L i.iij.i.i.it ^.ma«i Quan ly phat trien xa hoi lmh viTcy te crTay Nguyen HQUyJU THj THU H A * - VO THj MINH NGOC** Hdn 20 nam qua, y ted Tiy Nguyen da cd nhdng bUdc phat trien vOng chic, dat nhiiu kdt qua hoat dpng cham sdc svtc khde nhan dan, gdp phin dang ke vio qua tnnh phit tridn xa hdi va quan lyphat trien xa hpi cua vdng Mae du vin cdn nhidu khd khan, thach thvtc phit trien y td, die Met li y td ehdt lUdng cao vi mang ludi y te cd sd, song vdi cac chu trUdng, cMnh saeh Men hinh cua Dang vi Nhi nude, tUdng lai khdng xa, diy se li mpt linh viic phat tridn nhanh vi manh d khu vUc Tay Nguydn, gdp phin quan trgng vio sUphit trien xa hpi va quan lyphat trien xa hpi theo hudng ben vOng Quin ly phat triln xA hdi hu>ng ITnh v u c y t l tai n y Nguydn So vdi cae khu vflc khac, Tdy Nguydn cdn thieu dieu kiln ii phat triln toan didn vl y tl, nhu cha't lUdng dich vu y t l chUa cao, nhan lUc han ehl, cd sd v^it chd't thid'u bhdh Tuy nhien, ne'u nhin vko qui trinh phat triln cua y t l t^i Tay Nguydn giai do^n tfl bat diu thflc hi^n dli mdi tdi nay, ed thl nh^n tha'y nhflng thdnh tflu linh vUc ndy la rd't lang ghi nhdn Mdt Id, phat triin cd sd kh6m, chUa b$nb Sau khoang 20 nftm, s i U^ng b§nh vipn va cac tr^m / te t^i Tay Nguyen tang ga'p Iln, so phdng kham tang hdn lin TrUdc nam 2000, td'c dp phat trien cac cd sd kham, chfla benh d Tdy Nguyen nhin chung cdn tha'p, khd ed t h l dap flng dUde nhu elu vl kham, chfla bdnh cang tang cua ngudi dan, dac biet la ndi tap trung nhilu dong bao dan tpc thieu so' vdi khdng it cac phong tuc, tap quan cdn lae hau vl cham sdc sfle khde Nam 2011, y t l Tay Nguyen cd sfl thay doi dang ke, ddc bidt la so lupng tram y td' va bdnh vien dUde xay diing mdi T^i cac benh vien, sd'giudng bdnh tang tfl 3.714 giudng benh len 8.878 giudng (gd'p 2,4 Iln), sd' giudng benh tai cdc phdng kham tang ga'p khoang Iln, so* giudng benh tai cac tram y td' cung tang gin 1,7 Iln So' lUdng giudng bdnh tai cdc cd sd y te da tang ga'p 2,2 Iln, tfl 5.812 gifldng len 12.968 giudng Ngoai he thd'ng eae cd sd y te cdng lap, y te tu nhan tai Tay Nguyen eung phat trien tUdng doi manh, nha't la he thong bdnh vien tu nhdn, nhU Benh vien Da khoa Thien Hanh, Bdnh vien Dai hpe Y DUde Hodng Anh Gia Lai * PGS, TS Pho Chu nhiem Khoa Xa hoi hoc, Dai hpc Khoa hpc xa h6i vk Nhan vfin ** ThS Khoa Quan 1^ nhk nUdc, Hpc vi^n H^nh chfnh quoc gia S694 (10-2014)1 DliNDAN-f>6l THOAI Hai Ja, phat trien dpi ngU nhan lUc nganh y te Song song vdi p h a t trien ve ed sd vat cha't, edng tae phat trien dpi ngu n h a n lUc n g a n h y te t a i Tay Nguyen cflng dUdc dac bidt chu trpng Tong so' y, bdc si t a n g tfl 3.870 ngUdi n a m 1990 len 12.007 ngUdi n a m 2011, ga'p 3,1 lan Tinh hdn 20 nam, so' lupng bac si tang n h a n h nha't, gd^p hdn 10 lan (tfl 292 ngUdi len 2.980 ngUdi) De tiep tuc tang cUdng can bp y te' eho cac khu vUc vung sau, vung xa cua ca nUde, nam 