Thực trạng và nhu cầu nguồn nhân lực bác sỹ trong hệ thống y tế dự phòng tại các tỉnh miền Trung và Tây Nguyên Việt Nam năm 2013

Nghiên cứu mô tả cắt ngang kết hợp định lượng, định tính về thực trạng và nhu cầu nguồn nhân lực bác sỹ trong hệ thống y tế dự phòng tại các tỉnh miền Trung và Tây Nguyên Việt Nam năm 2013. Tác giả: Võ Văn Thắng, Lê Đình Dương, Đoàn Vương Diễm Khánh, Hoàng Đình Huề, Nguyễn Hoàng Thùy Linh, Hoàng Đình Tuyên, Trần Bình Thắng. Hội nghị khoa học quận Thủ Đức, thành phố Hồ Chí Minh. Y học thực hành (880).

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

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'iYngfJ{Jih9C Y DU'C)'c Hue

TOMTAT

Ml,lc tieu: 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 y te 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'ngauoc thl,fChi~n tren 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 s9chu yeu la quen 19va giamsatchung (59,8%); cong tee chuyen mon dl)' phong (20,1%); aieu trj (19,4%); quen 19cae cturonq trinh, df,J a ' y te (11,8%); I~p ke hoect: chi agO tuyen (10,4%); t6ng hQ'p va beo cao (6,1%) C6 Sl) ' thieu h1 , ltcIangke nguon nMn 1l)'Cbee s9lam viec trong Mthang y te dl)' phong atat ca 6tinh;chi c6 17,7%

(9/51) cIonvi tuyen tinh c6 au ajnh moc bien cM bees9theo quy dint:

Khaosat tren 182 k9 nang chia thBnh 2 nh6m nang 1l)'C: nh6m nang lire chung (9 nh6m vo! 98 k9 nang) , nh6m nang lire CI , 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)'C CI , the la 38,2%.

Ket lu~n: C6 sir thitJu hut aang ke nguon nMn lire Mc s9lam viec trong M tMng yttJ 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~ th6ng yte dl)' phOng te! khu VI)'C nay

TIPkh6a: Nguon nnen 1l)'C,Mthang y te 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 were3 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 avera e, 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 includedmaking plans 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 a serious sh rtage of human resources for preventive medicine in the central highlandareasofVietnam There should be increased recruitment The findings ofthis study also will be usedto enhance profession l training for preventive medicine at pre-service and in-service levels.

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

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 hond~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'nghon 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'CX 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 atrong tinh tr<;1ngchi

cua hEilthong y t~ dl,J'phong ca nuoc , Muc tieu nghien CLYUcua de tai nharn:

1 Tim hifJutturc 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

yttJ dll phOng

3 Tim hifJu nhu c8U clao t<;30va tuyfJn dl,Jnfl cl6i voi bee s9 trong ITnh vue yttJ 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 kynang BS YT voi bo cau hoi tl,J'dien d~ thu thap so liEiluduatren 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,Jngthuonq 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 CLYUthamdo d~ hieu chlnh bO cong CI,Jduoc 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 lie u beo cao cue cec sa y ttJ 1212012)

-4S0

4001 - ,·

3S0

3M

2S0

2M

1 0

100

5

o

Quang QlI<ing IT Hue QU4ng einh {)ilk

Sinh Tr Ngai Ojnh Uk

4S0 400

350

300

2.50

lO{)

lS0

100

5 {)

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 s91CSYT atuyen tlnh cao non so voi tuyen huyen 4/6 tlnh co ty IEilbac

lam viec tal tuyen tlnh cao hon so v6'i tuyen huyen d~c biet ty IEilnay tal TT-Hu~ la3,6/1

Bang 1: Thuc tranq ngubn nhan Il, ' cy te hien nay

(-): Cac don vi khOng c6 dinh moc b i en cha theo T hong tir08

Tat ca cac tinh tham g i a nghie!n CLPUd~u thieu nhan Il, ' c & cac don v i true thuoc.chl c6 17 , 7% (9/51) don vi tuyen tin h c 6 d u dinh rmrc bien c he ba c sy theo quy dinh; trong d6 cu thll tlnh tranq thieu BS & cac do n vi nhu ' : TTGDS K (6/ 6 ); TTCSS K SS ( 5 /6) ; TT Y TDP tlnh, HIV/AIDS, PCSRNT (4/6).

Ket qua tli n hien CL P Udinh t l nh cO n g cho thay c6su th i eu hut r o ret ngubn nhan Il,I'c CBYT va bac si lam vie c t rong h $ thong YHDP & hau het cac don vi tham gia nqhien CLPU :

" Ttwc tr<;ln g gu6n nhan tu c bee s9 n6 i chung , bee SI YTOP n6i rieng thiau r c 1tnhieu so vo! nhu c8U.

vd : chi Cl)C v~ si nh A TTP chi c6 1 bee s 9 , chi Cl ) C ka boect: h6a gia dinh cb! c6 1as,can cac trung tam

kMc chic6 2 - 3 as T r ung tam yta Tay Tre , vue lam amang d i eu tri vue lam amang dl! phong chi c6

3 as ' (PVS- QN).

