Y HOC Vl|T NAM THANG 9 - SO 1/2014 6. Elsayed TY, Hassan FM (2013), "Assessment of
platelets count and coagulation parameters among Sudannese patients witn liver cirrhosis", Ri^J, Vol 38, N3, pp 215-218.
Vukovich. Th, H.Teufelbauer, M.Fritzer (1995) "Hemostatic activation in patient with iiver cirrhosis". Thrombosis Reseach, Vol 77, Nn 3 , pp 271-278.
DANH GIA NHU CAU NANG CAO NANG IU'C CUNG CAP DfCH VU Y TE LAO DONG CO BAN CUA HE THONG Y TE DU" PHONG TAI VIET NAM
T6M TAT
Nghien ciiXi tien hanh till" 2009-2010 nhSm danh gid thyt tr^ng kha nSng vS n5ncj lut cua cac dcJn vi trong he thong j te dy* phong va nhu cau nang cao nang lyt cung cap didi vu y t§ lao dong (YTLO) cd ban tai V i ^ Nam. 1190 cd sd dUdc dieu tra bang phieu phong van va khao sat thi/c te du'dc tien hanh tai m$t so ddn w dai dien. Hpi thao v^ ttiao luan nhom' dUdc to chiTc vcfi sU tham gia cua cac can bo quan ly va can bO triTc d^p cung cap djch vu YTLD cd ban tai mot so ddn vj.
Ki?t qu^ nghien citu cho thay Vi?t Nam co he thong YTLD cung cSp djch vy YTLD cd ban tu'dng doi ho&n chinh tir trung udng <Jen cd sd, trong do cac Trung tam Y te dU phong (TTYTDP)/ Trung tam bao ve su'c khoe lao dpng va m6i tru'dng (TTBVSKLD & MT) cac tinh/thanh pho va cac Trung tam y te cac Bp/Nganh la cac ddn vj chii yeu cung cap djch vu YTLD cho doanh nc^hiep va ngu'di lao dpng. Theo kel qua nghien cu^, kha nang va ning luc cua cac ddn vt cung ca^ djch vy YTLD cd ban trong he thong y te dii phong con yeu va han che ve cac miit. Nhan lut cung cSp djch vu YTLDCB con thieu va 6 1 % can bp chu^
dU^c dao tao day dCi ve ITnh vu'c sii'c khoe nghe nghiep. Cd sd vat chS^t cua cac tuyen chuS dam bao cung cap day du cdc dich vu YTLD ai ban cho ngu'di lao dpng: 60-100% cac ddn vi thieu trang thiet bj chuyen npanh. Dp bao phu cung cap d[ch vy YTLO cd ban t?i cac hjyen thap. Tuyen tinh co do bao phii cung cSp dich vu YTLD cd ban tii 2,1-13% doanh nghiep va 3,7-32,8%' lao dpng. Cac Trung tam BVSKLO&MT tinh/thanh pho va Trung tam y te cac Bp/Nganh co dp bao phil cung cap djch vy cao hdn gap 2-5 lan cac TTYTDP tinh/thanh pho. Tuyen huyen co dp bao phii cung cap djch vu y te lao dpng cd ban tir 3,7-28,2%
doanh nghiep va 1-19,4% ngu'di lao dpng. Cac ho^t dpng tuyen truyen ATVSLD cho doanh nghiep va ngu'di lao dpng cd d^ bao phu cao nhat 19,1-28,2%.
Ket qua cua nghien culj da chi ra nhu cau can thiet nang cao nang Iu'c cho cac ddn vj cung cap dich vy y te lao dpng cd ban d cac tuyen ve mpi mSt d \flet Narn.