2007, Chinh phu phe duyet De an "Dao tao n h a n luc y te' cho vung khd khan, vung nfli cua cac tinh thupc mien Bdc, mien Trung, vung dong bang sdng Cflu Long va vflng Tay Nguyen theo che dp cfl tuyen" Theo danh gia cfla cac sd y te' De an cung vdi mpt so' chUdng trinh, dU an khae ed lien quan da va dang gdp p h a n q u a n trpng n a n g cao so' lUdng cha't lUdng dpi ngu nhan lUe nganh y td' tai cac dia phUOng, dac biet d tuye'n cd sd, gdp phan vao nang cao hieu qua kham, chfla benh cho ngUdi dan Tay Nguyen Ba la, phat then he thd'ng mang ludi y te, kham, chUa benh tai dia phuang Mac du y te' Tay Nguyen da cd nhflng bUdc phat trien VUdt bac, nhien, van edn r a t nhieu khd khan, thach 40 I S694 (10-2014) Bmh vimdaUioaNiioai-Siln^Hgiiyen-bfflh vien tirnhinUnnhat khu vi/c Tay Nguyen tai thflc ca ve phdt trien mang ludi cd sd k h a m , chfla benh va n a n g cao cha't lUdng kham, chfla benh Theo Sd Y te' t i n h Kon Tum, ne'u t i n h theo eae tieu ehi mdi (theo Quyet d i n h so' 3447/QDBYT, 2 - - 1 , eua Bp trUdng Bp Y te' ve viec b a n h a n h "Bp tieu ehi qud'c gia ve y te' xa giai doan 1 2020"), so' xa dat ehuan cfla Kon Tum ehi Id 11 xa, chie'm 11,3% tong sd' xa toan tinh Dong thdi, so' 26 xd da dUdc edng n h a n d giai doan trfldc, chi cd xa dap iing dUde bp tieu ehi mdi Xet ve mflc dp hai long d a n h gia ve h e thd'ng cd sfl vat cha't t a i cae ed sd y te hien nay, p h a n ldn ngfldi dflli d khu viic Tay Nguyen danh gia d mflc dp binh thudng Trong do, xet rieng d mflc d a n h gia tdt, cac benh v i ^ tuyen t i n h chiera ty le cao nha't (28,8%), cae t r a m y t^ xa, phudng d vi tri thfl hai vdi 18,2% Khd k h a n v l cdsJ L l ilJ.l.l.lt.lli.lllB»a»IB cdn cflng khdng gid'ng Cang d eac tuyen trdn, kha ndng tie'p can dich vu cua ngudi dan cang giam Theo dd, eac tram y t e l a ndi ngudi dan cam thay d l dang nhat viec tid'p cdn cdc dieh vu (60,3%), tid'p theo Id b d n h vien qudn/huyen (33.3%), eudi cung Id bdnh vien tinh (23,4%) fkt cha't dUdc coi la mpt ;rong nhflng n h a n to' then :hd't anh hudng tdi cha't Udng dich vu kham, chfla ldnh d khu viic Bd'n la, cdng tac kham, •:bQa benh Tinh de'n hd't n a m 2011 )enh vien tuye'n tinh efla inh Tdy Nguyen h l u nhU sfl lung hd't 100%) edng s u a t giudng benh (trfl Dak Ndng), hdm chi ed nhieu tinh hdn 00% edng sua't d tuyd'n luyen t r u n g binh khoang 60%) - 70% edng sua't, cac bdnh vien da khoa khu vuc thudng sfl dung khoang 85% - 90%) cdng sua't Do dac thfl dieu kien tU nhien d Tay Nguyen nen khoang cdeh tid'p can, sfl dung cac dich vu y td' gifla ndng thdn va thi cdn n h i l u chenh lech NgUdi dan ndng thdn thudng gap nhieu khd k h a n hdn so vdi ngUdi ddn d dd thi viec tid'p can cac dieh vu Vdi cac cd'p cd sd kham, chfla benh khac nhau, mflc dp tiep Nam la, van debao hiem y te Ve dp bao phu eua bao hiem y te', Tay Nguyen Id khu vue ty le ngUdi dan cd the bao Mem y te eao hdn so vdi