"so vai nhu c ~ u t nuc ta atren , tinh thia u khoang 30% as cho h~ dl! phong. C6 nhCmg huy~n can

h n n h ngemt inh tru ng binh la k h oang 40% " (PVS-DL)

• 2 C o g vi~c , nang I If va ky n ang c e ln t hi~t cua cac bac 5y hi~n dang lam vi~c trong h~ thong y

tf!dlf phon g

100

90

80

70

60

50

4

3

2

10

o

• Tuyen huy~n

- • Tuyen tnh

Q u a n Sinh Quang Tri Thi r a Thien Hu~ Quang Ngai Sinh Din h Dak l ak

Pho n g v an t ren 423 bac sy da ng l a m vi e c tr ong h $ t hong y t e dl,l' phOng cho thay dO tuoi trung blnh cua cac doi t U ' Q ' ngnghien CLPU 4 , 6 ±6 , 5 ; so n a rn la m viec t rung blnh 11313 , 26 ± 8,39 ;

NhiernVI,J va cang viec chfnh c u a ca c bac sy c hu y e u 113 quan 19va giam sat chung (59 , 8%) ; cang tac chuyen man dl , l' phonq (20,1 % ) ; di~u tri (1 9 , 4%) ; quan 19cac chuon trlnh, dl,l an y te (11 , 8%) ; lap ke hoachchi da o t uyen (10 , 4%) ; ton g h op va ba o cao (6 ,1 %)

N gh ien c uu k y n a ng bac sy dua tren 2 nh6m na n Il, ' C c h f nh 1 13 nh6m nang Il, ' cchung (9 nh6m), nh6m ni:l ngI l , I'cCI,Jt h (11 n ang luc); tong co n g c6 182 ky nan g N ghi e n CLPUtan suat Slf dl, l ng cac nh6m nang

Il , I'ccho tha y: ty 1$ SLYdl , lng thU'ang xuyen nh 6 m n a ng I l, ' c ch u ng 11349 , 6% ; nh6m nang Il, ' c Cl,l thl l 113 38,2%va c6 Sl , I'k hac nhau gilia tu yen ti nh va huyen ( p<0 , 0 )

90

80

70

60

50

40

30

20

10

Quanlyvi.t3 chu.:yti

Chlnh achvi

lu~tyti

n!!Pi~m

.TYl~ %SD NL tlnrongxuyen

illTYl?Al danh gia dntlll~t

BitJU do 3:Phan bo tan suat vam{PC;de) can thiet cue nh6m nang It,J'cchung

10 0

9

8

7

60

50

40

30

20

10

o

Ve chat Iuvng nguon nhen /t,J ' C:Phan lon cac

d n 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 q a conq viec chua cao, con b]

dong trong cong taco "Dap (mg hi~n nay t h eo muc

a( > no!c hu ng la, n~u me chia theo mire a(> thi cOng

la tr un g 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'cmire

t6i t hi~ u cho la tioen thenh nhiem VI) cnir cnue

auoc n on mfa Kinh phi khOng co, ngu6n nnen

iuc khOng au thi co lam theo ki~u aoi co d i et: atJn

la t a ch6ng , khong a~cno d;ch Ian xay ra

chUng ta moi chi lam atJn aU'Q ' cmoc a(>khi codie t:

atJn thi c h ung ta kMng chtJ va d{)p t~t duoc

n6 " (PVS- E JL)

"Nang tuc cong tee mang YTOP a mire trung

binh Du thl)'c hi~n vahoen tnen t : nhi e m VI), tuy

nhien kha nang a~aap Ifng kh6i 1U ' Q ' ngcon g v i ec

Q u nIy An t oan va Sire kh o e Di nh diron g S i e ho e S i e h oe N h an k hAuDich t S hoe Th&ngke N h n hoe na n g l i fe h6

t ha m ho a va si r e h oe m6i tnro ng va a n ro an cac li ra t u i ho e duon g ho e va k i em sinh h oc/he va y xii hOi tro

pho ng ng h S ng h i ep thtrc ph a m va si r e h e soat benh thong thong hoe

t lu ro n g tieh

Bieu do 4: Phan bo tan suat vam{PC;de) can thiet cae nh6m nang It,J'CC(.l the

trong tinh hinh b~nh diet: pturc t<;lPhi~n n ay

thitJu nhieu.(TLN-QN).

Mot so can bo chua yen tam conq tac vac on

tU'cYng chu quan, thieu y thirc hoc hai, ca u

"nnin chung noet a(>ng r~t t6t ntumq co 1 86 ng

khOng an tam voi cong viec cur phOng, c 6

ngU ' oiaa chuy~n sang Maieu tri "(PVS-QN)

"Vi va ctiem va eo Il)'c acong tee YTDP kh

nhieu nen nhieu as ctiu quan, it muon hQ c

nang cao trinh a(> a6i vo! cong tee YTDP" (~

QN)