* Vien Sire khde nghe nghiep va Moi tru'dng Chlu trach nhi?m chfnh; Nguyen Bich Diep Email: [email protected] Dt: 09M.155.008 Phan bien khoa hpc: PGS.TS Tran Thj Ngpc Lan Ngay nhan bai: 22.7.2014
Nguyin Bich Difp*
S U M M A R Y
ASSESSMENT OF THE NEEDS FOR B U I L D I N G CAPACITIES I N P R O V I S I O N
OF BASIC OCCUPATIONAL HEALTH SERVICES I N V I E T N A M This study was carried out in 2009-2010 to aim at assessment of the capacities of preventive medicine facilities at different levels over the country and the needs for enhancing In provision of basic occupational health services (BOHS) in Vietnam. 1190 facilities were investigated by questionnaires and a walkthrough was conducted in some representative facilities at different levels. The workshops and group discussions were organized with participation of managers and staffs involving in BOHS provision at different preventive medicine facilities.
The results showed ttiat Vietnam has a complete occupational health network from national level to grass root level in providing BOHS to workers in which the provincial preventive medicine facilities and different industry ministenal occupational health centers were the key organizations providing BOHS to enterprises and employees. Their capacities of providing BOHS were limited in all aspects. There was lack of competent human resources related to BOHS.
6 1 % of staffs did not receive enough training on occupational health. Ttie infastructure did not ensure to provide the complete BOHS as regulated: 60-100%
of facilities lacked occupational health equipment. The BOHS coverage was low at different levels. At provincial level, the BOHS coverage was from 2.1-13%
of enterprises and 3.7-32.8% of workers whereas at the industnal branches/sectors there was higher by 2-5 times. At district level, the BOHS coverage was from 3.7-28.27o of enterprises and 1-19.4% of workers and OSH infomiation and communication accounted for the highest percentage of coverage (19.4-28.2%).
These findings indicated the needs for strengthening BOHS capacities for all organizations providing BOHS at different levels and in all aspects.
L DAT VAN DE
Dich vy y te lao dpng (YTLO) cd ban la djch vu thiet y§u de bao ve su'c khoe con ngu'di khi lam viec, de nang cao su'c khoe, tinh than va kiia nang lam viec cung nhu* phong tranh benh tat va
Y Hpc VlfeT NAM THANG 9 - S 6 ia014 tai nan thUdng tich. Trong tong so 3 ty ngUtfl lao
dong tren the gidi, tren 80% dang song va lam viec ma khong dUdc tiep can vdi cac dich vu ch'Sm soc su'c khoe nghe nghiep [6]. Viet Nam la mot nude dang phat trien d Oong Nam A vdi dan so nam 2010 la 86,9 trieu ngUdI, trong dd co hdn 49 trieu ngUdi lao dong va tap trung chu yeu d cac doanh nghiep thuoc thanh phan kinh te ngoai nha nude, chiem 86,2% ^S], Theo bao cao cong tac y te lao dpng hang nam ciia Cue Quan ly moi trudng y te," cac hoat dong YTLO cua 63 tinh/thanh pho tren ca hudc hau hit tap trung_d cac doanii nghiep Idn va vita thupc thanh phan kinh te nha nude va co von dau tU nUdc ngoai.
Tuy nhien, theo thong ke loai hinh doanh nghiep nay chi chiem 13,8% trong tong s5 doanh nghiep tren c4 nuflc [5]. Vi vay, cham soc vao bao v6 siifc khoe cung nhu cung cap day du cac djch vu YTLO cd ban cho lUc luWng lao dpng dong dao nay la thach thu'c Icin cho cac nude dang phat trien cung nhU Viet Nam va dSc biet dSi vdi nganh y te.
