THU'C TRANG vA NHU cAu NGUON NHAN LU'C BAc stTRONG '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 THANGTrU'iYng fJ{Ji h9C Y DU'C)'c Hue

TOM TATMl,lc tieu: Nghitm cou mo ta tnuc trgng nguon nMn 1l)'C,cac nang lire va k9 nang can thiet cue cac

bacs9 lam viec trong h~ thang y te dl)' phOng va nhu ceu tuyim dl,mg, cIao teo nguon nMn 1l)'Cnay tet khuV(J'c mi~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'ngauocthl,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~ccIi~mdan toc hoc, tinh trgng cong viec va cac k9 nang lam viec. Nghien cou dinh tinh aU'Q'ctien bent: tren27 bac s9(3 phOng van seu va 3 tMo 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 19vagiam sat chung (59,8%); cong tee chuyen mon dl)' phong (20,1%); aieu trj (19,4%); quen 19cae cturonqtrinh, df,J'an y te (11,8%); I~p ke hoect: chi agO tuyen (10,4%); t6ng hQ'p va beo cao (6,1%). C6 Sl)' thieuh1,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:

Khao sat tren 182 k9 nang chia thBnh 2 nh6m nang 1l)'C: nh6m nang lire chung (9 nh6m vo! 98 k9nang), nh6m nang lire CI,I tM (11 nh6m voi 84 k9 nang). Tan suat sif dl,lng thU'ong xuyen cac nh6m nangII,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 telkhu VI,fCmi~n Trung va Tay Nguyen. Nghien cou cho tMy can thitJt tang cU'ong aao teo va aao teo Igi choh~ th6ng y te dl)' phOng te! khu VI)'C nay.

TIPkh6a: Nguon nnen 1l)'C,M thang y te dl)' phOng, bee s9, nang lire, k9 nang.SUMMARYObjectives: This study describes the real situation of human resource and needs of recruiting doctors

workingin 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 districtlevels were 35.2%. A self-administered questionnaire was used to collect information about demographiccharacteristics,job conditions and technical competencies. 27 doctors participated in in-depth qualitativeinterviewsand focus group discussions.

Results: The average age of the doctors was 46.6 years (s.d=6.5) and the majority (69.7%) 'weremale. On average, they had worked in this role for 13.3 years (s.d.=8.4). The main roles of the doctorsincluded 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 tasksincludedmaking 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. Only17.7% (9/51) provincial units had enough doctors to meet service requirement.· The survey identified atotal 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 usingthegeneral and specific competencies (49.6% and 38.2% respectively).

Conclusion: There was a serious shortage of human resources for preventive medicine in the centralhighlandareas of Vietnam. There should be increased recruitment. The findings of this study also will beusedto enhance 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 SLYCktcho cong dong. Theo bao cao cua WHO - 2006, tinh tranq thi~u hut nquon nhan tuc y t~ dang ton tal aquoc 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 co50% cac quoc gia thieu can bo y t~ voi so ILI'Q'nghon 1 trieu nhan vien y t~ [5]. Theo So Y t~, ViEiltNdLl'Q'cxep vao nuoc nhli'ng nuoc co ty IEilnhan vien y t~ cao (> 5 bac 59 tren 10.000). Tuy nhien, nglnhan Il,J'CX t~ ViEiltNam lai p~an ~o mat can doi gili'a c~c ~ung, mien, gili'a cac chuyen nganh[1]. DOi.rcan 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 tephonq tai cac tuyen tlnh co trlnh do DH va SDH chiern ty IEilchua t6'i 50%. Hau het bac 59 dang lam vtrong 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 tthan. HEilthong Y t~ dl,J'phonq tai cac tlnh Mien Trung va Tay Nguyen cOng dang a trong tinh tr<;1ngchicua 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 JV(.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 they ttJdll phOng

3. Tim hifJu nhu c8U clao t<;30va tuyfJn dl,Jnflcl6i voi bee s9 trong ITnhvue y ttJ dll phOng t<;3ikhu V(.J'I

II. D01 TU'Q'NGvA PHU'O'NG PHAp NGHIEN cuuThi~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'ngphap 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 liEiludua tren 10 nh6m nang luc chung va 10 nh6m nang luc CI,Jthethi~u cua 1 bac s9 YTDP ViEilt Nam duoc phat trien trong nqhien CLYUnhu cau dao t<;10bac s9 y hocphOng tal cac trLl'cmg dal hoc Y ViEiltNam cua Dl,J'an Nuffic narn 2008 [3]. Mot bac si dLl'Q'cdanh gia ladl,Jngthuonq xuyen mot nh6m nang hrc khi co sli dunq it nhat 50% so nang hrc trong nh6m nang luc alrmrc dO thLl'ong xuyen tra len. Nqhien CLYUtham do d~ hieu chlnh bO cong CI,Jduoc thuc hien tal trung talt~ dl,J'phonq thanh pho Hu~ va tham van cua cac chuyen gia, ngLl'oi quan Iy trong hEilthong y t~ dl,J'phoNghien CLYUdLl'Q'ctien hanh tal 6 tlnh: Quang Sinh, Quang Tri, ThCYaThien Hu~, Quang Ngai, Sinh DinhDaklak 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 IEilla76,8% (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 LUAN1. 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......------------....,·

