基层医疗卫生机构作为我国卫生服务体系的网底，在应对重大传染病防控中扮演着重要的角色。重大疫情防控期间，基层医疗卫生机构既承担着基本医疗卫生服务，又承担着疫情防控工作任务，在“两方面任务都要完成”的要求下，如何兼顾服务质量和有效提升疫情防控能力至关重要。目前有关基层医疗卫生机构疫情防控能力建设的文献较少，且多数聚焦于某一点来开展讨论，不具有系统性和全面性，理论结合实证分析的研究鲜有看到。为此，本研究聚焦基层医疗卫生机构疫情防控能力建设制约因素及策略，基于能力建设相关理论研究成果提出适用于我国基层医疗卫生机构疫情防控的多层次能力建设理论分析框架，基于该框架分析我国基层医疗卫生机构疫情防控的能力现状，分析基层医疗卫生机构疫情防控能力提升的制约因素，提出基层医疗卫生机构疫情防控能力提升策略。

本研究采用了如下研究方法：（1）采用文献研究法和专家咨询法构建适用于我国基层医疗卫生机构疫情防控的多层次能力建设理论分析框架；（2）基于多层次能力建设理论分析框架，采用政策文本分析法和定性研究方法，对影响我国基层医疗卫生机构疫情防控能力建设的外部环境及其制约因素进行分析；（3）基于多层次能力建设理论分析框架，采用定量研究和定性研究方法，对东、中、西部6省12区/县190个基层医疗卫生机构及基层医务人员开展疫情防控能力调查，从基层医疗卫生机构和基层医务人员两个层面研究我国基层医疗卫生机构疫情防控能力制约因素；（4）在实证研究基础上，提出加强基层医疗卫生机构疫情防控能力建设的策略和政策建议。

研究首先构建了“外部环境——机构——人员”的基层医疗卫生机构疫情防控多层次能力建设理论分析框架，认为基层医疗卫生机构疫情防控能力建设应从外部环境、基层医疗卫生机构和基层医务人员三个层次具体展开，其中：（1）外部环境因素主要包括政策环境、系统支持、联防联控机制和信息化建设四个方面；（2）基层医疗卫生机构层面能力建设因素主要包括岗位设置、人员配备、基础设施设备、组织协调与管理、基本医疗服务能力和公共卫生服务能力、疫情防控能力等六个方面；（3）基层医务人员层面能力建设因素主要包括技术能力、人岗匹配、激励机制和教育培训四个方面。基于基层医疗卫生机构疫情防控的多层次能力建设理论分析框架，本研究发现影响基层医疗卫生机构疫情防控能力的制约因素主要有：（1）在外部环境层面，主要存在疫情防控工作定位难以执行、联防联控机制不顺畅、协同机制不健全、应急物资储备缺乏、基层首诊制度不完善等方面的制约因素；（2）在基层医疗卫生机构层面，主要存在机构用房面积不足、机构用房及租用资金来源困难、设施设备老化不能满足需要、机构建设标准相关政策不完善、公共卫生科室设置与人员配备不规范等方面的制约因素；（3）在基层医务人员层面，主要存在人员数量不足、工作超负荷、人员配置及其编制明显不足、卫技人员专业服务能力不足、专项教育培训不足与培训效果欠佳并存等制约因素。

基于研究发现，本研究从“外部环境——基层医疗卫生机构——基层医务人员”三个层面提出提升基层医疗卫生机构疫情防控能力的策略，建议应该从明确基层医疗卫生机构在疫情防控中的职责、加强公共卫生机构与上级医院对基层医疗卫生机构的专业化支撑、提升社区治理体系综合防控、完善区域健康信息平台、加强基层医疗卫生机构硬件设施建设、优化机构公共卫生科室设置和人员配备、提升基层医务人员疫情防控教育培训的精准性等方面综合施策，加强基层医疗卫生机构疫情防控能力建设。本研究是国内首次系统全面地调查基层医疗卫生机构疫情防控状况的研究，研究提出的能力建设策略可以为完善相关政策提供支撑，有利于强化基层医疗卫生机构疫情防控能力，提高基层医疗卫生机构疫情防控资源利用率和疫情防控水平。

