S Leung

Hong Kong is a developed, highly sophisticated and plural society. It has a mixed medical and health economy. The private sector provides mostly primary health care services and a small percentage of secondary health care. In the public sector, the Department of Health (DH) is responsible for delivering preventive and primary health care services as well as those of rehabilitation, while secondary and tertiary care services are provided by the Hospital Authority (HA).

1. Health Services for Mothers

1.1 Maternity Services

As the socio-economic conditions improve and fertility rate continues to drop, parents are demanding high quality maternity services. Most of the deliveries are now occurring at hospital settings where Obstetric and Neonatal expertise and facilities are concentrated. In 1997, about two-thirds of the 60,000 deliveries took place at public hospitals and the rest at private institutions. The remaining few maternity homes are gradually phasing out.

In the public sector, antenatal care is shared between the Obstetric Departments of the HA hospitals and the Maternal and Child Health Centres (MCHCs) of the Department of Health. The antenatal programme consists of screening for maternal illness, recognition and treatment of abnormality in pregnancy, assessment of fetal development and well-being, detection of fetal abnormality and giving health advice through individual counseling and antenatal classes. In antenatal classes, a variety of issues such as healthy life-style, maintenance of health during pregnancy, preparation for birth and breast-feeding, care of the neonate, family planning, are discussed.

Postnatal services are available at the hospitals as well as the MCHCs. Traditionally, postnatal clinics have been introduced to ensure physical health of the mother. The challenge ahead will be to broaden the scope to include safeguarding the emotional and social health of the mother, as it is well recognized that maternal depression does not only affect the mother but can have detrimental effect on the development of the child. A local study has recently shown that about 10% of postnatal woman are affected.¹

1.2 Family Planning Services

Family planning service is available at the 50 MCHCs and the Birth Control clinics of the Hong Kong Family Planning Association. Condom and contraceptive pills are purchasable over the counter.

2. Services for Children

2.1 Childhood public health services

The Family Health Service and Student Health Service of the Department of Health (DH) provide public health services, namely, health promotion, disease prevention, screening and surveillance, for children from birth to teenage, completely free of charge, through 50 Maternal and Child Health Centres and 13 Student Health Centres. It is underpinned by health promotion, which, as defined by the WHO, is the process of enabling children and their families to increase control over, and to improve, their health. Issues for health promotion and disease prevention include the promotion and maintenance of breast-feeding; enabling children to adopt healthy life-style such as healthy eating, exercise, avoiding passive and active smoking; maintenance of oral health; injury prevention; immunization to prevent communicable diseases; promotion of parentchild relationship, positive parenting and teaching of effective discipline methods in order to reduce child behavioural problems and child abuse.

Screening and surveillance comprise neonatal screening of G6PD deficiency and congenital hypothyroidism, which is administered by the Clinical Genetic Service, DH and in the MCHCs and SHSCs, growth monitoring, developmental monitoring, detection of physical anomalies, hearing and vision screening are routinely carried out.

In the past, much emphasis has been put on early detection of diseases through an array of surveillance and screening processes, many of which have been based on no good evidence. There is a need to streamline these procedures, based, as far as possible, on currently available scientific evidence.

2.2 Primary, secondary and tertiary child health care services

While the private paediatricians and general practitioners deliver primary health care to a substantial proportion of children, secondary, tertiary and rehabilitative services are provided mainly by the Hospital Authority and the Department of Health in the public sector.

Children with illnesses or injuries are attended by health workers at the Accident & Emergency departments and Paediatric departments of hospitals, the general outpatient clinics of the Department of Health, as well as by private general practitioners and paediatricians. The Child Assessment Service (DH) and the Duchess of Kent Child Assessment Centre are responsible for assessing and placing children with disabilities whose needs for therapy, treatment and special education are met by the para-medics in the hospitals, non-governmental organizations and the Special Education Services of the Education Department. Professionals dealing with the whole spectrum of childhood behavioural problems range from primary child health care doctors and nurses, paediatricians, social workers, clinical psychologist to child psychiatrist in various health care and social service settings. Child protection is an arena shared by workers in the Police, the Social Welfare Department and the hospital paediatricians.

3. Future Challenges

The present division of the health care structure into the Hospital Authority and Department of Health, each carrying some policy and provider roles, is not conducive to an integrated maternal and child health function. This calls for the commitment of professionals in all relevant health service settings to communicate and collaborate to work for a coherent health care policy and seamless service provision.

In Hong Kong, as in many other parts of the world, in order to cope with the ever advancing bio-technology and escalating aspiration of the society on the one hand and the scarcity of health care resources on the other, service planning and development must be based on the rational process of needs assessment, and programmes developed must be properly monitored and evaluated to ensure effectiveness as well as cost-efficiency.

To effectively address the social, economic and environmental determinants of health which are often outside the direct influence of health services, health promotion strategies such as those put forth by the Ottawa Charter (1986)²: building healthy public policy, creating supportive environment, strengthening community action, developing personal skills and reorienting health services need to be fully explored in the local socio-economic and political environment. This requires the collaboration between all health and non-health agencies.

References

1. Lee DT, Yip SK, Chiu HF, et al. Detecting postnatal depression in Chinese: validation of the Chinese Edinburgh Postnatal Depression Scale. Br J Psych 1998; 172: 433-7.

2. Charter adopted at an international conference on health promotion. November 17-21 1986 Ottawa, Ontario, Canada. Co-sponsored by Canadian Public Health Association and the World Health Organization.