status, continuous training need for traditional health staff at provincial hospital and evaluation of intervention

MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOG _________________________ TRINH YEN BINH CURRENT SITUATION OF HUMAN RESOURCES, CONT

MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOG

_

TRINH YEN BINH

CURRENT SITUATION OF HUMAN RESOURCES,

CONTINUOUS TRAINING NEED FOR TRADITIONAL HEALTH STAFF AND EFFECT OF INTERVENTION

1 Associate Professor Ngo Van Toan, MD, PhD

2 Professor Phung Dac Cam, MD, PhD

Opponant 1: Associate Professor Tran Quoc Kham, MD, PhD

Opponant 2: Associate Professor Hoang Minh Chung, MD, PhD

Opponant 3: Dr Do Hoa Binh, MD, PhD

Thesis will be defended to the Assesment Committe in National Institute of Hygien and Epidemiology

Time: Date:

Thesis found at:

- Library, National Institute of Hygien and Epidemiology

- National Library

PUBLISHED ARTICLES RELATED TO THESIS:

1 Trinh Yen Binh, Ngo Van Toan, Phung Dac Cam, Tran Thi Hong

Phuong (2011), “Traditional medicine and pharmacy human resources in

Vietnam”, Journal of Preventive Medicine, Vol XXI, No 7, 103 – 108

2 Trinh Yen Binh, Ngo Van Toan, Phung Dac Cam (2011), “Continuos

training need of traditional medicine and pharmacy staff”, Journal of

Preventive Medicine, Vol XXI, No 7, 110 – 116

3 Trinh Yen Binh, Tran Thi Hong Phuong, Nguyen Thi Phuong Lan

(2012), “Human resources of the traditional medicine and pharmacy at

provinces”, Practical Medicine No 8, Ministry of Health, 66 – 68

BACKGROUND

1 Rational

The traditional medicine and pharmacy existed for a long time The traditional medicine and pharmacy developped a long with the national culture For thousand of years, the traditional medicine and pharmacy had excellences of prevention and treatment Vietnam is one of ASEAN countries and recognized in traditional prevention and treatment

Recently, The Central Party and Government issussed policies and strategies to enhance the traditional medicine and pharmacy in prevention and treatment in order

to improve population’s health However, up to now the quality of health services in terms of traditional medicine and pharmacy is limited Traditional medicine human resources are limited in terms of quantity and quality, especially staff with high quality To develop the traditional medicne resources is not appropriate to respond requirment of health care of people This research filed is not enough carrying out Objectives of this thesis include:

1- To describe the distribution of traditional health staff in provincial traditional hospitals among different geographical areas in 2010

2- To identify the countinuos training need for traditional medicine and pharmacy staff in provincial traditional hospitals among different geographical areas

in 2010

3- To evaluate effects of the training course in improving knowledge and skill in terms of productio, recognition and distinguish traditional medicines for traditional health staff in provincial hospitals

2 New findings of the thesis

2.1 This is a new thesis studies the distribution and quality of traditional health staff

in provincial traditional medicine hospitals in Vietnam and at the same time thesis provides the continuous training need in traditional medicine for traditional health and pharmacy staff

2.2 Effects of the intervention to improve knowledge and skills in producing, recognizing and distinguishing traditional medicines at provincial traditional medicine hospitals Thesis also provides effects of training traditional health and pharmacy staff of the provincial traditional medicine hospitals With a short time of training (3 days), the knowledge of staff improved a lot in producing, recognizing and distinguishing traditional medicines to improve quality of care

2.3 The findings will be used for implementation of decision 07/2008/TT – BYT dated 28/5/2008 (guidance of the countinuous training for health staff)

3 Science and practical meaning

3.2 Practical meaning and policy implication:

Findings of the thesis will help policy makers and planners to develop and improve the quality and quantity of traditional medicine It also help them to orient and develop contents of continuous traditional training

4 Thesis structure:

Thesis includes 124 pages, except annexes and divided into: Introduction 3 pages, Part 1: Literature review 33 pages, Part 2: Subject and Methodology 19 pages, Part 3: Results 34 pages, Part 4: Discussion 27 trang, Conclusion 2 pages, Recommendation: 1 page Thesis includes 45 tables, 7 charts, 2 figues Annex includes 101 references (79 Vietnam, 22 English), tools, hospital list, list of staff

participating in the study

CHAPTER 1 LITERATURE REVIEW

1.1 TRADITIONAL MEDICINE SYSTEM

• State management offices of traditional medicine

- Central: Dept.of Traditional Medicine, MOH

- Provincial: Dept of Health centre

1.2 HUMAN RESOURCES OF TRADITIONAL MEDICINE HOSPITAL

Total number of state traditional medicine staff increased in the last 5 years from

241498 in 2003 to 299100 in 2008 There are 56208 traditional medicine physicians (including PhD and master levels), 49213 assistant physicians, 10524 pharmacists and university level, 12533 pharmacists and secondary level, 67081 nurses, 22943 midwives, 882 traditional healers and 15682 technicians

1.3 TRAINING AND RESEARCH IN TRADITIONAL MEDICINE

The training of human resources for traditional medicine mainly carriy out by the Traditional Medicine Unversity and 2 Dept of Traditional medicine of Hanoi Mecical University and Ho Chi Minh City University In some secondary medical schools, the traditional Medicine Dept did not fulfil their duty in training of traditional medicine assistant physicians

Some traditional medicine staff have been trained in some other university such

as Military Medical University, Hospital 103, Military Traditional Medicine hospital and National Traditional Medicine Hospital, National Accupanture Hospital However, there are not enough traditional medicine staff as compared to requirment

1.4 COUNTINUOUS TRAINING

The continuous training in traditional medicine is conducted mainly based on the contribution of the trainees There is no fund from government paying for the continuous traditional medicin training

CHAPTER 2 SUBJECTS AND METHOD

The thesis used two kind of study designs: cross-sectional study and intervention study

2.1 CROSS-SECTIONAL STUDY

2.1.1 Subjects

● Directors of the provincial traditional medicine hospital

● Head of Dept of traditional medicine, provincial traditional medicine hospital

● Physicians at provincial traditional medicine hospitals

● Pharmacists, provincial traditional medicine hospital

2.1.2 Subject selection

Staff worked at the hospitals at least 6 months

2.1.3 Subject select out

Staff worked at the hospitals but being absent at the time of study

Subjects did not collaborate

2.1.4 Cross-sectional study

2.1.4.1 Design: Combination of two kind of designs: qualitative and quantitative

using second data and available data

- Directors of hospital: each hospital 3 người: 3 x 54 hospitals = 162

- Head of dept 432 persons

- Pharmacists: 5 x 54 hospitals = 270 persons

- Total : 1944 persons

2.1.4.3 Tools

- Administrative questionnaire forms: for directors of hospital

- Interview questionnaire: face to face interview and sending questionnaires + Face to face interview for physicians, asst Physicians, pharmacists They come from 24 provincial traditional hospitals: Bến Tre; Hưng Yên; Phú Thọ; Thái Bình; Hồ Chí Minh; Bình Thuận; Hà Tĩnh; Hà Nội; Bình Định; Cần Thơ; Đà Nẵng; Hòa Bình; Hải Phòng; Lâm Đồng; Lạng Sơn; Tuyên Quang; Yên Bái; Bắc Ninh; Hà Nam; Đồng Tháp; Thanh Hóa; Đồng Nai; Bình Dương; Sơn La representating for 8

geographical areas: Region I: Red River Delta; Region II: Northwest; Region III: Central Coast; Region IV: Highland; Region V: Southeast; Region VI: Mekong River Delta

+ Administrative questionnaire interview implemented in remaining 30 provincial traditional hospitals

2.1.5 Time: 06/2009 – 12/2010

2.2 INTERVENTION STUDY

2.2.1 Subject

• Chairmen of Medicine committte of hospitals;

• Head of Pharmacy Dept

• Staff who produce traditional medicine

2.2.2 Subject selection

Staff worked at the hospitals at least 6 months

2.2.3 Subject selection out

Staff worked at the hospitals but being absent at the time of study Subjects did not collaborate

2 2 2 1 1 1 2

/ 1

2

1

) (

) 1 ( ) 1 ( )

1 ( 2

P P

P P P P Z P P Z

n

n

−

− +

− +

−

=

= −α − β

Where:

n1: Sample size before intervention

n2: Sample size after intervention

- Recognation of 10 traditional medicines easy to get confuse

- Producing 10 common traditional medicines

Pharmacist

Pre Test Data 1

Training

Pharmacist

Post Test

Data 2 Comp

are

* Training method

- Theory:

+ Lecturing

+ Lecruring producing 10 traditional medicines: Hương phụ; Hoàng kỳ; Bạch

truật; Hạnh nhân; Hắc phụ tử; Bạch phụ tử; Bán hạ; Hà thủ ô đỏ; Thục địa; Ba kích

- Practice:

+ Recognition of 10 traditional medicines

+ Producing traditional medicines

- One course in Tuyên Quang

- Time: 10 days, from 06/01/2011

Including 3 days in theory and 7 days in practices

- Relevant level to daily working

+ Assess the capacity of staff

- Distinguish some traditional medicines: Questionnaire included 20 questions, each question for 1 point Four levels:

p

p − x 100 p1: Knowledge of health staff in traditional medicine before intervention

p2: Knowledge of health staff in traditional medicine after intervention

2.3 DATA ANALYSIS

● Available data from hospitals was entered and analyzed in software Excel

2003

● Data form questionnaires was entered and analyzed in software SPSS 10.0

● Results were presented in tables, frequencies, percentages, chart Statistical Test were used to compare events before and after intervention P value was used to define significant if < 0.05

2.4 TIME AND PLACE

+ Time: 03 years, including:

- Phase 1: descriptive study: 06/2009 – 12/2010

- Phase 2: intervention study: 01/2011 – 06/2012

+ Place:

- Descriptive Study was carried out in 54 provincial traditional hospitals

- Intervention studywas carried out in 20 provincial traditional hospitals

3.1 DISTRIBUTION OF TRADITIONAL STAFF AT PROVINCIAL TRADITIONAL MEDICINE HOSPITALS

3.1.1 Traditional health staff at province level

Table 3.1 Distribution of traditional health staff by training

Degree Number %

Physician 1086 17.2 University level Pharmacist 104 1.6

Among 6307 staff, doctor occupied 17.2%; University pharmacist was Dược sỹ

đại học chiếm 1.6% and Asst Physicians was 20.4%

Percentage of staff with post graduate such as master, specialist I was 7.2%,

graduate staff was 8.2% and other such as college, secondary and primary traditional

medicine school was 83.6%

Table 3.3 Distribution of traditional medicine staff by specillity

Position Number %

Traditional 3599 57.0 General 1441 22.9

Others 1267 20.1 Total 6307 100

Percentage of staff with traditional medicine was 57%, general doctor was

22.9% and others was 20.1%

3.1.2 Distribution of traditional staff by hospital level

Table 3.4 Distribution of traditional staff by hospital level

Percentage of traditional doctor at hospital level II was 18.4%, level III was

15.9% There was statistic significant (p < 0.01)

Percentage of university pharmacist at hospital level II and III was 1.6% and

1.7% There was no statistic significant (p > 0.05)

Table 3.5 Distribution staff by hospital level

Traditional health

staff

Hospital level P

II III Number % Number %

Figuue 3.1 Distribution of staff by training speciality and hospital level

Percentage of trained traditional medicine staff in hospital level II is less than that in hospital level III (p > 0.05)

Percentage of trained general medicine staff in hospital level II is more than that

in hospital level III (p > 0.05)

3.1.3 Distribution of traditional medicine staff by geographical areas

Table 3.6 Distribution of staff by geographical areas

I (%) n= 1251

II (%) n= 1254

III (%) n= 1051

IV (%) n= 796

V (%) n= 965

VI (%) n= 990

Percentage of university pharmacist in region I was highest (1.8%), lowest in

the region III and VI (p < 0.05)

Percentage of university nurse was so different between regions, highest in the

region I (1.3%); lowest in he region III (0.2%), (p < 0.01)

Table 3.7.Distribution of specialized traditional medicine staff by geographical region

III (%) n= 640

IV (%) n= 375

V (%) n= 562

VI (%) n= 546

Percentage of specialized traditional medicine master in region I is highest

(2.8%), region V (2.4%) and lowest in region II (0.6%) (p < 0.05)

Percentage of university specialized traditional medicine in the region I is

highest (11.8%), lowest in the region III (6.2%) (p< 0.05)

Table 3.8 Distribution staff by specialized by region

I (%) n= 1251

II (%) n= 1254

III (%) n= 1051

IV (%) n= 796

V (%) n= 965

VI (%) n= 990

Percentage of traditional medicine staff in region III is highest (60.9%), region I

is (60.1%), and lowest in region IV (47.1%) ( p < 0.05)

Percentage of general medicine staff in region I is highest (28.9%), lowest in

region VI (15.3%) (p < 0.05)

3.3 CONTINUOUS TRAINING NEED IN TRADITIONAL MEDICINE BY

Figure 3.2 Percentage of staff reported without continuous training

There is only 36% of staff who received the continuous traning

Table 3.9 Training need for staff in future

Staff received continuous training 440 35.8

Staff did not receive continuous

training

788 64.2

Staff received continuous training in

the last 5 years

194 43.2

Staff did not receive continuous

training in the last 5 years

255 56.8

In the last 5 years, there were 56.8% staff who were not receive any continuous

training course Other staff who received continuous training course but they also

need to be updated knowledge and skills

Table3.10 Contents of training for specialized traditional medicine staff

medicine; 42.5% of staff who need to be updated in treatment of traditional medicine;

13.8% of staff who need to be updated in diagnosis of general medicine

Table 3.11 Contents of training for pharmacist

Distinguish some traditional medicines 242 78.8

Producing some traditional medicines 206 67.1

Producing some other traditional medicine 12 3.9

n = 307

There is 78.8% pharmacist who have training need in distinguish some

traditional medicines, 67.1% of them has training need in producing some traditional

medicines and 3.9% has training need in producing some other traditional medicines

3.3.2 Continuous traing need in traditional medicine by geographical

II (%) n= 325

III (%) n= 215

IV (%) n= 70

V (%) n= 158

VI (%) n= 163

Traditional

medicine

42.3 34.3 39.3 40.0 29.9 26.4 < 0.05 57.7 65.7 60.7 60.0 70.1 73.6 < 0.05

100 100 100 100 100 100

Percentage of staff who did not receive any knowledge in traditioan medicine in

the region VI was highest (73.6%), lowest in region I (57.7%) (p < 0.05)

Percentage of staff who did not receive any knowledge in traditioan medicine in

the last 5 years in the region VI was highest (77.1%), region II (75.5%), lowest in