DU' PHONG TAl cAc TfNH MIEN TRUNG , vA TAv NGUYEN VII

THU'C TRANG vA ^NHU cAu NGUON NHAN LU'C BAc st

TRONG 'HE THONG V Tt: DU' PHONG TAl cAc TfNH MIEN TRUNG

, vA TAv NGUYEN VII;T NAM NAM 2013

VQ VAN THANG, LE DiNH DU'O'NG, DoAN VU'O'NG DIEM KHANH, HOANG DiNH HUE, NGUYEN HOANG THUY LlNH

HOANG DiNH TUYEN, TRAN BiNH THANG TrU'iYng

fJ{Ji

h9C Y DU'C)'c Hue

TOMTAT

Ml,lctieu: Nghitm cou mo ta tnuc trgng nguon nMn 1l)'C,cac nang lire va k9 nang can thiet cue cac bacs9lam viec trong h~ thang yte dl)'phOng va nhu ceu tuyim dl,mg, cIao teo nguon nMn 1l)'Cnay tet khu V(J'cmi~n Trung va Tay Nguyen, Vi~t Nam.

PhU'O'ngphap nghien CLPu:Sif dl,mg phU'ong pheo nghien

cuu

^{ket hop.} Nghien cou ajnh 1U'Q'ng

auoc

thl,fChi~ntren

423

bsc

s9 (76,8%). Bo

ceu

no!

tir ai~n aU'Q'csif dl,mg

ae

thu tMp

cac

thOng tin v~ a~c cIi~mdan toc hoc, tinh trgng cong viec va cac k9 nang lam viec. Nghien cou dinh tinh aU'Q'ctien bent: tren 27 bac s9(3phOng van seu va 3tMo lu~n nh6m).

Ket qua: Do tu6i trung binh cue aai tU'Q'ngnghien cou

46,6

±

6,5;

sa nam lam viec trung binh la 13,26

±8,39;nam chiem

69,7%),

nCf:30,3%. Nhi~m VI,I va cong viec chfnh cue

cac

bee

s9

chu yeu la quen 19va giamsatchung

(59,8%);

cong tee chuyen mon dl)' phong (20,1%); aieu trj

(19,4%);

^{quen 19}

cae

^cturonq

trinh, df,J'an

y te ^(11,8%);

I~p ke hoect: chi agO tuyen (10,4%); t6ng hQ'pva beo cao

(6,1%). C6

^{Sl)' thieu} h1,ltcIangke nguon nMn 1l)'Cbee

s9

lam viec trong

M

thang y te dl)' phong

a

^{tat ca}

⁶

tinh;chi c6

17,7%

(9/51) cIonvi tuyen tinh c6 au ajnh moc bien cM bee

s9

^{theo quy} dint:

Khaosat tren

182

k9 nang chia thBnh

2

nh6m nang 1l)'C: nh6m nang lire chung

(9

nh6m vo!

98

k9 nang),nh6mnang lire ^CI,I tM

(11

nh6m voi

84

k9 nang). Tan suat sif dl,lng thU'ong xuyen

cac

nh6m nang II,fCchung la49,6%; nh6m nang 1l)'CCI,I the la 38,2%.

Ket lu~n:

C6

sir thitJu hut aang ke nguon nMn lire

Mc s9

lam viec trong

M

tMng

y

ttJ dl)'phOng tel khu VI,fCmi~n Trung va Tay Nguyen. Nghien cou cho tMy can thitJt tang cU'ong aao teo va aao teo Igi cho h~ th6ngy

te

^dl)'phOng te! khu VI)'C nay.

TIPkh6a: Nguon nnen 1l)'C,

M

^{thang yte dl)'phOng, bee s9,} nang lire, k9 nang.

SUMMARY

Objectives: This study describes the real situation of human resource and needs of recruiting doctors working in the preventive medicine system in central and highland areas of Vietnam.

Methodology: The study used

a

^{mixed method approach.} A total of

423

^{doctors (response} rate=76,8%)participated in the quanlitative survey, of which provincial levels occupied

64.8%

and district levels were35.2%. A self-administered questionnaire was used to collect information about demographic characteristics,job conditions and technical competencies.

27

doctors participated in in-depth qualitative interviewsand focus group discussions.

