Research Article

Strengthening the Frontline: A Qualitative Evaluation of Emergency Response Capacity at Grassroots CDCs in Post-Pandemic China

DOI:

10.3791/69946

⸱

December 23rd, 2025

 ,  ,  ,  ,  ,  , 
1School of Public Health, Xinyu University, 2Xinyu Center for Disease Control and Prevention

In This Article

Summary

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

This qualitative study evaluated the emergency response capacity of grassroots CDCs in Jiangxi, China, through interviews with 35 employees from 7 grassroots CDCs. It identified key challenges in human resources, infrastructure, and early warning systems, providing evidence for strengthening public health emergency preparedness.

Abstract

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

As the first responders in public health emergencies, grassroots Centers for Disease Control and Prevention (CDCs) play a critical role in emergency response efforts. Thus, it is essential to thoroughly understand and improve their capabilities to handle public health emergencies effectively.

Qualitative interviews involved 35 employees from 7 grassroots CDCs in Jiangxi province who were actively engaged in or responsible for managing public health emergencies. Both literature research and qualitative research methods were utilized to gather relevant insights and information.

Analysis of the data resulted in the emergence of three themes and eight sub-themes. The findings suggest deficiencies in the authorized strength of grassroots CDCs, with varying talent quality in their emergency response teams. Low remuneration leads to talent attrition and recruitment challenges, while the personnel face heavy workloads and significant psychological stress. Although there have been some improvements in hardware facilities, grassroots CDCs' overall predictive and early warning capabilities remain weak.

In conclusion, to enhance the capacity of grassroots CDCs in responding to and managing public health emergencies, it is essential to focus on recruiting and training personnel with expertise in epidemiological investigation, data analysis, and early warning systems, and to continuously improve their capabilities. Additionally, it is crucial to enhance the predictive and early warning capabilities of these institutions.

Introduction

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

Public health emergencies refer to sudden occurrences of diseases or health events with large-scale and serious hazards that have a significant impact on public health and social stability1. Such events may be caused by infectious diseases, natural disasters, environmental pollution, and other factors, such as influenza epidemics, earthquakes, chemical leaks, etc. Within the past two decades, acute infectious diseases have contributed significantly to the emergence of public health emergencies worldwide, posing severe threats to both global health and the economy2,3. In recent years, China has also experienced several outbreaks of acute infectious diseases, including severe acute respiratory syndrome (SARS) in 2003, H1N1 influenza in 2009, H7N9 avian influenza in 2013, and the novel coronavirus pneumonia (COVID-19) in 20192. The frequent occurrences of acute infectious diseases in China, constitute a significant public health threat to population health and health system strengthening efforts4,5,6.

Public health emergencies are characterized by their suddenness, unpredictability, widespreadness, and diverse causes7. In the face of public health emergencies, timely and effective measures to respond are very important, including the monitoring and early warning mechanism to detect and control the spread of the epidemic as early as possible and the improved ability to prepare for and respond to the health emergency8. Since the SARS outbreak in 2003, China has dedicated the necessary resources, including personnel, funding, and materials, to establish a robust and efficient public health system9. In China, the Centers for Disease Control and Prevention (CDCs) serve as the foundation of the public health system and play a central role in disease prevention and control10,11. During the 12th meeting of the Central Committee for Comprehensive Deepening of Reform on February 14, 2020, the importance of improving the mechanisms for primary epidemic prevention and control, as well as strengthening the national public health emergency management system, was emphasized12. China has established a comprehensive four-tier disease control system consisting of national, provincial, municipal, and county-level CDCs13.The most numerous county-level CDCs often act as the first responders to public health emergencies14. The grassroots CDCs in the study include the county-level CDCs and the economically backward municipal CDCs. These municipal CDCs are located in prefecture-level cities with relatively lower levels of economic development and limited financial support. As a result, their resource allocation, staffing structure, and emergency response capabilities differ from those in more developed areas and more closely resemble the operational reality of county-level CDCs. Therefore, including them in the grassroots category provides a more comprehensive reflection of the emergency response capacity within the disease control system of economically underdeveloped regions2,15. During a public health emergency response, these grassroots CDCs are responsible for extensive daily monitoring and emergency warning tasks, and their emergency response capabilities significantly impact the effectiveness of managing public health emergencies16. The outbreak of COVID-19 further highlights the importance of enhancing these capabilities of grassroots CDCs17.