D l t3ng cudng cung cap djch vu YTLD cd ban cho ngUdI lao dpng cung nhu ap dung thanh cong phUdng phap tiep can djch vu YTLD cd ban trong dieu kien va he thong y te lao dpng Viet Nam hien tai dam bao tien tdi 80-90% ngutJI lao dong CO the tiep can va nhan duBc cac djch vu YTIO cd ban, tien hanh nghien citu dieu tra cO ban nhSm danh gia thUc trang kha nang nang luc cung nhu nhu cau nang cao ning lUc cung cap dich vu YTLD cua cac ddn vj cung cap hien nay trong toan he thong y te dU phong la rat can thiet. Nghien culi dudc tien hanh tif 2009-2010 II. odl TU<I?NG VA PHirONG PHAP NGHIEN COU
2.1. eja d i l m nghiSn cufu: Tat ea cac ed sd y te du phdng (YTDP) tit trung Udng den dia phudng bao gom cac 04 Vien thude he YTDP, 63 Trung tam YTDP/Trung tam BVSKLO & MT cac Tinh/TP, 08 Trung tam y te Bp/Nganh, 336 Trung tim YTDP c^c QuSn/HuyIn, 126 Tr?m y te xa va 653 Tram/phpng y te dpanh nghiep Idn, vu^ va nho tal 63 tinh/ thanh pho tren ca nudc.
2.2. eSI tu'dng nghiSn cihi: Cae can bp quan ly va can bp lam cong tac YTLO tai cac cae cd sd YTDP tren el nUdc; eae so lieu, thong tin vS kha nang, ning lUc cung cap djch vu YTLD cd ban (nguon nhan lire, mIy mdc trang thiet bj, cd sd v|t chat, cac phong thi nghiem va cac xet nghiim; cac so lieu lien quan nhu' quin ly glim sat mdi trudng lao dpng (MTLO), sire khoe ngudi lao dpng, tai nan lap dpng, thong tin, tuy§n tnjySn, tip huan, w .
2.3. Phu'dng p h i p nghien clhi: Nghien ciru mo t l cit ngang eo phin tich
III. KET QUA VA BAN LU$N
3.1. Banh gia icha nSng va nSng Iu'c cung cap djch VM YTLO cd ban
3.1.1. Nhan IfTc cung cap dich vu YTLB cdban
Nhan luc cung cap dich vu YTLO cd ban chu yeu la nff chiem 57%. Tuy nhien, d cac tuyen co sU phan bo khac nhau (ty l§ dao dpng 53,1- 76,2%). Tuoi trung binh ciia nhan lUc cung cap dich vu YTLD cd ban la 38,4 tuoi (tuoi thap nhat 19, cab nhat 70). Tuoi dudi 30 chiem 1/3 tong so. Tuoi tir 31-40 tudi chiem gan 24% va tren 40 tuoi chiem 43%. Tham men trung binh khoang 10 nIm. So can bo CO thSm nien dudi 5 nlm chiem gan 50% va dudi 10 nSm chiem 64%; tren 20 nam chiem khoang 17%. Trinh dd hpc van chii yeu la Trung cap (chigm 55,3%). 38,5% co trinh dd dai hoe v l sau d^l hpc. Ve trinh dp chuyen mon: 28,2% II y si, 16,2% dieu dudng, ky sU/Cir nhan cic nglnh chiem 15,5%. d c bac sT chi chiem 13,6% v l bac sT chuyen khoa VSDT/YTDP ehi chiem gin 1,2%. Phin bd bac si d ele tuyen cd sU khac nhau: 40% d tuyen trung Udng, 20-32,6% d tuyen tinh; tuyen Quan/Huygn tUdng ddi thap (3%) v l tuyen xa la 11,3%. 59%
so can bd da du'dc dao tao cac khoa dao tao ngin han dudi 2 tuan ve ATVSLO v l SKNN; Oao tao cd bin chi chiem 13,3% va dao tao sau d^l hoe chiem 6,7 v l chii yeu d tuyen triing udng;
43,9% dupe dao t?o cd bin v l 13,6% sau dai hoe. Thuc trang cxi cau nhin lUe v l dio tao ciia cac can bp cung cap dich vti YTLO cd bah nSm trong thUc trang ehung ciia he YTDP. Thep bao d p thuc trang nhanJUc eiia Cue YTDP nam 2010 trong DU aii phat trieri nguon nhin lUe YTDP glal doan 2011-2020 [3], can bp chuyen nglnh y H 54% tai tuyen trung u'dng va 68,1% t?l tuyen tinh, trong nghien eUu eiia ehung toi chung cho cac tuyen la 59,2%. CIn bd cd trinh dd sau dai hpc la 18% chung eho el' he YTDP t?l tuyen triing Udng v l doi vdi he YTLO tuyen trung Udng trong nghien eiru nay II 23%. TUdng ty, ^ le d c d n bo ed trinh do trung cap trong hp thong YTDP tuyen tinh II 37% va trong h i thSng YTLD tuyen tinh trong nghiin ciru nay II39%.
