Many viewers were deeply moved by the portrayal of Hsing Chu (幸珠) — a public health center nurse exhausted and overwhelmed by the heavy demands of healthcare and administrative work — in The World Between Us 2 (我們與惡的距離Ⅱ), the second season of the popular Taiwanese television crime series.
Hsing’s burden causes her to suffer physically and mentally. Her situation is a realistic depiction of the long-standing challenges faced by personnel at health clinics in Taiwan — understaffing, heavy workloads and poor division of labor. It is a system that can no longer be sustained through passion and enthusiasm alone.
Taiwan has 374 public health centers, which have for many years shouldered a wide range of tasks — cancer screenings, infectious disease prevention, vaccinations, health promotion and care for children and elderly people. In the past few years, their duties have become increasingly complex, now including long-term care services and social safety net responsibilities.
Data from the Executive Yuan and the Ministry of Health and Welfare show that the number of nurses and midwives at public health centers in most areas at the end of last year fell short of legal requirements. Newly established health centers face even more extreme and persistent personnel shortages, indicating clear insufficiencies in the field of public health.
Even more serious than staff shortages is the unreasonable and unequal division of labor. Many non-clinical public health responsibilities — such as community risk assessment, epidemic monitoring, policy implementation and data compilation — have long been performed by nursing staff, which detracts from their primary clinical duties, negatively affecting the quality of care and staff morale, and placing a heavy physical and mental burden on frontline personnel.
Article 13 of the Public Health Specialists Act (公共衛生師法), passed in 2020, says that public health specialists can practice in a number of diverse areas — such as environmental health, disease investigations and prevention, public health status investigations, health promotion and food safety — making them well-suited to undertake non-clinical public health tasks and complement the role of nurses. Formally integrating public health specialists into the establishment of public health centers and employing them institutionally would significantly enhance the efficiency and resilience of frontline public health operations.
However, most public health centers employ non-certified personnel on a contract or project basis, meaning that they are not given institutional guarantees or a clear path to stable career development. With this system, it is difficult to retain qualified public health professionals and nearly impossible to support long-term and systematic public health policy goals.
The government should establish full-time positions for certified public health specialists within the official staffing system of public health centers, giving priority to those with certification and clearly dividing job responsibilities to build a modern, cross-disciplinary public health system.
To respond to Taiwan’s aging population and the mounting pressure on the healthcare system, then-premier Su Tseng-chang (蘇貞昌) launched a plan to upgrade the public health service system. The plan involves four strategies:
The first is to provide localized healthcare services by increasing the allocation of medical personnel in accordance with the resources, characteristics and needs of the jurisdiction.
Second is increasing flexibility in medical personnel hiring by allowing local governments to flexibly hire staff in accordance with community needs.
Third is to subsidize the renovation of public health centers’ long-term care and social welfare office buildings, and establish new hardware environments and facilities.
Fourth is to make telemedicine more convenient and accessible in rural areas.
With a budget of NT$2.4 billion (US$81.49 million) over eight years, the plan made initial progress in improving infrastructure and management.
However, without a stable and professional workforce to share the burden, progress in infrastructure and management alone are not enough to enhance the quality of service provided at public health centers. Only by allowing nurses to focus on clinical care, while public health specialists are responsible for tasks related to population health, could the burden on frontline personnel be alleviated and service efficiency improved.
Public health personnel are not superheroes. Institutional support is essential to safeguarding the health of the whole nation.
Wong Ruey-hong is chairman of the Taipei Public Health Specialists’ Association and a professor at Chung Shan Medical University’s School of Public Health.
Translated by Kyra Gustavsen
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