【作者】 徐鹏；

【导师】 郝模； 于竞进； 陈政；

【作者基本信息】 复旦大学 ， 社会医学与卫生事业管理， 2007， 博士

【摘要】 一、研究目的和意义2003年SARS疫情的发生和流行，极大地考验了我国疾病预防控制机构对突发公共卫生事件的处置能力，暴露出我国疾病预防控制体系存在的弊端；促使全社会关注疾病预防控制，意识到疾病预防控制体系的重大意义，以及我国疾病预防控制体系的薄弱环节。(一)本研究是疾病预防控制体系建设的需要党中央和国务院提出：争取用3年左右的时间，建立健全疾病预防控制体系。围绕该目标和要求，疾病预防控制政策研究专家、政策制定者和政策实施者三方通力合作，进行了我国疾病预防控制体系建设的战略研究：(1)明确了我国疾病预防控制体系的功能定位，界定了各级疾病预防控制机构的职责与任务；(2)理顺了疾病预防控制体系的管理体制；(3)围绕职能和项目，明确了我国疾病预防控制体系所必需的人力、经费与装备标准等资源。如何把已有的经费、人力及仪器设备合理地分配到疾控机构各项具体工作中去?如何在机构、科室以及具体工作中把公共职能贯彻执行?这些都需要一套系统的、规范的、标准的技术和管理程序，从机构、科室和项目工作三个层次上来对疾控机构进行管理，指导人力、经费以及仪器设备等资源合理分配，使工作项目能够具体落实，从而实现疾控机构公共职能的落实。(二)我国突发公共卫生事件处置工作进展及面临的挑战目前，在工作实践和研究中，缺乏对突发公共卫生事件处置工作的规范和标准化的操作和管理：如缺乏在“三级预防”理念指导下完善的工作目标、明确的各相关部门的职责和职能落实标准、科学的技术流程和工作步骤、规范的技术文书，也缺乏系统的工作数量、质量监控指标体系和绩效考核标准、合理的工作配置标准(如人员、工作经费和仪器设备的标准配置等)。疾病预防控制体系存在一系列的问题和挑战：(1)缺少权威性的指挥协调机构，各相关部门及其职能不明确。没有一个有效的指挥协调体系，在处理重大突发公共卫生事件时，往往出现多头领导，各自为政，职责不清，资源分散浪费，不能形成高效的运作机制，延误了处理突发事件的时机，导致事态扩大。(2)工作步骤和流程不明确，造成各步骤的随意性，工作信息流动不畅。例如，信息来源于多个部门和系统，缺乏统一标准与共享机制，不能及时获得准确全面的数据，不能形成信息平台，没有形成信息共享，不能全面对突发事件进行综合分析与评价，无法为处置决策服务。(3)应急处置人力队伍、工作经费、设备和技术物资储备等资源不能满足处理突发公共卫生事件的需要。由于长期投入不足，工作环境与条件落后，疾控机构人才队伍建设滞后；检验检测设备、交通通讯、防护装备、物资储备等不足；对新发、罕见疾病和各类突发事件的快速鉴别、现场处理和救治技术的研究都比较薄弱。(4)缺乏一整套对突发公共卫生事件处置的工作数量、质量和绩效指标体系。长久以来，对突发公共卫生事件预防控制的考核使用单指标评估和模糊定性的评价，缺乏系统的较精确的数量和质量指标体系；缺乏对总体结果的监控指标，也缺乏对每一工作步骤和业务流程的评价标准。(5)针对类似“非典”此类的新的“群体性不明原因”的传染病，需要有新的应对措施，还需要完善相关立法。《传染病防治法》和《突发公共卫生事件应急条例》的某些规定比较原则，也需要进一步具体化；在“非典”预防和控制工作过程中暴露出的一些薄弱环节，也亟需强化相关法律制度。以上都迫切需要深入的系统的的技术和管理方面的规范化、标准化研究。二、材料与方法本研究以“卫生系统宏观模型”作为指导性研究方法，遵循“三级预防”原则，运用业务流程管理理念和国际标准化组织(ISO)质量管理理念研制工作规范的框架要素；运用“定性定量多重论证”方法进行突发公共卫生事件处置工作规范各框架要素具体内容的完善和论证；使用“标杆管理”理念进行完成规范的人力、工作经费与仪器设备需求研究；选用“规范差距分析法”进行“现实”与规范“理想”间的差距比较；运用聚类分析、相关和回归等统计方法，分析工作规范的效果。主要的资料收集方法包括文献归纳、机构意向调查和机构基本情况调查、焦点问题访谈、二级资料提取、头脑风暴法、以及规范机构模拟运作等。样本机构包括浙江、江苏、广东、山东、江西、湖北、湖南、黑龙江、陕西和甘肃在内的10个省；在每个样本省内抽取9个地(市)级疾病预防控制机构，在抽取的样本市内抽取1个县级疾病预防控制机构。按照该抽样原则，共抽取并调查了168个疾病预防控制机构(其中83个地(市)级机构，85个县级机构)。收集并分析5个市级、6个县级机构从2005年7月—12月的规范模拟运作资料信息，以此作为工作规范的完善以及测算人力、工作经费和仪器设备的依掘。三、主要研究结果(一)《突发公共卫生事件处置工作规范》的研制1、工作规范研制原则(1)合法的原则(2)职责任务一致的原则(3)强化流程管理和注重实证的原则(4)现实与发展兼顾的原则2、突发公共卫生事件处置工作规范研制的框架及界定(1)突发公共卫生事件处置工作规范概述部分突发公共卫生事件处置规范概述作为整个规范的前言部分，包括以下内容：简要介绍突发公共卫生事件概念和分类；简要阐述我国突发公共卫生事件处置目的与意义，形成工作的总体目标；依据工作经验和理论结晶，围绕总体目标(目的)，描述必须完成的突发公共卫生事件处置工作项目；按“三级预防”原则的逻辑操作顺序，形成总体上的工作任务流程图。(2)突发公共卫生事件处置规范分述部分工作规范分述对突发公共卫生事件不同工作项目，分别针对各工作任务和目的、工作内容和方法、工作流程和步骤、技术文书、过程质量控制要求、工作数量和频率、工作考核指标7个框架要素的具体内容展开阐述。(二)突发公共卫生事件处置工作规范的论证对研制出的《我国突发公共卫生事件处置工作规范》的7个框架要素及其具体内容，进行了全国10省83个市级和85个县级机构的机构意向论证。论证结果为：10省168家疾病预防控制机构对工作内容的总体认可程度达到了98.9％，对规范的工作流程和步骤的认同率为97.8％，对规范的关键质量控制指标总体认同率为97.9％，对规范的工作量与频率指标总体认同率为96.5％，对规范的工作绩效考核指标总体认同率为96.7％。工作规范的总体认可程度达到了97.4％，7个框架要素中最高的为工作内容和方法，认可程度达98.9％，最低的为工作数量和频率要求，也达到96.5％；同时，通过对不同框架要素的分工作项目、分级别和分省别分别进行认可程度分析，发现：不管机构的级别如何，以及机构所在省份如何，样本机构对规范7大要素内容是高度认可的。说明，经过14轮论证和完善的工作规范具有普遍可接受性，也表明课题组这一套研制规范的思路、方法和框架要素是科学和可行的。(三)工作现状与拟定规范要求的差距及制约因素分析突发公共卫生事件处置机构的各项工作内容的工作质量均没有达到工作规范的理想要求：最高的为“突发公共卫生事件的报告”，达到了81.3％；最低的为“健康教育督导与评估”，为62.4％。工作数量和频率要求亦未完全落实：完成最好的为“突发公共卫生事件的报告”，完成了77.8％，最低的为“健康教育督导与评估”，完成了56.1％。经统计分析，地市级和县级机构没有显著性差异。分析上述突发公共卫生事件处置现实与规范之间差距的原因发现，前三位制约因素归结为：一是与工作规范配套的工作经费不到位，二是与工作规范配套的人力资源缺乏，三是与工作规范配套的仪器设备配置不到位。其他的如与规范工作内容相配套的制度不完善、职责分工的不明确、部门协调乏力等也是工作规范现实开展的制约因素。(四)突发公共卫生事件处置工作规范支持系统研究1、组织保障和制度保障研究组织保障和制度保障得到了10省83个市级和85个县级机构的一致高度认可，总体认可程度分别达到了95.2％与94.1％。具体内容见附件《突发公共卫生事件处置工作规范》组织保障和制度保障部分。