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CHAM SOC StfC KHOE BAN DAU VI MUC TIEU SU'C KHOE CHO MOI NGUCil PHAM THI TINH" Quan dilm cila T6 chirc Y te the gidi ve siic lihde vii cham sdc sire Idioe Thu hudng mpt tinh ttang sQc khde tit nhit cd thi da trd mue tieu ma Td chQc Y tl thi gidi (WHO) no luc diu ttanh va coi nhu mdt quyln co ban cua mdi ca nhan suit hon 60 nam qua dl mgi ngucri, dae biet la ngudi ngheo, ngudi de bj ton thuang deu cd dugc quyln Mdi quan tam din sue khde eiia cpng ddng qudc te thi Men qua mpt sl mlc chinh sau (A.Irwin va E.Scali, 2007): - Nam 1948, vua ddi, WHO da dua mgt djnh nghTa kha diy du ve sue khde: "Sue khde la ttang thai hoan toan khde manh vl the chit, tinh thin va xa hpi, chu khdng chi don gian la khdng cd benh" WHO cung dat mue tieu phai dat dugc mQc sue khde cao nhit cho mgi ngudi Cac ylu to xa hpi anh hudng den sQc khde, eong bing, bit binh ding vl sQc khde da duge de cSp den - Thap ky 1950, ehju nhilu anh hudng ciia chiln tranh Ianh, WHO bj le thudc chu ylu vao My Su bung nl cac ky thujt y hpc, thudc, vacxin, cac nudc dang phat triln, he thing y tl tap tning vao ky thuat y hgc Cac chuong trinh y tl tap trung vao cac benh nhu Lao, sdt ret va cac cdng nghe, ky thuat, - NhQng nam 1960 diu thap ky 1970: Md hinh cham sdc sue khde cd sy tham gia cua cpng ding, nang cao nang lyc cpng ddng, gan sQc khde vdi QUYEN CON NGLTOl (QCN), edng bing xa hdi va cac yeu to anh hudng ldn nhu kinh te, chinh trj, xa hdi va mdi trudng dugc md rgng Giao due sQc khde va phdng benh trd tam diem cua cac chuang trinh y te va giai quyet cac yeu td xa hgi anh hudng den sue khde - Nam 1978, Hdi nghj qudc te tai Alma Ata da chap nhan mue tieu "sQc khde cho mgi ngudi den nam 2000" va md hinh "Cham sdc sQc khde ban dau" (Primary Health Care - PHC) dugc chpn de dat mue tieu tren Dd la mdi quan tam den cdng bang sue khde va cac yeu td xa hdi anh hudng den sue khde, md rdng cac cham sdc y te co ban xudng CO sd, tang cudng ngudn lyc cho cac cpng ddng ngheo nham han che su phii thugc vao cac chuyen gia y khoa, - TQ nam 1979 din diu thap ky 1980, md hinh PHC cd chgn lpc dupe sQ dung bdi nhieu nha tai ttp va lanh dao WHO cho ring md hinh PHC qua rpng, khdng dem lai ket ' ThS.; Vifn Nghien ciiu Con nguci, Vifn Hin lam Khoa hpc Xi hpi Vipt Nam 42 Ngliien ctia Con ngudi s6 6(60) 2013 Chdm soc sue khde ban ddu qua eu thfi, viee "ndng cao quyen cho edng dong" la mdi de dga dfin nghfi nghiep cua nhflng ngudi hiep hgi y khoa Md hinh PHC cd chpn Igc Id uu tien tap tiung cac ngudn lyc vao cac bfinh cd ti Ie mie vd chfit cao nhit va dem Igi hifiu qua cao ve gid dp dung cac bien phap can thifip eu thfi - Dau nhung nam 1980, chu nghia tu mdi phdt trifin vdi quan diem: thj tradng ty khdng ehju su tde dgng eua nha nudc se raang lai hieu qua eao nhdt viec phdt trifin va phan phdi cac sdn pham xd hgi Dfi dat mue tieu, can ban chfi vai trd eua nha nudc nhiing ITnh vyc hogt dgng kem hieu qua, gom ed ITnh vyc y te vdi trifit Iy: su cat gidm cd thfi gay ton thuong rapt sd cOng ddng thdi gian ngan nhung se duoc btt Igi bang nhiing lgi ich ldu ddi nen kinh tfi phdt trien cao ban - Nhung nam 1990, chu nghTa tu kinh tfi mdi tiep tuc rad rdng, nhiing chuong trinh "tdn thuong ngin han" edng lam trara trpng thfim cde vin dl xd hpi, nhu gido due, dinh dudng, nude saeh, vfi sinh mdi tradng, nhd d Trudc tinh hinh tren, cdc nudc G8 va IMF da tien hanh difiu chinh: giam ng eho nudc ngheo, tang ehi phi xd hgi cho y tfi, gido due; thifit ldp nhom hdnh dpng Sttc khde va phat trien, phdt trifin eae ehinh sach nham dat mue tifiu: Sttc khoe cho mgi ngudi; Sttc khde chinh la mgt yeu td cho phat trifin, can dugc tai dau tu - Nam 2000, "Hien chuong Sttc khde cho nhdn dan" ddi trfin co sd eae ehinh sdch todn cau va toan dien ve PHC vdi khdng djnh: Sttc khoe Id mpt van de xd hpi, kinh te, ehinh trj va tren hit Id quyln co bdn etta ngudi Sy bat binh dang, ngheo doi, ngn bdc lot, bgo Iuc vd bdt cdng Id nguyen nhan gay bfinh tdt vd chfit chdc cho ngudi ngheo, va quyfin co ban cua eon ngudi Id dat duge cho minh tinh trang sue khoe cao nhdt, Cde chinh sach toan cdu vd todn dien ve PHC phdi la nfin tdng cho cae ehinh sdeh lifin quan dfin sttc khde - Nam 2003, Hpi nghj qudc tl vl Cham sdc sttc khde tai Madrid da dua nhflng djnh hudng ehiln luge cho PHC nhim dgt mue tifiu "Sttc khoe eho mpi ngudi" vdi khing djnh: PHC vdn la triet ly mang tinh ehien luoc y tfi nfin tang nham xdy dyng mgt he thdng y tl phu hop vdi mgt thi gidi dang thay ddi, nhu gid hda ddn s6, nhilm mdi tmdng, biln ddi hau, sy thay doi mo hinh bfinh tdt, deu tac ddng den sue khoe, sttc khoe dugc coi la yfiu to ctta sy phdt trien - Ndm 2005, Uy ban vl cdc yfiu td xd hgi dnh hudng tdi sttc khde ddi - Nam 2007, tgi Hpi nghj qudc tl Sttc khoe cho phat trifin to chtte tai Argentina, WHO vdn tdi khdng djnh: PHC van Idraptchia khda ctta chinh sdch y te todn dien, nhan ban, gan sttc khde vdo sy phdt trifin dfi dgt cdc Myc tifiu phdt trifin Thifin nien ky (MDGs) vdi nhieu co hgi vd thaeh thttc radi Ljch stt: cde xu thfi va co hdi phat triln khdi niem sttc khde vd chdm soc sttc khde dugc tdm tdt qua hinh sau: Nghiin ciiu Con ngudt sS6(69) 2013 ^-5 Pham Thi Tinh Ngudn: Trdn Hirng Minh (CCIHP), Cong bdng sice khde, khdi ni?m vd ludng Quan diim cua WHO