DANH GIA NHU CAU DAO TAO CUA C A N BO QUAN Lt
TRONG Hi THONG Y TE TUYEN TINH, HUYEN TAI TINH CAO B A N G , BAC KAN
TOM TAT
Vi$c ning cao kiin thOc vi quin Ip vi l$p ki ho^ch cho cic cin b^ quin ip y ti tuyin tlnh. huyin li rit cin thiit va gdp phin ding ki vio viic ning cao hi$u qui dich vg chim sdc sOC khde cho ngudi din. Di xiy dung chuang trinh vi ndi dung dio d^o phO hgp vdi nhu ciu thuc tiin, di/in "Hd trg chinh sich khim chQa b$nh (KCB) cho ngudi nghio" do Chinh phO Luxembourg tii trg tiin hinh thUC hi$n dinh gii nhu ciu dio cda cin bd quin ly tuyin tlnh, huy^n t^i 2 tlnh Cao Bing, Bic K^n. Kit qui nghiin cOu cho thiy hi$n tai vin cd khoing cich khi Idn giOa kiin thi/c, kp ning vi quin ly so vdi nhu ciu cin thiit cOa cing vl$c. Mdt tmng nhOng Ip do cd bin li tp Id cin bd dugc tham gia khda dio tao vi quin ly cdn thip. cdn lai gin 3/4 dn tjd quin Ip chua dugc tham gia bit cO khda dio tao nio vi quin Ip. NSm tfnh vuc cd nhu ciu dugc dao tao nhieu nhit li: Lip ki hoach y ti; Quin ly tii chinh y ti;
Kinh tey ti vi BHYT; Quin Ip nhin luc y ti; Quin lp chat lugng.
Tukhoa: Dinh gii nhu du dao tao, dao tao quin Ip, nhu du dio tao. quin Ip binh viin,...
SUMMARY
Improvement of management knowledge and skill for the health managers at provincial and district level is essential to contribute significantly to increase the efficiency of health care sen/ice pmvision. With the aim of developing tmining programs appropriate to the real needs, the project "Support to the health cam policy for the poor" funded by the Luxembourg Government conducted tmining needs assessment of staff management of provincial and district levels in two provinces of Cao Bang, Bac Kan. Study findings show that there are still big gap between the current management knowledge/skill and working need mquired. One of the masons is the low rate of health managers attended management training courses, remaining neariy three-quarters managers are not involved any kind of training program for managers.
Five amas am in the greatest need of training am:
health planning, financial management, health economics and health insurance, Humance resource management; Quality managemenL
Keywords: Training need assessment, management tmining, TNA, hospital management,. .
DAT VAN D i
Xuat phat tir bdi canh cde chinh sdch y te, tdi chinh y te lien tuc dupc ban hanh, bo sung, suia ddi trong vdng 10 nam trd lai day nham dap Cfng su phdt then va nhu eau cham sdc sflc khde ngudi dan, dac bidt quan tdm den ngudi ngheo, can ngheo va cac nhdm ddi tuong xa hpi. Doi hoi cae can bp quan IJ y te can cd kien thflc ve quan I;? benh vien, kinh te y te, tai chinh y
NGUYIN TH! THOY NGA H O A N G T H I PHUpNG, BUI THI N'Y ANH t l n h i m dap img vdl su thay ddi ldn cfla chinh sdch.
Vide ndng cao k i l n thfli:: v l q u i n ly vd lap k l hoach cho cde edn bp quan Ij? y t i tuyin tlnh, huyen noi chung, Id r i t c i n thilt gdp p h i n ddng ke vao vide nang cao hidu qua djch vu chdm sdc sflC khde cho ngudi ddn ddc biet. De xdy dung chuong trinh va ndi dung ddo dao phfl hpp vdi nhu cau thUC tidn, dU an H o trd chinh sdch khdm chijfa bdnh (KCB) cho ngudi ngheo"
do Chfnh phfl Luxembourg tdt trp t i l n hdnh danh gia nhu c i u ddo cfla can bd q u i n ly tuyen tlnh, huyen tai 2 tlnh Cao Bang, Bac Kan trong thang 4 ndm 2013.
PH JONG P H A P NGHigN CCOJ 1. Thie't ka ddnh gid,
Thiet k l nghidn cCfu cat ngang cd phdn tich so sanh, k i t hpp phuong phap nghien cflu ^ n h tinh va djnh lupng, tidi cflu so lidu, thdng tin san cd.
