Chfnh sach y te doi vdi dan tdc Cong va Sila d huyen MiTdng Te va Nam Nhun, tinh Lai Chau LE MINH ANH* PHAM THI THU HA*= Tom tdt: Cdng vd Si La Id hai tpc ngucd cd ddn sd rdt it d nii&c to, tap trung chu yeu & xd Nam Khao, Can Hd (huyin Mudng Te) vd xd Nam Chd (huyen Nam Nhiin), tinh Lai Chdu Theo sd lieu dieu tra ndm 2014, ngu&i Cdng d Lai Chdu cd 1.256 ngUdi (chiim 0,32%), ngU&i Si La cd 521 ngiiai (chiim 0,14%) Cupc sdng cda hg chu yiu gdn liin v&i sdn xudt nong nghiep vd khai thdc cdc sdn vdt tu nhiin Nhiing ndm qua, ngdnh y te tinh Lai Chdu dd triin khai nhiiu chUOng trinh, chinh sdch nhdm ndng cao nhu cdu chdm sdc sUc khde & cdc tpc ngu&i thiiu sd, cd ngU&i Cdng vd Si La d hai huyin Mudng Te vd Nam Nhun NhUng chinh sdch ndy da giup cho dong bdo cd ca hpi diigc tiep can vd hUdng thu cdc dich vu y ti, hgn che chuyin tuyin dieu tri khong cdn thiit Tuy nhien, dia bdn cu tru cda ngUdi Cdng vd Si La & vung sdu, vung xa nen cung gdy nhUng khd khdn khong nho viec triin khai mpt sd chiOmg trinh, chinh sdch y ti DUa trin kit qud nghiin cdu tgi hai xd Nam Khao vd Can HS (huyin Mu&ng Te) vd xd Nam Chd (huyin Nam Nhdn), bdi viet gop phdn cung cdp nhUng tU lieu mdi vi mpt sd chinh sdch y ti ddi v&i ngU&i Cdng vd Si La bdi cdnh hiin Tit khoa: Chinh sdch y ti, ddn tpc Cdng, ddn tpc Si La, Mu&ng Te, Nam Lai Chdu l T h t f c t r a n g cliinh s a c h y t e h i ^ n n a y 1.1 Chinh sdch phdt trien mang litdfi y te Nhun, cham sdc sflc khde eho ngudi dan thdng qua sfl phat triln cua mang ludi y te Hien i- i - D m nay, toan tinh co Irung tam y td huygn/thanh phd, benh vien da khoa, Trong nhflng nam qua, nganh y t l tinh benh vidn chuydn khoa, 15 phdng kham da Lai Chau da ed nhieu nd Ifle vide khoa khu vflc va 108 tram y t l xa, phudng TS Le Minh Anh, ThS Pham Thi Thu Ha, Vien Dan toe hoc Li Minh Anh Phgm Thi Thu Hd - Chinh sdch y te ddi vdi ddn tgc 77 thi tran'^l NhOng nam qua, Benh vien da cac dich vu kham, ehfla benh, eae chfldng khoa tinh Lai Chau va cac Trung tam y td' trinh y td' qud'e gia, phat Men sdm va trien tuye'n huydn ludn nhan duge sU quan tam, khai nhuftig bidn phap phdng, ching dich cM dao kip thdi eua Sd Y te vide bao benh xay tren dia ban Vdi ngfldi Cdng ve va eham sdc sUc khoe cho ngUdi dan va Si La - noi dau tien hp cd the de dang trdn dia ban tid'p can va kham, ehfla benh la Tram y te' Trung tara Y td' huyen Mudng Te Mgn xa Nam Khao, Tram y t l xa Can H i (huy- gora ed 14 Tram y te xa/thi tran, en Mfldng Te) va Tram y te xa Nam Cha benh vidn da khoa, dpi y te dU phdng, (huyen Nam Nhun) dpi eham sde sflc khde sinh san va phdng Ben canh ed sd y te tuyen tinh, huydn, kham vdi tdng sd 90 giudng bdnh, 33 bac xa tM Y t l thon ban dflpc coi la "ehan rit" si (trong cd bae sT chuyen khoa I), 72 cua y te' tuye'n xa, lam viec dfldi sU eM dSn, y SI, 42 dilu dfldng, 22 dfldc si, 18 nfl hp giam sat cua Tram trudng y te xa hay sinh, ky thuat vien, 10 can bd dan sd va ngu&i dugc Tram trUdng y te uy quyin 30 can bd khac'^' Trong tuyg'n y t l tai thbn ban edn eb thdm Tmng tam Y te huyen Nam Nhun dflgc mdt sd' ehflc danh nhfl cgng tae vidn dan cMa khoi, gora: khd'i Hanh chinh, so, egng tae vign dinh dUBng, cb dd thdn khd'i Dfl phdng va khdi