trung binh cua ca nUdc cd nhieu ddi tupng thupc dien dupe Nhd nUdc hd trd miln phi, nhU ngUdi ngheo, ngUdi ddng bao dan tpc thieu sd' Dp bao phu eua bao hiem y te'cung rat khac nhau, nhU nam 2012, tai D i k Ndng, ty Id ngudi dan cd the bao hiera y td'mdi cM dat 62%, tai D i k Lak, ty le la 67%, Gia Lai dat 71,3% Rieng tai Kon Tura, nam 2013, ty le kha cao, dat 84,3% khu vUc thi, thdi quen sfl dung the bao hiem y te cua ngudi dan bid'n hdn so vdi khu vUc ndng thdn (41,8%) so vdi 23,2%) Phan ldn ngUdi dan dUdc hdi cho rang, nhdm cd thu n h a p trung binh la nhdm sfl dung bao h i l m y te nhieu nhd't, chie'm 43,7%) Sau la, cdng tac cham soc stic khde sinh san Trong khoang 10 ndm trd lai day cung vdi ca nUdc ty S694 u-20Mi| 41 I H P ^ D I I N OAN - D I THOAI le phu nfl dp tuoi tfl 14 d i n 49 sinh thfl trd ldn da ed xu hudng giam Trong dd, mflc giam t a i k h u viic Tay Nguyen nhieu hdn so vdi mflc giam ehung cua ca nUdc (11% so vdi 7,5%) Mac dfl vay, ty le phu nfl sinh thfl d Tdy Nguydn n h i n chung v i n cao hdn nMeu so vdi ty Id t r u n g binh ehung cfla ca nUdc Cdc thd'ng ke khac ve y td' cho tha'y, Tay Nguyen la khu vUc cd ty sud't tre dudi tudi, gdm ca nhdm tre sd sinh, tre dudi tudi va dUdi tudi tfl vong cao nha't ca nUdc sud't nhie'u nam qua Trong giai doan 1999 - 2006, ty sua't tre sd sinh tfl vong tai khu vuc Tay Nguyen da giam qua tflng nam va giam hdn 1/2, tfl 64%o xud'ng cdn 28%o, nhUng vdn cao gan ga'p lan so vdi ca nudc la 16%io Mat khae, mflc dp giam ty sua't tfl vong cua tre sd sinh d Tay Nguyen cung giam khdng ben vflng Ndm 2012 ty sua't tfl vong d tre em dUdi tuoi tai Tay Nguyen da giam hdn 1/2 so vdi n a m 1999, nhien vdn cdn cao hdn ty sua't trung binh chung cua ca nUdc la ll%o Ben canh dd, mac dfl cdn nhieu khd khan, nhUng theo eae kd't qua khao sat ve y te' quy md qud'c gia cho tha'y, Hnh vUc cham sdc sUc khde sinh san, sflc khde ba me, tre em tai khu vUc Tay Nguyen da cd nhieu tie'n bp I Sd94 "•014) dang kd, t h d m ehi cd nhieu ehi so' cao hdn so vdi mflc t r u n g b i n h e h u n g cua ea nUde Ty le p h u nfl dUdc k h a m thai dinh ky, ty le sinh cd can bd y te dd, ty le sinh t a i eac cd sd y te h a y ty Id ba me va tre em dUde cham sdc s a u sinh deu t a n g Theo thd'ng ke, ty Id k h a m thai lan trd ldn d Tay Nguyen ia 12,4%, dae bidt k h a m thai I l n trd len dd t a n g tdi 28,1%, cao hdn 9.2% so vdi ty le t r u n g binh ea nUdc Bdn canh nhflng ke't qua, t h a n b tUu t r o n g l i n h vUc phat trien y te', hdn 20 n d m qua, qua t r i n h p h a t trien y td' t a i Tay Nguyen cung da va d a n g tdn t a i n h i l u b a n che', ba't cap Ngoai nguyen n h a n khach quan, nhflng b a n chd', ba't cap de'n tfl nhflng nguyen nhdn ehu quan to chfle, q u a n ly p h a t tridn xa hpi linh vUe y te tai Tay Nguyen Tha nhi't, he thd'ng mang ludi y te' p h a t trien chUa ddng bp, dac biet la y td' cd sd, so' lUdng cdc t