Quan dilm cila T6 chirc Y te the gidi ve siic lihde vii cham sdc sire Idioe Thu hudng mpt tinh ttang sQc khde tit nhit cd thi da trd thanh mue tieu ma Td chQc Y tl thi gidi WHO no luc di
Trang 1CHAM SOC StfC KHOE BAN DAU
VI MUC TIEU SU'C KHOE CHO MOI NGUCil
PHAM THI TINH"
1 Quan dilm cila T6 chirc Y te the gidi ve siic lihde vii cham sdc sire Idioe Thu hudng mpt tinh ttang sQc khde tit nhit cd thi da trd thanh mue tieu ma Td chQc
Y tl thi gidi (WHO) no luc diu ttanh va coi nhu mdt quyln co ban cua mdi ca nhan suit hon 60 nam qua dl mgi ngucri, dae biet la ngudi ngheo, ngudi de bj ton thuang deu
cd dugc quyln nay Mdi quan tam din sue khde eiia cpng ddng qudc te thi Men qua mpt
sl mlc chinh sau (A.Irwin va E.Scali, 2007):
- Nam 1948, ngay khi vua ra ddi, WHO da dua ra mgt djnh nghTa kha diy du ve sue khde: "Sue khde la ttang thai hoan toan khde manh vl the chit, tinh thin va xa hpi, chu khdng chi don gian la khdng cd benh" WHO cung dat ra mue tieu phai dat dugc mQc sue khde cao nhit cho mgi ngudi Cac ylu to xa hpi anh hudng den sQc khde, eong bing, bit binh ding vl sQc khde da duge de cSp den
- Thap ky 1950, ehju nhilu anh hudng ciia chiln tranh Ianh, WHO bj le thudc chu ylu vao My Su bung nl cac ky thujt y hpc, thudc, vacxin, 6 cac nudc dang phat triln, he thing y tl tap tning vao ky thuat y hgc Cac chuong trinh y tl tap trung vao cac benh nhu Lao, sdt ret va cac cdng nghe, ky thuat,
- NhQng nam 1960 diu thap ky 1970: Md hinh cham sdc sue khde cd sy tham gia cua cpng ding, nang cao nang lyc cpng ddng, gan sQc khde vdi QUYEN CON NGLTOl (QCN), edng bing xa hdi va cac yeu to anh hudng ldn nhu kinh te, chinh trj, xa hdi va mdi trudng dugc md rgng Giao due sQc khde va phdng benh trd thanh tam diem cua cac chuang trinh y te va giai quyet cac yeu td xa hgi anh hudng den sue khde
- Nam 1978, Hdi nghj qudc te tai Alma Ata da chap nhan mue tieu "sQc khde cho mgi ngudi den nam 2000" va md hinh "Cham sdc sQc khde ban dau" (Primary Health Care - PHC) dugc chpn de dat mue tieu tren Dd la mdi quan tam den cdng bang sue khde va cac yeu td xa hdi anh hudng den sue khde, md rdng cac cham sdc y te co ban xudng CO sd, tang cudng ngudn lyc cho cac cpng ddng ngheo nham han che su phii thugc vao cac chuyen gia y khoa,
- TQ nam 1979 din diu thap ky 1980, md hinh PHC cd chgn lpc dupe sQ dung bdi nhieu nha tai ttp va lanh dao WHO cho ring md hinh PHC qua rpng, khdng dem lai ket
' ThS.; Vifn Nghien ciiu Con nguci, Vifn Hin lam Khoa hpc Xi hpi Vipt Nam
Trang 2qua eu thfi, viee "ndng cao quyen cho edng dong" la mdi de dga dfin nghfi nghiep cua
nhflng ngudi trong hiep hgi y khoa Md hinh PHC cd chpn Igc Id uu tien tap tiung cac
ngudn lyc vao cac bfinh cd ti Ie mie vd chfit cao nhit va dem Igi hifiu qua cao ve gid
thanh khi dp dung cac bien phap can thifip eu thfi
- Dau nhung nam 1980, chu nghia tu do mdi phdt trifin vdi quan diem: thj tradng ty
do khdng ehju su tde dgng eua nha nudc se raang lai hieu qua eao nhdt trong viec phdt
trifin va phan phdi cac sdn pham xd hgi Dfi dat mue tieu, can ban chfi vai trd eua nha
nudc trong nhiing ITnh vyc hogt dgng kem hieu qua, gom ed ITnh vyc y te vdi trifit Iy: su
cat gidm cd thfi gay ton thuong rapt sd cOng ddng trong thdi gian ngan nhung se duoc
btt Igi bang nhiing lgi ich ldu ddi khi nen kinh tfi phdt trien cao ban
- Nhung nam 1990, chu nghTa tu do kinh tfi mdi tiep tuc rad rdng, nhiing chuong
trinh "tdn thuong ngin han" edng lam trara trpng thfim cde vin dl xd hpi, nhu gido due,
dinh dudng, nude saeh, vfi sinh mdi tradng, nhd d Trudc tinh hinh tren, cdc nudc G8 va