2、人力需求研究根据模拟运作测算结果，全国地(市)级疾病预防控制机构投入到突发公共卫生事件处置工作需要2036.0人，回顾性调查计算所得的实际人力投入为942.3人，两者比较有一定差距，表明：现在地(市)级疾病预防控制机构投入到突发公共卫生事件处置工作的人力不足。县级疾病预防控制机构，根据回顾性调查结果，投入到突发公共卫生事件处置工作的实际人力为7345.9人，而回顾性调查计算所得的理想人力需要60479.2人。比较可知：实际投入人力和理想投入人力之间的差距较大。3、工作经费需求研究根据模拟运作测算结果，全国地(市)级疾病预防控制机构投入到突发公共卫生事件处置工作需要9430.5万元，回顾性调查计算所得的实际投入为7188.3万元，回顾性调查计算所得的理想投入为25503.1万元，全国县级疾病预防控制机构，根据模拟运作测算结果，投入到突发公共卫生事件处置工作需要15869.8万元，而回顾性调查计算所得的实际投入为30955.6万元，回顾性调查计算所得的理想投入为126409.7万元。无论地级机构还是县级机构在经费的实际投入经费都与理想投入有差距。4、仪器设备需求研究开展突发公共卫生事件处置工作，地(市)级机构需要配置的常用的仪器设备有46种，县级疾病预防控制机构需要48种。目前我国地(市)级机构已经配备的常用的各类仪器设备7521件，满足突发公共卫生事件处置工作需要配置152423件，需要增加1926.6％。目前地(市)级机构已经花费各类仪器设备购置经费9547.2万元，但满足突发公共卫生事件处置工作需要购置经费42874.2万元，在现有基础上需要增加349.1％。目前地(市)级机构实际每年平均专项经费为8788.2万元，每年保证仪器标准配置所需追加投入经费32776.0万元，经费缺口为23987.8万元，在目前的基础上需要增加273.0％。目前我国县级机构已经配备各类仪器设备66864件，满足突发公共卫生事件处置工作需要463729件，需要增加593.5％。目前县级机构已经花费各类仪器设备购置经费60280.3万元，但满足突发公共卫生事件处置工作需要327857.7万元，需要增加443.9％。目前县级机构每年平均专项经费投入24212.8万元，每年保证仪器标准配置所需追加投入经费65571.5万元，经费缺口为41358.7万元，在目前的基础上需要增加170.8％。5、突发公共卫生事件处置的部门协调与社会参与研究突发公共卫生事件处置工作的各工作项目均涉及到多个相关职责单位或机构，包括：地、县级疾病预防控制机构、卫生行政部门、城镇社区和街道居委会、农村乡镇政府和村委会、各级各类学校、各类媒体、各级各类医疗保健机构、其他各类企事业单位等。同一机构的落实程度各工作项目之间差异不大，不同机构之间差异明显。疾病预防控制机构的落实程度均在80％～90％之间，卫生行政部门在70％～80％，各级各类医疗卫生机构的落实程度在60％～80％之间，其他如乡镇、街道预防保健机构的落实程度均在60％～70％之间。因而，实际工作中应切实加大所有相关部门职责与任务的落实力度。(五)工作规范的效果分析研究此次研制的工作规范与2001年版《疾病预防控制工作规范》相比，在整体上更具全局性、系统性、逻辑性，研究内容上更加详尽。新增加工作内容7项，分别为：培训健康教育队伍、开展日常性的健康教育活动、健康教育督导与评估、监测与预警、参与制定辖区内突发公共卫生事件应急预案、控制效果评估、工作督导。针对新增加的7项工作内容，增加84个框架要素内容。细化工作内容7项；针对细化的7项工作内容，保留了4个框架要素，完善了56个框架内容。新研制规范共有定量性指标36个，比原有规范新增加27个，保留原规范的工作考核指标5个，废除3个。从样本机构的意向调查结果来看，规范中有关各工作项目过程质量指标及要求能够把握突发公共卫生事件处置工作的质量(93.6％机构认同)；规范中有关工作量和工作频率要求能够实现突发公共卫生事件处置工作的目标(94.3％机构认同)；规范中有关工作考核及其标准要求能够全面把握和评估其工作绩效(94.4％机构认同)。通过定量数据的分析，发现：突发事件报告及时率、现场控制方案齐全程度、工作督导完成程度3个指标与规范执行程度均呈正相关。比较各组情况，规范高执行程度组的突发事件报告及时率是中执行程度组的1.03倍，规范中执行程度组的突发公共卫生事件报告及时率是低等执行程度组的1.10倍；规范高执行程度组的现场控制方案齐全程度是中执行程度组的1.05倍，规范中执行程度组的现场控制方案齐全程度是低等执行程度组的1.05倍；规范高执行程度组的工作督导完成程度度是中执行程度组的1.11倍，规范中执行程度组的工作督导完成程度是低等执行程度组的1.09倍。其他指标之间的统计分析也得到类似的结果。表明：本次规范研究能够得到落实的话，对增加突发公共卫生事件处置工作效果具有重要作用。四、研究的主要探索和创新1、将三级预防、业务流程管理、国际标准化组织(ISO)质量管理理念、全面质量管理、卫生系统宏观模型、标杆管理法、定性定量多重论证等方法，综合运用于研制突发公共卫生事件处置的工作规范，经论证和模拟检验，本规范被全国疾病预防控制机构广泛认可和接受。因此，本研究可为其他项目的工作规范的研制提供可资借鉴的模板、思路和框架要素。2、研制的一整套系统指导突发公共卫生事件处置工作的规范，明确了工作任务和目标，提出了详尽的工作内容和方法、符合逻辑的工作流程和步骤研制，一整套工作过程质量控制指标及要求，一整套完成突发公共卫生事件处置工作任务所必需的工作数量和频率，一整套指导工作实践的技术文书，以及一整套工作考核指标体系，为进行突发公共卫生事件处置工作的项目管理提供了依据。3、遵循“结构—过程—结果”模型，通过主成分分析、Pearson相关系数计算、线性回归、聚类分析方法，针对突发公共卫生事件处置工作，研制并创建了突发公共卫生事件处置工作人力、工作经费和仪器设备投入水平与工作规范化程度的回归模型，明确了投入的人、财、物水平直接制约着突发公共卫生事件处置工作的规范化程度，投入水平越高，规范化程度也越高。4、创建了工作规范化程度与工作效果回归模型，明确了工作规范化程度与工作效果之间的动态定量关系。借鉴相对危险度的分析思路，创建了突发公共卫生事件处置工作规范化程度与社会职责(以及人力、工作经费和仪器设备投入)对工作效果作用的定量模型，论证了工作规范化和社会职责(以及人力、工作经费和仪器设备投入)对工作效果有协同作用。5、运用期望值法和标杆法，通过机构调查和机构模拟运作获得必要的数据，研究并创建了突发公共卫生事件处置工作人力需求测算思路、步骤和公式，为测算全国地、县级疾病预防控制机构人力配置奠定了基础。研究并创建了突发公共卫生事件处置工作经费投入测算思路、步骤和公式，为测算全国地、县级疾病预防控制机构经费投入标准奠定了基础。研究并创建了突发公共卫生事件处置工作仪器设备配置标准的测算思路、步骤和公式，并测算出了仪器设备的配置标准。更多还原