As the bottom of healthcare system, primary healthcare institutions played a significant role in the prevention and control of major infectious diseases in China. When major infectious diseases break out, the primary healthcare institutions should not only provide basic medical and health services, but also participate in epidemic prevention and control. Under the pressure of dual tasks, how to give consideration to efficiency and effectively improve the epidemic prevention and control capacity was crucial. At present, there were few studies on the capacity building of epidemic prevention and control at primary healthcare institutions, and most of the existing studies were one-sided, not systematic and comprehensive, and few studies could combine theoretical and empirical analysis. Therefore, this study focused on the constraints and strategies of epidemic prevention and control capacity building at the primary healthcare institutions. First, based on the existing theoretical research on capacity building, this study proposed a multi-level capacity building theoretical framework for epidemic prevention and control at the primary healthcare institutions. Then, based on the framework, the current situation of the epidemic prevention and control system and the constraints to improve the capacity of the primary healthcare institutions were analyzed. Finally strategies for improving the epidemic prevention and control capacity of primary healthcare institutions were proposed.

The following research methods were adopted in this study.: (1) The literature research method and expert consultation method were adopted to build a theoretical analysis framework of multi-level capacity building for epidemic prevention and control in primary healthcare institutions in China; (2) Based on the theoretical framework of multi-level capacity building, policy text analysis and qualitative research methods were used to analyze the external environment and its constraints that affect the construction of epidemic prevention and control capacity of primary healthcare institutions. (3) Based on the theoretical framework of multi-level capacity building, a survey on the epidemic prevention and control capacity of 190 primary healthcare institutions and workers personnel in 12 districts/counties of 6 provinces in the east, middle and west was carried out by using the method of combining quantitative and qualitative research. The current constraints on the epidemic prevention and control capacity of primary healthcare institutions were studied. (4) On the basis of empirical research, this study proposes strategies and policy recommendations to strengthen the construction of epidemic prevention and control capacity of primary healthcare institutions. 

In this study, a multi-level capacity building theoretical framework of "external environment - institutions - personnel" was constructed, and it was proposed that the capacity building of epidemic prevention and control of grassroots medical and health institutions should be carried out from three levels: external environment, primary healthcare institutions and primary healthcare workers. (1) The external environmental factors mainly included policy environment, system support, communication and cooperation mechanism between departments and information construction. (2) The factors of capacity building at the primary healthcare institutions level mainly included six aspects, including post setting, staffing, infrastructure and equipment, organization, coordination and management, basic medical service capacity and service capacity. (3) The factors of capacity building at the primary healthcare workers level mainly included four aspects: technical capacity, staff matching, incentive mechanism and education and training.

According to the multi-level capacity building theoretical framework for epidemic prevention and control at of primary healthcare institutions, this study conducted an empirical investigation and the results showed that: (1) At the external environment level, there were mainly constraints on capacity building in terms of imperfect communication and cooperation mechanism, difficult performance of epidemic prevention and control responsibilities, lack of emergency supplies reserves, and imperfect primary diagnosis system. (2) At the level of primary healthcare institutions, there were mainly constraints in terms of insufficient work area, difficulties in funding institutional housing, outdated facilities and equipment, imperfect policies related to institutional construction standards, and non-standard public health departments and staffing. (3) At the personnel level, there were mainly constraints such as insufficient personnel, overload, obvious shortage of personnel and staffing, insufficient professional service ability of health technicians, insufficient special education and training, and poor training effect.

    Based on the research findings, this study proposes strategies to improve the epidemic prevention and control capacity of grassroots medical and health institutions from the three levels of "external environment - institutions - personnel". A series of comprehensive measures were introduced to strengthen the construction of epidemic prevention and control capacity of primary healthcare institutions, including clarifying the epidemic prevention and control responsibilities of grassroots medical and health institutions, strengthening the professional support of public health institutions and superior hospitals for primary healthcare institutions, improving the comprehensive prevention and control of community governance system, strengthening the construction of hardware facilities of primary healthcare institutions, optimizing the setting and staffing of institutional departments, strengthen regional health information platform,and improving the accuracy of education and training of health workers. This study is the first time in China to systematically and comprehensively carry out the investigation on epidemic prevention and control in primary healthcare institutions. The proposed strategies could provide support for improving relevant policies, strengthen the epidemic prevention and control capacity of primary healthcare institutions, and improve the utilization rate of epidemic prevention and control resources and epidemic prevention and control level of primary healthcare institutions.