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

4S04003503002.50lO{)lS010050

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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 1CSYT a tuyen tlnh cao non so voi tuyen huyen. 4/6 tlnh co ty IEilbaclam 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 CHIMil

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 66,73. Chi Cl,lcVSAITP (-) (-) (-) (-)

4. IT PC benh xii hoi 1/3 33,3 2/3 66,75. IT PC HIV/AIDS 5/6 83,3 4/6 66,76. ITCS-SKSS 2/6 33,3 5/6 83,37. Chi CI,ICDS-KHHGD (-) (-) (-) (-)8. TT Truven thonQ GDSK 2/6 33,3 6/6 1009. TT PC Sot ret noi tiet- CT 2/5 40,0 4/5 80,010. TT Kiem dich quoc te 1/1 100,0 1/1 100,011. TT Da lieu (-) (-) (-) (-)12.. Tuven huven 2/6 33,3 5/6 83,3

(-): Cac don vi khOng c6 dinh moc bien cha theo Thong tir 08Tat 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 CLPUdinh tlnh cOng cho thay c6 su thieu hut ro ret ngubn nhan Il,I'cCBYT va bac silam 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: chi Cl)C v~ sinh A TTP chi c6 1 bee s9, chi Cl)C ka boect: h6a gia dinh cb! c6 1 as, can cac trung tamkMc chi c6 2-3 as ....Trung tam y ta Tay Tre, vue lam a mang dieu tri vue lam a mang dl! phong chi c63 as' (PVS-QN).

"so vai nhu c~u tnuc ta ... a tren, tinh thiau khoang 30% as cho h~ dl! phong. C6 nhCmg huy~n canhon 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 ytf! dlf phong

100

908070605040302010

o

• Tuyen huy~n

- • Tuyen tinh

Quang Sinh Quang Tri Thira Thien Hu~ Quang Ngai Sinh Dinh Dak lak

Bieu do 2: Phan bo not cong tsc cua bac 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 blnhcua cac doi tU'Q'ngnghien CLPU46,6 ± 6,5; so narn lam viec trung blnh 11313,26 ± 8,39;

NhiernVI,J va cang viec chfnh cua cac bac sy chu yeu 113quan 19va giam sat chung (59,8%); cang tacchuyen man dl,l' phonq (20,1 %); di~u tri (19,4%); quan 19cac chuonq trlnh, dl,l' an y te (11,8%); lap kehoachchi dao tuyen (10,4%); tong hop va bao cao (6,1 %).

Nghien cuu ky nang bac sy dua tren 2 nh6m nang Il,I'Cchfnh 113nh6m nang Il,I'cchung (9 nh6m), nh6mni:lngIl,I'cCI,J the (11 nang luc); tong cong c6 182 ky nang. Nghien CLPUtan suat Slf dl,lng cac nh6m nangIl,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 11338,2%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

100908070605040302010o

Ho~t~vi. Oi&odl,l<t:u~ch~t.dnhy thongvi.ning

ti quoc ~a cao.u.: kh"e

Quanlyvi.t3chu.:yti

Chlnh .achvi.lu~tyti

N!!PiencUu Cangvi~clrongkhoa hoe ph/mglhl

n!!Pi~m

.TYl~ % SD NL tlnrongxuyenillTYl?Al danh gia dn tlll~t

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

100908070605040302010o

Ve chat Iuvng nguon nhen ./t,J'C:Phan lon cacdon vi dap ling dU'Q'c yeu cau nhiern VI,! ve YTDPdU'Q'c giao. 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 muca(> no! chung la, n~u me chia theo mire a(> thi cOngla trung binh hay gQi la aap Ifng tioen thent: nhiemVI) thOi, moc hoen tnenh nhi~m VI) ctur cture th~not la t6t bon duoc mfa... chi moi a<;lt aU'Q'cmiret6i thi~u cho la tioen thenh nhiem VI) cnir cnueauoc non mfa ... Kinh phi khOng co, ngu6n nneniuc khOng au thi co lam theo ki~u aoi co diet: atJnla 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 duocn6."(PVS-EJL)

"Nang tuc cong tee mang YTOP a mire trungbinh ..... Du thl)'c hi~n va hoen tnent: nhiem VI), tuynhien kha nang a~aap Ifng kh6i 1U'Q'ngcong viec

Quan Iy An toan va Sire khoe Dinh dirong Sire khoe Sire khoe Nhan khAuDich tS hoe Th&ngke Nhan hoe nang life h6tham hoa va sire khoe m6i tnrong va an roan cac lira tubi hoe duong hoe va kiem sinh hoc/he va y xii hOi tro

phong nghSnghiep thtrc pham va sire khoe soat benh thong thong hoechong sinh san t~t tin y tS

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 naythitJu nhieu.(TLN-QN).