3.1.2. Cd sd vit chSt (phdng Iim viec):
trong so d e ed sd dieu tra, 68% ddn v{ bao cao khdng dii diin tich de lam viec. 36,3% ddn vj cd nha xay kleii co trong khi do 20% sd ddn vj cd nhi cap 4/d tam va di d nhd. Cd labo xet nghiem ve SKNN chii yeu cd d tuyen trung Udng (87,5%), trong khi dd 26,4% rac ddn vl tuyin tinh v l 7,1% tuyin quin/huyin ed labo x4t nghiem SKNN.
3.1.3. Khi ninp vi ning IM cung dp djch vu YTIO cdban ddc tuyin
Tuyin Trung u'dng (4 Vlln thudc h$
YTDP): Tat d d e ddn vj cd hau hit d c may mdc phMC vu cung cap djch vu YTLO ed ban.
Y HOC VIET NAM THANG 9 - SO 1/2014
ngoai trCr mot so thiet bi sinh hoa huyet hpc de phuc vu chan doan benh nghe nghiep va nhiem doc nghe nghiep. Ca 4 Vien co kha nang cung cap djch vu do giam sat moi triidng lao dpng (MTLD) ve cac yeu to vat ly, hoa hpc va sinh hoc, ngoai trCr mpt ddn vi khong co kha nang giam sat MTLD ve cacjeu to sinh hoc. Ca 4 ddn vj c6 kha nSng cung cap 42-92% cac dich vu xet nghiem sinh hoa huyet hpc va 33-92% cac xet nghiem khac de phuc vu kham su'c khoe djnh ky, tuyen dung noi chung. £)6i vcfi kham benh nghe nghiep, hai trong s6 4 Vien co kha nang cung cap cac djch vij xet jighiem sinh hoa huyet hpc n^he nghiep de chan doan iienh nghe nghiep va nhiem 6gc nghe nghiep, trong kh| do mpt ddn vi chi c6 the cung cap 10% tron^ tong so cac xet nghiem n^y va mpt ddn vj khong lam du'dc bat cu" xet nghiem nab.
ivySn tinh: Tat ca cac ddn vj co cac may moc va trang thiet bj thiet yeu hien so do giam sit moi tru'dng lao dong (MTLD), trong khi do cac may moc va TTB khac phuc vu lay mau va phan tich cac yeu to vat ly va hoa hoc trong phong thf nghiem hau nhi/ con thieu nhu" may lay miu hdi khf doc (63%); may so mau UV-VIS (64,4%); M^y do bui ca nhan (79,5%); bui trpng luang (46,5%); bui bdng va bui amiang (^B,A%).
VI vdy, doi vdi dich vu do giani sat cac yeu to vat 1^ thong dung trong MTLD, cac ddn vi co kha nSng cung cap day du cac dich vu, ngoai trLr bdc xa ion hoa va diSn tir tru'dng. Doi vcfi bttc xa ion h6a, Sd Khoa hoc va Cong nghe cac tinh quan ly v^ giam sat ve an toan biTc xa, Do vay, nhieu tinh CO TTB, nhuTig khong sir dung. Rat it ddn vj cd kha nang cung cap dich vu do va giam sat yeu t5 hda hpc va sinh hpc trong MTLD (3-10%). Doi
\^i dich vu kham su'c khoe noi chung, hau het die ddn vf cd du cac trang thiet bj thiet yeu cd ban cho c^c phong kham su'c khoe. Doi vdi cac
trang thiet bi chuyen dung cho kham sii'c khoe^
dac biet cac TTB phuc vu kham su'c khoe nghe nghiep, 30-56,2% cac dPri vj cd cac TTB nay nhu"
may X quang di dong hoac co djnh, may do chirc nang ho hap, do thinh Iu'c, dien tim, sieu am, w.