vi Chdm soc sue khde ban ddu Theo Tuyfin ngdn Alma Ata nam 1978 thi "Chdm sde sttc khde ban dau Id nhttng cham sdc sue khde thifit yeu, dya tren nhiing phuong phdp va ky thugt thuc hanh, dua dfin tan cd nhan vd timg gia dinh cpng dong, dugc mpi ngudi chdp nhan thdng qua sy tham gia ddy du eua hg, vdi gia thdnh cd thfi chap nhdn dupc nham dat mtte sttc khoe cao nhdt cd the" Ddy Id bp edc gia trj, nguyfin tae vd edeh tifip cdn toan difin nhim cdi thien tinh cong bdng chdm sde sttc khoe va tinh hifiu qud each stt dung cdc ngudn cung cip, nang eao sttc khde cua cac cu dan bj thiOt thdi Vdi nhieu mue tieu: sttc khde tdt hon, benh tat it hon, cdng bdng hon, va nhung cai thien rgng Idn ket qua hoat dong eua cdc h? thdng y te Nam 2008, Bdo cdo Sice khoe thi gidi "Primary Health Care - Now More Than Ever" da ddnh gia 30 ndm thye hien Tuyen ngon Ahna Ata: cac h? thdng y tl, cd tai edc nudc phdt tiifin nhit dfiu khdng dgt cdc myc tieu Tuyen ngdn Alma Ata dua Nhin tdng the, eon ngudi hifin khde manh hon, sung tuc hon vd sdng thg hon Dd co nhflng cai thifin quan trpng vfi nudc sgch, v^ sinh vd chdm sde trudc sinh, nhihig bude tien tiong edi thifn sttc khde, diu tranh chdng bpnh tat va keo ddi tudi thg Tuy nhien, Nghiin eiiu Con ngudt s66(69} 2013 Chdm soc sice khoe ban ddu ngudi dan tren khip thfi gidi vdn khdng thda man vdi cde he thdng y tfi hien ed MOt nhiing khue mie Idn nhat la vl chi phi chdm sde sttc khde Bdi, moi nam Iai cd khodng 100 trigu ngudi roi vao cdnh ngheo ddi phdi trd chi phi cham sdc sttc khoe Hang tripu ngudi nua khdng the tiep can bit ky hogt ddng chdm sdc sue khoe ndo Ngudn gde cua van de Id cac he thdng y tfi vd cdc chuong trinh y tl da bien thdnh mOt mdng chdp va cdc bd phgn cdng viec Sy chuyen mon hda thdi qud etta edc nttdc gidu, cdc chuong trinh chi tdp trung vdo mgt benh vd chay theo ede nhd tdi tig tgi edc nudc ngheo Phan ldn cde ngudn dau tu dugc danh cho ede djeh vu ehua tri, viec phong ngtta vd nang cao sttc khde cdn bj xem nhe (chilm 70% gdnh ndng benh tdt) Cde he thdng y te dudng nhu bj cudn di ttt mgt uu tien ngdn han sang mdt uu tien ngdn ban khde, edng cdng bj chia cdt rdi rgc vd khdng ed mot djnh hudng rd rang hon la edi thifin khd ndng ddp ttng eua hg vd ludng trade nhttng thach thtte radi Ngudi ta ngdy edng nhgn ring, vigc cung cip edc dich vu y tl thong thudng qua cdc co chl khdc va dudi nhihig ly khde khong chi it hieu qua md thudng gap phdi mgt loat nhung khiem khuylt vd nhung bit cap nhu: Chdm soc ngu(rc: Nhting ngudi ed dilu kien nhit, nhflng ngudi cd it cdc nhu ciu vl chdm sdc sttc khde thudng duge cham sdc nhifiu nhdt (d thdnh phd), nhung ngudi cd It dieu kifin vd ed nhieu van de ve sttc khde nhit Igi dupc chdm sde it nhdt (d ndng thdn) Chi tieu cong cOng vfi djeh vu y tfi hay lara lgi cho ngudi gidu hon la cho ngttdi ngheo d cde nude cd thu nhdp cao va thip diu nhu Chdm soc ldm bdn ciing hoa: Noi nao ngudi ddn khdng co bdo trg xa hgi vd vi?c chi trd djch vy y tl chu ylu bing tien tui, ho phdi doi mat vdi nhung khodn chi khimg khilp Tren 100 triOu ngudi moi nam roi vdo cdnh ban ciing vi phdi chi trd cho chdm sde y tl Idm tdng khodng cdch giau ngheo vd tdng bdt binh dang xa hdi Chdm soc phdn dogn vd xe nhd: Su chuyfin mon hda thai qua cua nhd cung edp djch vu eham sdc y te vd sy tap trang hep cua nhifiu chuong trinh kifim sodt bfinh tat cdn trd cdch tifip can todn dien vdi cde ed nhdn, edc gia dinh vd khdng de cao nhu cau chdm sdc lien tyc Cdc djch vu y tfi cho ngudi ngheo, edc nhdm bj dat ngoai lfi xd hgi thudng bj phdn dogn qud nhd vd thieu ngudn lyc trim trgng, Cham sdc khong an todn Thilt kl he thdng cham sdc y tfi ngheo ndn khdng dam bdo sy an todn dan tdi ti 1^ nhdp vien eao eung vdi nhiing sai Idm ve su dung thude vd nhttng tdc dyng trdi ngupc dan tdi ttt vong va sttc khde kem Chdm soc khdng dung huang: Phdn bo nguon lye quanh eae dich vu chfta benh tdn kem, bd qua cdng dogn phdng ngua ban diu vd nang cao sue khde (tdi 70% gdnh ndng bgnh tat) Vife chdm sde sttc khde khdng eo chuyen mdn dl gidm nhe cdc tae dung phu vdi sue khoe tu cde ITnh vue khdc, cd thfi ddng gop cho sue khde Trade nhflng bit cap cua hg thdng y tl, WHO ehi nhihig thaeh thue cua mgt thi gidi dang thay doi Vdi mtte tdng tradng kinh tl y te todn cdu nhanh hon so vdi tdng sgn phdm qu6c npi (GDP), titi-pngtii8% nam 2000 Ifin 8,6% nam 2005 GDP till gidi, gdm Nghiin Cliu Con nguHt s^6(69) 2013 - Pham Thi Tinh ca lam phat vdi mue tang ttirdng 35% chi tieu y tl thi gidi nam CuOe each mang cdng nghe dang nang cao tilm nang y te va biln dli kT nang ve y te xa hpi toan ciu Co chl quan ly toan ciu dang xuit hien, dd la: tang cudng su ttao ddi giQa cae qudc gia, sy y thuc nhQng mli de dga, nhtmg thaeh thuc hoac eo hdi se chia; nghTa vu toan ciu xda bd ddi ngheo dugc neu ttong MDGs Tuy nhien, cOng ed nhihig xu hudng khd doan; Thli nhdi, nhflng tiln bp to ldn vl y tl miy thap ky qua cang gay bat cdng sau sic vl y tl giua eac quic gia, xu hudng tap trung vao khu vuc y te da dupc cai thi?n d mdt bp phan ldn tren till gidi, ban nfla, cdng ngh? thdng tin phat ttiln giup ta cd ngudn tai lieu dli dao ma 30 nam tt^dc khdng cd Ben canh dd la viec mdt sd nudc bj tut lai phia sau hoac sa sut ban khdng du tiem Iuc phat ttien Thli hai, ban chit vin dl y tl dang thay dli va chiing ta