Dieu tri Khd'i Hanh ban Khao sat tai dia ban cho thay, eM ed ehinh gom cd phdng: Phdng To ehUc - ban Nam Khao (xa Nara Khao) vSn tri Hanh chinh quan tri, Phong Ke hoach chfle danh cpng tac vidn dan sd, cbn lai da NgMep vu va Phong Tai vu; khd'i Dfl phdng sd y te' thon ban Mem ludn cdng tac dan sd' gbm cd dpi: Dpi Cham sdc sflc khoe sinh va dinh dudng^*' san va Dpi Y te dfl phdng; khdi Dieu tri Chinh saeh phat triln mang lUdi y t l gbm khoa: Khoa Kham benh, Khoa Ndi - tai tinh Lai Chau da giup cho ngUdi Cd'ng NM - Lay - Hoi sflc ca'p cflu, Khoa Ngoai - va Si La ed nMeu eu hdi Ifla chpn cae cd sd s a n - Chuyen khoa, Khoa Can lam sang va Khoa Dupe Trung tam co tat ea 149 can bp, vien chfle; dd cd 15 bac si da khoa, 72 y si, 21 dilu dfldng, 13 dflgc si, nfl hd sinh, ky thuat vidn xet ngMem'^' y t l Theo bao cao eua Tram y te xa Nam Khao nam 2017, cd 3.239 Iflgt ngfl&i den khara ehfla bgnh, dat 87,5% cM tieu de ra; dd ed 2.344 Iflgt kham ehfla benh cho ngfldi ngheo, 102 Iflgt dieu tri ndi tru, Trong he thd'ng ehara sdc sflc khde cdng 3.137 Iflgt dieu tri ngoai trii Tai xa Can lap, Tram y te xa la ncfi d^u tien ngU&i dan Ho, nam 2016 cb 4.726 Iflgt kham ehfla c6 the t i l p can kM o'm dau, dich benh va bgnh; dd cd 2.903 Iflgt kham ehfla eac v^n d l lidn quan dd'n sflc khoe NMem bgnh eho ngfldi ngheo, dat 88,3% cM tidu vu cua Tram y td' xa la thfle Mdn vide eham dflge giao NgMen cflu tai xa Nam Cha sdc sflc khde ban d^u, bao gom t r i l n khai (huydn Nam Nhun), thdi gian 2014 - 78 Nghien cdu Dong Nam A, sd_6/2^jZ 2017, so Iflgt ngfldi kham chUa benh tang toan nganh y t l cua tinh cd hun 3.076 can bb, nhan vien; db, tuyen tinh la dia ban cho thay, mac du mang lUdi y te d 1.118 ngfldi; tuye'n huyen 1.297 ngUdi; tinh Lai Chau duge Mnh va phat tuyln xa 661 ngUdi va 1.077 ban cd nhan triln kha sdm, nhuhg ngU&i Cong va Si La vign y t l thbn ban, 174 ed dd thdn ban;ed cM thfle sfl quan tam va tiep can vdi cac eU 387 bae si, 43 dUpe sy dai hpe, 98 dieu sd y te khoang 10 nam trd lai day, dac biet dudng, 26 CUf nhan y te ebng ebng, Hien la sau tai dinh cfl thuy dign Lai Chau nam nay, cb 108/108 Tram y t l xa/phUdng/thi 2014 So vdi nen y hpc el truyin da phat tra'n cd nhd tram, 66,7% Tram y te xa co trien lau ddi tM he thbng Tay y da the bac si lam viec (trong db cd 13,8% Tram y hien nhung uu dilm vupt trdi vide te cd bae si bien c h i tai tram), 84,6% Tram phat Mdn sdm va giai quye't nhanh nMeu y te eb nfl hb sinh hoae y sy san nhi, 95,5% can benh khd ehfla Sfl phat trien eua thdn, ban cb nhan vidn y te boat dpng'^' tfl 3.124 Iflgt len 4.188 Mgt Khao sat tai mang Ifldi y te va Meu qua ehfla benh De nang eao ehat Iflpng nguon nhan Iflc hign ed, nganh Y te tinh Lai Chau da tham nhan thfle, mem tin eua ngfldi Cong va Si muu vdi UBND tinh v l edng tac dao tao La viec eham soc sflc khoe theo nang cao nang lue eho nguon nhan luc phflong phap khoa hpc Men dai nganh Y Theo dd, nMeu van ban da duge ban hanh nhU: Quye't dinh sd 42/2004/QD1.2 Chinh sdch ve nhdn lite y te UB 30/7/2004 cua UBND tinh Lai Dd'i vdi mgi linh vflc tM eon ngfldi ludn Chau ve cMnh saeh hd trg dao tao, boi dbng vai trd trung tam, quye't dinh sfl dudng va thu hut ddi vdi can