Tuy nhien, cac TTB phuc vu cho cac xet nghiem sinh hoa, huyet hoc chan doan nhiem doc nghe nghiep thi hau het cac ddn vi khong cd. 15,5- 31% cac ddn v[ cd cac may sinh hda phan ti'ch mau va nu'dc tieu noi chung. Vi vay, rat it ddn vj cd kha nang cung cap djch vu cac,xet,nghiem sinh hda huyet hoc nghe nghiep de chan doan benh nghe nghiep va nhiem dpc nghe n^hleg (2- 23%). Tu'dng tiT, doi vdi cac xet nghiem ve da 98,6% cac ddn vi khong lam du'dc; 68% khong do du'dc su'c nghe; 64,4% khdng do du'dc chu'c nang ho hap va hdn 80% cac ddn vi khdng cd kha nang chup X quang phuc vu chan doan benh bui phoi nghe nghiep.
Tuyen Quan/Huyen: It hdn 9% cac ddn vi cung cap djch vu do giam sat cac yeu to ddn gian trong MTLD nhU vi khi hau, anh sang, tieng on. Cac yeu td khac hau nhu' khdng do dut(c nhu*
rung, dien tir tru'dng, biTc x| ion hda. 97-99%
cac Trung tam khong cung cap du'dc cac djch vu iien quan den xet nghiem cac yeu to hda hpc, biii va vi sinh vat trong khong khi. Hau het cac ddn VI chi cd cac may mdc ddn gian, ph6 bien lien quan den cung cap djch vu kham sire khde chung va hau nhu" khong cd cac TTB lien quan den kham sire khde nghe nghiep.
Tuyen xa: Cac tram y te xa g i dii cac trang thiet bj va vdi sd lu'dng dii dung de cung^ cap djch vu cham sdc sire khde ban dau va sd cap ciru va hau nhu" khong cd cac TTB de cung cap djch vu giam sat MTLD va cham sdc sire khde nghe nghiep
3.2. Thu'c trang dd bao phu cung cSfp djch vu YTLb cd ban
Hinh 1:06 bao phii cung cap dich vu VTLO cd ban cho cac doanh nqhiep tai cac TTYTDP Tinh/TP (Hinh trai) va tai cac TTBVSKLD & MT tuyen tinh/TP. va TTYT cac Bp/Nganh (Hinh phai)
„ ,..^^^
- " i ^ ^
N T T ^ ^ J , , ,„,„ i
Tlieo thong ke ciia d c Trung tam YTDP, doanh nghiep va 2,722,168 njUdi lao dpng. NhU TTBVSKLD & MT tinh/TP v l d c TTYT Bp/Nganh, vly, dp bao phii eiia cung rap djch vu YTLD cd tlin dia bin d c Trung tim quin ly cd 39,025 bin chii yeu tir 2,1-13% (tuy vIp timg hpatdpng
Y HOC VIET NAM THANG 9 - s 6 1/2014 va npi dung). Cac ndi dung chiem ty le cao la
tuyen truyen, tap huan ATVSLD bao phu khoang 12-14% doanh nghiep va cho khoang 6,7%
ngu'di lao dong. Do kiem tra MTLD va lap ho sd VSLO bao phil 11-12% doanh nghiep. To chu'c kham SKDK cd dp bao phii 9,9% doanh nghiep va 32,8% ngu'di lao dpng. Kham phat hien BNN bao phil cho 3,7% ngu'di lao dpng (Hinh 1). Thu'c trang dp bao phu thap phan anh bdc tranh thu'c te hien nay ve phan bo lao dpng cung nhU cac doanh nghiep theo cac ttianh phan kinh te. Theo so lieu nSm 2011 ciia Tong cue thdng ke, 13,8%
sd ngu'di lao dpng hien nay dang lam viec trong cac doanh nghiep nha nu'dc va cac doanh nghiep cd von dau tii nu'dc ngoai. Day la cac doanh nghiep Idn va viia va viec thu'c hien cung cap djch vu YTLD cd ban trong cac loai hinh doanh nghiep nay va cho ngu'di lao dpng tot hdn so vdi cac doanli nghiep trong khu vu'c tu" nhan va khong chfnh thu'c, ndi ma so doanh nghiep va ngu'di lao dpng chiem da sd (86,2%) [5]. Thu'c te d Vi?t Nam hien nay, cac ddn vj cung cap djch vu YTLD cd ban chii yeu cung cap cho cac doanli nghiep va ngu'di lao dpng trong cac doanh nghiep Idn. Ket qua nghien ciiu ciia chiing tdi phan anh thu'c trang chung cung cap djch vu YTLD cd ban tai cac nu'dc dang phat trien.