' 3. Nhu c&u dao tao va tuy~n dl , lng nha n

y t~ dlf phong tilli cac tinh Nghien cuu cho thay nhu cau tuyen dl,m gn

luc can bo y te, d~c blet la nhan Il,I'C bacsi

viec cho h$ thong y hoc dl,l' phonq 113ratIa n a

ca 6tlnh 95,5% cac don vi y te dl,l' phongc6

cau tuyen dunq tCr1 - 12 bac sy (trung b inh

bac sy/dO'n vi) Phang van sau mot lanh dao

12 YHTH (880) - HOI N GH! KHOA HOC B~NH VI~N QUAN THO BaC TP H6 C HIM

H PHU HO'P GILYADAo TAO vA KHA NANG DAp lrNG CONG VIEC

VQ VAN THANG, NGUYEN MINH TAM

Kho a Yt e C o g c 9 9 , T! U' iYng D~i h9C YDlJ'9'C Hue

TRAN BINH THANG

Trung t a m Nghie n CLPUS (PC khoe c9n9 dong , TrU'iYng D~i h9C YDlJ'9'C Hue

MICHAEL P DUNNE

TAT

ctie u: M6 ta noi la m vi e c cue s i nh v i en Y te Cong cong (Y T CC) sau khi t6t nghi~p , nhCmg cong

C(ItM da ng aam nh~n , tint: phu hop cue noi dung aao teo vo! kha nfmg dap ( f ng cong viec hi~n tei

dl nMn Y te Gong c o ng ( GN Y TCC) da t6t nghi~p cDng ntur xac dinh cac nang lire dap (fng t6t trong V$chi~n t9i PhU 'O 'n g ph ilp: T hiet kt J nghi{m cou c~t ngang , ket hOp nghi{m cou dinh ILfO'ngvadinh

d 6i tllr;m gla GN YTCC da t6t nghi~p te i T r L f lyng f)H Y DLfO ' CHue dang lam viec tren toen qu6c va

I nh c1~ 0cac don v i tuyen dl , mg tlf thang 4/2012 den 1/2013 Ket qua: Noi cong tee chu yeu cue CI,J ' U

~n l aMy te dl) ' ph O ng (60 , 9% ), 9 , 1% 6 ' Md i eu tri Cec mon hoc phu hO'P voi nhCmg yeu ceu trong

~ cua no (ap dl,mg dLfO ' ctrong cong v i ec tren 70%) ntur : quen 19y te , chinh sect: y te va kinh te y

"i~n cti u khoa hoc ; diet: te ho c va th6ng ke Co m6i lien quan co 9 nghTa th6ng ke giCl ' a chLfong

daot~ o vai muc 00ep dl,mg trong cong vie c Hau het cac CN YTCC deu tir tin trong cong viec hang

chi~mty I~ tren 80% , d~c b i ~ t urtin d6i voi cac nhom nang luc ve quen 19 YTCC , nghien cuu - l am

nh6m/ gi a o tiuc tru y en thOng Tuy nbien , gan 50% ' CI , J ' U sinh vien cho ding chuonq trinh dao t90 cture

nMt n hi e u voi tiurc t i en , con n~ng ve 19 thuyet bon tturc hanh Ket lu~n : Pben b6 noi lam viec cue

si nhvif:ntr e ca3 mi e n c u V i~t N a m, xa hoi co nhu ceu t u yen dl)ng CN YTCC cao , m~c du , mot s6

V Ituyd ndl)ng van cture hieu ra vai tro va cnoc nang ciie CN YTCC Noi cong tee cM ytJu la h~ Y te

p hOng, co sa aao t90 va b~nh v ien Cec nhom nang tuc chinh lien quan den cong viec hi~n tei la ouen

y M nghif : n cuu khoa hoc - la m v i ec nh6 m / giao tiu c t r uyen thong ve cacITnhvuey te cong congo

UMM ARY

Correspondence between taining and the functions performed at work by Bachelor of Public

graduates from Hue University of Medicin and Pharmacy, Vietnam

Object ives : The study obje c t iv e i s to i de nt ify th e d ist ribution of Bachelor of Public Health (BPH)

atesi n t he health c are system an d the i r job d s cr i ptions , to assess the relevance and adequacy of

k now/e dgeand sk i lls acqu i red during t he BP H p rogram and to identify the relative importance of a

of public health compe ten c ie s pe r fo rme d b y a lu mn i in the ir pre s ent work Methods: This

cross-al s t udy was conducted w ith pu bl ic healt h a lumni (121) and leaders between April 2012 and

ary201 3 and used a c o m b i n tion of qu a nt ita t iv e and qualitat i ve d ata collection methods Results:

" BP H graduates wor k i n P r eventive M e di c in e C ente r s (60.9%) and the clinical field (9 1%) The

nt sub jec t sof the BPH prog r a m that appli ed t o t heir job (70%) i nclude: Health management , health

and h ealth econom i cs ; sc i e tific meth ods i n p u bl i c health ; epidemiology and Biostatistics Most

ni agreed that the BPH cu rric u lu m c o rre spo n e w i th the working r equirements of public health

iona ls Many BPH al umn i r e o e f eelin g c o fid en t perfo r m i ng competencies in normal work

es (8 0% ), especially in p u blic h a lth manag e m en t s ci e ti f i c research , health education and

o rk However , ne arly 5 % o f partic ip ants report ed that the c u r ri culum of the program has not been

tedan d p l aces too muc h emp h s is o a c a e mi c t h eo r y a d lacks field practice sufficient to achieve

leamin g Con c lu s i on: Hue Univers it y BPH a lum n i are di s tri bu t ed a c ross the 3regions in Vietnam

tal ne eds have inc rea sed r ecr ui t me nt fo r B P H g ra d ua t es , but s ome health agencies still lack

r s tandi n gof the r o l e an d f u nct ions o f BP H T e c o mpeten c ie s mo s t st r ongly related to their current

am in p bl i c h alt h s e rvice ma n ge m ent , sc i e ti fic resea rc h , health promotion/education and

works kills

Keywor ds: B a c h elor of Publi c Health, a l umni, cu rri cu lu m, c omp e ten ci es