【Abstract】 1. Study Objectives and Significances(1) To meet the need of disease prevention and control system reform and constructionSARS (Severe Acute Respiratory Syndrome), which broke out in 2002, attacked 266 counties of 24 provinces in China and resulted in 5327 cases and 349 patients died of SARS. This contagious disease threatened the life safety badly, influenced the economic development, social stability and external intercourse. Which made the Central Government and common people realized that Chinese disease prevention and control system was weak and indispensable to rebuild the system. Therefore, the State Council put forward the objective of rebuilding Chinese disease prevention and control system in about 3 years. In order to realize this objective, the experts in policy research, policy makers and executors of disease prevention and control developed the strategetic research on building the system of disease prevention and control in China. Firstly, taking the public health product as the yardstick, to define the functions of Chinese disease prevention and control system and the concrete functions of CDCs at state, province, city and county levels and the health prevention and care organizations at grass roots. Secondly, using the advanced administrative mode of the developed countries as the reference, to reform the current administrative system of disease prevention and control and bring forward the suggestion on establishing Disease Prevention and Control Bureau in China. Finally, in order to fulfill the defined public functions and projects, to measure the allocation criteria of manpower, expenses, material resource and institution construction for disease prevention and control institutions at all levels.At present, Chinese disease prevention and control system was improved step by step. the institution functions were defined, and the research of organization construction was completed. the allocations of manpower, expenses and material resource and the work conditions were improved to a certain extent. But how to allocate the definite manpower, expenses and material resource for one project of disease prevention and control rationally? How to accomplish the defined functions in the whole institution, some sections or one concrete project? These questions need to be resolved through making a systemic and standardized technology and management procedure which instruct us to allocate the resources of disease prevention and control reasonably, among of them including manpower, expenses and material resource. To carry out the management on three administrative levels which are the whole institution, section and project to accomplish the public functions of disease prevention and control in deed.(2) To enhance the capability of dealing with the public health emergency in ChinaThere are many problems and challenges in the dealing with the public health emergency in China. In 2002, the society began to realize the weakness of the Chinese disease prevention and control system because of SARS. The researchers have put forward many problems of the system, for example, the lack of manpower, expenses, material resource and the Standardizations of the jobs.The study focus on every disease prevention and control projects and selects the dealing with the public health emergency as the objective to develop a frame and essentials of the workbook, and to study the method and procedure in developing the workbook. Based on the guidance other projects could develop the respective workbooks. The study select the city and country disease preventing and controlling institutions as the research objectives to develop the workbook, which engage in the technical and administrant work. Thus, with