Mot so can bo chua yen tam conq tac va contU'cYng chu quan, thieu y thirc hoc hai, cau"nnin chung noet a(>ng r~t t6t ntumq co 1 86 ngkhOng an tam voi cong viec cur phOng, c6ngU'oi aa chuy~n sang M aieu tri. "(PVS-QN)

"Vi va ctiem va eo Il)'c a cong tee YTDP khnhieu nen nhieu as ctiu quan, it muon hQcnang cao trinh a(> a6i vo! cong tee YTDP" (~QN)

'3. Nhu c&u dao tao va tuy~n dl,lng nhany t~ dlf phong tilli cac tinh

Nghien cuu cho thay nhu cau tuyen dl,mgnluc can bo y te, d~c blet la nhan Il,I'C bac siviec cho h$ thong y hoc dl,l' phonq 113rat Ian aca 6 tlnh. 95,5% cac don vi y te dl,l' phong c6cau tuyen dunq tCr 1 - 12 bac sy (trung binhbac 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

H PHU HO'PGILYADAo TAO vA KHA NANG DAp lrNG CONG VIECCUA SINH VIEN TOT NGHIEP CHUYEN NGANH .

., A ~ A _ ~

CU' NHANY TE CONG CONG TRU'O'NG DAI HOC Y DU'O'C HUE. ...

VQ VAN THANG, NGUYEN MINH TAMKhoa Y te Cong c9n9, T!U'iYng D~i h9C Y DlJ'9'C Hue

TRAN BINH THANGTrung tam Nghien CLPUS(PC khoe c9n9 dong, TrU'iYng D~i h9C Y DlJ'9'C Hue

MICHAEL P DUNNETrU'iYng Y te Cong c9n9, D~i h9C Cong ngh~ Queensland, Uc

TATc tieu: M6 ta noi lam viec cue sinh vien Y te Cong cong (YTCC) sau khi t6t nghi~p, nhCmg cong

C(I tM dang aam nh~n, tint: phu hop cue noi dung aao teo vo! kha nfmg dap (fng cong viec hi~n teidlnMn Y te Gong cong (GN YTCC) da t6t nghi~p cDng ntur xac dinh cac nang lire dap (fng t6t trong

V$c hi~nt9i. PhU'O'ng philp: Thiet ktJ nghi{m cou c~t ngang, ket hOp nghi{m cou dinh ILfO'ngva dinhd6i tllr;mgla GN YTCC da t6t nghi~p tei TrLflyng f)H Y DLfO'CHue dang lam viec tren toen qu6c va

Inh c1~0cac don vi tuyen dl,mg tlf thang 4/2012 den 1/2013. Ket qua: Noi cong tee chu yeu cue CI,J'U~n la M y te dl)' phOng (60,9%), 9,1% 6' M dieu tri. Cec mon hoc phu hO'P voi nhCmg yeu ceu trong~ cua no (ap dl,mg dLfO'ctrong cong viec tren 70%) ntur: quen 19y te, chinh sect: y te va kinh te y"i~n ctiu khoa hoc; diet: te hoc va th6ng ke. Co m6i lien quan co 9 nghTa th6ng ke giCl'a chLfongdaot~ovai muc 00 ep dl,mg trong cong viec. Hau het cac CN YTCC deu tir tin trong cong viec hangchi~mty I~ tren 80%, d~c bi~t ur tin d6i voi cac nhom nang luc ve quen 19 YTCC, nghien cuu - lam

nh6m/giao tiuc truyen thOng. Tuy nbien, gan 50% 'CI,J'Usinh vien cho ding chuonq trinh dao t90 cturenMt nhieu voi tiurc tien, con n~ng ve 19thuyet bon tturc hanh. Ket lu~n: Pben b6 noi lam viec cuesinhvif:ntren ca 3 mien cue Vi~t Nam, xa hoi co nhu ceu tuyen dl)ng CN YTCC cao, m~c du, mot s6VI tuydndl)ng van cture hieu ra vai tro va cnoc nang ciie CN. YTCC. Noi cong tee cM ytJu la h~ Y te

phOng,co sa aao t90 va b~nh vien. Cec nhom nang tuc chinh lien quan den cong viec hi~n tei la ouenyM. nghif:ncuu khoa hoc - lam viec nh6m/ giao tiuc truyen thong ve cac ITnh vue y te cong congoTilkh6a: Cif nMn y ttJ cong cong, CI,J'Usinh vien, chLfong trinh dao t90, nang lireUMMARY

Correspondence between training and the functions performed at work by Bachelor of Publicgraduates from Hue University of Medicine and Pharmacy, Vietnam