chi thiy ttude timg phan vdi tic dp hoan toan khdng thi du bao dupc Sy gia hda dan sl, tac ddng cua thj hda, quan ly kem va toan cau hda dang day nhanh su lan truyen cac benh lay nhiem va tang ganh nang cua cac benh kinh nien va khdng lay Ngay cang ed nhieu ngudi xuat hien nhflng trieu chQng phuc tap ddi hdi djch vu y te phai md rdng di?n quan ly ca b?nh thong nhat va bao quat ban Mpt the gidi dang nhieu loan bdi tac ddng cua bien ddi h^u, nhQng thach thuc ve an ninh luong thue va cac ap lyc xa hpi, va phan ldn khdng the dy bao dugc ve tinh hinh sue khde nhirng nam tdi Thli ba, cac he thdng y te khdng each biet khdi budc di mau 1? cua su thay ddi va eai bien dang la bd phan chu yeu cua toan cau hda Khung hoang kinh te, chinh tri dang la thach thuc ddi vdi nha nude va cac td chuc ddng vai trd dam bao viec tilp can, cung cip va tai ttg ViSc thuong mai hda khdng cd kiem soat dang dugc trg giup bdi tinh trang khdng rd rang gifla cac tac nhan cdng va tu, viec sip xip chuc trach, cac quyln cang bi chinh trj hda Thdi dai thdng tin Iam thay dli cac mdi quan he giQa cac cdng dan, cae nha chuyen mdn va cac ehinh khach Sy khdng bit kjp gifla cac ky vpng va kha nang thuc hien la II khiln cac ca quan hiiu ttach ve y te lo lang Coi sue nang ve kinh te va y nghTa xa hpi cua khu vyc y tl dang cang tang cung la li dl cac chinh khach mdt quan tam hon tdi y tl "Trung binh cac vin dl cham sdc sire khde dugc nhic tdi hem 28 lin ttong mdi cu0c ttanh cQ so bg gin day d My" Khi xa h^i hien dai hda, nguoi cin nhilu hon tir cac hetiidngy te cho ban than, gia dinh va xa hgi Ngay cang cd sy ung hg rpng rai hon dli vdi binh dang ve y te; vdi cac dich vy y tl tSp trung vao cac nhu ciu va mong mudn cua ngudi; vdi an ninh sue khde cho cac cpng ddng noi hg sdng; vdi nhting tilng ndi c6 anh hudng tdi van de sue khde Nhflng gia trj cua PHC: cung cip nude sach, ve sinh moi trudng; cai thi?n dinh dudng; tidm chimg md rdng; phdng chdng, kilm soat djch b?nh; giao dye sQc khde, cho ngudi dan tuyln co sd da nhan dupc sy ung hd rdng rai cua cac chinh phu va sy ky vgng ciia ngudi dan Tuy nhien, hieu qua cua PHC phutiiupcvao dilu kien moi nudc va 46 Nghl€n Cliu Con ngudi s6 6(69) 2013 Chdm sdc sue khoe ban ddu nhflng tdc ddng ttt ngodi ngdnh y tl Thyc tfi, chifin lugc PHC thudng don gian hda cdc thdng diep, ddn din tinh trang dau cd vd ddu torn, kera phu hgp vdi edc boi cdnh va van de Do do, can phai ed mOt he thdng ede cdi each dac thu, phu hgp vdi hoan cdnh, ddp ttng ede dieu kifin ve y tfi cua hien tai vd cdc thdeh thtte cua tuong lai Cdn phai tdi dinh hudng ede he thdng y tfi dua tifin bing chttng khoa hgc viing chac vd sap xep hgp Iy, cdn thong nhdt gifta ehinh quyfin vd ngudi ddn vfi y tfi va chara sde sttc khde Cdc cdi cdch PHC dugc xde djnh bang vific xde djnh vai tid etta ede he thdng y te vd cac nganh cd lien quan xd hgi "Primary Health Care - Now More Than Ever" ddi, WHO hy vgng lam sdng lgi cudc ddi thoai 30 nam trudc ve sy chuyen hudng mdu mue tu vfi sue khde, vd dua dfi nghj xay dyng he thong y te va edc quyfit sdch phdt tiien y te theo bdn djnh hudng Ddy Id nhiing nguyfin tic cdt ldi cua PHC thdi ky hgi nhgp: Cdi edeh dien bao phu cap de cdi thien binh ddng ve y te: Dfi giara bdt eae bat binh dang ve y te thi phdi ldm eho cdc dich vu y tfi sdn ed hon cho tat ca mpi ngudi Mgi ngudi dfiu cd the tiep can vdi he thong cham sde sttc khoe Viec md rgng difin bao phii cap cung cdp djeh vu phdi di cttng vdi bdo trp y tfi xa hpi, thong qua gop qfly vd trd trade thay vi trd bang tien tui cac chi phi cua ngudi stt dung Tttc la cap tifip can kfit hgp vdi bdo tig y te xa hgi - dieu kien can thifit dfi cdi thifin binh dang ve y tfi Cac he thdng da hodn thdnh difin bao phu cgp gan ddy eho thdy, edc cdi cdch can dugc thyc hien eung vdi cde bien phap chu dpng de dat cai chua dat dugc: nhiing edi each ma sy sin cd djch vu vd bdo trg xd hdi dem lai qud it de bu Iai cdc hau qud vfi y tfi cua sy phan tdng xa hdi Ddy ehinh la li khdi cac eai each ve cung cap dich vu dttng vdo Cai each cung cdp dich vu Idy ngudi Id tmng tara: nghia la, thay doi viec cung cap djch vu thdng thudng cham sdc ban ddu, tdi uu hda ddng gdp eua cac djch vu y tfi - edc he thdng y te dja phuong, edc mang eham sdc y tfi, va binh dang ddp ling cdc mong mudn ngdy edng tdng: "ddt ngudi vdo tnmg tdm cua chdm sdc y te "cham soc tap trang vdo ngudi, dam bdo tinh todn difin vd thong nhdt, tinh Hen tuc tiong chdm sdc vdi sy thara gia eua benh nhan, gia dinh va cgng ddng He thong y tfi se ddp ttng tot hon ede nhu eau eua eon ngudi thong qua cac diem cung cap djeh vy gdn vdi ede cgng ddng Phuong phap ndy md ede ca hgi phong benh va ndng cao sttc khde cflng nhu viec phat hien sdm bfinh Nudc Cong hoa Hoi gido Iran co 17.000 tram y tl, mdi trgm phuc vy khodng 1.500 ngudi, dieu da giup Iran gidm manh ti le chet vdng hai thdp ky qua, vdi tuoi thg tnmg binh tdng tdi 71 tuoi vdo ndm 2006 (ttt mtte 63 tuoi ndm 1990), Cham sdc ban ddu cd thi lam dugc nhilu dilu dl eai thien sttc khde, nhung khong the dap ttng tat ed cdc mong mudn cua ngudi dan Do dd, Chinh phu edn xay dyng mang chinh saeh edng dfi ddi phd vdi edc thdeh thuc vfi sttc khde the gidi todn cdu, nhu thj hda, d nhiem mdi tmdng, bien ddi hgu, phdn bifit gidi hay phdn tdng xa hgi, Cai cdch chinh sdch y te