bb, ebng chfle, thdnh cdng, phat triln eiia linh vflc dd Vdi vien chfle di hgc va d i n cong tae tai tinh linh vflc y te tM vai trb eua ngu&i edn Lai Chau; Quye't dinh so 29/2011/QDquan trgng ga'p bdi kM k i t qua dieu tri phu UBND 06/10/2011 eua UBND tinh thupc ehii ye'u vao dpi ngu bae si Chinh vi quy dinh ve chinh sach hb trg dao tao dd'i vay, eac ehinh saeh lien quan din dao tao, vdi can bp, ebng ehflc, vibn chfle di hpe va phan bo nguon nhan lUc y te se ed anh thu hut nhflng ngfl&i tinh nguyen d i n Lai hudng ra't ldn d i n vigc dat cae mue tieu Chau edng tae; Quye't dinh sd 46/2014/QDcdng bang, Meu qua va phuc lgi xa hgi eua UBND 29-12-2014cua UBND tinh vl viee ban hanh quy dinh thfle hign eMnh nganh Y^^' sach thu hut nguon nhan lUe va hb trg dao Cdng tac phat trien nhan lUc y te tao, bbi dudng dd'i vdi cdn bd, cdng ehflc, thdi gian qua tai tinh Lai Chau da dat dupe vien ehUe trdn dia ban tinh Lai Chau nhOftig tflu dang ke, dae biet UBND Trong thang diu nam 2017, Sd Y te tinh tinh luon ban hanh nMeu cMnh sach d l Lai Chau da cfl 03 vidn ehflc di hge Idp dai thu hut ngudn nhan Iflc cho tinh, dd hoc; 05 vien chfle di hpc Idp cao dang; 17 ed nganh y t l Tinh den 30/6/2017, thdi gian qua da gbp phan nang eao Li Minh Anh, Phgm Thi Thu Hd - Chinh sdch y te doi vdi ddn tgc 79 vien chUe di hpc Idp Trung ca'p Ly Man dilu y dflc va quy tac flng xfl cua ngfldi lam CMnh tri; 18 vien chfle di hgc l&p Quan ly edng tae y te'.Dbi ngu can bd cua Tram ebn nha nude chuong trinh Chuygn vidn; 17 la nhuiig ngfldi tre tuoi, nMet tinh, ed ngfl&i di hpc Idp Chuygn vidn chinh; 115 trach nMem vdi cdng viec va eb vai trd edng chfle, vien ehflc di hgc Idp tieng dan quan trgng cham sdc sflc khoe cho tdc Hmdng; 90 cdng ehflc, vien ehflc di dn, ngfldi Cd'ng va Si La trdn dia ban dfl tM dai hgc va sau dai hpc Ben canh dd, Sd Y t l tinh edn mcf 01 l&p bbi dfldng Me'n thfle Y hpe co truyin cho 29 vien chfle lam viec tai Trara y te xa/phu&ng/thi tra'n, md 02 Idp dao tao nhan vien y t l thdn ban eho 60 hpc vien thdi gian thang, mcf 01 16p y sy da khoa eho 30 hpc vien cua nflde CHDCND Lao, trt dao tao 02 Idp dai hpc dieu dfldng tai trfldng Trung cap y te, dong thdi cdn dao tao hen tuc ve ehuyen mdn cho 311 vien chfle nganh y te'"'' 1.3 Chinh sdch tdi chinh cho y te CMnh sach tai ehinh y te la mgt nhiJng cMnh saeh quan trgng nhat quylt dinh den cong tac bao ve va eham sde sflc khde eho ngfl&i dan.Sau hcfn nam thfle Men D l an "Nang cao ehat lugng boat ddng he thdng y td' eo sd giai doan 20162020", Ban Chap hanh Dang bd tinh Lai Chau da huy dbng nMeu nguin lUe de dau tu, nang ea'p trEuig tMet bi y te eho cae tuye'n Nhd da giup cho vide kham, ehfla Tai Trung tam Y te huyen Mfldng Te va benh ban dau eua ngU&i Cd'ng va Si La b Nam Nhun, lanh dao Trung tam thfldng hai huyen Mudng Te va Nam Nhun dupe xuyen soat nhu e^u dao tao hang nam thuan tien va Meu qua hOn eho can bd y te, dae biet la can bb y t l tuyen xa Trong nam 2018, cd 04 can bp di hgc bae si da khoa va 05 can bb di hgc dai hge dieu dudng Hien Tram y t l xa Nam Khao (huyen Mudng Te) ed can bp (3 bien ehe va htfp dong), db eb y si da khoa, dflgc si va y ta; Tram y te' xa Can H i (huyen Mu&ng Te) cd can bd (4 bien che va hgp dong), dd ed bac si, y si, nfl hd sinh, dugc si; Tram y te xa Nam Cha (huyen Nam Nhun) c6 ean bb, cM cb y si da khoa, ehfla cd bac si, dugc si, dilu dUBng, nfl hd sinh Nhflng can bd lam viee tai cac Tram y te ludn khdng ngdng eung eo, nang eao tinh D i n nay, benh vien da khoa tuyen tinh va Trung tam Y te huyen MU&ng Te, Nam Nhun deu eb he thdng may mbc y te' Men dai phue vu edng tac ehan doan, dilu tri ehuyen sau nhu may chup CT-Scanner, phau thuat sp nao, phau thuat npi soi, chay than nhan tao, tru sd lam vide tUcfng ddi khang trang Tuye'n xa cung dflpc tang cudng ve eu sd vat cha't, trang tMet bi, dd Tram y te xa Nam Khao, Can Ho (huydn Mudng Te) v l cu ban duge trang bi tren 80% danh rauc trang thiet hi thiet ye'u theo quy dinh Tram y te' xa Can Hb da dat tigu cM qud'e gia ve y te xa'^' t h a n traeh nhiem, thai dd phue vu cham Ve eo ban, eae Tram y te xa da dam bao sde n ^ & i bdnh, thfle Men ngMem tuc 12 du thude, vat tU hda chat cho cdng tae so kham, ehfla benhva thUc Men cae chUcfng trinh mue tieu y te qud'e gia theo phan tuyen quy dinh Tram y te' xa Nam Khao (huyen Mu&ng Te) Men ed 10 phbng: phdng hanh cMnh, phdng true, phdng tiem, phbng eham sde sflc khde sinh san, phbng thu thuat, phbng Methadone, phdng bdnh nhan, phdng kho, phdng dflgc, phbng truyin thbng; 03 phdng tap t h i danh eho can bd y te; 01 nha bep/nhd an danh cho benh nhan; 01 vU&n thud'c Nam dign tich 300m2; 02 dan may vi tinh va may in; 02 tu lanh; 01 may hap, s^y; 01 may phat dien'^' Tram y te" xa Can Ho cflng g6m 10 phbng, dd Id phbng hanh ehinh, phdng Ddng y, phbng kham benh, phdng tidm, phbng trfle, phbng san, phdng thu thuat, phdng benh, phdng kho/dflgc Thude men cua Trara eu ban day du, dflge nhan ve hang thang'^"' Trara y td' xa Nam Cha (huyen Nam Nhiin) dia ban ebn nMlu khb khan nen eac cu sd vat chat eua Tram cdn nMeu tMeu thbn Nghien cdu Dong Nam A, i6/20jt the BHYT K2, nlu ngU&i bdnh di kham, ehfla khdng dung tuyen van dUpc I^Y BHYT toan cM pM kham, ehfla bgnh nhfl di dung tuye'n ddi vdi bdnh vien tuyen huyen, dilu tri ndi trii db'i v&i bdnh vien tuyln tinh, tuye'n trung uung (khdng c^n giay chuyen tuye'n kham ehfla bgnh) Neu kham benh tai cac benh vidn tuyen trung uung, ddi vdi dilu tri npi trfl (cd eM dinh nhap vien) tM dugc BHYT cM tra 100%, cdn db'i vdi trUdng hgp chi dieu tri ngoai tru (kham benh, nhan thud'c va dieu tri tai nha) tM can dupe xin giay ehuyin tuyg'n eija benh vien huyen de dUpc hfl&ng 80% cM pM kham, ehfla bdnh Neu nhfl trfldc day kM ddi sd'ng edn kho khan, ngfl&i dan thfl&ng tU ehfla tri bang eac bai thube dan gian moi kM dm dau nhUng tfl kM dUde ca'p the BHYT, rihieu ngU&i da big't dupe ldi ich cua kham, ehfla benh va nhan thay rang, dg'n benh vien de dugc cac bac si thara kham la mbt each dilu tri tot nhat Day la ye'u td vi-t quan trpng Bao Mem y te (BHYT) la mbt trong eong tae chara sdc sUe khde toan nhiing eMnh sach tru cot hd thd'ng dien, gdp ph^n nang eao chat lu&ng eude an sinh xa hgi ciia Dang va Nha nUde ta, sdng cho ngU&i Cd'ng va Si La tai dia ban mang y nghia nhan dao va eb tinh cMa se Ngoai ra, cMnh sach BHYT cua Nha nU&c edng dbng sau sac Theo Luat BHYT, ngUdi cdn giup cho ngU&i dan giam