( 880) · HOI NGH! KHOA HOC B~NH VI~N QU~N T HO one TP 8 6 CHf MINH 51

I DAT VAN Dt:

He thong Y te Cong cong (YTCC) dang van

hanh trong boi canh rna nhieu bien dong xay ra

lien tuc, gay nhieu ap hrc len he thong y te [3]

Tren T<;Ip chi Lancet, Robert Seaglehole da phan

tlch ro nhCmg su thay doi nay bao gom do 113Sl,l'

thay doi nhanh chong ve tinh hinh sue kh6e tren

toan cau von da phuc tap nay lai dang dien ra

trong boi canh ma Il,'c 1U'Q'ngcan bo y te cong cong

chua san sang de dU'O'ng dau vot nhCrng thli thach

do Sl,I' chua s~n sang nay phan nao 113do cac thli

thach do ton va phuc tap, do luc 1U'Q'ngcan bo va

ha tang co sa cua nqanh y te cong cong da b] lang'

quen, va do con thieu cac chuonq trinh dao tao

chuyen sau ve linh vue nay vfln de canq tram

tronq hon bai viec tap trung kinh phi cho cac

nqhien cuu y sinh hoc va su khonq thanh cong khi

giai quyet va lam viec voi cac van de can quan tam

co lien quan den sue khoe, va dieu nay duy trl va

thuc day phat trien nhCrng rno hinh hanh vi co hc;li

cho sue kh6e va mat conq b~ng trong y te Mot

van de gop phan lam han che nhCrng chuc nang

cua nhCrng ngU'oi dang cong tac trong linh vue Y

te thi nhCrng can bo ve YTCC thU'ong chua duo'c

xem trong trong linh vue ho phu trach bai he thong

dieu tri luon dU'Q'Cde cao trong he thong y te f)e

lam dU'Q'c dieu nay, tam nhin ve y te cong cong

khOng chi dU'Q'c truyen ba den nhCrng ngU'oi lam

cong tac y te conq cong ma can pho bien cho cong

dong nhCrng ngU'oi hoach dinh chinh sach, do 113

nhCrng ngU'oi rna hanh dong cua ho 113yeu to thiet

yeu de cai thien sue kh6e cho cong chunq f)lrng

truoc nhCrng thach thuc va co hoi trong linh vue Y

te Cong cong, chunq toi tien hanh khao sat cac

cong viec, nhCrng nhom nang Il,I'Cva ky nang cua

cac Cli nhan YTCC dang phu trach Muc dich cua

nqhien ctru nharn xac dinh ro hon ve chuc nang

cua Cli nhan YTCC va ra so at lai chtronq trinh

dao tao cua doi tU'Q'ng nay nharn co nhCrng dieu

chinh thich hop trong boi canh co nhieu thach thtrc

doi voi linh vue YTCC

Khoa YTCC cua trU'ong f)H Y DU'Q'CHue 113co

sa dao tao cung cap chuonq trinh dao tao va thuc

hien cac nqhien cuu cOng nhu pho bien cac chinh

sach ve YTCC, v&i nhiem VI,Ichinh 113dao t<;lOnhan

vien y te cho khu Vl,lCmien Trung va Tay Nguyen

cua Viet Nam Vao nam 2005, theo Sl,l'chi d<;locua

So Y te, Truong da b~t dau dao t<;lOchuyen nganh

Cli nhan YTCC (h$ chinh quy hoc 4 nam) Vao

nam 2012, co 3 khoa sinh vien da tot nghi$p v&i

tong cong 136 CN YTCC tot nghiep Ml,lc tieu

nghien Clru: 1 Mo ta nO'i lam vi$c cua sinh vien

YTCC sau khi tot nghiep va nhCrng cong viec CI,

the ma hO dang dam nh$n; 2 Mo ta tinh phu hQ'p

cua noi dung dao t<;lOv&i kha nang dap lrng cong

viec hien t<;licua CN YTCC da tot nghiep; 3 Xac

dinh cac nang Il,I'c dap lrng tot trong cong

tal cua CN YTCC da.tot nghiep ,

II.PHU'O'NG PHAP NGHIEN CU'U

1 Thi~t k~ nghien cu>u Thiet ke nqhien cuu ket hop dong thai

ap dunq, va day 113kieu thiet ke trongdo

dlnh 1U'Q'ngva dinh tlnh duoc thu th$pso

phan tlch rieng sau do dU'Q'c tlch hQ'p,

nghien cuu nay, nqhien cuu dinh 1U'Q'ng dU'Q'cthiet ke thu thap de rno ta tinh phil chuonq trinh hoc va lrng dunq trongcO