The development of emergency response capabilities in grassroots CDCs has recently gained significant attention both domestically and internationally7,8,18,19. For instance, Lv et al. identified the inadequate health infrastructure and a paucity of technical expertise in the grassroots CDCs in Shenzhen14. Cao et al. analyzed significant public health emergencies in China over the past decade, revealing issues such as a shortage of highly qualified emergency personnel and insufficient investment in emergency funds2. Previous studies have mainly focused on the emergency response capacity of CDC institutions in the developed region of China.

Located in the southeast central part of China, Jiangxi Province has a total area of 166900 square km and a population of 45.02 million people in 2024. The GDP of Jiangxi Province in 2024 is 3420.25 billion yuan, ranking moderately among 31 provinces and cities20. Currently, there is limited research on the emergency response capability of grassroots CDCs in Jiangxi Province, which is located in central China. Therefore, we adopt qualitative research methods to comprehensively analyze the current status of the grassroots CDCs' capacity to respond to public health emergencies in Jiangxi Province. Additionally, this study aims to identify the influencing factors and provide targeted recommendations and data support for policymakers. The findings can provide a reference for the government and related health institutions in improving the construction of China's health emergency management system.

Access restricted. Please log in or start a trial to view this content.

Protocol

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

This study was approved by the Ethical Review Committee of Xinyu University (Approval Number: 2020076). Prior to any involvement, potential participants were comprehensively informed about the study's aims, significance, potential benefits, and risks, and were assured of their right to withdraw voluntarily at any time. Strict confidentiality was maintained by anonymizing all data and using secure storage. Written informed consent was obtained from each participant only after confirming their complete understanding of the study.

Study design
We employed a qualitative research design and conducted semi-structured interviews with relevant stakeholders. Based on literature analysis21, interview outlines were designed using a thematic framework analysis method, which is suitable for policy research22. The study analyzed the emergency response capability of grassroots CDCs in Jiangxi Province during the COVID-19 pandemic and identified associated challenges. This investigation comprised three main aspects: (1) The current status of personnel allocation in grassroots CDCs. (2) The emergency response capability of grassroots CDCs and influencing factors, such as the emergency planning system, availability of emergency supplies, laboratory equipment, emergency training and drills, and forecasting and warning capabilities. (3) Measures and recommendations to enhance the emergency response capability for public health emergencies in disease control.

Participants
Research subjects were selected using purposive sampling and following the information saturation principle. To ensure sample representativeness, we chose prefecture-level cities in Jiangxi Province according to their economic level (average GDP per year) and geographical location. Specifically, within Ganzhou (high GDP), Yichun and Shangrao (moderate GDP), and Xinyu (low GDP), 1 or 2 institutions per city were included as our target. Our interview subjects included 1 or 2 individuals engaged in emergency management and 4-6 healthcare professionals actively involved in COVID-19 emergency prevention and control at selected grassroots CDCs. We interviewed 35 healthcare personnel from 7 grassroots CDCs, designated as IDentification(ID)-1-ID-35. The distribution was as follows: High GDP: 5 from Ganzhou City  Ganxian District CDC; Medium GDP: 4 from Yichun City Fengxin County CDC, 5 from Yichun City Zhangshu City CDC, and 4 from Shangrao City CDC; and Low GDP: 5 from Xinyu City CDC, 5 from Xinyu City Yushui District CDC, and 7 from Xinyu City Fenyi County CDC.

