy of Preventive Medicine. He said China had made leaps in constructing its public health emergency system in terms of policy support, as well as upgrades to software and hardware. He pointed out that another step forward hinges on "scientific decision-making in the system," which is the biggest challenge to China's upgrade of its public health emergency system.

Wang said in order to make scientific decisions the government must remain strong in the face of crisis. On the one hand, the government should collect accurate information from all corners of society, which will be the premise for decision-making; on the other hand, the government should listen to advice from experts and professionals before making a decision, so as to avoid a disastrous outcome led by misjudgments made by a handful of people.

"If experts and professionals could have participated in the early stages of the fight against SARS, some later mistakes would have been avoided," Wang said. "It really taught us a lesson."

The encouraging news is that government agencies have already taken measures to address such a problem. In January 2006, the Ministry of Health founded a consultation panel on public health emergencies, which consists of 105 experts on public health. This panel has provided consultation on the drafting and revision of the national health emergency plan, management of particular public health accidents, preparations for public health accidents, and appraisals of emergency response procedures.

One repercussion of economic globalization is the potential for an accelerated spread of diseases. In this context Wang believes China's public health system must seek information and technological support from the international community.

"China has a lot of opportunities for conducting international cooperation and the key is whether it can seize one," said Wang. He admitted that China still has a long way to go in this regard.

Wang said he also believes that related government departments must maintain good communication channels with the media as it is an important medium to inform the public and prevent groundless panic in the event of an epidemic.