Results: The average age of the doctors was

46.6

years (s.d=6.5) and the majority

(69.7%)

'were male. On average, they had worked in this role for 13.3 years (s.d.=8.4). The main roles of the doctors included program management and staff supervision

(59.8%),

duties! major of preventive medicine (20.1%), managing treatment services

(19.4%),

and medication management

(11.8%).

Further tasks includedmakingplans and guidelines for disease control (10.4%), data analysis and report writing (6.1%).

In-depthinterviews revealed

a

^lack

of

doctors in preventive medicine systems in all six provinces. Only 17.7% (9/51) ^provincial units had enough doctors to meet service requirement.· The survey identified

a

total of 182 ^skills. These were grouped within "general competencies"

(9

^{groups with}

98

skills) and 'specific competencies" (11 groups with

84

skills). However, less than half

of

the doctors reported using the general and specific competencies

(49.6%

^and

38.2%

respectively).

Conclusion: There was aserious shortage

of

human resources for preventive medicine in the central highlandareasofVietnam. There should be increased recruitment. The findings ofthis study also will be usedtoenhance professional training for preventive medicine at pre-service and in-service levels.

Keywords (3-5):Human resource, preventive medicine system, doctor, competency, skill

YHTH(880) - HOI NGH! KHOA HQC B~NH VI~N QUAN THO one TP. H6 CHf MINH 9

I.DATVAND~

Y t~ 'dl,J'phOng la cau noi gili'a y hoc va y t~ cong cOng. Trong khi y hoc quan tam d~n chan dean va d tri benh cho mot benh nhan thi y t~ cong cong quan tam nhieu

hon

d~n phOng benh va nanq cao SLYCkt cho cong dong. Theo bao cao cua WHO - 2006, tinh tranq thi~u hut nquon nhan

tuc

y t~ dang ton tal

a

quoc gia, th~ gi6'i dang thieu khoanq 4,2 trieu nhan vien y t~. U'6'c tinh tai khu Vl,J'CDong - Nam

A

^co

50% cac quoc gia thieu can bo y t~

voi

so ILI'Q'ng

hon

1 trieu nhan vien y t~ [5]. Theo So Y t~, ViEiltN dLl'Q'cxep vao

nuoc

nhli'ng

nuoc

co ty IEilnhan vien y t~ cao (> 5 bac 59 tren 10.000). Tuy nhien, ngl nhan Il,J'C

X

t~ ViEilt Nam lai p~an ~o mat can doi gili'a c~c ~ung, mien, gili'a cac chuyen nganh[1]. DOi.r can bo y te dl,J'phonq vua thieu ve so ILI'Q'ngvua han che ve trinh do chuyen men, so ILI'Q'ngcan bo y te phonq tai cac tuyen tlnh co trlnh do DH va SDH chiern ty IEilchua t6'i 50%. Hau het bac 59 dang lam v trong hEilthong y t~ dl,J'phonq hien nay la bac 59 da khoa khong

duoc

dao t<;10chlnh quy ve linh Vl,J'Cy t~

phong rna chu y~u qua mot so kh6a dao t<;10ng~n han, cac lop tap huan va kinh nghiEilm lam viec cua

t

than. HEilthong Y t~ dl,J'phonq tai cac tlnh Mien Trung va Tay Nguyen cOng dang

a

trong tinh tr<;1ngchi cua hEilthong y t~ dl,J'phong ca

nuoc,

Muc tieu nghien CLYUcua de tai nharn:

1. Tim hifJu

tturc trenq

ngu6n nhen IIIC bee s9 clang lam viec trong M th6ng

y

ttJ dll phOng tei

J

V(.fCmien Trung va Tay Nguyen.

2. Mo ta cong

viec,

nang IIIC va k9 nang c~n thiM

cue

cac bee s9 hi~n clang lam

viec

trong M the

y

ttJ dll phOng

3. Tim hifJu nhu c8U clao t<;30va tuyfJn dl,Jnfl cl6i voi bee s9 trong ITnh vue

y

ttJ dll phOng t<;3ikhu

V(.J'I

II. D01 TU'Q'NG vA PHU'O'NG PHAp NGHIEN cuu

Thi~t k~ nqhien CLYUrno ta cat ngang. Sli dunq

phuonq

phap nqhien CLYUk~t

hop

gili'a dinh ILI'Q'ng dinh tlnh.