Objectives: The study objective is to identify the distribution of Bachelor of Public Health (BPH)atesin the health care system and their job. descriptions, to assess the relevance and adequacy of

know/edgeand skills acquired during the BPH program and to identify the relative importance of aof public health competencies performed by alumni in their present work. Methods: This cross-al study was conducted with public health alumni (121) and leaders between April 2012 and

ary 2013 and used a combination of quantitative and qualitative data collection methods. Results:"I BPHgraduates work in Preventive Medicine Centers (60.9%) and the clinical field (9.1%). The

nt subjectsof the BPH program that applied to their job (70%) include: Health management, healthand health economics; scientific methods in public health; epidemiology and Biostatistics. Most

ni agreed that the BPH curriculum corresponded with the working requirements of public healthionals. Many BPH alumni reported feeling confident performing competencies in normal work

es (80%), especially in public health management, scientific research, health education andork.However, nearly 50% of participants reported that the curriculum of the program has not been

tedandplaces too much emphasis on academic theory and lacks field practice sufficient to achieveleaming.Conclusion: Hue University BPH alumni are distributed across the 3 regions in Vietnam.tal needs have increased recruitment for BPH graduates, but some health agencies still lackrstandingof the role and functions of BPH. The competencies most strongly related to their currentam in public health service management, scientific research, health promotion/education andworkskills.

Keywords:Bachelor of Public Health, alumni, curriculum, competencies

(880)·HOINGH! KHOA HOC B~NH VI~N QU~N THO one TP. 86 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 ralien tuc, gay nhieu ap hrc len he thong y te [3].Tren T<;Ipchi Lancet, Robert Seaglehole da phantlch ro nhCmg su thay doi nay bao gom do 113Sl,l'thay doi nhanh chong ve tinh hinh sue kh6e trentoan cau von da phuc tap nay lai dang dien ratrong boi canh ma Il,I'c 1U'Q'ngcan bo y te cong congchua san sang de dU'O'ng dau vot nhCrng thli thachdo. Sl,I' chua s~n sang nay phan nao 113do cac thlithach do ton va phuc tap, do luc 1U'Q'ngcan bo vaha tang co sa cua nqanh y te cong cong da b] lang'quen, va do con thieu cac chuonq trinh dao taochuyen sau ve linh vue nay. vfln de canq tramtronq hon bai viec tap trung kinh phi cho cacnqhien cuu y sinh hoc va su khonq thanh cong khigiai quyet va lam viec voi cac van de can quan tamco lien quan den sue khoe, va dieu nay duy trl vathuc day phat trien nhCrng rno hinh hanh vi co hc;licho sue kh6e va mat conq b~ng trong y te. Motvan de gop phan lam han che nhCrng chuc nangcua nhCrng ngU'oi dang cong tac trong linh vue Yte thi nhCrng can bo ve YTCC thU'ong chua duo'cxem trong trong linh vue ho phu trach bai he thongdieu tri luon dU'Q'Cde cao trong he thong y te. f)elam dU'Q'c dieu nay, tam nhin ve y te cong congkhOng chi dU'Q'c truyen ba den nhCrng ngU'oi lamcong tac y te conq cong ma can pho bien cho congdong nhCrng ngU'oi hoach dinh chinh sach, do 113nhCrng ngU'oi rna hanh dong cua ho 113yeu to thietyeu de cai thien sue kh6e cho cong chunq. f)lrngtruoc nhCrng thach thuc va co hoi trong linh vue Yte Cong cong, chunq toi tien hanh khao sat caccong viec, nhCrng nhom nang Il,I'Cva ky nang cuacac Cli nhan YTCC dang phu trach. Muc dich cuanqhien ctru nharn xac dinh ro hon ve chuc nangcua Cli nhan YTCC va ra so at lai chtronq trinhdao tao cua doi tU'Q'ng nay nharn co nhCrng dieuchinh thich hop trong boi canh co nhieu thach thtrcdoi voi linh vue YTCC.

Khoa YTCC cua trU'ong f)H Y DU'Q'CHue 113cosa dao tao cung cap chuonq trinh dao tao va thuchien cac nqhien cuu cOng nhu pho bien cac chinhsach ve YTCC, v&i nhiem VI,Ichinh 113dao t<;lOnhanvien y te cho khu Vl,l'Cmien Trung va Tay Nguyencua Viet Nam. Vao nam 2005, theo Sl,l'chi d<;locuaSo Y te, Truong da b~t dau dao t<;lOchuyen nganhCli nhan YTCC (h$ chinh quy hoc 4 nam). Vaonam 2012, co 3 khoa sinh vien da tot nghi$p v&itong cong 136 CN YTCC tot nghiep. Ml,lc tieunghien Clru: 1. Mo ta nO'i lam vi$c cua sinh vienYTCC sau khi tot nghiep va nhCrng cong viec CI,Ithe ma hO dang dam nh$n; 2. Mo ta tinh phu hQ'pcua noi dung dao t<;lOv&i kha nang dap lrng congviec hien t<;licua CN YTCC da tot nghiep; 3. Xac