2. Ooi tupng danh gia.
Tuyin tmng uang: Dai 3\en lanh dao Vu K l hoac^- tdi chinh, Vu Khoa hpc dao tao, Bp Y te;
Tuyen tlnh: Lanh dao UBND tmh; Can bp lanh dao cfla SYT va cac ddn vi y te true thupc tlnh (khdi dieu tri vd du phdng); can bo lanti dao BHXH, phu trach BHYT; dai dien lanh dao ngdnh LD-TB-XH;
Tuyen huyen (6 huyen tai 2 tlnh thupc dU dn): Lanh dao UBND huyen; BV huyen/TTYT huyen; Dai dien lanh dao BHXH huyen, phu trach BHYT; dai dien lanh dao nganh LO-TB-XH.
3. Thdi gian tien hanh danh gia: Danh gid dupc t i l n hdnh vao thang 4/2013.
4. C d mau va chpn mau.
Phdng vin dn t>0 quin Ip tuyin tinh huyen thong qua hinh thOc phat vin bd ciu hdi tudiin:
Cd m l u : ap dung cong thijic tinh cd mlu nglu nhien ddn:
^ p x q x e
n: cd mdu (sd can bd quan ly dupc lua chon de phat v i n )
p= 0,5 de cd cd m l u tdi thieu Idn nhat q = 1 - p =0,5
z = 1,96 (a = 0,05 img vdi dp tin cay 95%) d: Tl Id sai sd cho phep trong nghien ciifU ndy duac chpn Id 0,1
e: Hd sd hieu qua thiet ke vdi e=2
Thay sd vdo cdng third trdn ta cd n = 192. lam tron thdnh 200. Tren thuc te, tong sd phieu thu ve ia 207 phieu, trong dd 96 phieu cfla Bae Kan va 111 phieu cfla Cao Bang.
Chpn mdu: Sfl" dung phuong phap chpn ngau nhien hd thdng d l \da chpn ddi tupng tham gia dieu tra cho d i n khi dat dupc c3 mdu can thilt.
Y H p c THVC H A N H (878) - S 6 8/2013
5. Phan tich so lidu va viet bdo cao.
- Sd lidu dinh lupng dupc lam sach va nhdp bang chuong trinh epidata 3.1, Sijf dung chUOng trinh SPSS 17.0 de phan tfch sd lieu. Cdc thdng sd dupe tfnh toan bao^gom: gid trj %, gid trj p, gia tri tmng blnh, do lech chuan.
- Thdng tin tSnh ti'nh thu dupe tfl" RVS va TLN dupe gd bang vd phdn tich bang phuang phdp ma hda md (Open-coding) theo tflng chfl d l .
KET QUA VA B A N LUAN
1. Ky nang va nang luc quan \p cua cac can bo quan ly tuyen tlnh huyen.
1.1. Mgt sd thdng tin chung vd ddi tugng dinh gia.
Cdn bp quan IJ tham gia phdng v i n deu d dp tudi tir 30-49, chilm ^ le kha cao d ca hai tinh Du an (70.8% d Cao Bang va 63.1% d Bac Kan), dd tudi 50- 60 (29%) vd nhdm tudi <30 chiem tJ le t h i p (4,3%) So sanh v l t$ id nam vd nilT chung gifl ciiong vj quan ly d ca 2 tinh cho t h i y tp Id cdn bp quan l^ la nam gidi cao hon so vdi nfl gidi (55,1% vd 44,9); Trong sd cac ddi tupng tham du phong v i n chfl y l u Id trudng, phd cac khoa phdng (58,9%) va cac gidm ddc/phd giam ddc (23.2%). Da sd cdn bp phdng van Id cdn bp nganh y te (72,3%), can bd nganh BHYT chilm 6,3%, nganh LD- TB-XH chiem 8,2%.
Ve trinh dp chuyen mdn, p h i n Idn can bp dUOe phong van cd diuyen mon y khoa (55,6%), can bp cd chuyen nganh tai chinh ke toan (17,4%), can bd cd chuyen nganh quan tj ehiem tJ le kha thap (3.4%). Ve trinh do hpe van, 41,5% can bo cfl trinh dg dai hoc, hon 1/3 edn bp trinh dp thac sT, chuyen khoa I vd II (37,7%). T j Id cdc can t>p quan \j cd ban md ta eong viec chiem g i n 2/3, tuy nhien vdn edn cd khoang g i n 40% can bp quan ly chua cd ban md ta cdng viec.