the workbook guidance, the workbooks of other administrative levels institutions such as the nation, province level that just have the administration functions and the grass roots which include the towns, could be written.2. Research methods and Data SourcesThe study applied "Structure-process-outcome" of "A Macro-Model of Health System" to develop a frame and essentials of the workbook on how to dealing with the public health emergency in China. With the frame and essentials guidance, using the method of "Qualitative and Quantitative Multi-demonstration" to develop and demonstrate all contents of the workbook. We adopted the methods of "Benchmarking" to study the manpower, expenses and equipment demand of dealing with the public health emergency in China, and creating the method, procedure, the formulas and approaches to measure the human, expenses demand of dealing with the public health emergency. The study also used the method of "Gap analysis between practice and ideal" to analyze the difference between the ideal conditions in practice and the requirement of the book.Data-collected methods include the literature review and induction, institution investigating and basic condition survey, focused interview and focused group study, routine statistic data collection and the simulation and operation in practice, etc. This study selected 10 provinces including Hubei, Hunan, Jiangxi, Jiangsu, Zhejiang, Guangdong, Heilongjiang, Shandong, Gansu and Shanxi as the surveyed sample provinces. From these provinces, selecting 83 institutions at city level and 85 institutions at county level.During developing the workbook of dealing with the public health emergency in china, the study consulted 540 person-times of 103 experts to improve it again and again. To survey 168 sample institutions to perfect and demonstrate it. Besides this, the study applied it to 5 institutions at city level and 6 ones at county level to demonstrate its applicability. The study collected suggestions put forward by 5 institutions from July to December in 2005 and perfect the workbook further again.3. Main study results(1) To develop a workbook on dealing with the public health emergency◆To form principles on how to develop the workbook—Legitimacy—Assignment is assigned according to its responsibility—Giving emphasis to work procedures, work approaches and work evidence—pay more attention to the work can not only guide work practice at present but also meet the work development need(2) The frame and essentials of the workbook◆Summarization of the workbookSummarization of the workbook is preface of the book, it synthetically generalizes some contents, including—To simply illuminate the aim and significance of dealing with the public health emergency, to develop general work objective.—To describe all work items that have to performed in order to realize the general work objective.—Taking general objective realization as center, to develop work items flow chart according to the principle of tertiary prevention on the basis of work experience and theoretic knowledge.