Data collection
To comply with the COVID-19 prevention and control measures in Jiangxi Province, our team conducted interviews between December 2020 and June 2021 using either Tencent meetings or face-to-face group interviews. All interviews were conducted by the same interviewer and note-taker to minimize bias23. The interviewer and recorder have received training and extensive experience in qualitative interviewing. Before the interview, the purpose, content, and assurance of anonymity were explained by the interviewer, and consent was obtained from the participants. The recorder then assisted in documenting the entire process. During the interviews, the interviewer encouraged participants to share their opinions and adjusted the discussion based on real-time feedback, gathering more in-depth and authentic information24. After the interviews, the interviewer cross-verified and provided feedback to the participants on the main points discussed. A total of seven group interviews and five in-depth interviews were conducted, with each group interview lasting 20-30 min per person and each in-depth interview lasting 60 min per group.

Statistical analyses
All audio or text materials were transcribed and processed by two researchers. We systematically analyzed the text using thematic analysis based on the grounded theory approach25. The process involved the following steps: (1) Familiarizing with the original textual materials. (2) Identifying key themes or keywords. (3) Establishing a thematic catalog or analytical framework based on the identified themes. (4) Coding the original materials according to the thematic catalog. (5) Classifying the data according to the identified themes or subthemes. (6) Summarizing the data. (7) Interpreting the data. The NVivo 8.0 software was employed for text analysis, coding, and deduction for this qualitative research to derive the final themes. Researchers engaged in discussions and comparisons of the themes until reaching the point of information saturation, where no new themes emerged.

Access restricted. Please log in or start a trial to view this content.

Results

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

Demographic information of interviewees
A total of 28 frontline healthcare professionals and 7 emergency managers actively responding to the COVID-19 pandemic were interviewed for this study. Detailed demographic information is presented in Table 1.

<...
Frontline health profess-sionals (N=28, %)Emergency managers (N=7, %)

Access restricted. Please log in or start a trial to view this content.

Discussion

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

Our findings indicated that grassroots CDCs face shortages in both the quantity and quality of public health personnel, consistent with previous studies3. Liu et al. found that most grassroots CDCs suffer from limited authorized strength and lack emergency personnel4. A survey conducted at grassroots CDCs in Shenzhen revealed that emergency personnel accounted for less than 50% of their workforce, and there was a lack of a dedicated emergency management department

Access restricted. Please log in or start a trial to view this content.

Disclosures

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

The authors declare no conflicts of interest.

Acknowledgements

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

This study was supported by the Social Science Planning Project of Jiangxi Province (20SH17).

Access restricted. Please log in or start a trial to view this content.

Materials

List of materials used in this article
NameCompanyCatalog NumberComments
NVivo 8.0 softwareQSR InternationalNVivo 8.0Qualitative data analysis software for coding and theme derivation
Tencent MeetingsTencent Holdings LtdN/AOnline video conferencing platform used for remote interviews