rno ta cac nhorn chuc nang va nang Il,I'C

CN YTCC duoc ap dl,lng trong trong cong

ho Thiet ke nqhien cuu dinh tlnh (ph6ng (PVS) , thao luan nhorn (TLN)) se k nhCrng van de : tlnh phu hop cua chU'O'ng

tao CN YTCC, nhCrng kh6 khan ho g~pP

qua trinh lam viec va tlnh chap nhancua n

dl,lng CN YTCC

2.Dbi tU'Q'ng nghien cu>u f)oi tU'Q'ng nqhien ctru la cac CN YT nghiep va cac can bo tanh dao dang sli

nghiep la 136 (2005 - 2009; 2006 - 2010

2007 - 2011) dang conq tac a cac trnhtha

ca nuoc TY Ie tham gia nqhien CLYU

(121/136) cscCN YTCC Ve gi&i Nam Nit b~ng nhau trong nghien cuu nay (Nam43,

56,2%) Khoa sinh vien 2007-2011 chiern

voi 46%; khoa 2006 -2010: 20,6%; Kh6a

2009: 33,9%

Cac can bo lanh dao (5 ngU'oi) dang cac CN YTCC a cac tuyen y te: Say I tam y te dl,l' phong Tlnh, Senh vien

3 PhU'O'ng phap thu th~p dQ>Ii~u

dU'Q'c chuyen t&i 135 cli nhan tot ngh'

tru>ong f)H Y DU'Q'CHue Mot cli nhan tot tro Iy nghien ctru cua nghien CLrUnay n tham gia vao khao sat dU'Q'C.Cac doi tU'Q' gia dU'Q'c tiep fuc lien lac thong qua email thoai de tang tl Ie tra loi Tong cong c6 YTCC tham gia nqhien ciru va 14 ngU'Oi

tham gia vi cac Iy do khac nhau Cong cv

chlrc nang, nang Il,I'c sli dl,lng trong ngh'

dU'Q'cxay dl,lng dl,la vao chuan dau raeN

sli dl,lng cac nhom nang Il,I'c theo nhCrng cao cua M<;Ing 1U'&i cac cO' sa dao t<;lOy

cong cua CMu A- Thai Sinh DU'O'ng(8

va mot so nghien ClrU ve Cl,l'Usinh vien Australia [3, 7] Cac nang Il,I'c sli dl,mg scale theo 5 mU'c tll' 0-4 de danh gia t~mq

va mlrc do tl,ltin trong cong viec

hanh tren 5 CN YTCC de kiem tra l<;IibO

trU'&c c4.0c khao sat chinh Trong ngh'

phOngvan sau duoc thvc hien vai 7 CN

tham ~ia nghieln cuu, 113nhCl'ng ngU'ai da

capnhieu thong tin khi tra lai bO cau h6i tl,l'

hl'tngngU'oinay 113dai dien cho cac nhorn

nghi~pchinhrna cac Clr nhan cOng tac sau

hi~p.Chung toi cOng thu c hi en ph6ng van

Wi51Anhdao hoa c n uoi q uan 19cua cac Clr

YTCC{S6'Y te, Trung tam YTDP va benh

v6 tamquantonq cua cac chirc nang cua

vacac ky nangd uoc lng dunq rna cac Clr

naythl,J'chien trong bOi earth cOng viec hien

bo

XiP I y thOng ke: Nghien CLPUdjnh 1U'Q'ng:

thongke mo ta va kiem dinh phi tham sO

htYI~ Fisher Exact Test Cac phep thOng ke

ngphanrnern Stata 12 phan tlch Nghien

d1nhtinh: PMn tlch cac bang ma tran phan

nll6mchu debosung cho ket qua cua nqhien

dlnhIU'O'ng

K~T QuA vA BAN LU~N

• Ncri lam viec cua sinh vien YTCC sau khi

hitp va.nhiPng cong vi~c clJ th~ mil hQ

d i m nhan

nbo riO'ilam viec cu cac Clr nhan tOt

cJAchirar~n~ trU'ang DH Y DU'O'c Hue da

~ nhan II,I'Cve CN YTCC cho nhieu vung

khacnhau 6'Viet Nam va nhCrng Clr nhan

khitot nghiep dang lamviec tai nhieu noi khac

a c 3 mien Bac (12,4%), mien Trung

)va mie Nam (12,4%) dat nuoc. Tap trung

thongyte tuyen tinh va tuyen huyen chiern ty

,8 %va31 , 4% Cong tac tai don vi y te dl,l'

chiemty Ie cao nhat 60,9%, sau d6 113cac

scHaot ao 1 , 5% va chiern ty Ie sOcan bo lam

d~y6'cac co sagiao due Cao d~ng, d<;lihoc

nhatso vai 2 trU'ong khac (DH YTCC Ha NOi

, t)HY DU'Q'cTPHCM 5,5%) 7,5% lam viec

c:6ctochLYCNGO va dang quan tam la c6 den

'Cl,rUsinhvien cong tac ahe dieu tr] [1]

Tlnh phu hop c ua nQi dung dilo t ao vai

ning dip (Png cong vi~c hi~n t~i cu a clJ'u

viin

C6cmOnhoc trong chU'O'ng trlnh dao t<;lOCN

(!U'O'cxem la phu hO'pvai nhCl'ngye diU

cOnvieccua hOnhU': To chlic q an 1 yte,

sach y te va kinh te y te Thl,lc te day 113

mOnhoc dU'Q'cdap ling trong chU'O'ngtlnh

~n 80% T Y Ie ap dl,lng trong cOng viec la

cao hO'nkhiso sanh vai nghien clu cua Le

Unhva Cs nam 2007 [5]