◆Detailed part of workbookThe detailed part of the workbook expatiate the work target and tasks, work contents measure and method, work procedure and approaches, technical documents that could guide practice of dealing with the public health emergency, procedure quality index and the keys of quality control, work amount and frequency criteria and work performance assess index. (3) Gap analysis between current work and workbook criterion and influence factors researchThe rate of achieving procedure quality index and its criterion of the workbook at present is 71.6%. The rate of accomplishing work amount and frequency criteria of the workbook at present is 68.6%. Making influence factors analyses to find that there are common influences factors result in the low degree of quality reaching and quantity accomplishing. The first influence factor is short of work expenses, the second is insufficiency work human power, and the third is absence of apparatus and equipments. Other influences factors are social institutions concerned aren’t perfect, assignments and tasks aren’t definite and cooperation between social institutions or departments concerned isn’t smoothly.(4) Sustaining System study of the workbook◆Organizational guarantee, Institutional guarantee research See to see Appendix 1＜Workbook on dealing with the public health emergency in China＞.◆Work manpower demand researchThe work manpower for all CDC at city level nationwide is 2036. The work manpower for all CDC at county level in China is 11570.◆The expenses demand researchWork expenses of all CDC at city level nationwide is 94.30 million Yuan (RMB) every year, Work expenses of all CDC at county level nationwide is158.69 million Yuan (RMB) every year.◆Apparatus and equipment demand researchThe equipments for CDC at city level are 46 kinds and for CDC at county level are 48 kinds◆Social departments and institutions concerned and their responsibility and basic assignmentsThere are more than 7 social departments and institutions concerned to the item of dealing with the public health emergency. They are disease prevention and control institutions for example CDC at city and county level, all kinds of hospitals and health care institutions at all levels, health administration departments at all levels. Any items can’t complete by any single department or institution. The leading department or institution that takes charge of a work item is different.In dealing with the public health emergency, average rate of function and assignments of social departments or institutions above were accomplished is 71.1%. Disease prevention and control institutions such as CDC at city and county level highest (the rate is 80%～90%), the second is the health administration departments at all levels, all kinds of hospitals and health care institutions at all levels (the rte is 60%～80%). (5) Effect evaluation and analysis of the workbookThe new developed workbook is more systemic, logical and comprehensive on the whole. The contents of the workbook are more detailed and elaborate than the old workbook of 2001 year edition. Among the 14 work items, there are 7 items preserved and 7 items increased. As for the work performance assess indexes, the workbook increased 27.From the surveyed technical personnel engaged in dealing with the public health emergency, a series of procedure quality indexes and quality control keys of the workbook was enough to grasp and control the quality of dealing with the public health emergency (93.6% agreed of all). A series of amount and