IMF da tien hanh difiu chinh: giam ng eho nudc ngheo, tang ehi phi xd hgi cho y tfi, gido
due; thifit ldp nhom hdnh dpng Sttc khde va phat trien, phdt trifin eae ehinh sach nham
dat mue tifiu: Sttc khoe cho mgi ngudi; Sttc khde chinh la mgt yeu td cho phat trifin, can
dugc tai dau tu
- Nam 2000, "Hien chuong Sttc khde cho nhdn dan" ra ddi trfin co sd eae ehinh sdch
todn cau va toan dien ve PHC vdi khdng djnh: Sttc khoe Id mpt van de xd hpi, kinh te,
ehinh trj va tren hit Id quyln co bdn etta con ngudi Sy bat binh dang, ngheo doi, ngn
bdc lot, bgo Iuc vd bdt cdng Id nguyen nhan gay ra bfinh tdt vd chfit chdc cho ngudi
ngheo, va quyfin co ban cua eon ngudi Id dat duge cho minh tinh trang sue khoe cao
nhdt, Cde chinh sach toan cdu vd todn dien ve PHC phdi la nfin tdng cho cae ehinh
sdeh lifin quan dfin sttc khde
- Nam 2003, Hpi nghj qudc tl vl Cham sdc sttc khde tai Madrid da dua ra nhflng
djnh hudng ehiln luge cho PHC nhim dgt mue tifiu "Sttc khoe eho mpi ngudi" vdi
khing djnh: PHC vdn la triet ly mang tinh ehien luoc y tfi nfin tang nham xdy dyng mgt
he thdng y tl phu hop vdi mgt thi gidi dang thay ddi, nhu gid hda ddn s6, 6 nhilm mdi
tmdng, biln ddi khi hau, sy thay doi mo hinh bfinh tdt, deu tac ddng den sue khoe, sttc
khoe dugc coi la yfiu to ctta sy phdt trien
- Ndm 2005, Uy ban vl cdc yfiu td xd hgi dnh hudng tdi sttc khde ra ddi
- Nam 2007, tgi Hpi nghj qudc tl Sttc khoe cho phat trifin to chtte tai Argentina,
WHO vdn tdi khdng djnh: PHC van Id rapt chia khda ctta chinh sdch y te todn dien, nhan
ban, gan sttc khde vdo sy phdt trifin dfi dgt cdc Myc tifiu phdt trifin Thifin nien ky
(MDGs) vdi nhieu co hgi vd thaeh thttc radi
Ljch stt: cde xu thfi va co hdi phat triln khdi niem sttc khde vd chdm soc sttc khde
dugc tdm tdt qua hinh sau:
Trang 3Ngudn: Trdn Hirng Minh (CCIHP), Cong bdng sice khde, khdi ni?m vd do ludng Quan diim cua WHO vi Chdm soc sue khde ban ddu
Theo Tuyfin ngdn Alma Ata nam 1978 thi "Chdm sde sttc khde ban dau Id nhttng cham sdc sue khde thifit yeu, dya tren nhiing phuong phdp va ky thugt thuc hanh, dua dfin tan cd nhan vd timg gia dinh trong cpng dong, dugc mpi ngudi chdp nhan thdng qua
sy tham gia ddy du eua hg, vdi gia thdnh cd thfi chap nhdn dupc nham dat mtte sttc khoe cao nhdt cd the" Ddy Id bp edc gia trj, nguyfin tae vd edeh tifip cdn toan difin nhim cdi thien tinh cong bdng trong chdm sde sttc khoe va tinh hifiu qud trong each stt dung cdc ngudn cung cip, nang eao sttc khde cua cac cu dan bj thiOt thdi Vdi nhieu mue tieu: sttc khde tdt hon, benh tat it hon, cdng bdng hon, va nhung cai thien rgng Idn trong ket qua hoat dong eua cdc h? thdng y te
Nam 2008, Bdo cdo Sice khoe thi gidi "Primary Health Care - Now More Than
Ever" da ddnh gia 30 ndm thye hien Tuyen ngon Ahna Ata: cac h? thdng y tl, ngay cd tai edc nudc phdt tiifin nhit dfiu khdng dgt cdc myc tieu Tuyen ngdn Alma Ata dua ra Nhin tdng the, eon ngudi hifin nay khde manh hon, sung tuc hon vd sdng thg hon Dd co nhflng cai thifin quan trpng vfi nudc sgch, v^ sinh vd chdm sde trudc sinh, nhihig bude tien tiong edi thifn sttc khde, diu tranh chdng bpnh tat va keo ddi tudi thg Tuy nhien,