PhLl'O'ng phap nqhien CLYUdinh ILI'Q'ng:Sli dunq thang do danh gia cac nanq

luc

va

ky

^{nang BS YT}

voi bo cau hoi tl,J'dien d~ thu thap so liEilu

dua

tren 10 nh6m nang

luc

chung va 10 nh6m nang

luc

CI,Jthe thi~u cua 1 bac s9 YTDP ViEilt Nam

duoc

phat trien trong nqhien CLYUnhu cau dao t<;10bac s9 y hoc phOng tal cac trLl'cmg dal hoc Y ViEiltNam cua Dl,J'an Nuffic narn 2008 [3]. Mot bac si dLl'Q'cdanh gia la dl,Jng

thuonq

xuyen mot nh6m nang hrc khi co sli dunq it nhat 50% so nang hrc trong nh6m nang

luc al

rmrc dO thLl'ong xuyen tra len. Nqhien CLYU

tham

do d~ hieu chlnh bO cong CI,J

duoc thuc

hien tal trung tal t~ dl,J'phonq thanh pho Hu~ va tham van cua cac chuyen gia, ngLl'oi quan Iy trong hEilthong y t~ dl,J'pho Nghien CLYUdLl'Q'ctien hanh tal 6 tlnh: Quang Sinh, Quang Tri, ThCYaThien Hu~, Quang Ngai, Sinh Dinh Daklak voi 116 don vi tham gia nqhien

cuu

(tuyen tlnh 51, huyen 65); Chon mau toan bo co t6ng cong ~ bac s9 tham gia nqhien

cuu

ty IEilla 76,8% (tuyen tinh la 64,8%, tuyen huyen/thanh pho 35,2%).

Nghien cuu ^{dinh tinh}

duoc thuc

hien tal 3 tinh: ThCYaThien Hue, Quang Ngai va Daklak co t6ng c~

27 bac s9 tham ,gia ,(3 p'h6ng v_ansau lanh dao va 3 thao luan nh6m).

III. Kt::T QUA VA BAN LUAN

1. Th,!c tr~ng ngu6n n'han I,!c bac

si

dang lam vi~c trong h~ thong y t~ d,! phonq tal 6 ti mi~n Trung va Tay Nguyen

(s6 lieu beo

cao

cue cec sa y ttJ 1212012)