hdt nhflng khb ngheo, ding bdo dan tpc thieu sd sinh sd'ng khan vl Mnh te, day manh ebng cube xda d viing Mnh te khb khan duge h§ trg 100% ddi giam ngheo, gifl viMg on dinh cMnh tri the BHYT, dd cd ngUdi Cb'ng va Si va cung cd long tin cua dong bao dan tgc La BHYT cua ngfldi Cd'ng va Si La thudc tMlu sd ddi vdi Dang, Nha nfldc'^i* the K2 danh eho vung flU tien (K2 la ma ncfi ngfl&i dan tde thilu sd va ngU&i thupc Trong nhflng nam qua, cae Chuung hp gia dinh ngheo tham gia BHYT, dang trinh mue tieu qude gia v l y te ludn duge sinh song tai vung eb dilu Men kinh te - trt va thuc Men thU&ng xuyen tai vung xa hpi dac biet khb khan) Vdi trU&ng hgp ngfldi Cd'ng va Si La, nhU: ehuung trinh Le Minh Anh, Phgm Thi Thu Hd - Chinh sdch y te ddi vdi ddn tgc 81 phdng chdng lao, tigm ehung mcf rdng, benh n h a n dd'i vdi trfldng hgp bgnh nhan eham sde sflc khoe sinh san, phdng chong mac cae benh phai dieu tri ndi tru dai suy dinh dUdng, dan so - k l hoach hba gia (tu trd len) tai eac eo sd y te cua (Bnh, NhiJng chuong trinh da gdp Nha nflde tfl tuyen huydn trd len phan quan trpng vao mue tieu cham sde Tai huyen Nam Nhun, Trung tam Y te sflc khde va nang cao y thUc phdng ngfla huydn da chi dao Tram y t l xa thfle hien dich benh cho ngfldi dan soat dd'i tUpng duge thu hudng hang Ngoai nhiJng cMnh sach ve y t l ndi nam Trong dd, giai doan 2014 - 2017 da tren, ngU&i Cong tai huyen Mu&ng Te va hb trg 27,424 trigu ding eho y te thdn ban, Nam Nhun cdn dUgc thu hu&ng De dn phdt hd trg 210 phu nfl mang thai vdi t i n g Mnh triin kinh ti - xa hdi vdng cdc ddn tpc pM 210 trieu dong, ho trp 254 tre sd sinh Mdng, La Hd, Cdng, C& Lao dUpc Thii vdi tong Mnh phi la 254 trieu dong*^^' tudng Chinh phu phd duyet tai Quyet dinh NhiJng ehinh saeh da gbp phan quan so 1672/QD-TTg 26/9/2011 va dugc trgng vieegiam ty le suy dinh dUdng, UBND tinh Lai Chau phe duydt eM tig't tai cai tMgn tinh trang sflc khoe eua phu nfl Quyet thdi ky sinh nd dinh sd 1695/QD-UBND 30/12/2011 D l an dflgc trien khai vdi Ngfldi Si La dang sinh sing tai ban Seo muc tieu hd trg va tao dieu Men eho dbng Hai va Si Thau Chai (xa Can Hb, huyen bao phat trien san xuat, thoat ngheo, nang Mudng Te) cung dang duge thu hUdng De cao d&i sd'ng vat chat, tinh than, gbp phan an Hd trg, phdt triin ddn tgc rdt it ngU&i vao viec bao ve mbi trfl&ng, rflng d^u ngu- trin on va chu quyen bien gidi qud'e gia (UBND 2017-2025, dupe Thu tUdng CMnh phu phe tinh Lai Chau, 2011) Ndi dung eua D l an duyet tai Quyet dinh 2086/QD-TTg tap trung den ehinh sach hd trg phat trien 31/10/2016 Ndi dung ciia D l an tap trung dia bdn tinh Lai Chdu giai dogn y te, dd la: cap thuoe cho thon ban; hd trp vao mpt so eMnh sach vl kinh t l , van hda, ngU&i n h a benh n h a n di dieu tri tai benh xa hpi, dd cd mang hd trp v l y te cho vidn, phu nfl thdi ky mang thai, sinh ngU&i dan Du Men thdi gian diln nd, h5 trg dinh dUdng eho trd so sinh, hd du an, tong Mnh pM ho trg cho y t l ddi v&i trg lan dau eho n h a n vien y te ban dbng hao Si La la 1,048 ty dbng, gbm hb Tai xa Nam Khao (huydn Mu&ng Te), trg ba me mang thai la 524 trieu dong va giai doan 2014-2016, 149 ngU&i Cb'ng hd trg dinh dUdng eho tre em sU sinh 524 dflpe hd trg mang