C6cnh6mmon hoc ve Dich te hoc, Nghien cliu

hocvaThong ke tin hoc, Giao dl,lc slic kh6e

nAngcaoSLYCkl16 :4 nhOm noi dung ma CN

CChai 16ngvechU'O'ngtrlnh dao t<;lOcan nhU'

cJOquan trong trong cOng viec cua ho hang

t)ieu nay chothay cac van de giai quyet va

quan 19 me hlnh benh tat, dich te hoc g6p phfln quan tronq trong cOng viec hien tal va hflu het cac

9 kien cho r~ng cac man hoc tren la mot trong nhCrng noi dung cOt 10i cua nqanh Y te cOng cOng

NMn xet nay tuonq tl,l' voi phat hien tCr nqhien cuu cua nhorn N.T Hal va Cs ve vlec xac dinh tarn quan tronq cua man hoc Dich te hoc [2]

" Theoem thi thay man Djch t~ hoc quan trong

va (mg dl , mg ph6 bi~n khi di lam nhat, nhat te nhCmg ph ; jn Ii{m quan d~n benn truyrm nhi~m

Man d6 em tMy la (fng dl,mg nhitJu nMt va cech d~y cOng chi ti~tnifa"[Nam, Khoa kiem soat benh

tr yen nhiern va vac xin sinh pharn, TT YTDP,

-Tuy nhlen, cau true chung cua chuonq trlnh dU'ang nhu chua dU'O'c hoan thien va can duoc cal

tien, khi c6 toi tren 50% cac Clr'nhan cho r~ng giang day 19thuyet can giam tai va nen tang thai IU'O'ngthuc hanh va nang cao cac ky nang nghe nghiep [Phu luc bang]

" ctnronq trinh hoc con n~ng vtJ19 thuy~t nhitJu qua NQi dung aeo t90 vtJ djch t~, t6 cnoc y t~, dinh dU'cmg, giao due sue kh6e cac man hoc dung la man chuy{m nganh cue minh d6 nhU'ng thai Iwng it qua Va ceu true chU ' O'ngtrinh cen 6' day la d9y ca 19 thuy~t va ttnrc hent: luon, ch(f hi~n t9i con nghi{mg vtJ 19 thuy~t nhit J u qua'INCI ' ,Trung tam phong chOng HIV/AIDs, Ph6ng van sau]

3. Xac dinh cac chLPC nang, nang hfC dap LPng tOt trong cong vi~c vi~c hi~n tal cua CN YTCC da tOt nghi~p

3.1 Cae cturc niing cu« CN YTCC: Qua vlec

rno ta tlnh phu hop cua noi dung dao tao vai kha

nang dap ling cOng viec hien tai cua CN YTCC da tot nghiep cho thay rOnon ve mot gO'i 9 cho chunq

ta thay r~ng chuc nang quan 19 va dieu hanh ta

cue ky quan tronq dOi vai cOng viec cua ho Trong

cac thao l uan nh6m, ph6ng van sau voi cuu sinh vien CN YTCC va lanh dao don vi tuyen dl,lng, ket hop ket qua dinh ·1U'O'ng(a Bieu do 1) cho thay: cOng viec va ky nang can thiet thU'ang dU'O'cthvc

hien hanq ngay lien quan hO<;ltdong cua cac dl,l an

y te; dl,l an quOc te hay trong cOng viec t<;licac cO'

sa y te nhU':I$p ke hO<;lchcho cac chien dich; xay

dl,lng ke hO<;lch va bao cao cac hO<;ltdong; xay

dl,l'ng ke hO<;lchcua dO'n vi; trien khai va giam sat

chU'O'ng trlnh y te; xay dl,lng ke hO<;lchcho cac hoi

thao cua cO'quan va chlrc nang tham mU'u cho

lanh d<;lo;thOng ke va bao cao; giam sat dich te hoc Ket qua nghien ClrU tCr cac cac tac gia Betty

J Ruth a My ve Khao sat ve chU'O'ng trlnh dao t<;lO cho cac nMn vien YTCC va COng tac xa hOi [7] hay nghien ClrUve cac chlrc nang ve YTCC a Uc [6] cang xem cac ky nang chung nhU'viet bao cao,

dieu phOi dl,l'an va tat ca cac khla c<;lnh cua cOng tac len ke hO<;lchva quan 19deu rat quan trong

35

25

20

15

10

5

o

QU l lnly

clnroug

trjnh , d\r

an

Tlrvin

chinh sach

Ho"ch djllhk~

ho,dl

38

" , 5 " ,

-Dao tao Tri~ QlIanly QuanlY Trllye Nghien

k hai c a v i i daub vii daub th6ngy eiru

trinh y t~ djch \7\1 vu ~n d\lcvil

kham lam sang uaug cao c1If t a ffirckhoe b~

Lam c6 n

vi~

hau h

chinh (nll8n

" ", tai

c in h )