Trang 4ngudi dan tren khip thfi gidi vdn khdng thda man vdi cde he thdng y tfi hien ed MOt trong nhiing khue mie Idn nhat la vl chi phi chdm sde sttc khde Bdi, moi nam Iai cd khodng 100 trigu ngudi roi vao cdnh ngheo ddi do phdi trd chi phi cham sdc sttc khoe Hang tripu ngudi nua khdng the tiep can bit ky hogt ddng chdm sdc sue khoe ndo Ngudn gde cua van de Id do cac he thdng y tfi vd cdc chuong trinh y tl da bien thdnh mOt mdng chdp va cdc bd phgn cdng viec Sy chuyen mon hda thdi qud etta edc nttdc gidu, cdc chuong trinh chi tdp trung vdo mgt benh vd chay theo ede nhd tdi tig tgi edc nudc ngheo Phan ldn cde ngudn dau tu dugc danh cho ede djeh vu ehua tri, viec phong ngtta vd nang cao sttc khde cdn bj xem nhe (chilm 70% gdnh ndng benh tdt) Cde he thdng y te dudng nhu bj cudn di ttt mgt uu tien ngdn han nay sang mdt uu tien ngdn ban khde, edng ngay cdng bj chia cdt rdi rgc vd khdng ed mot djnh hudng rd rang hon la edi thifin khd ndng ddp ttng eua hg vd ludng trade nhttng thach thtte radi Ngudi ta ngdy edng nhgn ra ring, vigc cung cip edc dich vu y tl thong thudng qua cdc co chl khdc nhau va dudi nhihig ly do khde nhau khong chi it hieu qua md thudng gap phdi mgt loat nhung khiem khuylt vd nhung bit cap nhu:
Chdm soc ngu(rc: Nhting ngudi ed dilu kien nhit, nhflng ngudi cd it cdc nhu ciu vl
chdm sdc sttc khde thudng duge cham sdc nhifiu nhdt (d thdnh phd), trong khi nhung ngudi cd It dieu kifin vd ed nhieu van de ve sttc khde nhit Igi dupc chdm sde it nhdt (d ndng thdn) Chi tieu cong cOng vfi djeh vu y tfi hay lara lgi cho ngudi gidu hon la cho ngttdi ngheo d cde nude cd thu nhdp cao va thip diu nhu nhau
Chdm soc ldm bdn ciing hoa: Noi nao ngudi ddn khdng co bdo trg xa hgi vd vi?c chi
trd djch vy y tl chu ylu bing tien tui, ho phdi doi mat vdi nhung khodn chi khimg khilp Tren 100 triOu ngudi moi nam roi vdo cdnh ban ciing vi phdi chi trd cho chdm sde y tl Idm tdng khodng cdch giau ngheo vd tdng bdt binh dang xa hdi
Chdm soc phdn dogn vd xe nhd: Su chuyfin mon hda thai qua cua nhd cung edp djch
vu eham sdc y te vd sy tap trang hep cua nhifiu chuong trinh kifim sodt bfinh tat cdn trd cdch tifip can todn dien vdi cde ed nhdn, edc gia dinh vd khdng de cao nhu cau chdm sdc lien tyc Cdc djch vu y tfi cho ngudi ngheo, edc nhdm bj dat ngoai lfi xd hgi thudng bj phdn dogn qud nhd vd thieu ngudn lyc trim trgng,
Cham sdc khong an todn Thilt kl he thdng cham sdc y tfi ngheo ndn khdng dam bdo
sy an todn dan tdi ti 1^ nhdp vien eao eung vdi nhiing sai Idm ve su dung thude vd nhttng tdc dyng trdi ngupc dan tdi ttt vong va sttc khde kem
Chdm soc khdng dung huang: Phdn bo nguon lye quanh eae dich vu chfta benh tdn
kem, bd qua cdng dogn phdng ngua ban diu vd nang cao sue khde (tdi 70% gdnh ndng bgnh tat) Vife chdm sde sttc khde khdng eo chuyen mdn dl gidm nhe cdc tae dung phu vdi sue khoe tu cde ITnh vue khdc, cd thfi ddng gop cho sue khde
Trade nhflng bit cap cua hg thdng y tl, WHO ehi ra nhihig thaeh thue cua mgt thi gidi dang thay doi Vdi mtte tdng tradng kinh tl y te todn cdu nhanh hon so vdi tdng sgn phdm qu6c npi (GDP), ti ti-png tii 8% nam 2000 Ifin 8,6% nam 2005 GDP till gidi, gdm
Trang 5ca lam phat vdi mue tang ttirdng 35% trong chi tieu y tl thi gidi trong 5 nam CuOe each mang cdng nghe dang nang cao tilm nang y te va biln dli kT nang ve y te trong xa hpi toan ciu Co chl quan ly toan ciu dang xuit hien, dd la: tang cudng su ttao ddi giQa cae qudc gia, sy y thuc nhQng mli de dga, nhtmg thaeh thuc hoac eo hdi se chia; nghTa
vu toan ciu trong xda bd ddi ngheo dugc neu ttong MDGs Tuy nhien, cOng ed nhihig
xu hudng khd doan;
Thli nhdi, nhflng tiln bp to ldn vl y tl trong miy thap ky qua ngay cang gay bat cdng
sau sic vl y tl giua eac quic gia, xu hudng tap trung vao khu vuc y te da dupc cai thi?n
d mdt bp phan ldn tren till gidi, ban nfla, cdng ngh? thdng tin phat ttiln giup ta cd ngudn tai lieu dli dao ma 30 nam tt^dc khdng cd Ben canh dd la viec mdt sd nudc bj tut lai phia sau hoac sa sut ban do khdng du tiem Iuc phat ttien
Thli hai, ban chit vin dl y tl dang thay dli va chiing ta chi thiy ttude timg phan vdi