dinh cac nang Il,I'c dap lrng tot trong congtal cua CN YTCC da.tot nghiep ,

II. PHU'O'NG PHAP NGHIEN CU'U1. Thi~t k~ nghien cu>uThiet ke nqhien cuu ket hop dong thai

ap dunq, va day 113kieu thiet ke trong dodlnh 1U'Q'ngva dinh tlnh duoc thu th$p sophan tlch rieng sau do dU'Q'c tlch hQ'p,nghien cuu nay, nqhien cuu dinh 1U'Q'ngdU'Q'cthiet ke thu thap de rno ta tinh philchuonq trinh hoc va lrng dunq trong cOrno ta cac nhorn chuc nang va nang Il,I'CCN YTCC duoc ap dl,lng trong trong congho. Thiet ke nqhien cuu dinh tlnh (ph6ng(PVS) , thao luan nhorn (TLN)) se knhCrng van de : tlnh phu hop cua chU'O'ngtao CN YTCC, nhCrng kh6 khan ho g~pPqua trinh lam viec va tlnh chap nhan cua ndl,lng CN YTCC.

2. Dbi tU'Q'ng nghien cu>uf)oi tU'Q'ng nqhien ctru la cac CN YT

nghiep va cac can bo tanh dao dang sliYTCC. Tflt ca cac CN YTCC trong 3nghiep la 136 (2005 - 2009; 2006 - 20102007 - 2011) dang conq tac a cac trnhthaca nuoc. TY Ie tham gia nqhien CLYU(121/136). csc CN YTCC Ve gi&i Nam Nitb~ng nhau trong nghien cuu nay (Nam 43,56,2%). Khoa sinh vien 2007-2011 chiernvoi 46%; khoa 2006 -2010: 20,6%; Kh6a2009: 33,9%.

Cac can bo lanh dao (5 ngU'oi) dangcac CN YTCC a cac tuyen y te: Sa y Itam y te dl,l' phong Tlnh, Senh vien.

3. PhU'O'ng phap thu th~p dQ>Ii~uNghi{m cou dinh 1U'Q'ng:So cau h6i

dU'Q'c chuyen t&i 135 cli nhan tot ngh'tru>ong f)H Y DU'Q'CHue. Mot cli nhan tottro Iy nghien ctru cua nghien CLrUnay ntham gia vao khao sat dU'Q'C.Cac doi tU'Q'gia dU'Q'c tiep fuc lien lac thong qua emailthoai de tang tl Ie tra loi. Tong cong c6YTCC tham gia nqhien ciru va 14 ngU'Oitham gia vi cac Iy do khac nhau. Cong cvchlrc nang, nang Il,I'c sli dl,lng trong ngh'dU'Q'cxay dl,l'ng dl,l'a vao chuan dau ra eNsli dl,lng cac nhom nang Il,I'c theo nhCrngcao cua M<;Ing 1U'&icac cO' sa dao t<;lOycong cua CMu A- Thai Sinh DU'O'ng(8va mot so nghien ClrU ve Cl,l'Usinh vienAustralia [3, 7]. Cac nang Il,I'c sli dl,mgscale theo 5 mU'c tll' 0-4 de danh gia t~mqva mlrc do tl,l' tin trong cong viec.

Nghi{m CtfU dinh tinh: Ph6ng van saudhanh tren 5 CN YTCC de kiem tra l<;IibOtrU'&c c4.0c khao sat chinh. Trong ngh'

52 YHTH (880) - CONG TRINH NCKH CUA VI~N DAo TAO Y HQC DI,1PHONG & Y T~ cO

phOngvan sau duoc thvc hien vai 7 CNtham ~ia nghieln cuu, 113nhCl'ng ngU'ai da

capnhieuthong tin khi tra lai bO cau h6i tl,l'hl'tngngU'oi nay 113dai dien cho cac nhornnghi~pchinh rna cac Clr nhan cOng tac sauhi~p.Chung toi cOng thuc hien ph6ng van

Wi 51Anhdao hoac nquoi quan 19cua cac ClrYTCC{S6' Y te, Trung tam YTDP va benhv6 tam quan tronq cua cac chirc nang cuavacac ky nang duoc ling dunq rna cac Clr

naythl,J'chien trong bOi earth cOng viec hienbo.

XiP Iy thOng ke: Nghien CLPUdjnh 1U'Q'ng:thongke mo ta va kiem dinh phi tham sO

h tY I~Fisher Exact Test. Cac phep thOng keng phan rnern Stata 12 phan tlch. Nghien

d1nhtinh: PMn tlch cac bang ma tran phannll6mchu de bo sung cho ket qua cua nqhiendlnhIU'O'ng.

K~TQuA vA BAN LU~N• Ncri lam viec cua sinh vien YTCC sau khi

hitp va. nhiPng cong vi~c clJ th~ mil hQdim nhann bo riO'i lam viec cua cac Clr nhan tOtcJAchi ra r~n~ trU'ang DH Y DU'O'c Hue da

~ nhan II,I'Cve CN YTCC cho nhieu vungkhacnhau 6' Viet Nam va nhCrng Clr nhan

khitotnghiepdang lam viec tai nhieu noi khaca ca 3 mien Bac (12,4%), mien Trung)va mien Nam (12,4%) dat nuoc. Tap trung

thongy te tuyen tinh va tuyen huyen chiern ty,8% va 31,4%. Cong tac tai don vi y te dl,l'

chiemty Ie cao nhat 60,9%, sau d6 113cacscHaotao 16,5% va chiern ty Ie sO can bo lam

d~y6'cac co sa giao due Cao d~ng, d<;lihocnhatso vai 2 trU'ong khac (DH YTCC Ha NOi, t)H Y DU'Q'cTPHCM 5,5%). 7,5% lam viec

c:6cto chLYCNGO va dang quan tam la c6 den'Cl,rU sinhvien cong tac a he dieu tr] [1].