Tu ~n tinh Tuyen huyen

~~~~~---

4S04001...---....,·

3S0 3M 2S0 2M 150 100

50

o

Quang QlI<ing IT Hue QU4ng einh {)ilk Sinh Tri Ngai Ojnh Uk

4S0 400 350 300 2.50 lO{) lS0 100

50

{)

euo (fo

1:

Phan bo so lU'9'ng CBYT va BS lam vi~c t~i cae tuytm YTDP

100% cac tlnh co ty IEilbac s9

1

CSYT

a

tuyen tlnh cao non so voi tuyen huyen.

4/6

tlnh co ty IEil

bac

lam viec tal tuyen tlnh cao hon so v6'i tuyen huyen d~c biet ty IEilnay tal TT-Hu~ la

3,6/1

10 YHTH (880) - HOI NGH! KHOA HQC B~NH VI~N QUAN THO BaC TP. H6 CHI Mil

Bang

1: Thuc tranq

ngubn

nhan

Il,I'cy te

hien

nay

Stt Dan

vi

Can bo

v

te Bac s-

1. Tuven tinh So tinh thieu TVI~% So tinh th~u TVI~%

2. TTYTDP tinh 2/6 33,3 4/6 66,7

3. Chi Cl,lcVSAITP (-) (-) (-) (-)

4. IT PC benh xiihoi 1/3 33,3 2/3 66,7

5. IT PC HIV/AIDS 5/6 83,3 4/6 66,7

6. ITCS-SKSS 2/6 33,3 5/6 83,3

7. Chi CI,IC DS-KHHGD ^{(-) (-) (-)} (-)

8. TT Truven thonQ GDSK 2/6 33,3 6/6 100

9. TT PC Sot ret noitiet- CT 2/5 40,0 4/5 80,0

10. TT Kiem dich quoc te 1/1 100,0 1/1 100,0

11. TT Da lieu (-) (-) (- ) (-)

12.. Tuven huven 2/6 33,3 5/6 83,3

(-): Cacdon vi khOng c6 dinh

moc

bien cha theo Thong

tir

⁰⁸

Tat ca cac tinh tham gia nghie!n CLPUd~u thieu nhan Il,I'c & cac don vi true thuoc.chl c6 17,7% (9/51) don vi tuyen tinh c6 du dinh rmrc bien che bac sy theo quy dinh; trong d6 cu thll tlnh tranq thieu BS &

cac don vi nhu' :TTGDSK (6/6); TTCSSKSS (5/6); TTYTDP tlnh, HIV/AIDS, PCSRNT (4/6).

Ket qua tli

nqhien

CLPU

dinh

tlnh cOng cho thay c6

su

thieu hut ro ret ngubn

nhan

Il,I'c CBYT

va bac

si lam viec trong h$ thong YHDP

&

hau het cac don vi tham gia nqhien CLPU:

"Ttwc tr<;lngngu6n nhan tuc bee

s9

^{n6i chung,} bee SI YTOP n6i rieng thiau rc1tnhieu

so

vo! nhu c8U.

vd:chiCl)C v~ sinh ATTP chi c6 1bee

s9,

chi Cl)C ka boect: h6a gia dinh cb! c6 1

as,

can

cac

trung tam kMc chi

c6 2-3 as ....

^{Trung tam}

y

ta Tay Tre,

vue

^lam

a

mang dieu tri

vue

^lam

a

mang dl! phong chi c6

3 as' (PVS-QN).

"sovai nhu c~u tnuc ta ...

a

^{tren, tinh thiau khoang 30%}

^as

cho h~ dl! phong.

C6

nhCmg huy~n can hon nhung

em

tinh trung binh la khoang 40%" (PVS-DL) .

• 2. Cong vi~c, nang

IIfC

va

ky

nang celn thi~t cua cac bac

5y

hi~n dang lam vi~c trong h~ thong

y tf!dlf

phong

100 90

80 70 60 50 40 30 20 10

o

• Tuyen huy~n - • Tuyen tinh

QuangSinh Quang Tri Thira Thien Hu~ Quang Ngai Sinh Dinh Daklak

Bieu

do

2:Phan bo not cong tsc cuabac

sy

YTDP theo tuyen cham

see

Phong van tren 423 bac sy dang lam viec trong h$ thong y te dl,l' phOng cho thay dO tuoi trung blnh cua cac doi tU'Q'ngnghien CLPU 46,6

±

6,5; so narn lam viec trung blnh 11313,26

±

8,39;

Nhiern

VI,J

va cang viec chfnh cua cac bac sy chu yeu 113 quan 19va giam sat chung (59,8%); cang tac chuyen man dl,l' phonq (20,1 %); di~u tri (19,4%); quan 19cac

chuonq

trlnh, dl,l' an y te (11,8%); lap ke hoachchi dao tuyen (10,4%); tong hop va bao cao (6,1 %).

Nghien cuu ky nang bac sy dua tren 2 nh6m nang Il,I'C chfnh 113 nh6m nang Il,I'cchung

(9

nh6m), nh6m ni:lngIl,I'c

CI,J

the (11 nang luc); tong cong c6 182 ky nang. Nghien CLPUtan suat

Slf

dl,lng cac nh6m nang Il,I'ccho thay: ty 1$ SLYdl,lng thU'ang xuyen nh6m nang Il,I'c chung 11349,6%; nh6m nang Il,I'c Cl,l thll 113 38,2%va c6 Sl,I'khac nhau gilia tuyen tinh va huyen (p

