Describing the Chinese HIV Surveillance System and the Influences of Political Structures and Social Stigma

Zhang, Lei; Fung Chow, Eric Pui; Zhang, Jun; Jing, Jun; Wilson, David P

The fragmented authoritarian political structure directly affects the HIV surveillance system in China. First, fragmented authoritarianism leads to the absence of accountability in vertical administration of CDCs and lack of cooperation among CDCs on the same level. In this structure, the central China MOH cannot exercise direct supervision over the provincial MOHs, which retain the authority of personnel appointment, organisation structure and budget distribution. Conversely, policy immobility in inferior governments can only be overcome by the intervention of a superior government with the authority to resolve conflicting interests. In other words, lower-level governments tend to shift their policy overload to the upper levels in order to avoid assuming accountabilities [38] . Consequently, a large number of responsibilities and agenda items accumulate at the upper end of the political hierarchy. Therefore, China CDC, as a subordinate organisation of China MOH, is caught in an uneasy position whereby it is unable to exercise its designated authority and simultaneously overloaded with responsibilities which it is not designated to bear. This is reflected by the large amount of collected but unanalysed HIV data accumulated in NCAIDS in central China CDC. As pointed out by Sun, et al., the amount of HIV surveillance data from diagnoses, treatment, laboratory tests and behavioural surveillance overflows the organizational capacity of NCAIDS [14] . Apart from key indicators that require to be distributed to MOH and the general public, most of the surveillance data is under-utilised [14] . Although the web-based HIV reporting system provides an advanced technology base for data reporting and collection, the dissemination of related summary and policy to direct HIV prevention and care strategies remain slow and inefficient. In addition, such a fragmented system makes it difficult to authenticate the quality of the data, as intermediate levels of CDCs do not assume accountability for the accuracy of reported data. An evaluation of HIV surveillance systems by Loo et al., indicated that although the Chinese HIV surveillance system obtained high scores for flexibility and timeliness across in its surveillance activities, representativeness and completeness of data are poor in its case reporting [34] . Discrepancies are found between the HIV laboratory testing algorithm stated in protocols and the actual procedures implemented, which results in gaps in the data and reductions in quality [39] .