Health agency must have powers it needs

PUBLISHED : Wednesday, 02 June, 2004, 12:00am
UPDATED : Wednesday, 02 June, 2004, 12:00am

The weaknesses in Hong Kong's public health system so cruelly exposed by Sars highlighted the need for solid reforms.

Yesterday's launch of a new government agency to lead the fight against disease marks one of the most important changes to be made.

The Centre for Health Protection will bear much of the responsibility for ensuring that mistakes made during the outbreak last year are not repeated. It is a welcome addition to Hong Kong's public health defences.

However, questions remain about just how effective it will be. Much depends on it having the political and legal authority needed to take control in the event of another health crisis. The extent to which this will be possible is not yet clear.

The functions of the new organisation are wide-ranging and broadly in line with recommendations made last October by a panel of experts appointed by the government to investigate the Sars outbreak.

It will take on the key role of developing strategies for detecting and preventing the spread of disease. The centre will provide much-needed expertise in relevant fields and seek to enhance research.

The most important part to be played by the new body, however, is in responding to any new outbreak of disease. This is where we will find out whether lessons have been learned from Sars.

To be successful, efforts to combat any new outbreak must be carefully co-ordinated and cohesive. And accurate information needs to be made available to the public quickly to ensure effective community support and action.

The burden of ensuring that this is done will fall primarily on the new organisation. Given the broad scope of its functions, and contact with key stakeholders both here and overseas, it should be well placed to fulfil its responsibilities.

However, this will not be the case unless the centre is given what the expert panel described as 'primacy in outbreak management'. In other words, it must be able to take charge and, if necessary, exercise necessary legal powers, such as those concerning quarantine.

This is not currently the case. The legal tools remain in the hands of the director of health. The government has promised to amend the laws in the next legislative session. It should do so as soon as possible and ensure that the centre is given the powers it needs.

Clear lines of authority must also be established - and followed. Otherwise the centre will become yet another fragment in a cumbersome health system which is already too fragmented.

There is a need for clear and widely understood guidelines governing the new body's relationship with other parts of the health service. Britain's Health Protection Agency, for example, has published a management statement which sets out in detail the responsibilities and accountability of all the main players.

The centre, as the panel suggested, has been created within the Department of Health and has six branches. Any lack of clarity concerning its role risks adding to the confusion and poor co-ordination we witnessed during Sars. This would make it counterproductive.

There is also a need to ensure that the establishment of the centre marks the beginning of a reform process which will shake up the system.

It is a matter of concern that other changes proposed by the panel of experts have not yet been implemented. In particular, there is a need to restructure the Health, Welfare and Food Bureau. Earlier this year, the co-chairmen of the panel warned that the effectiveness of the centre would depend on these reforms.

The launch of the new organisation is an important step towards improving our health system. The centre promises much and only time will tell whether it will be able to deliver.

If it is given the necessary authority and support, it can help ensure that we never again endure an experience as terrible as Sars.