r a m y te dat chuan cdn tha'p, p h i n ldn da xud'ng ca'p so' t r a m y te' dUdc xay mdi cdn it Quy md bdnh vien tuye'n tinh, bdnh vidn khu vuc edn nhd Tinh t r a n g qua tai d benh vien tuye'n tinh, benh vidn da khoa khu vuc da xua't hidn va cang cd da'u hieu t r a m trpng hdn Viee md rpng, xay dung mdi he thd'ng y te cd sd edn n h i l u b a n e h l thieu nguon k i n h phi Cd sd vat cha't, t r a n g t h i e t hi kham, chfla b e n h t a i nhieu benh vidn edn lac h a u ndn chifa dap flng dUdc n h u e l u kham, ehfla b e n h eua ngudi dan Dpi ngu y, bac si cd tang, song chd't lUdng cdn han chi Thahai, chinh sach thu hflt n h d n liie cd ban, nen cl cae t i n h Tay Nguydn, dac biet la mpt sd' tinh, nhU Dak Ndng, Kon Tum ra't khd thu h u t dUdc dpi ngu bdc si c6 t r i n h dp chinh quy Dinh mflc t h u hflt va che dp, ehinh sach tha'p cflng d i l u kidn lam vide ehUa bao dam IJi n g u y e n n h d n chinh khien bac si cd trinh dp chinh quy it v l lam vide d cac benh vien dia phUdng Chinh sach luan ehuyen ed hieu qua nhUng ehe dp, chinh sach edn bpc Id nhieu ba't cdp, ehUa tao dUdc dpng Iflc thu h u t ddng dao dpi ngu bac si ThU ba, ty Id sinh thfl tai eae t i n h Tay NguySn vdn d mflc cao va cd xu hudng t a n g , giam thd't thfldng Trong vdng 10 nam, tfl nam 2002 den n a m 2012, ty 1$ sinh thfl d Tay Nguyfin ludn tri mflc tdng cao hdn khoang 10% so vdi ty 1? trung binh cua ea nflde, dong thdi, khdng bao dam dM(}c mfle giam on dinh Trong stf cac nhdm dd'i tUdng sinh thfl hien d Tay Nguydn, cd nhieu vflng thupc nh6m dong bdo dan tpe t h i l u so L I IJ '-il.^.lLH!gggm Tha tu, t i n h h i n h dieh Dpnh da dUde kiem soat tUdng ddi tot, song nhieu aguy cd v i n tdn tai, dae bi^t ia vd'n d l ngp dpc thfle p h i m b ckc vflng dong bao dan tdc thieu so Mac dfl dp bao phu 3ua bao Mem y te da t a n g sao, song v i n cdn mpt ty Id khdng nhd ngudi ddn chUa cd the bao Mem y t l Mat khac, vide sfl dung the bao Mem y t l k h a m , chfla benh cua ngudi dan edn chUa phd biln, chd't lUdng dich vu chUa cao Giiki ph^p ve phat trien y te vh quAn ly phcit trien xa hoi linh vUc y te tai Tay Nguydn Cung nhu cac va'n de xa hpi khac, va'n d l phat trien y t l Tay Nguyen dang dflng trudc kha n h i l u t h i c h thfle nham dat tdi cae muc tieu phat trien kinh te - xa hpi cua vflng dinh hUdng n a m 2020, t i m nhin 2030 De lam tot cdng tac quan ly, kiem soat va nang cao chat lUdng hoat dpng y td' t a i Tdy Nguyen, giai doan tdi, sin chu trpng thUe Men cac ^ a i phap tap t r u n g vao cae nhdm chinh sach phat tridn quy md, kd't cd'u t i n g cho ngdnh y t i c a e dia phUdng va 2hinh sach n a n g cao cha't lUdng dich vu y te Cu the: - ThUe hidn td't ehinh sach 3ao dam n h a n lUc y td' thdng jua cdc Uu dai cho boat dpng ldo tao, phat t r i l n dpi ngu n h a n vidn y t l cac tuyen, ldm tdt cdng tac phan bo va sfl dung cd hieu qua ngudn nhdn luc y te hien cd cua cae dia