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recently, the official website of the hunan provincial health commission (referred to as the "hunan provincial health commission") published the "reply of the hunan provincial health commission to proposal no. 1134 of the second session of the 13th provincial cppcc" (referred to as the "reply") ), in response to the "recommendations on reasonably adjusting the layout of maternal and child health care institutions in our province under the cold wave of low fertility rate" proposed by members of the provincial cppcc at the second session of the 13th cppcc provincial committee.

the "reply" disclosed that in recent years, the number of births in hunan province has changed dramatically, peaking at 835,000 in 2017, and rapidly falling to 373,700 (number of institutional live births) in 2023, a decrease of 55.25%. the birth rate continues to decline, and the number of newborns the decrease has caused a series of changes in the province's obstetric and pediatric medical resources.

on may 7 this year, the main leaders of the hunan provincial party committee emphasized at a symposium on the development of public hospitals that it is necessary to further strengthen research on major strategic issues, focusing on promoting high-quality population development, and planning and layout of social undertakings such as education and medical care in hunan province. conduct forward-looking and systematic research to establish and improve a scientific policy system in population and related fields. the provincial health and medical commission actively implemented the spirit of the meeting, combined with the proposals and suggestions, and formed a working group to carry out investigations and studies in changsha, zhuzhou, xiangtan, yiyang, changde, xiangxi and other places, conduct careful research and analysis, strengthen forward-looking planning, and submitted a proposal to the finance and economics office of the provincial party committee the research report on "investigation and research on the optimization of the distribution of medical resources in the province from the dimension of maternal and child health institution system construction" has been fully recognized and some opinions have been adopted.

regarding the suggestion by members of the hunan provincial committee of the chinese people's political consultative conference to gradually divest the public health functions of maternal and child health care, the hunan provincial health commission stated in the "reply" that in january 2024, the national maternal and child work conference proposed that in the process of promoting the reform of maternal and child health care institutions, it is necessary to follow the principles of "three constants" and "three no's": "the independent legal status of maternal and child health care institutions cannot be changed, the financial investment guarantee policy cannot be changed, and the functional positioning of combining prevention and treatment cannot be changed; maternal and child health care institutions cannot be canceled or merged in disguised form in the name of reform. maternal and child health care institutions must not be weakened for various reasons, and the management responsibilities of maternal and child health care institutions must not be weakened.”

the "reply" revealed that as of now, there are 137 maternal and child health care institutions in hunan province, including 1 at the provincial level, 14 at the municipal level, and 122 at the county level. they are all government-sponsored, not-for-profit, and provide public services to women and children. public welfare institutions providing health and basic medical services.

in response to the proposal to promote the development of well-run maternal and child health hospitals into comprehensive hospitals, the hunan provincial health commission pointed out that in response to the decline in obstetrics and pediatrics business volume in hunan province in recent years, which has triggered a wave of closures of obstetrics and pediatrics in grassroots hospitals, all hospitals in the province have the health administrative department at the national level coordinates the planning and layout of maternal and child health care institutions in the jurisdiction, and takes measures such as stabilizing grassroots institutions, extending the maternal and child health care service chain, and promoting the integration and diversion of personnel to promote the connotative development of maternal and child health care institutions.

the hunan provincial health commission stated that in 2024, the province will cancel the midwifery qualifications of more than 50 medical institutions with an annual delivery volume of less than 100 cases, support 49 maternal and child health care institutions to add the "women and children's medical center" brand, and support 25 postpartum rehabilitation services have been opened, 14 have opened confinement centers, 8 have opened "light medical beauty" services, 15 have opened optometry services, etc. from january to june this year, the province's maternal mortality rate was 3.79/100,000, the mortality rate of children under 5 years old was 3.52‰, the infant mortality rate was 2.29‰, and the neonatal mortality rate was 1.06‰. the core indicators for assessing the health of women and children continue to improve.

as for the proposal to gradually integrate some district-level and county-level maternal and child health hospitals with poor living conditions, the hunan provincial health commission responded that in recent years, health administrative departments at all levels have strengthened top-level design and coordinated planning for the construction of maternal and child specialist capabilities in their jurisdictions. we will refine and clarify the construction direction and tasks, and gradually build a maternal and child health service system and a maternal, obstetric and pediatric specialist group with complementary advantages in the region.

in 2024, the hunan provincial health and health commission will conscientiously implement the "notice of the general office of the national health and health commission on strengthening the management of midwifery services" (national health office maternal and child development [2024] no. 7), further strengthen the planning and layout of midwifery services, and ensure that midwifery services are service provision effectively meets the needs of pregnant women. as of now, counties and cities with a population of more than 300,000 are guaranteed to have at least two public medical institutions providing midwifery services, and counties with a population of less than 300,000 are guaranteed to have at least one public medical institution providing midwifery services.

at the same time, through the establishment of a maternal and child health service consortium, telemedicine (such as "cloud maternal and child"), and counterpart support, we will promote the sinking of high-quality maternal and child health service resources and guide medical institutions that provide maternal and child health services in regions to help each other around discipline construction. mutual assistance and complementary advantages will promote the balanced development of maternal and child health service capabilities among regions.

regarding the next step, the hunan provincial health commission emphasized that it will conscientiously implement the spirit of the speech at the symposium on the development of public hospitals in the province, focus on suggestions, face the problems head-on, and scientifically adjust and rationally allocate medical resources.

the hunan provincial health commission proposed three measures in its reply:

first, in accordance with relevant national policies and standards, corresponding policies and guidance are issued to scientifically adjust the allocation standards of obstetric and pediatric medical resources in hunan province, rationally transfer excess resources, accelerate the allocation of insufficient resources, and maintain the stability of grassroots maternal and child institutions;

the second is to promote the coordinated development of maternal and child medical resources and specialist resources such as rehabilitation nursing and medical care, and coordinate the "group-style" support of high-level hospitals in the province to maternal and child health care institutions in areas with weak foundations to help improve the level of maternal and child health services;

the third is to strengthen education and training. in view of the current and future difficulties of some obstetricians and pediatricians who are overstaffed and face transition and replacement, training and employment services will be strengthened to help obstetricians and pediatricians achieve transformation and replacement.