thai va sinh de vdi t i n g trieu dong^^*\ Du an da va dang trien khai so t i l n 149 tridu dong, 18 ban dflge hd trp tai dia ban se gbp phan nang cao ddi sd'ng cap thud'c vdi t i n g Mnh pM 18 trieu vat ehat va tinh than cho ngUdi Si La, dbng^^^^ Bdn canh dd, D l an ebn hd trg nang cao cha't lUgng dan so, giam ty le suy tien a n va cM pM di lai eho 01 ngfldi nha dinh dudng va tii vong d tre em, xba bb tU 82 Nghien cdu Dong Nam A, sd 6/2019 tM lai ed it bae si ma chii ylu la y si, y ^ tdt ngMep trinh dp Trung ca'p Nd'u eoi trinh dp eua bac si nhfl thU&c ve ehat Nhfing k h o k h a n t r o n g vigc thu'e lugng kham, ehfla benh thi cac tpc ngUdi h i ^ n cliinh s a c h y t e h i ^ n n a y nui day dang phai sU dung dich vu kham Thuc tiln cho tha'y,cac ehinh saeh y tg' ehUa benh khong eao Nlu muon kham thUe hign tai huyen Mudng Te va Nam ehfla bgnh b nhflng tuye'n eao hdn nhfl Nhun da dat duge nMlu tflU dang tuye'n huyen, tuye'n tinh hay tuyln trung ghi nhan, song cung v i n cbn tbn tai nhflng uung vdi may mdc, ky thuat Men dai tM hg han ehe Mae du Sd Y te tinh da ed nhieu phai ma't kha nhieu thdi gian, edng sflc va cMnh saeh dai ngd dii vdi can bg nganh Y tai chinh eho viee di ehuyin va dieu tri tfldng tu ti dan tdc de hba nhap vao sU phat t r i l n ehung cua huyen nhUhg cae bac si miln xubi v i n ehfla thUe Da phan can bd tai Tram y te xa kha tre ngn trinh chuyen mon cbn non ye'u, nay, nganh y t l Lai Chau ehfla thu hut dd qua trinh triln khai thUe Men dflgc bae si dao tao cMnh quy b cae dia nhidm vu cdn gap nMeu khd khan, bd ngd phUcfng khae ldn day ebng tae Sd lugng Tai Tram y te' xa Nam Khao (huydn can bb cd trinh dd dai hpe tang len cae Mudng Te) va Tram y te xa Nam Cha bac si la can bd y t l dia phUcfng duge eU di (huyen Nam Nhun) Mgn ehfla ed bac si hpc theo hinh thUe chuyen tu, cfl tuyln Xet ma cM cd y si, day eung la ye'u t l gay khb ve nhu eau, toan nganh y tg' Lai Chau can khan cho ebng tac kham, ehfla benh De tren 600 bae si nhflng Men mdi dap giai quye't bai toan tMeu hut bac si b Tram flng dupe 60% nhu cau Tai Bgnh vien Da y t l xa, thdi gian qua Sd Y te' tinh da cM khoa tinh Lai Chau, dfl duge xay mdi v&i eu dao cac bdnh vien, Trung tara chuygn khoa sd vat chat ky thuat hien dai, lUU lugng mbi tuyen tinh, Trung tam y te huyen chu ddng dieu tri ndi tni vk kham benh trung bd tri, sap xe'p cii bac si luan pMen tang binh eho 500 lUUt ngu&i nhung ehuyen efldng cho eae Tram y te xa Tuy nMgn, khoa nao eung tinh trang thie'u bac dieu bat cap la eac bae si lam viee tai Tram si,, Ddi vdi Mudng Te va Nara Nhun - hai cM dung gid hanh cMnh, khdng phai trfle huyen khd khan nha't cua tinh Lai Chau nen cb nhiJng ea benh khd ngoai gid tM lai tM tinh trang thilu nhan lUc la dieu d l khbng ed bae si de thfle Men tham kham Mlu'-^^' Bgn canh dd, trinh nhan lUc ciia Cong vide b Tram ra't nMeu kM ngudn nhan Ifle mong, phai Mem nMgm can bb y t l d tat ca cac tuyln khdng gib'ng nMeu viec (vfla phai kham benh, vflaphai Tuye'n tinh va tuye'n huyen thUdng thuc Men cae chUUng trinh y t l qud'e gia tap trung nMlu bac si cd tay nghe, trinh dp nhu di truyin thdng b eae ban), tien hd trg chuyen mbn cao, kM dd tuye'n eO sd cdng tac phi hau nhu khdng