Bifw do 1: cac nhom chLPCnang thll'CYng dU'g'c s&dl,mg cue cuu sinh vien

Ngoai ra, cac nh6m chuc nang ve Kinh te y te

cOng 113 mot trong nhCl'ng diem dU'Q'C phat hien

chinh trong nghien cuu nay Robert Seaglehole da

de nghi, trong bai bao ve te cong cong trong thap

nien mol, can cOng c6 nh6m ve van de kinh te y te

de phat trien bao hiem y te va quan Iy tlf cac quy

m6'i d~u tU' sue kh6e toan cau [3] Dieu nay l<;1imot

Ian nCl'a cho thay r~ng cac nh6m chuc nang lien

quan den kinh te y te can duoc tang cU'ong trong

qua trlnh giang day thong qua cac rnon hoc va can

c6 co hOi thuc tien de sinh vien c6 the lam t6t conq

viec sau ra trU'ong

" cir nhan YTCC thi nen diw teo them v~ kitJn

thoo tai chinh, kMng c~n ktJ toen, thi cec em tham

muu r~t t6t v~ tei chinh y ttJ, beo hiilm y ttJ , hi{jn

nay la cei linh VI)'C d6 la minh v~n con thitJu Hi{jn

thU'ong thi minh I~y nhCmg anh chi hoc ktJ toen re ,

nhCmg anh chi nay c6 kitJn tiurc r~t ky v~ thanh

toen, h~ch toen, nhU ' ng me kitJn tnoc v~ tai chinh

phOng bao nhieu, di~u tri bao nhieu, linh nay bao

tuytJn qu~n huy{jn [NCI',PVS lanh d<;1OSa Y tel

G~n lien voi chuc nang ve lap ke hoach d6 113

viec trien khai cac chuonq trlnh giao due SUC

kh6e Cac chuc nang ve giao due truyen thong

g6p phan kha quan tronq trong cac linh VI,I'Crna

CN YTCC dang cong tac: Y te du' phonq (11 %);

Dich Vl,Jlam sang (9,1%) Ket qua cho thay r~ng

cac chuc nang nay phu hop v6'i nhCl'ng ket qua

cua nqhien cuu Le VO Anh ve xac dinh chuc nang

Cung dpdjch

" him

s ang

Kh a

va nhiern Vl,JY te cong cong do Dai hocY ' hop voi WHO narn 2004 [4] M~c du100% nhan da c6 viec lam sau t6t nghiep tron~ cuu nay nhU'ng ho phai d6i m~t voi nhl

khan ban d~u d6 113 mot 56 co sa tuyendUI phan cong vi trl viec lam dung v6'ichucn

CN YTCC SI,I' hieu nharn ve nghe nghi$p YTCC 113 Iy do thU'ong dan den m¢t 56 ( vien CN YTCC duoc cac don vi tuyend xep nhCl'ng nhiern Vl,Jkhonq phu hop va I

toan khong hai long voi 51,1'phan cong nhlJ

nqanh YTCC, c6 nhieu he th6ng danh giaI khac nhau, nqhien cuu nay SLY dl,lng h$th SEAPHEIN 2,3,4 (113 he thonq cua CaGtn!

hoc YTCC cua Ch~1UA - Thai Sinh DU'on!

hieu rrurc dO SLY dl,Jng va 51,1'tl,l' tin khi!

nhCl'ng nang luc nay T6ng 56 co 34 n duoc liet ke theo 4 nh6m chinh: nhorn nan quan IY', nh6m nang luc dao t<;10It$p huA

nang Il,I'c ve nqhien cuu danh gia va nh(

II,I'Cve lanh d<;1Ova lam viec nhom/giaody thong Sang dU'&i cho thfiy ro cac ky na cac nh6m nang Il,I'c deu duoc (rng dl,lng trong conq viec va hau het cac CNYTC( tin va rfit tl,l' tin chiern ty Ie deu tren80~ cac nh6m nang Il,'c ve quan Iy YTCC, ngl

va l.anh d<;1O- Lam viec nh6ml giao dU thOng Ket qua nay tU'O'ng tl,l' voi ketqUI cuu ve nhan hrc y te cua Truong DH Y

NOi [1] va cua nh6m tac gia Le Cl,lLil nqhien cuu tren CI,I'Usinh vien 2 trU'6'ngf)

54 YHTH (880) - CONG TRINH NCKH COA VI~N DAo TAO Y HQC DlJ PHONG & Y T~ cO~

9H Y Duoc TP HCM [2] Mot Iy do giai thich

k6t qua nay c6 the la do cli nhan YTCC chu

lAm vi~c trong cac co quan cong I$p noi

9xuy~n phai slf dl,mg cac nang Il,l'c nay, do

hQ cam thay tl)' tin hon voi cac nang luc nay

IvcMng]