tic dp hoan toan khdng thi du bao dupc Sy gia hda dan sl, tac ddng cua do thj hda, quan ly kem va toan cau hda dang day nhanh su lan truyen cac benh lay nhiem va tang ganh nang cua cac benh kinh nien va khdng lay Ngay cang ed nhieu ngudi xuat hien nhflng trieu chQng phuc tap ddi hdi djch vu y te phai md rdng di?n quan ly ca b?nh thong nhat va bao quat ban Mpt the gidi dang nhieu loan bdi tac ddng cua bien ddi khi h^u, nhQng thach thuc ve an ninh luong thue va cac ap lyc xa hpi, va phan ldn khdng the dy bao dugc ve tinh hinh sue khde trong nhirng nam tdi
Thli ba, cac he thdng y te khdng each biet khdi budc di mau 1? cua su thay ddi va eai
bien dang la bd phan chu yeu cua toan cau hda Khung hoang kinh te, chinh tri dang la thach thuc ddi vdi nha nude va cac td chuc ddng vai trd dam bao viec tilp can, cung cip
va tai ttg ViSc thuong mai hda khdng cd kiem soat dang dugc trg giup bdi tinh trang khdng rd rang gifla cac tac nhan cdng va tu, trong khi viec sip xip chuc trach, cac quyln ngay cang bi chinh trj hda Thdi dai thdng tin Iam thay dli cac mdi quan he giQa cac cdng dan, cae nha chuyen mdn va cac ehinh khach
Sy khdng bit kjp gifla cac ky vpng va kha nang thuc hien la II do khiln cac ca quan hiiu ttach ve y te lo lang Coi sue nang ve kinh te va y nghTa xa hpi cua khu vyc y tl dang ngay cang tang cung la li do dl cac chinh khach ngay mdt quan tam hon tdi y tl
"Trung binh cac vin dl cham sdc sire khde dugc nhic tdi hem 28 lin ttong mdi cu0c ttanh cQ so bg gin day d My" Khi xa h^i hien dai hda, con nguoi cin nhilu hon tir cac
he tiidng y te cho ban than, gia dinh va xa hgi Ngay cang cd sy ung hg rpng rai hon dli vdi binh dang ve y te; vdi cac dich vy y tl tSp trung vao cac nhu ciu va mong mudn cua con ngudi; vdi an ninh sue khde cho cac cpng ddng noi hg sdng; vdi nhting tilng ndi c6 anh hudng tdi van de sue khde
Nhflng gia trj cua PHC: cung cip nude sach, ve sinh moi trudng; cai thi?n dinh dudng; tidm chimg md rdng; phdng chdng, kilm soat djch b?nh; giao dye sQc khde, cho ngudi dan tuyln co sd da nhan dupc sy ung hd rdng rai cua cac chinh phu va sy ky vgng ciia ngudi dan Tuy nhien, hieu qua cua PHC phu tiiupc vao dilu kien moi nudc va
Trang 6nhflng tdc ddng ttt ngodi ngdnh y tl Thyc tfi, chifin lugc PHC thudng don gian hda cdc
thdng diep, ddn din tinh trang dau cd vd ddu torn, kera phu hgp vdi edc boi cdnh va van
de Do do, can phai ed mOt he thdng ede cdi each dac thu, phu hgp vdi hoan cdnh, ddp
ttng ede dieu kifin ve y tfi cua hien tai vd cdc thdeh thtte cua tuong lai Cdn phai tdi dinh
hudng ede he thdng y tfi dua tifin bing chttng khoa hgc viing chac vd sap xep hgp Iy,
cdn thong nhdt gifta ehinh quyfin vd ngudi ddn vfi y tfi va chara sde sttc khde Cdc cdi
cdch PHC dugc xde djnh bang vific xde djnh vai tid etta ede he thdng y te vd cac nganh
cd lien quan trong xd hgi
"Primary Health Care - Now More Than Ever" ra ddi, WHO hy vgng lam sdng lgi
cudc ddi thoai 30 nam trudc ve sy chuyen hudng mdu mue trong tu duy vfi sue khde, vd
dua ra dfi nghj xay dyng he thong y te va edc quyfit sdch phdt tiien y te theo bdn djnh
hudng Ddy Id nhiing nguyfin tic cdt ldi cua PHC thdi ky hgi nhgp:
Cdi edeh dien bao phu pho cap de cdi thien binh ddng ve y te: Dfi giara bdt eae bat
binh dang ve y te thi phdi ldm eho cdc dich vu y tfi sdn ed hon cho tat ca mpi ngudi Mgi
ngudi dfiu cd the tiep can vdi he thong cham sde sttc khoe Viec md rgng difin bao phii
pho cap cung cdp djeh vu phdi di cttng vdi bdo trp y tfi xa hpi, thong qua gop qfly vd trd
trade thay vi trd bang tien tui cac chi phi cua ngudi stt dung Tttc la pho cap tifip can kfit