phUdng; ket hdp cung vdi cac chinh sach Uu dai, thu hflt nguon nhdn lUc y te' tfl cac vflng khac de'n vdi Tay Nguyen; chfl dao tao nguon n h a n lUc y te' la ngUdi d a n tpe ban dia va nhflng ngfldi am hieu cac dan tdc b a n dia Tay Nguyen vdi nhflng chinh sach dae t h u rieng eho nhdm dan eU cha't lupng phuc vy doi vdi edng dong Thflc hidn chinh sach thu hflt va phan bo hdp ly cac ngudn d i u tU tfl Nha nude, eac t l chfle, ea n h d n va ngoai nfldc dd'i vdi viee phat trien boat dpng y te' tai Tay Nguyen - Bao dam su binh ddng tiep can va sfl dung dieh vu y te ddi vdi moi ca n h a n epng dong, dac Met t a n g cUdng k h a ndng dUde k h a m , ehfla bdnh va cham sdc y te doi vdi ngUdi - Bao dam thuc hidn td't ddn vflng sau, vung xa, vflng chinh saeh xa hpi hda ddng bao dan tpc thieu so hoat dpng y td, thu h u t cae Chu trpng tuydn t r u y l n , n g u i n dau tU khae cho gido due vdi su phdi hdp cua hoat dpng eham sdc sflc khde toan bp he thd'ng chfnh tri, cpng ddng Ddc biet, tao dilu n a n g cao n h a n thflc cua kien phat trien mang ludi y ngUdi dan qua t r i n h te' ngodi edng lap, thu hut t h a m gia bao hiem y te va nguon d i u tU qude te' tao cae dich vu y te khac nhau, ddng lUc cho vide nang cao lam thay ddi hanh vi cua cac cha't lUdng chdm sdc y te tai nhdm dd'i tUdng cu the vdi eac dia phUdng Cu the hda cae ehinh saeh cu the Tranh ehinh sach khuye'n khich dung mpt ehinh sach ehung boat dpng t r u y l n thdng cho qua nhieu doi tUdng cham sdc sfle khde, ehu khac nhau, ddn dd'n khdng trpng dau tu ca ve npi dung thuc hien dUdc mpt each hidu va hinh thflc; phat huy gia qua, thara ehf gdy lang phf tri cua y hpc ed truyen, giflp nguon luc, mdt sd cho mdi ngUdi ddn deu cd the trudng hdp cdn gay phan tac trd bac si eua gia dinh dung Tang cUdng vai trd eua ngUdi ed uy tin cao - P h a t trien ke't ca'u quan ly xa hpi, phat huy eae t i n g eua eac ed sd y td' tfl gia tri van hda truyen thong, tuyd'n cd sd de'n cae quan, coi phuc vu n h a n dan la huyen bdng viee md rdng cac nhiem vu cua toan he thong ed sd kham chfla benh, tang y td', tflng budc ldm cho y t l eUdng dau tu ve trang thid't trd ye'u td' quan trpng bi y te, eai thidn hidn dai phdt t r i l n xa hpi ben hda cac trang thie't bi y td' vflng d Tay Ngu> en I cdc ed sd, bao dam td't nhat S694 ;i>2014)| 43 ... sinh cd can bd y te dd, ty le sinh t a i eac cd sd y te h a y ty Id ba me va tre em dUde cham sdc s a u sinh deu t a n g Theo thd''ng ke, ty Id k h a m thai lan trd ldn d Tay Nguyen ia 12,4%,... i k h u viic Tay Nguyen nhieu hdn so vdi mflc giam ehung cua ca nUdc (11% so vdi 7,5%) Mac dfl vay, ty le phu nfl sinh thfl d Tdy Nguydn n h i n chung v i n cao hdn nMeu so vdi ty Id t r u n g... cae ed sd y te hien nay, p h a n ldn ngfldi dflli d khu viic Tay Nguyen danh gia d mflc dp binh thudng Trong do, xet rieng d mflc d a n h gia tdt, cac benh v i ^ tuyen t i n h chiera ty le cao