1.2. Kieh tfiijt; vi ky nang Utuc td cua cac can bd quan Ip
- Ky ning lap ki hoach: K i t qua PVS va TLN cac can bp quan ly cho thd'y, h i u h i t cae ddn vj y te deu quan tdm chfl y den cong tdc lap k l hoach cho cac hoat dpng cfla cac don vj. Cac can bp quan ly deu nam dupc eac budc cfla chu trinh lap ke hoach. Hdn nfla, trong nhflng ndm gan ddy, cdc cdn bp quan ly cung dupe tham du nhilu Idp tap huan lien quan den lap ke hoach chuyen mdn va ca v l tai chinh do Sd Y te va cac chuong trinh du an. Tuy nhien, tren thuc te, viec lap ke hoach tai eac dja phUong dupc phan dnh con rat y l u kem, han che. Vide lap KH khdng di dflng theo quy trinh ma ctifl yeu lap ke hoach du^ vao sd lieu cfla nam tmdc, khdng can ciir vao nhu e l u thuctleung nhu cac van de cfla dPn vj. Viec lap ke hoach ve hinh thflc la tir dudi len nhung tren thuc te chfl yeu tir tren dua xudng - Uieo chT tieu ve chuyen mdn cung nhu kinh phi cfla tren dUa xudng (Trung uong, Sd Y te) (top - Sawn).
hay cfla eac Chuong trinh, du an.
- Kp nang lanh dao: Cd 2 ky nang "giam sat" vd
"giao quyen phan eong cdng viec" Id dat d mfl'c 3 ^ e m trd Idn tflc la "thUC hanh duoe, can hd trp", ky nang phdn tfch va lap ke hoach phat trien. thflc day va
khuyin khich ehi dat d mflc dudi 3 diem, tifc cdn Id
"thuc hdnh han c h l " .
- Kp ning quin lp til chinh: Hau h i t cac edn bp quan ly eho rang ky ndng v l quan ly tdi chfnh cfla minh cdn rat han che ( d i u 6 mflC tir 2-2,5 dilm). Khi dUdc hdi v l nhu cau ddi vdi cdc ky ndng nay, hp d i u mong mudn dupe tdng eudng kiln thflc, ky ndng v l quan ly tdi chinh.
- Ky ning quin Ip ngudn nhin luc binh viin: H i u h i t edn bp quan ly deu tU ddnh gia dang d mflC "thuc hdnh han c h l vd thuc hdnh dupc can b l sung them"
(2,5-3 diem). Nhung p h i n ldn cac nha quan ly cd nhu elu dupc tdng ky ndng v l quan ly nhdn luc vdi sd diem tir4 trd Idn d c a 4 ky ndng.
- Kp ning vi quin Ip chit lugng, quin Ip thuic vi TTB, quin Ip hi thing thdng tin BV: Can bd quan ly BV tuyen tmh, huyen ddnh gid ky ndng, k i l n thflc thuc t l cfla minh hien i:6n han c h l , chl dat d mflc "thuc hdnh cPn r i t han c h l " , mpt so it ky ndng dat d mflC
"thuc hanh duoc, c i n b d sung".
2. Nhu c a u d d o t a o c u a c a n b p quan ly.
K i t qua danh gia cho t h i y , t^ le can bp da dugc tham gia khda ddo tao ed bang tdt nghiep dai hpc/cfl nhan va cd ehiifng chT ve quan ly tai hai tinh D u an eon khiem tdn ( I l n lupt Id 23,7% va 25,1%), v i n con tdi 3/4 can bp quan ly c h u ^ dupc tham gia khoa ddo tao ve quan ly noi chung cung n h u QLBV. Ky ndng lanh dao va ky nang quan ly, dieu hanh dupc nhieu can bp quan ly tuyen tTnh, huyen mong mudn dupc ndng cao n h i t (60,9%), ky nang xac dmh muc tieu va lap KH (58,9%), ky ndng td chflc thUc hien KH (55,6%) va kiem tra, gidm sat viec thuc hien KH (50,2%)
VdtTnh vuc uu tien dn duoc dio tao Lap ke hoach dupc nhieu cdn bp quan ly de cap den nhd't (42,4%), tiep theo la kinh te y t l va quan ly tdi chinh y te (30,8%). BHYT (30,3%); Quan ly nhdn lUC (26,3%) va quan ly c h i t lupng (21,7%). Ddy cung la cac nfli dung duac h i u h i t nhiifng ngudi tham gia PVS va TLN bay td sU mong mudn dupe dao tao, tap h u i n trong thdi gian tdi.