ed hoae cd rat nhu Tram y t l xa - ndi ngfldi Cd'ng va Si it Tiln true cho can bg y te xa Men La tie'p can kham, ehfla benh nMeu nhat sU man md vdi Lai Chau Tfl nam 2004 de'n Le Minh Anh, Phgm Thi Thu Hd - Chinh sdch y te ddi vdi ddn tgc 83 r a t tha'p (25.000 dong/ngay v&i khdng sfl dung dich vu y te bang raflc trung thfldng; 32.500 dbng/ngdy v&i thfl 7, binh cua ebng dbng va raflc cM tra BHYT Chu nhat va 45.000 dbng/ngay vdi Id) cho hp eung ra't tha'p khie'n cho the BHYT nen ehfla thda man duge thdi gian, cdng cua ngfldi Cb'ng va Si La phat ehi lay so sflc cung nhfl thu nhap ciia can bg y te lupng hun la ehat lugng, khong giup dugc De "bao phii cham sde sflc khde" eho toan dan, Sd Y te tinh da tang efldng uu hg nMlu viee tiep can va sii dung dich vu y te tien eho can bb y te' tuye'n thdn ban Tuy Trang thiet bi y te tai cac Tram mac du nMen hien nay, nhflng ngfldi lara can bp y thu&ng xuydn dUpe ca'p phat nhungvan ebn t l thdn ban sau tham gia khda ddo tao tMg'u nMlu may mde cu ban nhu X quang, thang phai lam Mem nhiem ca can bd may sigu am, Tai Tram Y te xa Nam Cha dan sd, lai boat dbng dieu Men khd (huyen Nam Nhim), co sd vat chat ciia khan ve dia hinh, giao thdng vdi mfle phu Tram cdn chat hep, chi cd gian nha gd ca'p chi hdn 650.000 dong/thang CMnh ngn ehUa dam bao dupe ebng tae eham soc thu nhap khdng dara bao nen nhieu can bd sflc khoe cho ngfldi dan, ehfla cd kho thud'c y te thbn ban khbng "man ma" v&i nghe, rieng nen ebn gap trd ngai khau bao khdng du de cM pM eho cac sinh boat quan va quan ly thude gia dinh va eung ehfla tao dugc dgng Ket lu|in lUc cho can bd y t l nhiet huyg't vdi edng viec Cac co dd thdn ban ehu ylu la nhiJng can bd rat tre (ngoai 20 tuoi), mdi hge bet cap va ehi dUge dao tao, tap hua'n thang v l Mnh nghiem dd de nen tay nghe edn kem, ehUa duge ngUdi dan tin tU&ng, lua chpn Mae du Men d cac ban diu cb chfle danh ed dd thon ban nhung nMlu nam qua, cac ed dd hau nhU ehUa di dd de duge ea nao hoae it nhat eung cM cd 1-2 ca Ban than hg eung mong raub'n dUpe Trong nhflng nam qua, nganh y te tinh Lm Chau da cd nhieu nd lUe vide cham sdc sflc khde eho ngfldi dan thdng qua sfl phat trien eua eac cM'nh sdch vl y t l Mang Ifldi y te' cang md rpng da giup cho viec kham, ehfla benh cua ngfl&i dan dupe eai thien, eae trang thie't hi y te eang day du hcfn va tflng bUdc duge hidn dai hda, can bb y te' cang dflge nang eao vl trinh dp chuygn radn Tuy nhien, viec trien khai vk thfle hidn eae t h a m gia nhilu khoa tap huan, dao tao bun chinh saeh y te hien van ebn gap nfla d l nang eao chuyen mbn eua rainh nhieu trd ngai dan d i n hieu qua ciia nhufng Khao sat tai dia ban ngMen cflu cho chinh sach doi vdi ngu&i Cb'ng vk Si thay, eae ehinh saeh eham sdc sflc khde La chUa cao Mang lUdi y t l duge bao phu cho ngfldi ngheo, dong bao dan tpc tMeu so rgng khap nhUng trang thiet hi y tg' va thong qua the BHYT eb "danh" nMeu ban trinh dp nhan lUc d eae tuyg'n khbng dong "thuc" kM ngU&i cb BHYT midn pM deu, chat Iflgng can bp y te cu sd edn nhilu o-6/20l9_ Nghien ciJu Dong Nam A, so^ 84 han che', viee dau tfl tai chinh cua Nha nfldc va ciia tinh cho cac Tram y t l tuyln xa cbn kha khiem ton, sfl van hanh BHYT ebn nhieu bat