hgp vdi bdo tig y te xa hgi - dieu kien can thifit dfi cdi thifin binh dang ve y tfi Cac he
thdng da hodn thdnh difin bao phu pho cgp gan ddy eho thdy, edc cdi cdch can dugc thyc
hien eung vdi cde bien phap chu dpng de dat cai chua dat dugc: nhiing edi each ma sy
sin cd djch vu vd bdo trg xd hdi dem lai qud it de bu Iai cdc hau qud vfi y tfi cua sy phan
tdng xa hdi Ddy ehinh la li do khdi cac eai each ve cung cap dich vu dttng vdo
Cai each cung cdp dich vu Idy con ngudi Id tmng tara: nghia la, thay doi viec cung
cap djch vu thdng thudng thanh cham sdc ban ddu, tdi uu hda ddng gdp eua cac djch vu
y tfi - edc he thdng y te dja phuong, edc mang eham sdc y tfi, va binh dang trong ddp
ling cdc mong mudn ngdy edng tdng: "ddt con ngudi vdo tnmg tdm cua chdm sdc y te
"-cham soc tap trang vdo con ngudi, dam bdo tinh todn difin vd thong nhdt, tinh Hen tuc
tiong chdm sdc vdi sy thara gia eua benh nhan, gia dinh va cgng ddng He thong y tfi se
ddp ttng tot hon ede nhu eau eua eon ngudi thong qua cac diem cung cap djeh vy gdn
vdi ede cgng ddng Phuong phap ndy md ra ede ca hgi phong benh va ndng cao sttc
khde cflng nhu viec phat hien sdm bfinh Nudc Cong hoa Hoi gido Iran co 17.000 tram y
tl, mdi trgm phuc vy khodng 1.500 ngudi, dieu nay da giup Iran gidm manh ti le chet
trong vdng hai thdp ky qua, vdi tuoi thg tnmg binh tdng tdi 71 tuoi vdo ndm 2006 (ttt
mtte 63 tuoi ndm 1990), Cham sdc ban ddu cd thi lam dugc nhilu dilu dl eai thien
sttc khde, nhung khong the dap ttng tat ed cdc mong mudn cua ngudi dan Do dd, Chinh
phu edn xay dyng mang chinh saeh edng dfi ddi phd vdi edc thdeh thuc vfi sttc khde
trong the gidi todn cdu, nhu do thj hda, d nhiem mdi tmdng, bien ddi khi hgu, phdn bifit
gidi hay phdn tdng xa hgi,
Cai cdch chinh sdch y te cong de nang cao va bdo vfi sttc khde eho cOng ddng Chi
Trang 7rieng smh hgc khdng ly giai dugc nhttng khoSng each vl mdi tiig, nhung ehenh lech gitta eae vimg lan can vl giau va ngheo Su thyc, cd nhilu tiiir tac dpng tdi sue khde nim ngoai khu vuc y tl, nhu tiiuong mai, mdi ttudng, giao due, nong nghiep, Cac chmh sach cdng, cac chuong ttinh sue khde cd thi cd tac dung ddi vdi mdt sd van de, cd thi chi la can thiep duge chgn lgc tu ve sinh va phdng benh cdng cdng tdi nang cao sue khde, nhung c6 ddng gdp quan ttpng dli vdi y tl Chmh sach binh ding gidi, an tpan tiiyc phim, v? sinh mdi ttudng, deu cd anh hudng sau sic, tham chl quyet djnh tdi sue khde eon ngudi Do do, cin mdt su chuyin hudng trong cac chinh sach bdi mdt sd tac dgng vl sQc khde, cd thi thyc hien qua eac chucmg ttinh phat triln tre tha, truyen thdng giao due sQc khde cho phy nQ, Cin xem xet vin dl y tl ttong tat ca cae chinh sach dl dam bao ring, cimg vdi eac mue dich va cac mue tieu cua cac khu vuc khac, cac anh hudng cua nganh y tl se cd vai ttd quyet djnh trong eac chinh saeh edng
Cai each lanh dao dl lam cho cac co quan hihi ttach ve y te dang tin cay ban De
dua cac cai each vl dien bao phu phd c$p, cung cap djch vu va chinh sach cdng vao moi trudng cue ky phuc tap cua khu vyc y tl, can cai each bd phan lanh d^o thay vi ra Ifnh
va kilm soat, ban lanh d^o cin dan xip va hudng din Tat ca eac thanh phan trong xa hdi - gdm ca nhihig thanh phan vdn khdng cd lien quan gi tdi y te deu phai tham gia, ke
ea cac co quan dan chinh, khu vuc tu nhan, cac cdng ddng va khu vyc kinh doanh Lanh
d ^ nganh y te can dam bao rang cac nhdm cd kha nang bj tdn thuong phai cd mpt diin dan de bay td cac nhu eau cua minh Tuy nhien, viec nghien cim ve cac h? thdng y te la khu vyc thudng thieu kinh phi nghiem trgng Day ia viec rat can thiet de dua ra bing ehiing tdt nhat lam can cii cho nhirng quyet djnh ve y te