cong de nang cao va bdo vfi sttc khde eho cOng ddng Chi Nghiin ciiu Con ngudt s^6(69} 2013 AJ Phgm Thf Tinh rieng smh hgc khdng ly giai dugc nhttng khoSng each vl mdi tiig, nhung ehenh lech gitta eae vimg lan can vl giau va ngheo Su thyc, cd nhilu tiiir tac dpng tdi sue khde nim ngoai khu vuc y tl, nhu tiiuong mai, mdi ttudng, giao due, nong nghiep, Cac chmh sach cdng, cac chuong ttinh sue khde cd thi cd tac dung ddi vdi mdt sd van de, cd thi chi la can thiep duge chgn lgc tu ve sinh va phdng benh cdng cdng tdi nang cao sue khde, nhung c6 ddng gdp quan ttpng dli vdi y tl Chmh sach binh ding gidi, an tpan tiiyc phim, v? sinh mdi ttudng, deu cd anh hudng sau sic, tham chl quyet djnh tdi sue khde eon ngudi Do do, cin mdt su chuyin hudng cac chinh sach bdi mdt sd tac dgng vl sQc khde, cd thi thyc hien qua eac chucmg ttinh phat triln tre tha, truyen thdng giao due sQc khde cho phy nQ, Cin xem xet vin dl y tl ttong tat ca cae chinh sach dl dam bao ring, cimg vdi eac mue dich va cac mue tieu cua cac khu vuc khac, cac anh hudng cua nganh y tl se cd vai ttd quyet djnh eac chinh saeh edng Cai each lanh dao dl lam cho cac co quan hihi ttach ve y te dang tin cay ban De dua cac cai each vl dien bao phu phd c$p, cung cap djch vu va chinh sach cdng vao moi trudng cue ky phuc tap cua khu vyc y tl, can cai each bd phan lanh d^o thay vi Ifnh va kilm soat, ban lanh d^o cin dan xip va hudng din Tat ca eac phan xa hdi - gdm ca nhihig phan vdn khdng cd lien quan gi tdi y te deu phai tham gia, ke ea cac co quan dan chinh, khu vuc tu nhan, cac cdng ddng va khu vyc kinh doanh Lanh d ^ nganh y te can dam bao rang cac nhdm cd kha nang bj tdn thuong phai cd mpt diin dan de bay td cac nhu eau cua minh Tuy nhien, viec nghien cim ve cac h? thdng y te la khu vyc thudng thieu kinh phi nghiem trgng Day ia viec rat can thiet de dua bing ehiing tdt nhat lam can cii cho nhirng quyet djnh ve y te Bdn khoi cai each PHC dugc dan dit bdi cac gia tri chia se cung mpt the gidi toan cau hda Viec dua bdn cai each vao thuc tiln phu thugc vao dilu kien kinh tl, chinh trj, xa hdi cua moi nudc Nlu thuc hi& dugc bin mue tifiu PHC nay, cac h? thing y tl quoc gia cd till trd nen gin kit, hi?u qua han, cdng bing ban va cdng hon nhilu Cd thi ndi, mditiTrdngquic te hien dang thuan Igi cho viec khdi phye va tiln hanh cai each PHC, bdi: Y te toan cau dang dugc quan tam chua timg thiy, sy tang cudng cac hogt ddng, sy ling hp manh hon vdi cham sdc phd cap va toan dien, nhu: vdi nhung ngudi sing chung vdi HIV, nhQng ngudi quan tam tdi dilu trj va cham sdc, cac Lanh d?o y tl, hoac nhom G8, sy nd rp cac co che tai teg ttong m$t thi gidi dang thay ddi nhung cd sy lien kit chJt che todn cau 14 nhung diu hi?u dang mimg vl m^t su ddng thujn dl cimg xay dyng cac h? thdng ben viing cho y tl Triln vpng diu ttr ttong nudc tang len la co hpi tit dl tai ting cudng cdc h$ tiling y te xung quanh cac gid tti PHC T5ng trudng GDP cd till bi tdn hai sy gitoi sit vl kinh te, khung hoang luong tiiuc, nang lugng va hien tttgng im len toan ciu, khip till gioi dang nsip nang lupng cho chi tieu y tl Vi?c tan dyng sy tang trudng kinh tl se tao cac CO hgi dl tiln hanh cac cai each PHC cin thilt 48 Ngtjt^ etlu Con ngudi s66(691 2013 Chdm sdc sue khoe ban ddu Dodn kfit toan cdu vd vifin trg van Id khau quan trpng dfi bd sung va hd trg cac nude chdm phdt trien, nhung se kem hieu qua hon vifie tiao doi, hgc tap lan Cde eo quan huu trdch ve y te, ede nhd lanh dao ehinh trj deu khdng thodi mdi vdi cdc xu hudng hifin sy phdt trien cac he thdng y tfi vd viec phdi thieh ling vdi ede thdeh thtte sttc khde dang thay doi, cdc nhu cdu va mong mudn sinh Tam trgng thdt vgng va raong muon cua ngudi ddn vfi chara sde y tl binh ding hon, bao trg y te tdt hon dang hinh thdnh, dieu tmdc ddy ehua timg cd NIU ede chinh phu bilt nim bdt co hpi, diu tu vdo cdi cdeh PHC cd thi diy nhanh qud trinh bien doi cua cde he thdng y te nhdm cd dupe eac kfit qud vfi y tfi phan phoi eong bdng hon Trong thdp ky qua, cgng dong thfi gidi da gidi quyit tinh trgng ddi ngheo vd bat bmh dang rapt edeh he thong hon bdng cdch xay dung MDGs vd dua vin dfi bit binh ddng vao cot Idi cua vific hoach dinh chinh sdch xa hgi Trong dd, hogt dgng y tfi Id tmng tam gdn kfit ede ITnh vyc, tgo co hgi cho cde hogt ddng y tfi hieu qua hon vd eiing tgo cdc dieu kien xa hdi can thiet dfi thifit lap nhiing hen minh chat che ngodi y tfi Nhu vay, hogt dpng lifin ngdnh PHC dugc dat vdo giai dogn trung tdm Cdc co quan hiiu trdch vfi y te khdng cdn thdy gdnh nang trdch nhifim eua hg ve sttc khde bi gidi han d su sdng vd kiem soat benh tat md la mgt nhflng ndng lyc quan trgng ma ngudi dan xa hgi coi trgng Tinh hgp phap ciia ede co quan hflu tidch vfi y tfi ttty thudc vdo viec hg dam tidch tdt nhu thfi nao nhifim vu phdt tiien vd cdi cdeh khu vyc y te theo cai ma ngudi dan can vd difiu dupe ky vgng ddi vdi cac he thong y tfi xa hpi Cham s6e ban diu vi mue tifiu sttc khoe cho mpi ngirdi Quan diem: "Cham soc ban ddu - dgt ngudi Ien tien het" doi hdi nhiing 16 trinh quan trpng "Dgt eon ngudi Ifin trfin hfit" - de xudt vifie ndng cao sttc khde va phdng ngtta bgnh, chtta benh vd chdm sde eung theo each an toan, hifiu qud, ed lgi ve mgt xa hpi gifta ngudi ddn vd he thong chdm sde sue khde Bao ddm sy chdm sdc toan dien, thong