Tlnh phu hop cua nQi dung dilo tao vaining dip (Png cong vi~c hi~n t~i cua clJ'uviin

C6cmOnhoc trong chU'O'ng trlnh dao t<;lOCN(!U'O'cxem la phu hO'p vai nhCl'ng yeu diU

cOngviec cua hO nhU': To chlic quan 19y te,sachy te va kinh te y te. Thl,l'c te day 113mOnhoc dU'Q'cdap ling trong chU'O'ng trlnh

~n 80%. TY Ie ap dl,lng trong cOng viec lacaohO'nkhi so sanh vai nghien cliu cua Le

UnhvaCs nam 2007 [5].C6cnh6mmon hoc ve Dich te hoc, Nghien cliu

hocva Thong ke tin hoc, Giao dl,lc slic kh6enAngcao SLYCkl16e: 4 nhOm noi dung ma CNCC hai16ngve chU'O'ng trlnh dao t<;lOcang nhU'

cJOquan trong trong cOng viec cua ho hang. t)ieu nay cho thay cac van de giai quyet va

quan 19 me hlnh benh tat, dich te hoc g6p phflnquan tronq trong cOng viec hien tal va hflu het cac9 kien cho r~ng cac man hoc tren la mot trongnhCrng noi dung cOt 10i cua nqanh Y te cOng cOng.NMn xet nay tuonq tl,l' voi phat hien tCrnqhien cuucua nhorn N.T. Hal va Cs ve vlec xac dinh tarnquan tronq cua man hoc Dich te hoc [2]

"Theo em thi thay man Djch t~ hoc quan trongva (mg dl,mg ph6 bi~n khi di lam nhat, nhat tenhCmg ph;jn Ii{m quan d~n benn truyrm nhi~m.Man d6 em tMy la (fng dl,mg nhitJu nMt va cechd~y cOng chi ti~t nifa"[Nam, Khoa kiem soat benhtruyen nhiern va vac xin sinh pharn, TT YTDP,TLN] -

Tuy nhlen, cau true chung cua chuonq trlnhdU'ang nhu chua dU'O'choan thien va can duoc caltien, khi c6 toi tren 50% cac Clr 'nhan cho r~nggiang day 19thuyet can giam tai va nen tang thaiIU'O'ng thuc hanh va nang cao cac ky nang nghenghiep. [Phu luc bang]

" ctnronq trinh hoc con n~ng vtJ19 thuy~t nhitJuqua NQi dung aeo t90 vtJdjch t~, t6 cnoc y t~,dinh dU'cmg,.giao due sue kh6e ...cac man hocdung la man chuy{m nganh cue minh d6 nhU'ngthai 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~nt9i con nghi{mg vtJ19 thuy~t nhitJu qua'INCI',Trungtam phong chOng HIV/AIDs, Ph6ng van sau].

3. Xac dinh cac chLPC nang, nang hfC dapLPng tOt trong cong vi~c vi~c hi~n tal cua CNYTCC da tOt nghi~p

3.1. Cae cturc niing cu« CN YTCC: Qua vlecrno ta tlnh phu hop cua noi dung dao tao vai khanang dap ling cOng viec hien tai cua CN YTCC datot nghiep cho thay rO non ve mot gO'i 9 cho chunqta thay r~ng chuc nang quan 19 va dieu hanh tacue ky quan tronq dOi vai cOng viec cua ho. Trongcac thao luan nh6m, ph6ng van sau voi cuu sinhvien CN YTCC va lanh dao don vi tuyen dl,lng, kethop ket qua dinh ·1U'O'ng(a Bieu do 1) cho thay:cOng viec va ky nang can thiet thU'ang dU'O'c thvchien hanq ngay lien quan hO<;ltdong cua cac dl,l' any 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; xaydl,l'ng ke hO<;lchva bao cao cac hO<;ltdong; xaydl,l'ng ke hO<;lchcua dO'n vi; trien khai va giam satchU'O'ng trlnh y te; xay dl,l'ng ke hO<;lchcho cac hoithao cua cO' quan va chlrc nang tham mU'u cholanh d<;lo; thOng ke va bao cao; giam sat dich tehoc ... Ket qua nghien ClrU tCrcac cac tac gia BettyJ. Ruth a My ve Khao sat ve chU'O'ng trlnh dao t<;lOcho cac nMn vien YTCC va COng tac xa hOi [7]hay nghien ClrU ve 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<;lnhcua cOngtac len ke hO<;lchva quan 19deu rat quan trong .

