September 6, 2021 at 14:40 JST
Public health centers across Japan on the frontline of the battle against COVID-19 are on the verge of being overrun by this latest and worst-ever fifth wave of cases.
Known as “hokenjo” in Japan, they perform a wide range of roles in their efforts to contain the public health crisis. In recent weeks, they have been overwhelmed trying to allocate hospital beds and hotel accommodation for patients and monitoring the condition of those forced to recover at home. As a result, some facilities had to scale back the important task of contact tracing, which involves identifying and notifying anybody who came into contact with a carrier.
A shortage of manpower at public health centers is behind the rise in the number of patients who die at home after their health condition takes a sudden turn for the worse. As a result, complaints poured in from the public about phone calls not being returned or frequently finding phone lines to centers already busy.
In most cases, local health centers are the first facilities new COVID-19 patients turn to for help. There is an urgent need to enhance their capabilities.
A series of steps taken to tackle the problem include staff redeployment, transfers of local government officials in other departments to health centers, seeking support from the private sector, outsourcing tasks and downsizing or postponing non-urgent operations.
A growing number of health centers are turning to local clinics and home-visit nursing stations for help in monitoring the condition of patients with no or mild symptoms.
These efforts need to be continued and expanded. Health centers also need to ramp up their capabilities by working more closely with the central and prefectural authorities.
It would also help to sort out all the tasks performed by centers to identify those that can only be done by experts to allow non-experts to take on more of the burden. Measures that have enhanced operations should be shared among centers around the nation.
One idea worthy of serious consideration is to establish common task performance indicators to improve the efficiency of policy support to health centers by identifying operational bottlenecks and investing human and financial resources to eliminate them.
To establish such common indicators, local governments, for example, would collect data to assess, among other things, how long it took for public health centers to establish initial contact with patients after those individuals tested positive and were admitted to hospitals or other designated facilities. Comparing and analyzing such data would provide a clearer picture of the kind of support required for specific health centers and when.
The government is working on new criteria for issuing and lifting states of emergency. Policymakers are apparently working to adjust the current criteria to focus more on data concerning health care services provided to COVID-19 patients, such as ratios of occupied hospital beds, rather than simply tallying the number of new cases. They should incorporate all the data concerning operational situations at public health centers into the new criteria.
Even if more facilities and beds for COVID-19 patients are made available, they cannot be used efficiently if public health centers are unable to deal with related tasks in a timely manner. Effective responses to a surge in new cases are possible only if operational situations at public health centers, which link patients to medical institutions, are accurately monitored in real time.
Recent years have witnessed a major consolidation among local health centers that resulted in significant staffing cuts to improve the efficiency of administrative operations. This left the nation ill-prepared for the pandemic, forcing the government to take stopgap measures to deal with crisis.
In addition to making urgent efforts to beef up the capabilities of health centers, the government needs to glean lessons from past bitter experiences to lay out a vision for these crucial facilities based on a long-term perspective.
--The Asahi Shimbun, Sept. 5
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