1. BÁO CÁO ĐỀ ÁN 1816 CỤC QUẢN LÝ KHÁM CHỮA BỆNH Hà Nội, tháng 3/2010

2. I. T ổ ng quan  Thời gian qua công tác bảo vệ, chăm sóc sức khỏe nhân dân đã đạt được những thành tựu quan trọng. Tuy nhiên chất lượng công tác khám chữa bệnh vẫn còn nhiều hạn chế nhất là miền núi, vùng sâu vùng xa, do thiếu cán bộ y tế, đặc biệt cán bộ có chuyên môn sâu.  Việt Nam cũng giống như một số nước trên thế giới hiện đang phải đối mặt với sự phân bố nhân lực y tế không đồng đều giữa các vùng, miền, giữa nông thôn và thành thị.

3. Khả năng tiếp cận với dịch vụ y tế có chất lượng ở những vùng miền khác nhau cũng khác nhau Lực lượng cán bộ y tế có tay nghề cao chủ yếu tập trung ở các đô thị lớn như Hà Nội và thành phố Hồ Chí Minh....

4. DISTRIBUTION OF DOCTORS IN VN IN MEDICAL TREATMEN SYSTEM QualificationNational level N=34 Provincial N=274 Distric ts N=560 Other Sectors N=21 Private hospital N=65 Total N= 954 Sick-bed14650 9.9% 72889 49.4% 51248 34.8% 3655 2.5% 4985 3.4% 147427 100% Doctors4486 13.2% 16.138 47.8% 10018 29.6% 962 2.6% 2292 6.8% 33.860 100% Dr./sick- bed 1/3.31/4.51/5.11/3.81/2.11/4.4 Source: Supervising report in 954 hospitals, 2008

5.  Number of sick-bed in national level: 9,9%; Provincial level’s 49,4%; District's level 34,8%; Private: 3,4%  Doctors in national level 13,2%; provincial level’s 47,8%; District level’s 29,6%; Private 6,8%  General Dr/sick-bed =1/4,4; Dr/Sick-bed in private hospital =1/2,1. The rate of Dr/sick- bed in Private hospital is 2-times higher than in public hospital.

6. Quali ficati on National N=34 Provincial N=274 District N=560 Other Sector N=21 Private hospital N=65 Total N= 954 % Total268163327805411.4 Mass. 11791775218170353369510.9 SL2399894 5,5% 88 0,8% 5815515944.7 SL110625827 36.1% 3331 33.2% 2966571113732.8 Dr.15787479637841110471689350.2 PhD.44861613810018962229233860100 % - Total: 1,4% PhD. ; 10,9% Master ; CK2 4,7%; CK1 32,8%; Doctors 50,2%. - Provincial level: 5,5% specialty level 2, 36,1% specialty level 1 - District level: 0,8% specialty level 2; 33,2% specialty level 1 DISTRIBUTION OF HIGH QUALIFIED DOCTORS IN MEDICAL TREATMEN SYSTEM

7.  Almost every regions are deprivedin of doctors, specially in the mountainous provinces, remote and isolated areas…For instances: - Lai Chau, in 2004, there were 86 doctors, among that: 7 doctors work in commune level and 15 in district level, however, in 2007 there were no doctor work in commune level. - Hoa Binh, in 2004 there were 928 doctors, but in 2007 this number has reduced by 50%. -Kon Tum, in 2004: 404 doctors, in 2007: 199 doctors.  Specially Deprived of speciality doctors: Tuberculosis, Leprosy, Mental, Pediatrics, Cancer…  Grave deprived of high qualified doctors who work in general hospitals level and district hospitals.

8. THE NEED OF EXAMINE AND TREAT MEDICALLY The number of patient went to be examined and treated medically is increased annually from: 5,1 - 13,4% in every level. The number of patient treated in hospitals is increased annually from 7,2 - 12,3%. Disease model change

9. THE NEED OF EXAMINE AND TREAT MEDICALLY  The need of technique servies in examine and medically have increased: total surgery annually rate increased from 6,7 – 14,1%; from 1,34 million time 2004 to 1,96 million times 2008.  The number of skills which was performed have increased yearly, about: 12 – 29,2%; from 3,69 million times 2004 to 7,5 million times 2008.

10. II. 1816 PROJECT On the purpose of improving the situation, Minister of Ministry of health has approved the 1816 Project on the 26th of May, 2008 about in-turned appointing qualified health staffs in high level hospitals to low level hospitals in order to help strengthening the quality of medical treatment (1816 Project).

11. 03 main Objectives of 1816 project: 1. Enhancing quality of medical treatment in low level hospitals, especially in mountain areas which are lack of health staffs. 2. Improving the overload status of high level hospitals, especially national level hospitals. 3. Releasing technique and local-trainning to improve capacity for health staffs. II. 1816 PROJECT

12. The assignment in-turned appointing qualified health staffs in high level to low level takes an important role on medical treatment in community and on ensuring equity on health care services among regions and between urban and rural areas. Moreover, it also helps to develop human resources in local. II. 1816 PROJECT

13. III. ACHIEVEMENTS After over 1 year implementing, untill 3/2010, 64 hospitals (national level hospitals and hospitals of Hanoi, Hai Phong, Kien Giang, Ho Chi Minh city) have appointed: 2,096 qualified health staffs came and supported 189 low level hospitals in 62 provinces; Released 1.200 techniques (26 specialties); conducted 480 training courses for 22.000 trainees;

14. Provided health treatment directly for 220,000 patients; Implemented more than 5,000 surgeries; Reduced approximately 30% referral cases; 45 provinces/cities have established provincial 1816 project manegement. In domestic provincial level, around 30 provinces/cities have appointed over 1,500 health staffs in to 211 district-level hospitals and 500 health stations. III. ACHIEVEMENTS

15. IV. ADVANTAGES 1816 Project acquired the attention of VN Communist Party and Vietnamese government, espencially by financial support, legislation support and necessary policies (2008 support: 4.8 billion VND; 2009: 30 billion VND; 2010: 35 billion VND). Close collaboration between sectors. Close commitment of provinces/cities by establishing the 1816 project management board. The enthusiasm participation of Central hospitals. The supporting of local people.

16. V. DIFFICULTIES The shortage of human resource, equipment of low-level hospitals to receive transfering technique. Some health workers have not understand the objectives and the meaning of 1816 Project due to the shortage of 1816’s communication. The financial support of VN government is not enough to conduct 1816 project’s activities.

17. VI. ORIENTAL SOLUTION Uniting procedure of releasing technique from high level hospitals to low level hospital. Continuing to implement 1816 Project. Continuing to appoint health staffs in high-level hospitals to low-level hospitals. (national - provincial; provincial - district; district - commune). Developing legislation document to support 1816 project. Enhancing monitoring, surveillance and supervising of implementing 1816 Project. Deploying regular report system.

18. VII. PROPOSAL FOR SUPPORTING In order to improve the quality of 1816 activities, MOH call for supporting of international organizations of:  Developing training manuals for in-turn health workers.  Conducting training courses.  Developing 1816 management software.  Contributing nescessary equipments for transfering technique activity.  Financial support for commend and reward for excellent individual and organization on 1816 activities.

19. Thank you for your attention !