(880)·HOINGH! KHOA HOC B~NH VI~N QUAN THO m1c TP. H6 CHf MINH 53

40'38,8

35

25

20

15

10

5

oQUllnlyclnrougtrjnh, d\r

an

Tlrvinchinhsach

Ho"chdjllhk~ho,dl

38

""",5",-. 1,7-Dao tao Tri~ QlIanly QuanlY Trllye.l Nghienkhai cac vii daub vii daub th6ngy eiruchuong gii cac gii djch ta, giao

trinh y t~ djch \7\1 vu ~n d\lcvilkham lam sang uaug caoc1Ifta ffirckhoeb~

Lamc6ngvi~hauhchinh(nll8n"",tai

chinh ... )

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 tecOng 113 mot trong nhCl'ng diem dU'Q'C phat hienchinh trong nghien cuu nay. Robert Seaglehole dade nghi, trong bai bao ve te cong cong trong thapnien mol, can cOng c6 nh6m ve van de kinh te y tede phat trien bao hiem y te va quan Iy tlf cac quym6'i d~u tU' sue kh6e toan cau [3]. Dieu nay l<;1imotIan nCl'a cho thay r~ng cac nh6m chuc nang lienquan den kinh te y te can duoc tang cU'ong trongqua trlnh giang day thong qua cac rnon hoc va canc6 co hOi thuc tien de sinh vien c6 the lam t6t conqviec sau ra trU'ong.

" ... cir nhan YTCC thi nen diw teo them v~ kitJnthoo tai chinh, kMng c~n ktJ toen, thi cec em thammuu r~t t6t v~ tei chinh y ttJ, beo hiilm y ttJ, hi{jnnay la cei linh VI)'C d6 la minh v~n con thitJu ... Hi{jnnay thi cong tee tet chinh - ktJ toen cue minh,thU'ong thi minh I~y nhCmg anh chi hoc ktJ toen re,nhCmg anh chi nay c6 kitJn tiurc r~t ky v~ thanhtoen, h~ch toen, nhU'ng me kitJn tnoc v~ tai chinhla ngu6n 6' aeu, phan ttcn ngu6n, phan b6 dl)'

phOng bao nhieu, di~u tri bao nhieu, linh nay baonhieu, linh VI)'C kMc bao nhteu dil dam pMn chotuytJn qu~n huy{jn [NCI',PVS lanh d<;1OSa Y tel.

G~n lien voi chuc nang ve lap ke hoach d6 113viec trien khai cac chuonq trlnh giao due SUCkh6e. Cac chuc nang ve giao due truyen thongg6p phan kha quan tronq trong cac linh VI,I'CrnaCN YTCC dang cong tac: Y te du' phonq (11 %);Dich Vl,Jlam sang (9,1%). Ket qua cho thay r~ngcac chuc nang nay phu hop v6'i nhCl'ng ket quacua nqhien cuu Le VO Anh ve xac dinh chuc nang

Cungdpdjch""himsang

Khac

va nhiern Vl,JY te cong cong do Dai hocY'hop voi WHO narn 2004 [4]. M~c du 100%nhan da c6 viec lam sau t6t nghiep tron~cuu nay nhU'ng ho phai d6i m~t voi nhlkhan ban d~u d6 113 mot 56 co sa tuyendUIphan cong vi trl viec lam dung v6'i chuc nCN YTCC. SI,I' hieu nharn ve nghe nghi$pYTCC 113 Iy do thU'ong dan den m¢t 56 (vien CN YTCC duoc cac don vi tuyendxep nhCl'ng nhiern Vl,Jkhonq phu hop vaItoan khong hai long voi 51,1'phan cong nhlJ

3.2. Cac nhom nang II,I'C: Dei vainqanh YTCC, c6 nhieu he th6ng danh giaIkhac nhau, nqhien cuu nay SLY dl,lng h$thSEAPHEIN 2,3,4 (113 he thonq cua CaGtn!hoc YTCC cua Ch~1UA - Thai Sinh DU'on!hieu rrurc dO SLY dl,Jng va 51,1'tl,l' tin khi!nhCl'ng nang luc nay. T6ng 56 co 34 nduoc liet ke theo 4 nh6m chinh: nhornnanquan IY', nh6m nang luc dao t<;10It$p huAnang Il,I'c ve nqhien cuu danh gia va nh(II,I'Cve lanh d<;1Ova lam viec nhom/giao dythong. Sang dU'&i cho thfiy ro cac ky nacac nh6m nang Il,I'c deu duoc (rng dl,lngtrong conq viec va hau het cac CN YTC(tin va rfit tl,l' tin chiern ty Ie deu tren 80~cac nh6m nang Il,I'c ve quan Iy YTCC, nglva l.anh d<;1O- Lam viec nh6ml giao dUthOng. Ket qua nay tU'O'ng tl,l' voi ket qUIcuu ve nhan hrc y te cua Truong DH YNOi [1] va cua nh6m tac gia Le Cl,l'Lilnqhien 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 thichk6t qua nay c6 the la do cli nhan YTCC chulAm vi~c trong cac co quan cong I$p noi9 xuy~n phai slf dl,mg cac nang Il,l'c nay, do

hQ cam thay tl)' tin hon voi cac nang luc nayIvcMng].K~TLU~N

1.Nai lam viec cue sinh vien CN YTCC• Saukhi tot ~ghi$p va nhCrng cong viec Cl,JthehQ aang dam nhan trai deu cac tlnh thanh a 3

aat nuoc, tap trung lon a Mien Trung4%)va chu yeu cong tac trong tuyen y te dl,l'