<

0,01).

YHTH(880) - HOI NGH! KHOA HQC B~NH VI~N QUAN THO one TP. H6 CHr MINH 11

100

90

80 70 60

50 40

30

20

10

o

_Ho~t~vi. Oi&odl,l<t:u~

ch~t.dnhy thongvi.ning ti quoc ~a cao.u.: kh"e

Quanlyvi.t3 chu.:yti

Chlnh .achvi.

lu~tyti

N!!PiencUu Cangvi~clrong khoa hoe ph/mglhl

n!!Pi~m

.TYl~ %SD NL tlnrongxuyen

illTYl?Al danh gia dntlll~t BitJU do 3:Phan

bo

^{tan suat}

va

m{PC;de) can thiet

cue

nh6m nang It,J'cchung 100

90

80

70

60

50

40 30 20

10

o

Ve chat Iuvng nguon nhen ./t,J'C:Phan lon cac don vi dap ling dU'Q'c yeu cau nhiern VI,! ve YTDP dU'Q'cgiao. Tuy. v$y, nang luc heat dong, chat.

1U'Q'ngva hieu qua conq viec chua cao, con b]

dong trong cong taco "Dap (mg hi~n nay theo

muc

a(>

no!

chung la, n~u

me

chia theo

mire

a(> thi cOng la trung binh hay gQi la aap Ifng tioen thent: nhiem

VI) thOi, moc hoen tnenh nhi~m VI) ctur cture th~

not

^{la t6t bon}

duoc

^mfa... chi moi a<;lt aU'Q'c

mire

t6i thi~u cho la tioen thenh nhiem VI) cnir

cnue

auoc non

mfa ... Kinh phi khOng co, ngu6n

nnen

iuc khOng au thi co lam theo ki~u aoi

co

^{diet: atJn}

la ta ch6ng, khong

a~

cno d;ch Ian xay ra. ....

chUng ta moi chi lam atJn aU'Q'cmoc a(>khi

co

^diet:

atJn thi chung ta kMng chtJ va d{)p t~t duoc n6."(PVS-EJL)

"Nang tuc cong tee mang YTOP

a mire

^trung

binh ..... Du thl)'c hi~n

va

hoen tnent: nhiem VI), tuy nhien kha nang

a~

aap Ifng kh6i 1U'Q'ngcong viec

QuanIy Antoan va Sire khoe Dinh dirong Sirekhoe Sirekhoe NhankhAuDichtS hoe Th&ngke Nhanhoe nang life h6 thamhoa va sirekhoe m6itnrong va an roan caclira tubi hoeduong hoe va kiem sinhhoc/he vayxii hOi tro

phong nghSnghiep thtrcphamva sirekhoe soat benh thong thong hoe

chong sinhsan t~t tinytS

tlurong tieh

Bieu do 4: ^Phan

bo

^{tan suat}

va

m{PC;de) can thiet

cae

nh6m nang It,J'CC(.l the

trong tinh hinh b~nh diet: pturc t<;lPhi~n nay thitJu nhieu.(TLN-QN).

Mot so can bo chua yen tam conq tac vacon tU'cYng chu quan, thieu

y

^{thirc hoc hai,} cau

"nnin chung noet a(>ng r~t t6t ntumq

co

1 86ng khOng an tam voi cong viec

cur

phOng, c6 ngU'oi

aa

^{chuy~n sang}

M

aieu tri. "(PVS-QN)

"Vi va ctiem va

eo

^Il)'c

a

^cong

tee

^{YTDP kh}

nhieu nen nhieu

as

^{ctiu quan, it} muon hQc nang cao trinh a(> a6i vo! cong tee YTDP" (~

QN)

'3.

Nhu c&u

dao tao va

^tuy~n

dl,lng nhan

y t~

dlf

phong tilli

cac

tinh

Nghien cuu cho thay nhu cau tuyen dl,mgn luc can bo y te, d~c blet la nhan Il,I'C bacsi viec cho h$ thong y hoc dl,l' phonq 113ratIan

a

ca

6tlnh. 95,5%

cac

don vi

y

te dl,l' phongc6 cau tuyen dunq tCr1 - 12 bac sy (trung binh bac sy/dO'n vi). Phang van sau mot lanh

dao

12 YHTH (880) - HOI NGH! KHOA HOC B~NH VI~N QUAN THO BaC TP. H6 CHIM

THIlt ^TR4NG vA NHU cAu NGUdN NIlAN Lilt BAc st TRONG He TH4NG y Tt DU PHUNG TAl cAc TiNH MI~N TRUNG vA TAy NGUYEN...

Va Van n,&ng. D06n Vuong Diim Khanh. Hoang Dinh Hue •.•.

BANH GIA TINH HiNH sir DUNG AUUMIN TAl BENH VlEN Qu4M THU BUt THANH PH4 Hd CHi MINH HiM 2012

Nguy6n Minh Quan. Hang Lt My,

I ;;

IAru

HuYnh NgQC Dung,

Yo

PhUng

9UY~J \

I ~~XUlIIGVAM6TS6ytUTliL~

a ^NGoo1 ~61 TRa LlN T4I"1HA!tH PH4 Hd CHi h-IINH•••

D 0VVn DOng. Nguyen Va T(iP'.

D Anh • Nguy - g Hcia