frequency criteria of workbook was enough to complete corresponding work task and realize corresponding work target (94.3% agreed of all). A series of work performance assess indexes was enough to comprehensive corresponding work effect and performance (94.4%% agreed of all). In conclusion, the developed new workbook could achieve good result and effect if it was put in practice.4. Innovation and applicationThe study applied "Structure-process-outcome" of "A Macro-Model of Health System" to develop a frame and the essentials of workbook on how to dealing with the public health emergency in China. This study consulted 22 experts to perfect, demonstrate and define the frame and the essentials. The frame and essentials of the workbook could help to develop many workbooks on other work in the filed of disease prevention and control. All these will make for disease prevention and control system standardization and make a great progress in the future.During developing the workbook of dealing with the public health emergency in China, the study consulted 540 person-time of 103 experts to perfect and demonstrate it, surveyed 83 institutions of dealing with the public health emergency at city level and 85 institutions at county level to perfect and demonstrate it and applied it to 5 ones at city level and 6 ones at county level to demonstrated its applicability and prefect it further. In conclusion, "Qualitative and Quantitative Multi-demonstration" was adopted during the course of developing the workbook to make sure its acceptability and feasibility. Meanwhile, the effect evaluation and analysis of the workbook make sure its effect.The paper developed a systemic technical workbook on how to dealing with the public health emergency better for the first time, which presents specific work goal and task, detailed work contents, work measures and methods, logical work procedure and approach, a series of procedure quality indexes and keys of quality control, a series of amount and frequency criteria of work. a series of technical document that could guide practice of dealing with the public health emergency and a series of work performance assess indexes. The workbook put forward a criterion and lay the foundation for dealing with the public health emergency project management.To use the methods of "Benchmarking" to study human, expenses and equipment demand of dealing with the public health emergency in China. The study created a measure method and procedure, translated these into formulas and approaches to measure human, expenses and equipment demand of dealing with the public health emergency account to services target number. These formulas and approaches were demonstrated through simulation measure. The paper used these to measure human, expenses and equipment demand to dealing with the public health emergency of all institutions at city level and all institutions at county level countrywide. These outcomes bring forward a criterion and lay the foundation for the dealing with the public health emergency project management.The study make clear the organizational guarantee, institutional guarantee, the social departments and institutions concerned and their responsibility and basic assignments, these could make the workbook to be put in practice successfully and smoothly.更多还原