(67%).GOngvi$c cua cac CN YTCC dang dam nhan:nh6mcong viec (chirc nang) dang dam nhan

Tntn khai cac chuonq trinh y te (39%); truyengiao due va nang cao sire kh6e (38%); quan

IIOngtrinh, dl)' an y te (30%); hoach dinh ke(27%); Dao tao (20,7%); Nqhien cuu

4%);Lam cong viec hanh chinh (nhan sv, tai...) 16,5%.

1Tlnhphil h9'P cua niji dung CIao t~o vcy;ning crap (Png cong vi~c h;~n t~; cu« CN

da tot nghi~p• Tlnh phu hoopcua noi dung dao tao: phu hopy6utau cong viec va chuc nang cua nhan vienvi~ 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 dab6 tri ky thuc tap 1 thanq a cac co sa y te

thi t6t nghi$p. Muc do quan tronq cac noi dungc11lQ'caao tao tai trU'cmg (sap xep theo nh6m

hOC)va Sl)'ap dunq trong conq viec hien tal. 4mOnhoc da de C$P: Ouan Iy va chinh sach y

Giaocue sue kh6e va nang cao sire kh6e; Dichva Nghien cuu khoa hoc; Thong ke y te.

3. cae nhOm nang II,I'C Clap (Png tot vcy; conghlfn tiJictia c~u sinh vien

+ Quan19 y t~ Cong cong (Lap ke hoach valycacchU'O'ng trinh y te (74,6%); Theo doi vasat dich te hoc cac van de sue kh6e cOng(74,1%)). + Dao rao.Phat triem ke hoach vaIU'O'cxay dl)'ng nang Il,l'c (41,2%) + Nghif1n

cOng c16ng: O'ng dl,Jng cac ky nang may tinhh th~o, ky nang ve tin hoc thong ke, co ban

cOng vi$c (93,4%); Thu thap thong tin suetrong cong dong (77,4%); Danh qia va phantlnh hinh sue kh6e cua mot cOng dong

,5%). + Lanh agO - lam viec nnom: Giao tiep,aOngSl)' tham gia cua cong dong trong cacaOngbao v$ suc kh6e (76,6%); Giao tiep hi$uvai cOngdong bang viet va noi trong nhieu boi

h khac 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 chongnhiem khuan benh vien, chi dao tuyen va phonqchong djch tai benh vien, ky nang viet bao cao,nghien cuu van ban y te, ky nang tieng Anh va cacky nang rnern khac.

V. KI~N NGH!Ra scat chuonq trlnh dao tao di sau cac noi

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 khoahoc va chuonq trinh thuc tap cong dong.

Can co cac _chU'O'ng trlnh tu van co hoi viec lamcho cac CN YTCC long ghep cac noi dung quanqba vai tro cua CN YTCC khOng nhCrng doi voinhCrng ngU'CYilam conq tac y te conq cong rna canpho bien cho cong dong nhCrng ngU'CYihoach dinhchinh sach.

Xay dl,l'ng mot moi trU'cyng tU'O'ng tac nhu congthOng tin dien tli la rat can thiet nharn tan dl,JngdU'ooc nguon Il,l'c ve tai li$u va nang Il,l'c tU' van cuatrU'cyng cang nhu nhCrng dong gap hi phia cac CNYTCC da tot nqhiep.

TAl Lieu THAM KHAo1. Le va Anh (2012) £)tmh gia hi~n trgng aao

teo nhen II,fC Y t~ tei Vi~{Nam, Truocyng Dal hoc Yte cong cong, Dl,l' an nqhien cuu

2. Nguyen Thanh Hal, Bui Tu Ouyen va congSl,l' (2007)"ChU'O'ng trinh dao tao clf nhan y te congcong: Nhan dinh cua cuu sinh vien hai truocyng D<;lihoc Y Duoc tal Viet Nam". Tep chi Y t~ Gongcong, 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 tapthe". Tep chi Y t~ cong cong, 9 (9), tr. 4-9.

4. Le va Anh va cOng Sl,l' (2004)"Chuc nang vanhiern 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 PublicHealth (MPH) training at the Hanoi School ofPublic Health". Hum Resour Health, 5, 24.

6. National Public Health Partnership (2000)National Delphi Study on Public Health Functionsin 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 healthand social work: training dual professionals for thecontemporary workplace". Public Health Rep, 123Suppl 2, pp. 71-7.

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