So sanh dd bao phu cung cap dich vu y te lao ddng cd ban cua cac ddn vl tuyen tinh va Bo/
Nganh cho thay cac TT BVSKLO & MT tinh/TP. va TTYT cac Bp/ Nganh dp bao phu cao hdn han cac TTYTDP tinh/TP, cac npi dung kham sire khde dinh ky cho ngu'di lao ddng: gap gan 4 lan (60,4% so vdi 16,3%), kham phat hien BNN: cao gap gan 5 (an (7,3% so vdi 1,6%), do dac, giam sat MTLD: cao hdn 5 lan (34,2% so vdi 6,2%) va cac hoat dong khac cao hdn tir 2-3 lap. Oieu nay eung rat de hieu vi cac hoat dong ciia cac TT BVSKLO & MT tinh/TP, va TTYT'cae Bg/ Nganh vdi nhan li/c va kha nang tap trung vao cdng tac chSm sdc SKNN va cung cap djch vu YTLD cd ban nhiSu hdn so vdi cac TTYTDP tinh/TP, ndi phai dam nhiem cac nhiem vu khac nhu* bao ve va cham sdc sire khde va mdi tru'dng cpng €bng.
Tu'dng ty, tai tuyen Huyen dp bao phii cung cap dich vu y te lao dpng cd ban cho cac doanh nghiep dao dpng tif 3,7-28,2% va cho ngu'di lao dpng tir 1-19,4%, Hoat dpng tuyen truyen ATVSLD cho DN va nguidi lao ddng cd do bao phil chiem ty le cao nhat 19,4-28,2%. Cdng tac t$p huan cho cac doanh nghiep va ngu'di lao dpng cd dp bao phii tir 2,8-8%."sd DN du'dc cac TTYTDP huyen eung cap dich vu do dae kiem tra l^mo ehi chiem 5,7% va lap hd sd VSLO chiem 9,7%. So DN du'dc kham siTc khoe djnh ky chiem 11,5% va so ngu'di lao ddng du'dc kham la
15,2%. Ty le ngu'cfl lao ddng du'dc kham phat hien BNN chiem ty le rat thap (1%)
Tai tuyen xa cac hoat dpng cung cap djch vu YTLO cd ban du'dc thu'c hien chii yeu la cac hoat ddng tuyen truyen giao due ve ATVSLD (gan 40%), to chii'c sd cap cuTu TNTT cho ngu'di dan, ngu'di lao dpng tren dja ban xa (56%). Cac djch vu khac nhu' kiem tra giam sat MTLD, kham siTc khoe djnh ky, lap ho sd VSLO, quan ly ho sd siTc khoe cho ngu'di lao dpng cho cac DN ddng tren dja ban hau nhu" khdng thi/c hien
Cac hoat dpng cung cap djch vu y te lao dpng cd ban du'dc thu'c hien hau het tal cac doanh nghiep dieu tra. Cac npi dung cung cap djch vu y te lao dpng cd ban chiem tren 60%
(61,6-76,3%), ngoai trir ndi dung kham phat hien BNN (32%) v^ thdng ke TNTT tai doanh nghiep (43,5%), Cac doanh nghiep Idn du'dc cung cap djch vu YTLD cd ban tot hdn (chiem tir 47,5-91,4%) so vdi cac doanh nghiep toai vii^
(32,1-76,4%); va DN nhd: (14,7-58,7%), dac biet d ndi dung do dac giam sat MTLD, kham SKDK va kham phat hien BNN,
3.3. Nhu cau nang cao nang Iu'c cung cap djch v\f YTLD ctf ban