Bang 1. Cae ITnh vUc Uu tien can dao tao Chis8
Lapkehoacti BHYT Wnhteytg vSQujninCYT Qu^n ly nhan luc QuSn ly chat liionq
l/utlen 1 42.4 30,3 30,8 26,3 21,7
l/utSh 2 17,2 27,8 29,8 23,2 17,7
l/uSen 3 16,7 22,7 16,7 21,2 23,2
UilWn 4 9,6 12,1 10,1 19,7 23,7
Uijten 5 14,1 7,1 12,6 9,6 13,6 N0i dung mong mudn du>^ dao tao (rong Unh vuc lip kdho^ch y td: Cd 5 npi dung chinh dupe lua chpn nhilu nhat la: Ky ndng lap KH (55,1%), Ky nang theo doi, giam sdt va danh gia (45,4%); Tdng quan ve lap KH y t l (36,7%); Tong quan ve quan ly vd cac nguyen ly quan ly (33,8%),
Ngi dung mong muidn dugc dio tao trong ITnh vuc Quan ly tai chinh y td: Cac noi dung chinh trong ITnh vuc quan ly tai chinh y t l dupc lua chon nhieu la- Lap KH huy dpng ngudn thu va chi hieu qua tai don vi
Y HOC THU'C HANH (878) - SO 8/2013
(39,1%); Kiln thflc vd ky ndng xdy dung vd phdn tfch KH d i u tu (36,7%); ldp KH dU toan thu ehi tdi chfnh;
thuc hien dU toan thu chi tdi chfnh; quylt todn; k i l m tra, gidm sat viee thUC hien d u todn thu ehi tdi chfnh (32,4%). Cd sukhac biet nho gifls hai tinh dUdn d npi dung ndy. TJ le cdn bd q u i n ly cfla tTnh Cao B i n g cd nhu cau ddo tao ndi dung ldp ngan sdch, chuin bj bdo cdo tdi chfnh vd cdc ky ndng phdn tich bdo cdo tdi chinh cao hon so vdi tlnh B l c Kan (Iln lUpt Id 37,8% vd 21,9%; 34,2% vd 19,8%),
N^i dung mong mudn diopb dio t^a trong Unh VI/C Kinh td Y ti': Cdn bfl q u i n ly uu tidn nhilu hon cdc nfli dung nhU phdn tfch chi phf y t l (48,8%);
phuong phap danh gid trong KTYT (40,6%); dde d i l m thi trudng sflC khde (36,7%).
N0I dung mong mudn dugic dio t^ trong linh vgc Bao hi^ Y td: Hai npi dung de cdp nhilu nhit Id:
Nhung vdn d l chfl y l u vd cae giai phdp ndng cao c h i t luong KCB cho ngudi bdnh BHYT, ddc bidt Id ngudi ngheo/DTTS (45,4%); vd cdc he thdng b i o h i l m vd phuang thflc ehi tra trong KCB BHYT (42,5%).
Nil dung mong mudn dugfc dio tao trong linh vgc Quan iy ngudn nhin li/c y td: Ldp KH, quy hoach phat trien ngudn nhan lUc la npi dung dupe nhilu cdn bd quan ly lua chpn nhat (48,8%), xdy dung bang mo ta cdng vide va tuyen dung (44%). Cdc npi dung khac nhu dpng vien, khuyin khich nhdn vien. danh gid, dao tao va phdt tnen nhan vien eung d l cap d i n .
3. Tinh ben vflng cua khda ddo tao.
Khi dupc hoi ve cae yeu td anh hudng d i n viec tham d u khoa hpc, cd tdi tren 50% ngudi tra ldi do thilu thdi gian de tham dU khda hoc do eong viec 6 cd quan kha ban ron, khflng cd nhdn iue lam viec, nen cac lanh dao vdn phai lam cdc cdng viec chuyen mdn khflng co ttidi gian tham dU khda hpc.
Bang 2. Thdi gian tap huan phfl hpp:
Chl sfi 2-3 nq^y
4nq&v 5 nqay
>6nqay Bac Kan n=91
52 18 12 9
57,1
%
19,8 13,2 9,9
Cao Banq n=109
61 21 16 11
56,0
%
19,3 14,7 10,1
Tfing n=200
113 39 28 20
56,5
%
19,5 14,0 10,0 M p t ly d o k h a c c f l n g d u p e d e c a p d e n Id vd'n d d t h i e u k i n h p h i d a o t a o 6 c d c c d s d y t e ( 3 1 , 5 % ) . H i e n
nay, cdc don vj d i u thuc hien t u chfl tai chinh, phdi tilt kidm, cat g i i m chi tieu tdi da, ngudn kinh phf ddnh cho ddo tao, tSip h u i n vi vdy cflng han c h l , chfl y l u d i ^ vdo cdc chuong trJnh, d u an tai trp.
KfeT L U A N V A KHUYfiN NGHj
Ket qua nghidn cCfu cho t h i y hien tai vdn co khoing cdch khd Idn giu^ kien thflc, k? ndng ve quan ly so vdi nhu c i u c i n t h i l t cfla cdng vide. Mdt trong nhung ly do cd ban Id tJ le edn can bp dupc tham gia khda ddo tao v l q u i n ly edn r i t khiem tdn, con lai g i n 3/4 can bd quan ly c h i ^ Suae tham gia bat cfl Khda ddo tao ndo v l quan ly. Ndm ITnh vUC cfl nhu c i u dupc ddo tao nhilu n h i t la: LTnh vUc lap ke hoach y t l (42,4%); LTnh vuc quan ly tdi chfnh y t l (30,8%); LTnh vuc kinh t l y te va BHYT (3(J,3%);
Quan ly nhdn lUc y t l (26,3%), LTnh vUC quan ly chat lupng (21,7%). V l thS\ gian td chflc khda hpc, da sd cdn bd quan ly (56,6%) Si nghj mdi khda hpc chi nen keo ddi 2-3 ngdy. Ngodi ra, c i n cd k l hoach ddo t^o cho cac tram tru6ng tram y te xa ve cdng tdc ldp k l hoach vd v l ITnh vUC BHYT vd dao tao thudng xuyen, lien tuc cho ddi ngfl Idnh dao va cac cdn bp chfl chdt ve cae npl dung tren.
T A I L l i u THAM K H A O
1 . T h o n g IU lidn t j c h s d 0 3 / 2 0 0 8 n T L T - B Y T - B N V , ngay 2 5 / 4 / 2 0 0 8 , v e H u P n g d a n c h f l c n d n g , n h i d m v u , quyen h a n v a eo c a u t d chflC c f l a S d Y t e , P h o n g Y t e thupc UJ ban n h d n d a n c a p t i n h , c a p h u y e n .
2. Quyet dinh 2037/QO-UBND cua UBND tlnh Bac Kan, ngay 22/10/2008, ve viec quy djnh vj tri, chflc ndng, nhiem vu, quyin han va eo cau td chflC bd may cfla Sd Yte.
3 Bp Y te (2010). K i t qua khao sat danh gia tinh hlnh thUc hien tu chfl benh vien theo Nghj djnh 43 tai 18 BV cong lap. Vien Chien lUOc va Chinh sdch y te, Vu Ke hoach - Tai ehinh.
4. B p Y t e ( 2 0 0 8 ) . B a o c a o c h u n g T o n g q u a n nganh Y te h a n g n d m .
5. C h i n h p h f l . N g h j d m h 4 3 / 2 0 0 6 / N D ^ P Quy dinh q u y e n tU c h f l , t U c h j u t r a c h n h i e m v e thUC hien nhiem vu, t d c h i t e b o m d y , b i e n c h l v d t d l chfnh d d i vdi ddn vj sif n g h i e p c f l n g lap.
6. S d Y t l B l c K a n ( 2 0 1 2 ) . B d o c d o hoat dong cdng tac y t e n d m 2 0 1 2 v d p h u a n g huPng n h i e m v u n d m 2013
7. S d Y t e C a o B i n g ( 2 0 1 2 ) . B a o c a o t d n g ket cong tac y t e n d m 2 0 1 2 v d phUOng hUdng n h i e m v u n d m 2013.
TiNH TRANG DINH D U S N G TRE EM DU015 TUOl TAI XA VU PHUC THANH PHO THAI BINH NAM 2013
TOM T A T
Nghien ci/u cit ngang md ti tren 400 tri em dUdi 5 tuoi tai xa Vu PhOc Thinh Phd Thii Binh nim 2013 kit qua cho thiy: Tp li SDD can ning theo tu6i la 13,9%, trong do chO yeu li SDD dd I chiim 11,2%,, cdn 0,3% tre SDD dd III. SDD thi rihe can thap nhit d nhdm tuoi dudi 12 thing. Tp le cdi cgc li 23,1. tp le cdi coc cd xu hudng ting dan theo nhdm tuoi. Tp li
NGUYfiN VAN THjNH - Bai hgc Y Thai Binh giy mdn ti 6,9%, d tri nam la 7,4% lai cao han tri nff li 6.5%,, khdng cd su khac biet vi tp le SDD cac thi theo gidi. Tp 1$ thifa can beo phi la 3,2%. 6 tre nOla 4 % c a o hdn tri nam li 2,5%, tap tmng d nhdm tm 49-60 thing tu6i.
Tir khda: Sup dinh dudng.
Y HpC THU'C H A N H (878) - S6 8/2013