cap, quyin lpi cua ngfldi sfl dung va ngfldi cung cap dich vu diu khong dflpc dam bao kMin BHYT ehfla thfle sU mang lai Meu qua cham sbc sflc khde cho ngfl&i dan De hoan thien cac cMnh sach y te Men nay, cac cap iiy dang, chinh quyen, doan t h i cac ca'p cin tang efldng dau tU nang ca'p cae Trung tam va Benh vien tuyg'n tinh va huyen theo hU&ng Men dai, ky thuat cao; tap trung phat triln tuyen y t l cd s&, nha't la dau tu xay dung Tram y te' xa dat tieu cM qub'c gia; nang cao y dflc va trach nhigm cila can bg y te, cham lo xay dung ddi ngu can bp y tg', nhat la bae si eho tuyen xa; tang cUdng edng tac luan pMgn can bb y t l tfl tuyg'n trgn ho trp cho tuyg'n y te cd sd; tflng bfldc thfle Mdn ehii truong xa hgi hda boat ddng y te, gdp p h i n dat dugc muc tigu ebng bang va phuc lgi xa hbi eho ngUdi dan./ nhiim vu cdng tdc y te ndm 2017; P^^^^^ hudng nhiem vu vd gidi phdp ndm 201 Le Minh Anh, Pham Thi Thu Ha (2018), "Mang ludi y te cham soc sdc khoe ciia ngudi Cdng va Si La & tinh Lai Chau , Tgp chi Ddn tpc hoc, Sd 3, tr 44-52 Dang Thi Le Xuan (2012), "Chinh sach y te va cham soc bao ve sdc khoe nhan din: ThUc trang va khuye'n nghi" Tap chi Kinh ti vd Phdt trien So 181, tr 48-56 Sd Y te tinh Lai Chau (2017), Bdx) cdo sa kit cdng tdc y ti thdng ddu ndm, nhiim vu vd gidi phdp thdng cudi ndm 2017 Sd Y te tinh Lai Chau, 2017, tldd Thong tin chi Vu Thi Tam, Trfldng tram Y t l xa Can Ho eung ca'p Tram Y te xa Nam Khao, 2017 10 Tram Y te xa Can Ho, 2016 11 Bich Dilm (2017), Bdo ddm chdm soc y ti cho dong bdo cdc ddn tpc thieu sd d Viit Nam, http://www.tapcMcongsan.orgvn /Home/Van-hoa-xa-hoi/2017/48440/Baodam-cham-soc-y-te-cho-dong-bao-cac-dantoc.aspx, truy cap 9/4/2019 12 UBND tmh Lai Chau (2011), Bdo cao viic thUc hien Nghi quyit so 16I2011INQ-HBNB ngdy 11712011 cda HBNB tinh ue cong tdc di ddn, tdi dinh cU thdy dien Lai Chdu CHU THICH 13 Trung tam Y te huyin Nam Nhiin (2017), tldd Db Nhung, Hoang Hgi (2016), Lai Chdu tdng cUdng cung cd vd hodn thien mgng ludi y ti ca sd, http://www.dangcongsan.vn/ khoa-giao/tai-chau-tang-cuong-cung-co-vahoan-thien-mang-luoi-y-te-co-so406756,html, truy cap 10/3/2019 14 UBND huyen Mubng Te (2017), Be dn hd trg phdt triin dan tpc rdt it ngudi trin dia bdn tinh Lai Chdu giai dogn 2017-2025 Trung tam Y te huyin Mfldng Te, 2017 Trung tam Y te huyen Nam Nhijn (2017), Bdo cdo ddnh gid tinh hinh thiic hien 15 Le Phii Hilu (2018), Lai Chdu khdc phuc tinh trgng thiiu hut ngudn y te, http ://wvAv tapcM congsan.org vn/Home/Va n-hoa-xa-hoi/2018/49094/Lai-Chau-Khacphuc-tinh-trang-thieu-hut-nguon-nban-lucy.aspx, truy cap 5/4/2019 ... tuyen van dUpc I ^Y BHYT toan cM pM kham, ehfla bgnh nhfl di dung tuye'n ddi vdi bdnh vien tuyen huyen, dilu tri ndi trii db'i v&i bdnh vien tuyln tinh, tuye'n trung uung (khdng c^n giay chuyen... can bd y t l dia phUcfng duge eU di (huyen Nam Nhun) Mgn ehfla ed bac si hpc theo hinh thUe chuyen tu, cfl tuyln Xet ma cM cd y si, day eung la ye'u t l gay khb ve nhu eau, toan nganh y tg' Lai. .. dinh cfl thuy dign Lai Chau nam nay, cb 108/108 Tram y t l xa/phUdng/thi 2014 So vdi nen y hpc el truyin da phat tra'n cd nhd tram, 66,7% Tram y te xa co trien lau ddi tM he thbng Tay y da the bac