Thu'c trang cung cap djch vu YTIO cd ban cho thay nhu cau rat can thiet tang cu'dng nang lire cung cap djch vu YTLD cd ban cho cac tuyen ve mpi mat, dac biet tuyen tinh, va Bd/nganh la cac ddn vj chinh cung cap djch vu cho ngu'di lao ddng va doanh nghiep,
3.3.1. Nhu cau tang cu'cmg nang cao nang Idc cua cac TTYTDP tuyin tinh/TP vi Bi/Nganh:
- Nhu cau vS nhan lire: So vdi chuan quoc gia cac Trung tam YTDP tinh/TP. chi dat 64,2% ve lanh dao khoa va 60,7% ve can bp. Nhu cau bd sung nhan Iu'c chiem 67,3% cac TTYTDP tinh va 62,5% d cac TTBVSKLO-MT va TTYT Bp/Nganh.
Cac TTYTDP tuyen tinh de nghj bo sung nhan lye vdi trinh dp dai hpc va trung cap, trinh dp chuyen mon yeu cau la bac sT, cir nhan va KTV xet nghiem. Odi vdi eae TTYT Bd/nganh va TTBVSKLD & MT yeu cau cac bac sT ciiuyen khoa, cir nhan YTCC va cac cdng viec dam nhiem cho cdng tac SKNN, xet nghiem sinh hoa huyet hpc NN, kham BNN, w ,
- Nhu cau v^ trang thiet bj; tir 68,7 den 78,2% cac Trung tam cd nhu cau bd sung may mdc TTB de phuc vu cdng tac SKNN va chii yeu cac may mdc kham sire khde va kham BNN (43,7-78,2%) va do giam sat MTLO (43-63,6%)
Y HOC V|£T NAM THANG 9 - SO 1^014 - Nhu cau dio tao can bo: Oa sd cac ddn v| cd
nhu cau dao tao d tat ca cac ndi dung cua cdng tac SKNN tir do dac, giam sat MTLD, den kham phat hien BNN va giam sat TWTT. Hinh thu'c dao tao chii yeu la tap trung va khoang du'di 50%
ddn vj de nghj dao tao kem cap va tuy vao tirng chiide
3.3.2. Nhu cau ting cu'dng ning cao nang lite cua dc TTYTDP tuyin quan/Huy$n:
- Nhu cau wl nhan ly'c: Tat ca cac TTYTDP tuyen quan/huyen hi?n nay deu cd nhu cau bo sung nhan lyc cho cdng tac SKNN vdi yeu cau trinh dp chuySn mon la cac bac sT va KTV cd trinh dp dai hoc, trung cap dam nhiem cdng tac SKNN t^l tuyen qu?n/huyen
- Nhu cSu ve TTB: TSt ea eae TTYTDP tuyen quan/huyen (99,4%) cd nhu cau bd sung cac TTB va may mdc phuc vu eung cap djch vy y te lao dpng ed ban. 58% cac TTYTOP quan/huyen cd nhu cau ve may mdc va TTB phuc vu cdng t^e kham BNN, giam sat MTLD va mot sd may mdc thiet bj xet nghiem sinh hoa huyet hpc - Nhu c3u v% dao tao can bd: Tat ca cac TTYTDP tuyen quan/huyen cd nhu cau dao tao can bo vdi ndi dung dao t^o lien quan den h3u het cac ndi dung cung cap djch vu YTID cd ban ma tuyen quan/huyen dam ntian
3.3.3. Nhu C3</ tSng cudng ning cao ning Idc cua cac Tr^m y ti'Xa:
• Nhu c3u vil nhSn ly'c: Hau het cac Tram y te Xa cd nhu clu bd sung nhan lye vdi trinh dp chuyen mdn la cac bac sT, y sT, cd trinh dp dai hpc, trung cap dam nhiem cdng tac y te tai tram va then khai i sd npi dung ve SKNN.