.K~TLU~N

1.Nai lam viec cuesinh vien CN YTCC

• Sau khi tot ~ghi$p va nhCrng cong viec Cl,Jthe

hQ aang dam nhan trai deu cac tlnh thanh a 3

aat nuoc, tap trung lon a Mien Trung

GOngvi$ccua cac CN YTCC dang dam nhan:

nh6m cong viec (chirc nang) dang dam nhan

Tntn khai cac chuonq trinh y te (39%); truyen

IIOngtrinh, dl)' an y te (30%); hoach dinh ke

4%);Lam cong viec hanh chinh (nhan sv, tai

) 16,5%

1Tlnh phil h9'P cua niji dung CIao t~o vcy;

ning crap (Png cong vi~c h;~n t~; cu« CN

da totnghi~p

•Tlnhphuhoopcua noi dung dao tao : phu hop

y6utau cong viec va chuc nang cua nhan vien

vi~ trong linh Vl)'C YTCC (hon 60% hai long)

trUcchung cua chuonq trinh la hop Iy va can

aa s6 khOng hai long v&i chuonq trinh da

b6 tri ky thuc tap 1 thanq a cac co sa y te

thi t6t nghi$p Muc do quan tronq cac noi dung

c11lQ'aaoc tao tai trU'cmg (sap xep theo nh6m

hOC)va Sl)' ap dunq trong conq viec hien tal 4

mOnhoc da de C$P: Ouan Iy va chinh sach y

Giaocuesue kh6e va nang cao sire kh6e; Dich

va Nghiencuu khoa hoc; Thong ke y te

3 caenhOm nang II,I'C Clap (Pngtot vcy; cong

hlfn tiJi ctia c~u sinh vien

+Quan19 y t~ Cong cong (Lap ke hoach va

lycacchU'O'ng trinh y te (74,6%); Theo doi va

sat dich te hoc cac van de sue kh6e cOng

IU'O'cxay dl)'ng nang Il,l'c (41,2%) + Nghif1n

h th~o, ky nang ve tin hoc thong ke, co ban

cOng vi$c (93,4%); Thu thap thong tin sue

trong cong dong (77,4%); Danh qia va phan

tlnh hinh sue kh6e cua mot cOng dong

,5%).+ Lanh agO - lam viec n nom : Giao tiep,

aOn Sl)'tham gia cua co g dong trong cac

aOngbao v$ suc kh6e (76,6%); Giao tiep hi$

vai cOngdong bang viet va n i trong nhieu boi

hkhac nhau (75%); Tien hanh cac hO<;lt dong

truyen thong ve cac van de sue kh6e cong dong (74,2%)

- Nh6m nang II!C khec: Giarn sat phOng chong nhiem khuan benh vien, chi dao tuyen va phonq chong djch tai benh vien, ky nang viet bao cao, nghien cuu van ban y te, ky nang tieng Anh va cac

ky nang rnern khac

V KI~N NGH!

dung ve quan Iy - chinh sach y te, Kinh te y te,

-quan Iy thOng tin y te, qiao due sue kh6e, Dich te hoc - Thong ke, cac ky nang ve Nghien cuu khoa hoc va chuonq trinh thuc tap cong dong

Can co cac_chU'O'ngtrlnh tu van co hoi vieclam cho cac CN YTCC long ghep cac noi dung quanq

nhCrng ngU'CYilam conq tac y te conq cong rna can pho bien cho cong dong nhCrng ngU'CYihoach dinh chinh sach

Xay dl,l'ng mot moi trU'cyng tU'O'ng tac nhu cong thOng tin dien tli la rat can thiet nharn tan dl,Jng dU'ooc nguon Il,l'c ve tai li$u va nang Il,'c tU' van cua trU'cyng cang nhu nhCrng dong gap hi phia cac CN YTCC da tot nqhiep

1 Le va Anh (2012) £)tmh gia hi~n trgng aao teo nhen II,fC Y t~ tei Vi~{Nam, TruocyngDal hoc Y

te cong cong, Dl,l' an nqhien cuu

2 Nguyen Thanh Hal, Bui Tu Ouyen va cong

Sl,'(2007)"ChU'O'ng trinh dao tao clf nhan y te cong cong: Nhan dinh cua cuu sinh vien hai truocyng D<;li hoc Y Duoc tal Viet Nam" Tep chi Y t~ Gong cong, 8 (8), tr 8- 16

3 Ruth Bonita (**) Robert Beaglehole (*), Orvi! Adams (****) Richard Horton (***), Martin McKee (*****) (2007)"Y te cong cong trong ky nquyen rnoi: Nang cao sue kh6e thOng qua cac hanh dong tap the" Tep chi Y t~ cong cong, 9 (9), tr 4-9

4 Le va Anh va cOng Sl,l' (2004)"Chuc nang va nhiern Vl,Jy te cong conq" Tep chi Y (~ cong cong,

2 (2), tr 4- 7

5 Le, L C , Bui, Q T , Nguyen, H T , Rotem,

A (2007)"Alumni survey of Masters of Public Health (MPH) training at the Hanoi School of Public Health" Hum Resour Health, 5, 24.

6 National Public Health Partnership (2000)

National Delphi Study on Public Health Functions

in Australia: Report on the findings", Melbourne, Australia

7 Ruth, B J , S Sisco, Wyatt, J , Bethke, C ,

Bachman, S S , Piper, T M (2008)"Public health and social work: training dual professionals for the contemporary workplace" Public Health Rep, 123

Suppl 2, pp 71-7

THIlt TR4NG vA NHU cAu NGUdN NIlAN Lilt BAc st TRONG He TH4NG

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

I ; ;IAruHuYnh NgQC Dung, Yo PhUng 9UY ~J \