nhdt va lifin tuc cd.thfi xdy dyng moi quan he tin cay gifta ngudi stt dung dich vu vdi ngudi eung cap djch vy, mdi quan he tryc tiep giua timg cd nhdn vd gia dinh cdng ddng vdi nhdn vifin chdm sdc sttc khde Nhdm cung cap djeh vu se nam ro tien stt etta moi ca nhan va hodn eanh cua hg, ngudi stt dung djeh vu ed thfi tin tudng ngudi chara sdc sttc khde cho rainh Difiu giup gidm 50% nhflng ea khdm cip ciiu, giam 30% nhflng ca ehuyin sang chdm soc ddc biet; thdi gian chd dcfi cua benh nhan dttpc nit ngdn dang ke Quan trgng nhdt Id hp edm thay hp dugc ling nghe, dugc ton trgng vd cam nhdn duge gia trj ciia sy chdm soc Vdi hinh thttc nay, sttc khde etta cdc vifin tiong gia dinh dttgc bdo vfi va nang cao phu hgp vdi hodn ednh vd dieu kifin Phuong phdp Idm eho eac djch vu hifiu qud vd cong bdng hon tren eo sd mdi quan hg trye tifip, gin bd gifta cdc ed nhan, cgng ddng vd nhirng ngudi eung cap djch vu Day la co sd cho tinh tap trung vdo ngudi, tinh Iifin tuc, todn difin va thdng nhdt tgo nfin nhiing dac diem rieng eua eham sdc ban ddu Nghiin ciiu Con ngudi s66(69) 2013 AQ Phgm Thi Tinh Tinh hieu qua va an toan Ichdng chi la nhiing vdn S'e Ity Ihugl The gidi y hgc dang din tiln tdi mpt nln khoa hpe dya trSn bang chiing nhim nang cap su an toan cho b?nh nhan Cac thdng sl ki thuat va sy an toan khdng phai la nhQng ylu td quyet djnh nhit, cdn cac ylu tl khac, nhu thulc tit, bom kim tiem dupc khu ttimg, Cam Ihong v&i nguai: cham soc tap trung vao nguai Dieu khdng chi giup giam nhe ndi lo cua ngudi benh ma cdn cai thien su thda man vdi cdng viec cua nha cung eip Viec eham sdc sue khde se hieu qua hem nlu nha cung cap djch vu hieu duge cac ylu tl tac ddng din sue khde eua ngudi ma hp eham sdc, va ngudi dan dupc quyln tham gia vao cac quyit djnh cd lien quan toi sQc khde cua hp va gia dinh ViSc ling nghe, ehia se va cam thdng gifla ngudi cung cip va ngudi su dung dich vu ve tinh ttang benh tat, nhiing anh hudng tdi sue khde, se tang leng tin va su ttian thu dilu trj, tao dilu kien tun tilng ndi chung ttong theo doi benh, phdng benh va nang eao siic khde La co hdi cho nha cung cip dich vu hieu khach hang, giup hg ed nhttng lya chpn dung Vi thi, cham sdc tap trung vao eon ngudi dugc xem la phuang phap giup cai thien dang kl chit lugng cham sdc va hieu qua dilu tti, ndng cao sQc khde va chat iQgng sdng Cac ddp img loan dien va ihdng nhdi: Tinh toan dien Iam tang y nghia dilu phli, van hanh va tang gia tti cua cham sdc Nlu ngudi dan bilt rd toan bd lieu trinh cua cham sdc hg se tilp nhan cae djch vu mdt each chac chan hon va tdi da hda cae eg hgi cham sdc phdng benh va nang cao sQc khde, giiip giam cham sdc chuyen sau hay cham sdc tai benh vien Cham soc toan dien va thdng nhat cho cac loai van de ve sQc khoe cpng ddng se hieu qua hon nlu dya vao cac djch vu cho cac van de chpn lgc, mpt phan vi nd dua tdi sy hieu biet tdt hon ve cu dan va xay dyng dugc ldng tin Idn hon Cac dich vu y te dua mdt bang lya ehpn toan dien cac djeh vu Iam tang kha nang thu hut va dien bao phu, chang han, cac chuong ttinh phdng ngira: sang lpc ung thu, tiem ehung, Cae djeh vu toan dien tao dieu kien phat Men sdm va phdng ngua cae van de ve sue khde, ca khdng cd yeu cau rd rang Cd nhieu van de ma cac nhan vien y te dia phucmg la ngudi cd the xu ly hieu qua, chang ban, hp la nhiing ngudi nhat co thi giup cac cha me cham sde tu giai doan phat triln diu tien ciia tre, day la ylu tl quyet djnh quan trpng cho sue khde khde manh va huu ieh sau Nhirng can thiep cin nhung nhan vien cham soc sQc khde chil ddng dua nhimg djeh vu toan dien Dieu phu thupc vao mdi quan he gan bd va tin cay giQa cac djch vu y tl vdi cac cpng ddng hp phuc vu, cac nhan vien y te la nhiing ngudi bilt ro ngudi dan cdng ddng dd Tinh lien tuc cita cham soc: Hilu ngudi dan va dilu kien noi hg sing khdng chi quan ttgng de c6 each xu Iy toan dien, tap trung, ma edn tao dilu kien cho cham sdc lien tuc Tinh lien tuc cua cham sdc la yeu tl quyit djnh quan trpng dli vdi hieu qua ciia viec xu ly, hoSe xQ Iy benh kinh nien, site khde sinh san, sQc khde tinh thin hoac dli 50 Nghl4n Cliu Con nguHn so 6(69) 2013 Chdm soc sue khoe ban ddu vdi viec ddm bao cho tre em Idn Ifin khde raanh Tinh lien tue cua chdm sde phu thude vao vific ddra bao Iifin tue cap nhdt thdng tin, vi sue khde thay ddi theo tudi tde, sy di chuyen noi d, hoge ed nhifiu nhan vien chuyen nghiep cttng chdm sde eho mOt ed nhan hoac mgt gia dinh Cdng nghfi khoa hgc phdt trien eung gdp phan khdng nhd vdo vific chdm sdc sttc khde Viec tiep can thong tin day dli tu cde hd so bfinh dn, se edi thifin vifie chgn lya quy trinh dilu tri vd phdi hgp chdm sdc Vifie stt dyng eong nghe thong tifi chdm sdc sttc khde giup ngudi dan vttng sdu, vimg xa tifip can djeh vu va tu vdn chuyfin radn nhanh, re (khong mat cdng di lgi); giiip cho cde nhd chuyen mdn theo ddi va tu vin tu xa, tra ldi nhanh chdng vd dieu trj thieh hop d nhflng noi khong co difiu kifin chiia tri Viec su dung cac dyng cu nhu ho so sttc khde difin ttt, edc don thuoc difin tu, cdc phuong tien tro giup khdm vd difiu tri, da mang lai nhflng phuong thuc mdi cho vific cham sdc ca nhan hoa, tap tmng vao ngudi an todn, kjp thdi Tinh todn difin, lifin tuc, tap tmng vdo ngudi co tam quan trgng quyet djnh lam cho cac kfit qua chdm sdc tot hon