- Nhu cau ve TTB: cac tram y te xa chu yeu cd nhu rau bo sung cae TTB phuc vu cong tac sd cap ciru ban dau
- Nhu ^ u v'S tfao tao Ccin bo: 74% tram y te xa ed nhu cau dao tao ve cac ndi dung li^n quan den cun^ cap djch vu y te lao ddng cd ban nhu' danh gia cac yeu td nguy cd, cac tac hai tai ndi lam viec, giam sat MTLO, chan doan BNN, l$p va quan ly ho sd su'c khde ngu'di lap dpng, ghi nhan va giam sat TNTT, xay dyng cpng dong an toan, nang rao su'c khoe cho ngu'di lao ddng
3.3.4. Nhu diu tang cuia^g nang cao nang l(/t aia dc edsdy te tuyin doanh nghl0p
• Nhu cSu vS nhSn Iu'c: 39,2% cac cd sd y te doanh nghiep cd nhu cau bd sung nhan lyc vdi trinh dp chuyen mdn la cac bac sT, y sT, cd trinh dp dai hoc, trung cap
- Nhu c3u vS TTB: cac TTB phuc vu cdng tac sd cap CLFU ban dau du'dc de nghj bo sung nhieu
nhat (22,1%) va vdi ty te nhd cd nhu cau ve mdt sd may mdc chuyen dung kiem tra giam sat MTLO va kham BNN (5,1-6,4%)
- Nhu cau ve dao tao nhan Iu'c: nhu cau dao tao can bp vdi cac chii de nhu' cac yeu td nguy cd, cac tac hai tai ndi lam viec, sd cap ciru ban dau tai nan lao dpng, sd cap cifu dien gtat va nang cao syc khoe cho ngu'di lao dpng, w (30-40%) IV. KET LUAN VA KIEN NGHj
Ket qua nghien OJIJ da chi ra nhan lyc cung cap djch vu YTLD ed ban cdn thieu va 61% can bp chuS du'dc dao tao day dii ve ITnh v\Sc sii'c khde nghe nghiep. Cd sd vat chat ciia cac tuyen ehu^ dam bao cung cap day du cac djch vu YTLO ed ban cho ngu'di lao dpng (60-100% c0 sd thigu eae thiet bi chuyen nganh). Nang lyc cung cap djch vu y te lao ddng cd ban eiia c^c tuyen cdn yeu va han che. Dp bao phii eung cap djch vy y te lao ddng cd ban tai cae tuyen thap(Tuyen tinh:
2,1-13% doanh nghiep va 3,7-32,8% lao dpng;
Tuyen huyen: 3,7-28,2% doanh nghiep v^ 1- 19,4% ngu'di lao ddng).
Can thiet phai nang rao nang lyc eho cac ddn vj cung cap djch vy y te lao ddng ed ban d cac tuyen ve mpi mat nhu' nhan lyc, cd sd vat chat, trang thiet bi, dao tao nhan lyc. Can t3ng cudng ciing CQ vh bd sung mdt sd hoat dpng trong ndi dung cung cap djch vy y te lao ddng ed ban ciia cac ddn vi trong thdi gian tdi, CIn ti§p tuc nghien ciTu chat lu'dng dich vy y te lao ddng cd ban du'dc cung cap tai Viet Nam vi nghien cxiu nay do mdt sd han che chi duYig Iai nghien ciru thyc trang kha nang, nang lyc cung cap djch vu y te lao ddng ed ban ve mat sd lu'dng, ehu^ dl sau nghien cyu chat lu'dng cung cap djch vu T A I U i u THAM KHAO
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