Bdn khoi cai each PHC nay dugc dan dit bdi cac gia tri chia se cung nhau trong mpt the gidi toan cau hda Viec dua bdn cai each nay vao thuc tiln phu thugc vao dilu kien kinh tl, chinh trj, xa hdi cua moi nudc Nlu thuc hi& dugc bin mue tifiu PHC nay, cac h? thing y tl quoc gia cd till trd nen gin kit, hi?u qua han, cdng bing ban va thanh cdng hon nhilu Cd thi ndi, mdi tiTrdng quic te hien nay dang thuan Igi cho viec khdi phye va tiln hanh cai each PHC, bdi:
Y te toan cau dang dugc quan tam chua timg thiy, sy tang cudng cac hogt ddng, sy ling hp manh hon vdi cham sdc phd cap va toan dien, nhu: vdi nhung ngudi sing chung vdi HIV, nhQng ngudi quan tam tdi dilu trj va cham sdc, cac Lanh d?o y tl, hoac nhom G8, sy nd rp cac co che tai teg ttong m$t thi gidi dang thay ddi nhung cd sy lien kit chJt che todn cau 14 nhung diu hi?u dang mimg vl m^t su ddng thujn dl cimg nhau xay dyng cac h? thdng ben viing cho y tl
Triln vpng diu ttr ttong nudc tang len la co hpi tit dl tai ting cudng cdc h$ tiling y
te xung quanh cac gid tti PHC T5ng trudng GDP cd till bi tdn hai do sy gitoi sit vl kinh te, khung hoang luong tiiuc, nang lugng va do hien tttgng im len toan ciu, khip till gioi dang nsip nang lupng cho chi tieu y tl Vi?c tan dyng sy tang trudng kinh tl se tao cac CO hgi dl tiln hanh cac cai each PHC cin thilt
Trang 8Dodn kfit toan cdu vd vifin trg van Id khau quan trpng dfi bd sung va hd trg cac nude
chdm phdt trien, nhung se kem hieu qua hon vifie tiao doi, hgc tap lan nhau
Cde eo quan huu trdch ve y te, ede nhd lanh dao ehinh trj deu khdng thodi mdi vdi
cdc xu hudng hifin nay trong sy phdt trien cac he thdng y tfi vd viec phdi thieh ling vdi
ede thdeh thtte sttc khde dang thay doi, cdc nhu cdu va mong mudn nay sinh Tam trgng
thdt vgng va raong muon cua ngudi ddn vfi chara sde y tl binh ding hon, bao trg y te tdt
hon dang hinh thdnh, dieu tmdc ddy ehua timg cd
NIU ede chinh phu bilt nim bdt co hpi, diu tu vdo cdi cdeh PHC cd thi diy nhanh qud
trinh bien doi cua cde he thdng y te nhdm cd dupe eac kfit qud vfi y tfi phan phoi eong
bdng hon Trong thdp ky qua, cgng dong thfi gidi da gidi quyit tinh trgng ddi ngheo vd bat
bmh dang rapt edeh he thong hon bdng cdch xay dung MDGs vd dua vin dfi bit binh ddng
vao cot Idi cua vific hoach dinh chinh sdch xa hgi Trong dd, hogt dgng y tfi Id tmng tam
gdn kfit ede ITnh vyc, tgo co hgi cho cde hogt ddng y tfi hieu qua hon vd eiing tgo ra cdc
dieu kien xa hdi can thiet dfi thifit lap nhiing hen minh chat che ngodi y tfi Nhu vay, hogt
dpng lifin ngdnh trong PHC dugc dat vdo giai dogn trung tdm Cdc co quan hiiu trdch vfi y
te khdng cdn thdy gdnh nang trdch nhifim eua hg ve sttc khde bi gidi han d su sdng vd
kiem soat benh tat md la mgt trong nhflng ndng lyc quan trgng ma ngudi dan trong xa hgi
coi trgng Tinh hgp phap ciia ede co quan hflu tidch vfi y tfi ttty thudc vdo viec hg dam
tidch tdt nhu thfi nao nhifim vu phdt tiien vd cdi cdeh khu vyc y te theo cai ma ngudi dan
can vd difiu dupe ky vgng ddi vdi cac he thong y tfi trong xa hpi
2 Cham s6e ban diu vi mue tifiu sttc khoe cho mpi ngirdi
Quan diem: "Cham soc ban ddu - dgt con ngudi Ien tien het" doi hdi nhiing 16 trinh
quan trpng "Dgt eon ngudi Ifin trfin hfit" - de xudt vifie ndng cao sttc khde va phdng
ngtta bgnh, chtta benh vd chdm sde eung nhau theo each an toan, hifiu qud, ed lgi ve mgt
xa hpi gifta ngudi ddn vd he thong chdm sde sue khde
Bao ddm sy chdm sdc toan dien, thong nhdt va lifin tuc cd.thfi xdy dyng moi quan he
tin cay gifta ngudi stt dung dich vu vdi ngudi eung cap djch vy, mdi quan he tryc tiep