Tat cd cde yfiu to phu thugc vao mdi quan he dn djnh, lau dai (moi quan he dpe) giua eu dan va nhflng ngudi hanh nghe chdm sde sue khde chuyfin nghifip Nhttng ngudi hdnh nghe y te se tdn trgng vd hifiu cde benh nhan cua hp, difiu ndy tgo su tuong tdc tich cue va trao doi thdng tin tot hon Hg se hifiu vd thay trade eac trd ngai eho vifie chdm sde lifin tuc, theo ddi sytifinbd vd ddnh gid viee trai qua bfinh tdt cd anh hudng the ndo tdi cugc sdng ctta mdi ngudi Mat khac, su hieu bifit vfi dieu kign, hodn eanh cua khdch hang gittp difiu chinh vific chdm sde phu hgp vdi ede nhu cdu dgc thu cua timg ngudi vd nhan bifit cdc van dfi sttc khde d nhiing giai dogn sdm Vdn dfi xay dyng long tin, Idm hdi long bfinh nhan cd thfi mang Iai chat lugng tdt hon cung nhu kit qua tdt hon viec eham sdc Ngudi dan su dung cttng mot nguon chara sdc eho hiu hfit edc nhu edu sttc khde eua hg se cd xu hudng tuan thtt tdt hon cde tu vdn hg nhan dupc, it dya vdo cdc djch vu khan cap hon, yfiu ciu nhap vifin it hon va hdi Idng hon vdi chdm sdc Nhd cung cip thi tilt kifim dugc thdi gian tham kham, gidm bdt nhu cau stt dung ede xet nghiem va chi phi, tdng nhan thttc ve chdm sdc phdng ngtta Nhu vdy, mgt djeh vu y tl eham sdc ngogi tiu sttc khde vd cdc van de Hen quan tdi sue khde tgi dilm diu vao phdi dua mdt bang Het ke todn difin edc dich vu chan dodn, chiia tri, phuc bdi vd gidm dau thdng nhdt Mdi quan he true tifip vd ldu ben gifta nhd eung eip va ngudi dan cgng ddng duge phye vu Id nhdn td ehtt yfiu de xera xet tdi hoan ednh cd nhan vd xd hgi cua benh nhan vd gia dinh hg, ddm bdo vifie chdm sdc lien tuc theo thdi gian cung nhu theo edc dieh vu Difiu kifin tien quyet de trd thdnh co sd chdm sdc ban diu la phai dam bao ehiing co thfi true tiep vd thudng xuyen tiep can dupc, nd dya vao vifie chi trd bing tiln ca nhan vd duoe bao hd edc ehuong trinh bao phli phd cap Bien djch vu cham soc thong thudng thdnh trung tam cham sdc ban dau la: Nghiin cihi Con ngUdt sS6(69) 2013 Phgm Thi Tinh Bua dich vu cham sijc tin gdn nguai ddn han, tai cae co sd eung cpng ddng va co quan he ttue tilp vdi cdng ddng, chuyin diem diu vao hetiidngy tl tir cac benh vien vl dja phuang va cac chuyen khoa vl eacttrungtam cham sdc ban dau gan gui khach hang, Vi$e lam t5ng tiiem tinh toan dien, lien tuc, tap trung vao ngudi, tang lpi ich cua viec chuyin djch Cac djch vu dupc tl chuc tiianh cae dilm nhd can ke khach hang se nim duge tinh hinh cdng ddng va dugc cpng ddng bilt tdi, va cd thdi gian du dn djnh dl thilt lap mli quan he lau bin cho giai quyit c4c vin dl sue khde tai dja phuang Trao cho nha cung cip djch vu eham sdc ban diu trdch nhiem ve mot nhom cu ddn xac dinh Nha cung cip cd thi dam nhiem tiieo chi gidi hanh chinh hoac cac thda thujn hgp ddng, cung cip djch vu cham sdc toan dien, lien tuc va tap trung vao ngudi cho cu dan dd, va huy ddng mdt tap hgp toan dien eac djch vu hd ttg - tu nang eao sue khde cho tdi giam dau giai doan culi Giao trach nhiem phi biln nhit d cac vung ndng thdn la dya tten cac chi gidi dia ly hoac thye hien theo Id gich hanh cbinh khu vye edng cgng Ddi vdi ngudi dan, cac kit nil chinh thuc vdi mot ngudn djch vu cham sdc se tang kha nang phat ttiln cac mli quan he lau dai; khuyin khich cac dich vu tang cudng sy quan tam tdi eac dilm cham sdc ban diu; lam cho cac myln truyin thdng ttd nen de tilp thu hon Ddng thdi, cac mang kit nil phdi hpp cd the dupe chinh thirc hda vdi eac cip cham sdc khac - cac bac sT ehuyen khoa, eac benh vien, cac djeh vu ky thuat khac vdi cac djeh vu xa hdi Cac ddi cham sde ban diu khdng the dam duomg trach nhiem toan difin cho cu dSn cua hp nfiu khdng cd su hd ttp tu cac eo sd djch vu chuyfin mdn, cac td chQc va cac co quan ben ngpai cpng ddng duge phuc vu Trong hoan canh ngudn luc bd hep, cac nguon hd ttp se dugc tap trung tai "mdt bfinh vifin Idiu vuc cap chuyfin den dau tien" Nhieu ngudn luc hem cho phep da dang hda: pham vi cac djch vu chuyen nganh tam vdi cd thfi bao gdm cac djch vu khan cap, cac chuyen khoa, co sd tang chan doan bfinh, cac ttung tam tham tach mau, sang lpc ung thu, cac nhan vien ky thuat mdi trucmg, cac co sd cham sdc lau dai, cac co sd dugc khoa, Vdi tu each la ddi cham sdc ban dau cd thfi hd trg cac cpng ddng cua hp t ^ dung tifim nang dd, cae ca hdi dac biet quan ttpng ddi vdi cham sdc sQc khde cpng ddng, sue khde tinh thin va dai han Mdi quan he giua dpi cham sdc ban diu vdi cac tl chuc khae la quan he hpp tac va phli hgp Dpi eham sdc ban diu ttd trung gian giQa edng ddng va eac cip cila he thing y te, giup ngudi dan vugt qua me Id cac djch vu y tfi va buy dpng sy hd ttg cua cac phuong tien khac bang each chuyin benh nhan hoac keu ggi su hd ttg cua cac djch vu chuyen khoa Sy phdi hop va vai ttd trung gian cdn md rdng toi cdng tac voi cac loai hinh to chiic khac, nhui;ac td chuc phi chinh phii, cac ca nhan ttong va ngoai nudc Cac to chuc cd tiie mang Iai sy hdtt-gcd y nghTa ddi vdi cham sdc ban diu sd tgi Hg cd thi hi ttp dam bao rang, eac co ciu kilm tta ddc lap hoac cac tl chuc bao vfi quyln lgi ngudi 52 Ngllt4n Cliu Con ngmU sS6(69) 2013 Chdm soc sice khoe ban ddu tieu dttng cd thi giup ngudi stt dung dua cac khieu nai quyfin lgi cua hg bj vi phgm Cdc nhdm ldm dugc rit nhieu vi?c hon la ehi cung cip thdng tin eho ngudi b?nh Hg giup ngudi ddn lo Heu cho hodn cdnh eiia chinh minh, cdi thifin sttc khde ban than, ddi phd tdt hon vdi tinh trang kem sttc khde, tdng them Idng ty tin vd gidm bdt qud tdi benh vien Chttc ndng phdi hpp raang lai mgt khudn khd thifit chfi dfi huy ddng cde khu vye nhdm dam bdo sttc khde eho cdc cgng dong sd tgi Dieu chu yeu thugc trdch nhiem giai quyet eua cdc dpi chdm sde ban diu Cde dgi chdm sde ban dau ehi ed the mgnh len tdng eudng cae mdi lifin kit vd thye hien chttc nang phdi hgp Cham soc ban dau vdi tir each la ni$t trung tam phoi hop: hinh mang tirdi cgng dong dirac phuc vu va vdi cac doi tac ben ngoai O o ^ ^ i p iahi- 5^0 luc \ \ IsioiaH:nS,a NGOs Ngudn: The World Health Report 2008, Primary Health Care - Now More Than Eve World Health Organiration Nghiin eiiu Con ngudi s46(69} 2013 53 Phgm Thi Tinh Sire khde va cham soc sux khoe vi mue tieu phat trien ngiroi "Con ngudi la cua cdi tiiye sy cua mdt qudc gia", vdi tuyen bd nay, Bdo cdo Phdt tiiln Con ngudi nam 1990 da khdi xudng each tilp can mdi nhin nhgn vdn de phit tiiln - Con ngudi la trung tam cua su phdt trifin! Mue tieu co ban cua phdt trifin Id tgo dyng mpt mdi tradng thugn lgi dl ngudi cd cupc sdng lau dai, khde mgnh va sang tgo Difiu ndy ngdy cang nhgn dugc sy ddng tinh ctta ede gidi chtte xd hgi vd dong ddo ngudi dan, nd dugc eoi nhu mgt difiu hifin nhien Tdt ea mpi chifin lupc, chinh sdch, luat phdp deu vi ngudi, cho eon ngudi Thye tl, ngdy cdng ed nhilu ngudi sdng Idu vd khde hon sy phdt trifin cua kinh te, su cdi thifin ehi dp dinh dudng va nhiing tiln bg vfi moi sinh nhu viec gift vfi sinh va ddp ling nhu edu nude saeh, dilu kifin sdng va lara viec duge edi thien, ede mdi nguy hai vl sttc khde dugc kilm sodt, nhung tifin bg cua y hgc dieu trj vd chdm sdc sttc khde duge dp dung Tuy nhifin, sy tien bp lai khdng ddng deu gifta cdc nude va mSi nude Cdn cd su chfinh Ifich kha xa vfi sue khoe ciing nhu tudi thg gitta nhdm gidu vdi nhdm ngheo, gifta thj vdi nong thon, dgc bipt la sy bdt binh ding ddi vdi nhdm de bj ton thuong Bdt binh ding dtt d bit ett ITnh vuc nao (thu nhgp, y tl, gido dye, vi?c lam, ) dfiu lam giam tdc dp phdt tiien, thgm ehi mdt sd tmdng hgp se chdn dttng hodn toan su phdt trien Bdo cdo Phdt tiiln Con ngudi toan ciu nam 2010 da tdm tit cdc yfiu td chinh ciia phat trien ngudi gom': Md rgng sy ty dl ngudi Idm nhiing vifie hg coi trgng va ed li dl coi trpng Chu yfiu Id lifin quan din quyln ty eo bdn vd nhflng lua chpn dfi cd cuOc sdng khde manh Iau dai, dugc hge hdnh, hudng thu mue sdng tdt, dugc ty vl chinh trj, dupc bdo ddm cde QCN vd phim gid ngudi, dugc tham gig vao cdc hogt ddng eo y nghia, tham gia vdo ddi song vdn hda, sinh kl an todn, - Phdt trien eon ngudi vtta la qua tiinh md rgng nhimg su lya ehon, ddng thdi cung Id tap hpp cae ket qua ludng mtte cai tiiien ddi sdng md cdc cd nhan va xa hOi da co dugc, gdm cd qua tiinh xdy dyng nang lyc, vigc su dung edc nang lyc va mtte dp su dyng ndng lye cupc sdng, - Coi ngudi Id chu till chu ddngti-ongtifintiinhphat tiiln chtt khdng phdi Id bfin tiiu hudng bi dOng Nd khdng chi Hen quan tdi mtte dp hdi Idng vdi nhttng nhu ciu co bdn md lien quan tdi mtte ngudi cd thfi chu dpng tham gia (quyln ty va UNDP, Bao cdo Quoc gia ve Phdt triin Con ngudi nam 2011: "Djch vy xS hpi phye vy Phdt tri^n Con nguin", Tr - 54 Nghiin Cliu Con ngudt sS6(69) 2013 Chdm soc sue khoe ban ddu lya chgn cua ngudi v l co hdi eung nhu qua trinh) CJ Viet Nam, vin dl cdi thifin chinh sach y te vd giao due dugc coi Id ehia khda de phdt trien ngudi nhdm hudng tdi mgt lyc lugng dan sd khde manh va cd tri thuc De dat dugc rauc tieu nay, mdt loat ede ehinh sdch, ede chuong trinh duge trifin khai nhu Chuong trinh HIV, nudc saeh vd vfi sinh mdi trudng, Vifie bdo vfi ngudi dan trade edc eu sdc ve y tfi, thu nhdp vd mdi tradng cflng nhu nhung anh hudng ctta vific phai tra chi phi qud cao eho y tfi khifin ti Ifi tdi ngheo cao, thdm chi edn ngheo hon trade, cimg vdi viec cung cap cde dieh vu y te chfta bfinh vd phdng ngtta cd thfi tilp can dugc, cd khd nang chi trd duge ehinh Id chia khda dfi thue hifin cdc mue tieu Viet Nam da ddt vd dang cd nguy co bj tut hgu Y tfi vd gido due co vai trd quan trpng vific phdt trien khd ndng vd lya chgn co hgi, dong thdi tgo difiu kifin dfi mgi ngudi the hien ndng lyc cua minh phu hpp vdi nhung gi hp coi trgng vd ho mong mudn Tuy nhifin, edc chi tifiu cho y t l eua Viet Nam vdn thdp hon cdc nudc khu vye mde dtt dd ed difiu ehinh tdng tong chi tifiu cho y tfi^ Vific edi thifin edc kit qud y t l vd gido due Id dilu kien tien quyfit nfiu Viet Nam mudn dgt dupc cde "dot pha ehinh" dupe neu Ke hoach phdt trien kinh te xa hdi vd Chien lupc phat trifin kinh tfi xa hgi, trd thdnh nfin kinh te cd k$? nang vd edng nghe cao, dam bdo tang tmdng kinh te todn dien, ben viing Binh ddng eiing Id mot phan thifit yfiu phdt trifin eon ngudi Ddy Id mdt nhiing Ii ma WHO cflng nhu ede qudc gia khdng ngimg nd luc cdi thifin de hudng dfin mpt thfi gidi cdng bang sttc khoe Hdi nghj Lien hgp qudc vfi Phdt trifin bfin vflng (2012) tai Rio de Janeiro da thdng qua mdt logt eac bien phdp gdp phdn xdy dung mgt thfi gidi cdng bdng, sgch se, xanh tuoi vd thjnh vugng hon, ddng thdi cdng nhgn cdc mdi lifin quan quan trgng gifta sttc khde vd phdt trifin Hgi nghj nhan mgnh thye te ring, sue khde tdt hem la mgt "dieu kien tien quyfit, mpt ket qua vd mpt chi so ciia tat ed ba khia cgnh etta phat triln bin vihig"; tdm quan trpng cua bao phu y te todn dan dfi tdng eudng sttc khde, gdn k i t xa hpi vd phdt trien ngudi vdi kinh te ben viing: " hdnh dpng giai quyfit nhiing yfiu to xd hgi va moi tradng ddi vdi sttc khde, cho cd ngudi ngheo, ngudi d l bj tdn thuang, eung nhu cho tdt cd mgi ngudi dan la rat quan trgng de tgo mdt xa hdi todn dipn, cong bing, hifiu qua kinh tfi vd khde manh Chiing toi keu ^ ChitiSucong cho y tfi chifim khoang 8,7% long chi tieu c6ng d Vi?t Nam so v6i miic 14,1% d ThSi Lan vi 9,9% a Trung Quoc Vi^t Nam c6 ti 1? chi ngan sich c6ng cho y tl 77 USD/ ngudi tinh theo ngang gid siic mua (PPP), cao hon mpt so nudc khu vuc (Indonesia, Campuchia, Philipin vd Ldo), thdp hem nhilu so voi Thdi Lan (242 USD) Malaysia (273 USD), Gia tri thuc cua chi tifiu cho y tl l^i thdp hon MOt phdn li khifin tong chi tifiu cua Vi^t Nam cho y tfi, co chi tifiu tir tifin tiii cd nhdn cao hon tuong dii so vdi mpt so nu6c la chi phi y tfi tSng nhanh {Bdo cdo Phdt trien Con ngudi loan cdu 201 /, Tr.l7) Nghiin Cliu Can ngudi s66(69) 2013 cc Phgm Thi Tinh gpi thuc hien diy du quyln dugc hudng tifiu chuin cao nhit cd thi dat dugc cho siic khde the chat va tinh than" Cpng ding khde manh la yeu tl rit cin thifit cho phat triln Dan sl khde manh giup tang nang suit Iao ddng, tao difiu kifin tdt cbo giao due, tang sue manh cpng ddng, giam ddi ngheo va bat binh dang xa hpi cung nhu cac rao can xa hdi Sy nhin nhSn khdng day du vfi sue khde ngudi va djnh dang su dap ung cua cae djch vu y tfi theo dae thii cua mdi cpng ddng va hoan canh cua mdi ca nhan la nhihig thifiu sdt quan trpng eham sde sue khde hien dan tdi khdng ehi tao su bat binb dang va eae san pham xa hpi cho cham sdc sQc khde ngheo nan, ma cdn lam giam Igi ich thu ve cho dau tu vao cac djch vu y tfi SQc khde dugc cci la nhan td quyfit dinh kha nang mpt ca nhan ho^c mpt cdng ddng cd the cd lgi cho mdt loat cac van dfi lien quan din quyen lgi va tu each phap ly Mpt qudc gia khde manh khdng chi la mot qudc gia cd su phSn phdi cdng bang cac ngudn lyc ma la mdt qudc gia cd cpng ddng chu ddng, tich cue tham gia manh me vao vific tao nhirng difiu kifin can thifit de cd nhiing ngudi khde manh Sy phat triln ciia mdt cpng ddng, qudc gia phu thugc rat nhieu vao lyc lugng dan sl khde manh va ed tri thuc Cd sQc khde, eon ngudi se md rgng dugc eac co hdi lya chgn va cd tri thuc, nang lyc, ngudi se dugc nang cao de lya chpn dung va thyc hifin tdt sy lya chgn cua minh Sue khde la then chot cho phat trien bfin viing Vi vay, siic khde phai dupc nhin nhan mgt each toan dien nhu la mdt tr^g thai tich eye; nd la chit lieu dl ngudi cd the d?t dupc myctifiutli h^u la mgt cudc sing khde manh, phong phu vl xa hgi va kinh tfi Do dd, vin dfi sue khde khdng phai chi dl cac nhan vifin y tfi ganh vie Thyc tl, cd rit nhilu djch vu cdng va tu cung nhu nbilu tl chuc khac gay anh hudng khien siic khde dan sd ttd nfin tdt hon hay xiu di Them vao dd, cac djch vu y te thudng khdng dap ung du cac nhu ciu cua cdng chung Tham chi, cdn xem hg nhu la nhttng dli tupng tilp nhan su cham sdc mdt each thu ddng lam giam nang lyc npi tai cua ngudi dan Vi vay, dl cd sue khde cho tit ca mgi ngudi ddi hdi cdc hoat ddng phai "dat ngudi d vj tti ttung tam" Dd la nhung thdng sl quan trpng dl dilu phoi cac boat dpng va dam bao rang "tieng ndi va sy lua chgn cua ngudi dan phai cd anh hudng quyit djnh tdi phuang tiiuc tiiilt kl va sy van hanh cac djch vu cham sdc sue khde" Tren tit ca, sQc khde cdn la vin dl cua QCN, da la quyln till Nha nudc cd nghTa vu phai tdn ttgng, bao vfi va thyc tbi trfin ca sd binh ding Phuong thQc di tdi mue tieu "sue khde cho tat ca mpi ngudi - Health for all" dugc WHO va cac quic gia vifin thing nhit lya chpn la Chifin lugc PHC 56 Ngttl£n Cliu Con ngudt s66(69) 2013 Chdm sdc sice khoe ban ddu Tai lieu tham khao Bao cao qudc gia tai Hgi nghi cap cao ciia Lien hgp qudc vl Phat tiien ben vCi'ng (RIO+20) (2012), "Thyc hien phat triln bin viing d Viet Nam" Hpi dong Sue khde nhan dan (2000), Hien chuong sire khoe cho nhdn ddn Trdn Hung Minh (CCIHP), Cong bdng sire khde khdi niem vd ludng, tr Partnership for Action in Health Equity (PAKE) (2011), Cong bdng sire khoe d Viet Nam gdc nhin xa hpi ddn su, Nxb Lao dong UNDP, Bdo cdo quoc gia ve Phdt triin ngudi 2011: "Dich vu xa hOi phuc vu phat trien ngudi" UNEP, Nxb Oxford (2001), (tai lieu djch) Sice khoe Moi trudng World Health Organization (WHO) (2008), The World Health Report 2008: "Primary Health Care - Now More Than Ever" Nghiin ciiu Con ngudis66(69) 2013 cj ... vd chfit chdc cho ngudi ngheo, va quyfin co ban cua eon ngudi Id dat duge cho minh tinh trang sue khoe cao nhdt, Cde chinh sach toan cdu vd todn dien ve PHC phdi la nfin tdng cho cae ehinh sdeh... phi xd hgi cho y tfi, gido due; thifit ldp nhom hdnh dpng Sttc khde va phat trien, phdt trifin eae ehinh sach nham dat mue tifiu: Sttc khoe cho mgi ngudi; Sttc khde chinh la mgt yeu td cho phat... te cho ban than, gia dinh va xa hgi Ngay cang cd sy ung hg rpng rai hon dli vdi binh dang ve y te; vdi cac dich vy y tl tSp trung vao cac nhu ciu va mong mudn cua ngudi; vdi an ninh sue khde cho
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