References

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,
  1. Oyebanji, O., et al. Building local capacity for emergency coordination: Establishment of subnational public health emergency operations centres in Nigeria. BMJ Glob Health. 6 (10), e007203(2021).
  2. Van Der Ende, J., Dávila Campos, V., Grobusch, M. P., Hanscheid, T. The dubious case of Urbanorum: A call to strengthen global pathogen verification mechanisms. Lancet Microbe. 6 (7), 101043(2025).
  3. Dembek, Z., et al. Ebola virus disease outbreaks: Lessons learned from past and facing future challenges. Mil Med. 189 (7-8), e1470-e1478 (2024).
  4. Pan, X., et al. Lessons learned from the 2019-nCoV epidemic on prevention of future infectious diseases. Microbes Infect. 22 (2), 86-91 (2020).
  5. Li, J. Y., et al. The epidemic of 2019-novel-coronavirus (2019-nCoV) pneumonia and insights for emerging infectious diseases in the future. Microbes Infect. 22 (2), 80-85 (2020).
  6. Pinho-Gomes, A. C., Allen, A., Rae, M., Ryder, J. Omicron: We must protect the health and wellbeing of the public health workforce. BMJ. 375, n3123(2021).
  7. Allen, T., Spencer, R. Barriers and enablers to using an emergency operations center in public health emergency management: A scoping review. Disaster Med Public Health Prep. 17, e407(2023).
  8. Lee, J. M., et al. Public health emergency preparedness for infectious disease emergencies: A scoping review of recent evidence. BMC Public Health. 23 (1), 420(2023).
  9. Wang, J., Yuan, B., Li, Z., Wang, Z. Evaluation of public health emergency management in China: A systematic review. Int J Environ Res Public Health. 16 (18), 3478(2019).
  10. Wang, L., Wang, Z., Ma, Q., Fang, G., Yang, J. The development and reform of public health in China from 1949 to 2019. Glob Health. 15 (1), 45(2019).
  11. Lee, J., Jang, S. N., Kim, N. S. Burnout among public health workers during the COVID-19 pandemic in South Korea. J Occup Environ Med. 65 (3), e141-e146 (2023).
  12. Cao, Y., Shan, J., Gong, Z., Kuang, J., Gao, Y. Status and challenges of public health emergency management in China related to COVID-19. Front Public Health. 8, 250(2020).
  13. Li, C., et al. The Centers for Disease Control and Prevention system in China: Trends from 2002-2012. Am J Public Health. 106 (12), 2093-2102 (2016).
  14. Lyu, H. X., Yin, L., Mei, S. J. Investigation on emergency response capacity of primary CDC institutions to public health emergencies in Shenzhen. J Med Pest Control. 36 (4), 356-359 (2020).
  15. Wang, C., et al. Efficiency and productivity of county-level CDCs in Qingdao municipal, China: A retrospective study based on 6 years of panel data. BMC Health Serv Res. 25 (1), 1275(2025).
  16. Brencic, D. J., et al. CDC support for global public health emergency management. Emerg Infect Dis. 23 (13), S183-S189 (2017).
  17. Li, Z., Gao, G. F. Strengthening public health at the community-level in China. Lancet Public Health. 5 (12), e629-e630 (2020).
  18. Hodge, J. G., Dunning, L. T., Piatt, J. L. State public health emergency powers in response to COVID-19. Am J Public Health. 113 (3), 275-279 (2023).
  19. Wang, H., Sun, J., Shi, Y., Shen, T. Driving the effectiveness of public health emergency management strategies through cross-departmental collaboration: Configuration analysis based on 15 cities in China. Front Public Health. 10, 1032576(2022).
  20. Implementation Opinions of Jiangxi Provincial Health Commission. , National Bureau of Statistics, China. https://www.jiangxi.gov.cn/jxsrmzf/2024nd20qzd1258q/pc/content/content_1873556427340886016.html (2023).
  21. Jiao, M., Mi, Y. Q., Wang, Z. D. Assessing health emergency response capacities of Centers for Disease Control and Prevention in China - Research methods and results: A literature-based analysis. Chin J Public Health. 39 (1), 62-67 (2022).
  22. Kiger, M. E., Varpio, L. Thematic analysis of qualitative data AMEE Guide No. 131. Med Teach. 42 (8), 846-854 (2020).
  23. Malterud, K. Qualitative research: Standards, challenges, and guidelines. Lancet. 358 (9280), 483-488 (2001).
  24. Dicicco-Bloom, B., Crabtree, B. F. The qualitative research interview. Med Educ. 40 (4), 314-321 (2006).
  25. Watts, L. L., et al. Qualitative evaluation methods in ethics education: A systematic review and analysis of best practices. Account Res. 24 (4), 225-242 (2017).
  26. Provincial Health Commission. On further promoting the province's close county health care implementation opinions on community construction. , Jiangxi Provincial Health Commission. Jiangxi Provincial Government. https://www.jiangxi.gov.cn/jxsrmzf/2024nd20qzd1258q/pc/content/content_1873556427340886016.html (2024).
  27. Cai, W., Li, C., Sun, M., Hao, M. Measuring inequalities in the public health workforce at county-level centers for disease control and prevention in China. Int J Equity Health. 18 (1), 179(2019).
  28. Qi, H., Feng, Y., Xiao, L., Chen, X., Zhou, J. J., Xi, Y. J., Li, Y. Q., Yan, F., Wang, G. A qualitative study of mood states in CDC staff in Beijing during the COVID-19 epidemic. Chin Ment Health J. 35 (1), 972-976 (2021).
  29. Makivić, I., Švab, V., Selak, Š Mental health needs assessment during the COVID-19 pandemic: Consensus based on Delphi study. Front Public Health. 9, 732539(2021).
  30. Alghader, M. R. M., Valvi, D., De La Hoz, R. E. Transmission and risk factors of COVID-19 among health care workers. Semin Respir Crit Care Med. 44 (3), 340-348 (2023).
  31. Ghahramani, S., Kasraei, H., Hayati, R., Tabrizi, R., Marzaleh, M. A. Health care workers' mental health in the face of COVID-19: A systematic review and meta-analysis. Int J Psychiatry Clin Pract. 27 (2), 208-217 (2023).
  32. Li, N., Wang, Y., Yu, E., Xiao, S., Liu, Y. Job satisfaction of staff in agencies for disease prevention and control in Hainan Province, China. J Pak Med Assoc. 70 (3), 523-525 (2020).
  33. Delassalle, N., Cavaciuti, M. Psychological distress and COVID-19: Evidence-based interventions for frontline health care workers-A literature review. Dimens Crit Care Nurs. 42 (2), 53-62 (2023).
  34. Wan-Yu, Z., Yi, L. Research on the emergency material support system of hospitals from the "structure-process-outcome" perspective: A case study of Wuhan Union Hospital during the COVID-19 pandemic. Med Soc. 33 (11), 90-94 (2020).
  35. Zhang, D., et al. Effect of virtual reality simulation training on the response capability of public health emergency reserve nurses in China: A quasi-experimental study. BMJ Open. 11 (9), e048611(2021).
  36. Dureab, F., et al. Assessment of electronic disease early warning system for improved disease surveillance and outbreak response in Yemen. BMC Public Health. 20 (1), 1422(2020).
  37. Jiaxin, W., Hao, W., Jingwei, Z., Yali, Z. Research on the evaluation index of emergency response capacity for major pandemics. Chin J Gen Pract. 21 (11), 1928-1931 (2023).
  38. Zhang, W., Ma, C., Zou, Z. Investigation on public health emergency response capacity of primary-level disease control and prevention institutes in an area. J Med Pest Control. 38 (3), 239-242 (2022).
  39. Rui, H., Wang, C., Hu, D. Optimization research of the national infectious diseases monitoring and early warning network based on blockchain technology. Chin J Manag. 17 (12), 1848-1856 (2020).
  40. Zhao, Y., Huang, J., Zhang, L., Lian, X., Wang, D. Is the Omicron variant of SARS-CoV-2 coming to an end. Innovation (Camb). 3 (3), 100240(2022).
  41. Nsubuga, P., Nwanyanwu, O., Nkengasong, J. N., Mukanga, D., Trostle, M. Strengthening public health surveillance and response using the health systems strengthening agenda in developing countries. BMC Public Health. 10 (Suppl 1), S5(2010).

Access restricted. Please log in or start a trial to view this content.

Reprints and Permissions

Request permission to reuse the text or figures of this JoVE article

Request Permission

Tags

Public Health EmergenciesEpidemiological InvestigationEarly Warning SystemsTalent RecruitmentPsychological StressData Analysis

Related Articles