giua timg cd nhdn vd gia dinh trong cdng ddng vdi nhdn vifin chdm sdc sttc khde Nhdm
cung cap djeh vu se nam ro tien stt etta moi ca nhan va hodn eanh cua hg, ngudi stt dung
djeh vu ed thfi tin tudng ngudi chara sdc sttc khde cho rainh Difiu nay giup gidm 50%
nhflng ea khdm cip ciiu, giam 30% nhflng ca ehuyin sang chdm soc ddc biet; thdi gian
chd dcfi cua benh nhan dttpc nit ngdn dang ke Quan trgng nhdt Id hp edm thay hp dugc
ling nghe, dugc ton trgng vd cam nhdn duge gia trj ciia sy chdm soc Vdi hinh thttc nay,
sttc khde etta cdc thanh vifin tiong gia dinh dttgc bdo vfi va nang cao phu hgp vdi hodn
ednh vd dieu kifin Phuong phdp nay Idm eho eac djch vu hifiu qud vd cong bdng hon
tren eo sd mdi quan hg trye tifip, gin bd gifta cdc ed nhan, cgng ddng vd nhirng ngudi
eung cap djch vu Day la co sd cho tinh tap trung vdo con ngudi, tinh Iifin tuc, todn difin
va thdng nhdt tgo nfin nhiing dac diem rieng eua eham sdc ban ddu
Trang 9Tinh hieu qua va an toan Ichdng chi la nhiing vdn S'e Ity Ihugl The gidi y hgc dang
din tiln tdi mpt nln khoa hpe dya trSn bang chiing nhim nang cap su an toan cho b?nh nhan Cac thdng sl ki thuat va sy an toan khdng phai la nhQng ylu td quyet djnh duy nhit, cdn cac ylu tl khac, nhu thulc tit, bom kim tiem dupc khu ttimg,
Cam Ihong v&i con nguai: cham soc tap trung vao con nguai Dieu nay khdng chi
giup giam nhe ndi lo cua ngudi benh ma cdn cai thien su thda man vdi cdng viec cua nha cung eip Viec eham sdc sue khde se hieu qua hem nlu nha cung cap djch vu hieu duge cac ylu tl tac ddng din sue khde eua ngudi ma hp eham sdc, va ngudi dan dupc quyln tham gia vao cac quyit djnh cd lien quan toi sQc khde cua hp va gia dinh ViSc ling nghe, ehia se va cam thdng gifla ngudi cung cip va ngudi su dung dich vu ve tinh ttang benh tat, nhiing anh hudng tdi sue khde, se tang leng tin va su ttian thu trong dilu trj, tao dilu kien tun ra tilng ndi chung ttong theo doi benh, phdng benh va nang eao siic khde La co hdi cho nha cung cip dich vu hieu khach hang, giup hg ed nhttng lya chpn dung Vi thi, cham sdc tap trung vao eon ngudi dugc xem la phuang phap giup cai thien dang kl chit lugng trong cham sdc va hieu qua trong dilu tti, ndng cao sQc khde va chat iQgng sdng
Cac ddp img loan dien va ihdng nhdi: Tinh toan dien Iam tang y nghia trong dilu
phli, van hanh va tang gia tti cua cham sdc Nlu ngudi dan bilt rd toan bd lieu trinh cua cham sdc hg se tilp nhan cae djch vu mdt each chac chan hon va tdi da hda cae eg hgi cham sdc phdng benh va nang cao sQc khde, giiip giam cham sdc chuyen sau hay cham sdc tai benh vien Cham soc toan dien va thdng nhat cho cac loai van de ve sQc khoe trong cpng ddng se hieu qua hon nlu dya vao cac djch vu cho cac van de chpn lgc, mpt phan vi nd dua tdi sy hieu biet tdt hon ve cu dan va xay dyng dugc ldng tin Idn hon Cac dich vu y te dua ra mdt bang lya ehpn toan dien cac djeh vu Iam tang kha nang thu hut va dien bao phu, chang han, cac chuong ttinh phdng ngira: sang lpc ung thu, tiem ehung, Cae djeh vu toan dien tao dieu kien phat Men sdm va phdng ngua cae van de
ve sue khde, ngay ca khi khdng cd yeu cau rd rang Cd nhieu van de ma cac nhan vien y
te dia phucmg la ngudi cd the xu ly hieu qua, chang ban, hp la nhiing ngudi duy nhat co thi giup cac cha me cham sde tu giai doan phat triln diu tien ciia tre, day la ylu tl quyet djnh quan trpng cho sue khde khde manh va huu ieh sau nay Nhirng can thiep nay cin nhung nhan vien cham soc sQc khde chil ddng dua ra nhimg djeh vu toan dien Dieu nay phu thupc vao mdi quan he gan bd va tin cay giQa cac djch vu y tl vdi cac cpng ddng hp phuc vu, cac nhan vien y te la nhiing ngudi bilt ro ngudi dan trong cdng ddng dd
Tinh lien tuc cita cham soc: Hilu ngudi dan va dilu kien noi hg sing khdng chi
quan ttgng de c6 each xu Iy toan dien, tap trung, ma edn tao dilu kien cho cham sdc lien tuc Tinh lien tuc cua cham sdc la yeu tl quyit djnh quan trpng dli vdi hieu qua ciia viec xu ly, hoSe xQ Iy benh kinh nien, site khde sinh san, sQc khde tinh thin hoac dli
Trang 10vdi viec ddm bao cho tre em Idn Ifin khde raanh
Tinh lien tue cua chdm sde phu thude vao vific ddra bao Iifin tue cap nhdt thdng tin, vi sue khde thay ddi theo tudi tde, sy di chuyen noi d, hoge khi ed nhifiu nhan vien chuyen nghiep cttng chdm sde eho mOt ed nhan hoac mgt gia dinh Cdng nghfi khoa hgc phdt trien eung gdp phan khdng nhd vdo vific chdm sdc sttc khde Viec tiep can thong tin day dli tu cde hd so bfinh dn, se edi thifin vifie chgn lya quy trinh dilu tri vd phdi hgp chdm sdc Vifie stt dyng eong nghe thong tifi trong chdm sdc sttc khde giup ngudi dan vttng sdu, vimg xa tifip can djeh vu va tu vdn chuyfin radn nhanh, re (khong mat cdng di lgi); giiip cho cde nhd chuyen mdn theo ddi va tu vin tu xa, tra ldi nhanh chdng vd dieu trj thieh hop d nhflng noi khong co difiu kifin chiia tri Viec su dung cac dyng cu nhu ho so sttc khde difin ttt, edc don thuoc difin tu, cdc phuong tien tro giup khdm vd difiu tri, da mang lai nhflng phuong thuc mdi cho vific cham sdc ca nhan hoa, tap tmng vao con ngudi an todn, kjp thdi
Tinh todn difin, lifin tuc, tap tmng vdo con ngudi co tam quan trgng quyet djnh lam cho cac kfit qua chdm sdc tot hon Tat cd cde yfiu to nay phu thugc vao mdi quan he dn djnh, lau dai (moi quan he dpe) giua eu dan va nhflng ngudi hanh nghe chdm sde sue khde chuyfin nghifip Nhttng ngudi hdnh nghe y te se tdn trgng vd hifiu cde benh nhan cua hp, difiu ndy tgo su tuong tdc tich cue va trao doi thdng tin tot hon Hg se hifiu vd thay trade eac trd ngai eho vifie chdm sde lifin tuc, theo ddi sy tifin bd vd ddnh gid viee trai qua bfinh tdt cd anh hudng the ndo tdi cugc sdng ctta mdi ngudi Mat khac, su hieu bifit vfi dieu kign, hodn eanh cua khdch hang gittp difiu chinh vific chdm sde phu hgp vdi ede nhu cdu dgc thu cua timg ngudi vd nhan bifit cdc van dfi sttc khde d nhiing giai dogn sdm Vdn dfi xay dyng long tin, Idm hdi long bfinh nhan cd thfi mang Iai chat lugng tdt hon cung nhu kit qua tdt hon trong viec eham sdc Ngudi dan su dung cttng mot nguon chara sdc eho hiu hfit edc nhu edu sttc khde eua hg se cd xu hudng tuan thtt tdt hon cde tu vdn hg nhan dupc, it dya vdo cdc djch vu khan cap hon, yfiu ciu nhap vifin it hon va hdi Idng hon vdi chdm sdc Nhd cung cip thi tilt kifim dugc thdi gian tham kham, gidm bdt nhu cau stt dung ede xet nghiem va chi phi, tdng nhan thttc ve chdm sdc phdng ngtta
Nhu vdy, mgt djeh vu y tl eham sdc ngogi tiu sttc khde vd cdc van de Hen quan tdi sue khde tgi dilm diu vao phdi dua ra mdt bang Het ke todn difin edc dich vu chan dodn, chiia tri, phuc bdi vd gidm dau thdng nhdt Mdi quan he true tifip vd ldu ben gifta nhd eung eip va ngudi dan trong cgng ddng duge phye vu Id nhdn td ehtt yfiu de xera xet tdi hoan ednh cd nhan vd xd hgi cua benh nhan vd gia dinh hg, ddm bdo vifie chdm sdc lien tuc theo thdi gian cung nhu theo edc dieh vu Difiu kifin tien quyet de trd thdnh co sd chdm sdc ban diu la phai dam bao ehiing co thfi true tiep vd thudng xuyen tiep can dupc, nd dya vao vifie chi trd bing tiln ca nhan vd duoe bao hd trong edc ehuong trinh bao phli phd cap Bien djch vu cham soc thong thudng thdnh trung tam cham sdc ban dau la: