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1 INTRODUCTION Necessity of the topic President Ho Chi Minh asserted: "No matter what, are made by people, and from small to large, from near to far, all are." Matsushita Konosuke has proved that: "Human resources, the key to success" Susan R Meisinger has stated: "Human is our most important asset" The above-mentioned summarized statements, although appearing at different times, cultures are not the same, have also affirmed the special importance of human resources for each country, each industry, each organization The health sector of Son La province has the responsibility and mission to carry out health care for more than 1.2 million people in the province and some provinces of Laos in the border with Son La province In order to complete the assigned tasks, the Son La health sector needs to have a strong enough system with a sufficient health network covering the provinces and communes, a high quality medical workforce Currently In Son La province, the state management of highly qualified health human resources is still limited such as: the elaboration and implementation of master plans, plans on development of the health sector in general, development of health human resources High level in particular has not kept up with development requirements Some plans have shown signs of inadequacy, contradiction and lack of feasibility; to organize the state management apparatus on the development of highly qualified health human resources, with a lack of concentration and unity; inspection, operation inspection and handling of violations in the field of development of highly qualified health human resources, though being paid attention to directing and implementing, are still sparse, post-bar handling checking each time, every place is not definitive; The effectiveness, efficiency, suitability and sustainability of state management on the development of highly qualified health human resources in the province have improved, but there are still many shortcomings There is a shortage of doctors, especially doctors with postgraduate and in-depth qualifications; a team of leading experts in a number of fields; human resource structure by region and field is not consistent with the regulations; the number of doctors working in the whole province is not enough and meets the provincial health sector development plan and natural population development plan The shortage of doctors in the field of health units in specific fields such as: Tuberculosis; Leprosy; HIV AIDS; Forensics; Psychiatry and at Medical station of commune, ward and town For the above reasons, Post-graduate chose the topic: "State management on the development of highly qualified health human resources in Son La" as a doctoral thesis 2 Overview of the research situation 2.1 Research situation on health human resources and development of health human resources Research topics on human resources for health development of health human resources have also been studied by many domestic and foreign authors These studies have clarified the important role of health human resources and the requirements for health human resources in the world At the same time, studies have also shown the need of health human resources in terms of quality and quantity However, the researches are generally on the development of health human resources without any indepth research on the development of highly qualified health human resources in localities and in Son La province 2.2 Research situation on state management for development of highly qualified health human resources The studies also identify factors affecting the state management of health human resources Specifically: (i) research on state management on human resource development in the industry; (ii), researches on state management of health human resources Realizing that some works and documents have been provided with relatively complete content and state management tools In the mentioned studies, there has been a work on state management of health but it has only stopped at general institutional management or state management on a specific human resource aspect research on state management according to health human resources associated with occupational characteristics; No study has fully evaluated and analyzed the scientific basis for state management of the development of highly qualified health human resources in localities and specifically in Son La province 2.3 Comments and research gaps Through researching the reviewed works, a number of issues have been specifically addressed:Firstly, there are different approaches to health human resources in general and the current status of the structure, qualifications of the global health human resources system, priorities for development and development policy in subsequent stages; general policies for health human resources for developing countries; joint action program of the world to improve the health system, its mission to improve the capacity of health workers and improve the quality of healthcare for patients Content of management and policies on health human resources in some localities and regions around the world such as India, Asia Pacific, Africa Secondly, a number of studies have focused on the analysis of the Vietnamese health system, the concept of human resources for health, the status of health human resources, including: development status, size and distribution; recruitment and remuneration policies for health workers in a number of localities and regions in the country; The current situation of health human resources with successes and inadequacies needs to be addressed, at the same time, forecasting the factors affecting human resource development and proposing some development orientations as well as providing similar solutions to develop health human resources Thirdly, a number of studies have mentioned medical human resources institutions, the role and importance of training content, quality monitoring content, and the use of remuneration policies when recruited for human resources for health Some studies also mention the link between economic, cultural, political and social conditions of each region, region and locality for the development of the health system and health human resources under the following angles degrees and degrees vary.Fourthly: a number of works and documents have relatively completed the elements, content and tools of state management of labor safety In the mentioned documents, there are documents that mention state management on health but only at general institutional management, there are no studies on state management according to specific fields can be associated with career specificity In a nutshell: the study of related works shows that "gaps" need to be further studied, namely: - Systematic theoretical framework associated with specific health sector including: the concept of health human resources, health human resources-tcc; content of state management on development of highly qualified health human resources in localities; criteria for evaluating state management on development of highly qualified health human resources in localities; Factors affecting state management on development of highly qualified health human resources in localities - Analyze and assess scientifically the situation of state management on the development of highly qualified health human resources in Son La province associated with specific conditions - Assessing the situation of factors affecting the state management of the development of highly qualified health human resources in localities, the case study of Son La province - Comprehensive and feasible system of solutions and recommendations for perfecting state management of highly qualified health human resources development in Son La province From the identified void, the research direction of the thesis is new with the inheritance and development of a research result from published works on the principles of state management and human resource development International Accordingly the research questions of the thesis are identified as: (i) the scientific basis of state management on the development of highly qualified health human resources in localities and the status of state management on the development of highly qualified health human resources in Son La Province?(ii) What factors affect the state management of the development of highly qualified health human resources in Son La?(iii) what should we to improve the state management of the development of highly qualified health human resources in Son La Province? Aims and tasks of the study 3.1 Aims of the study The thesis proposes major solutions and recommendations with scientific and practical basis to improve the state management of the development of highly qualified health human resources in Son La province, Vietnam 3.2 Task of the study Firstly, systematize and clarify the theoretical basis of state management for the development of highly qualified local health human resources The second is to study the experience of state management of highly skilled human resources in some provinces and cities in Vietnam to draw lessons for the health sector of Son La province Thirdly, conducting surveys and assessing the state management of highly qualified health human resources in Son La province; analyzing the situation of factors affecting the state management of health human resources in Son La province from which to draw conclusions about the successes, limitations and causes of these limitations Four are: researching the orientation, goals of developing highly qualified health human resources of Son La Province to 2025 and vision to 2030; propose a view to perfect the state management of the development of highly qualified health human resources in Son La province to provide scientific and practical basis for solutions and recommendations Subject and scope of the study 4.1 Subject of the study The subject of the study is state management of the development of highly qualified health human resources in localities in general and in Son La province, Vietnam in particular The subject of state management of the development of highly qualified medical human resources in localities is the People's Council and the provincial People's Committee, of which the Health Service is a specialized advisory agency Subject to state management are activities to develop highly qualified health human resources, including attraction, recruitment, arrangement and use; training and retraining; create motivation for highly qualified health human resources at local health facilities 4.2 Scope of the study Spatial scope: State management research on developing high-level local health human resources, practical research in Son La province 5 Scope of time: the reality of state management of highly qualified health human resources of Son La province in the period of 2015-2019 Proposing solutions to improve state management on development of highly qualified health human resources in Son La Province by 2025 with a vision to 2030 Scope of content: Within the scope of the thesis, a research framework is formed with a number of key aspects (see Figure 1): State management on the development of highly qualified health human resources in localities Contents of State management on Development of highly qualified health human resources in locality Organize the Inspect and Develop implementatio supervise the strategies, n of state development of master management highly qualified on the plans, and health human development resources in foundations of highly localities for qualified developing health human highly resources qualified in localities health Subjective factor Economic conditions; Cultural and social human characteristics; Capacity of State management resources in officials; Facilities, medical equipment in localities localities Effic iency Criteria for evaluating state management on development of highly qualified health human resources Effec in localities Suita tiven ess bility Sustai nabili ty Objective factor Legal policy; Health sector development strategy; Training facility system of health human resources with high qualifications Factors affecting state management on development of highly qualified health human resources in localities Figure 1: Research framework of thesis Source: Proposed by postgraduate Research method 5.1 Methods of collecting information Using the method of dialectical materialism and historical materialism based on objective phenomena and economic law as the methodology and are applied throughout the research Sources of information and data for the research of the thesis include all secondary and primary data sources For each of the above data types, postgraduate has her own collection methods to get the most correct and reliable data source for analyzing the current situation of developing highly qualified health human resources of Health sector in Son La province 5.1.1 Document research method - Document study method: Applied to collect secondary data sources from the Ministry of Health agencies; Department of Health, Department of Home Affairs of Son La province, some hospitals or health care facilities at all levels of Son La province, summary reports on professional tasks, summary data of scientific conferences, journals related to highly qualified health human resources under the research scope of the thesis - Case study method: Conducted at Son La General Hospital and Thuan Chau District General Hospital are two hospitals used to illustrate the assessment of provincial and district health facilities - Expert method: Topic refer to and use the opinions of experts in the medical field; Experts are consulted in the fields of: Principals of highly qualified health human resources training institutions; Leaders at Service, Department of Health; Leaders of Son La Department of Health; Leaders of the provincial hospitals, leaders of district hospitals in the health sector of Son La province - In-depth interview method: On the basis of document review and conducting preliminary research on state management on development of highly qualified health human resources in the locality, the postgraduate conducted in-depth interviews with 08 representatives at the Ministry of Health; Department of Health of Son La province; leaders of the provincial and district hospitals; leaders of highly qualified health human resource training institutions to correct, screen, and remove the manifestations of the statements to develop survey questions and supplement some detailed information about state management on development of highly qualified health human resources in Son La province - Investigation, survey method: About survey content; objects; sample size 5.2 Information processing method: Secondary data processing: Collected data are sorted by time, specific content and encoded by subject data and performed analysis according to specific criteria using method of statistics, analysis, comparison Primary data processing: It is done through the form of quantitative research (postgraduate gives 529 valid votes in 700 questionnaires) to analyze and create descriptive statistical data for the scale, rate or rank (such as: gender, seniority, education level, job position, ); describe scales such as the content scale of the state management on the development of highly qualified health human resources, the influencing factors, In summary: By a combination of research methods, postgraduate has obtained full, multi-dimensional and objective information on the state management status on developing highly qualified health human resources in Son La province Significance of the thesis 6.1 Scientific significance The thesis has systematized and developed a basic theoretical step on state management for the development of highly qualified health human resources in localities, including: (i) establish the concept of state management on development of highly qualified health human resources in localities; (ii) develop a theoretical framework on the content and criteria for evaluating state management on development of highly qualified health human resources in localities; (iii) identify the key factors affecting state management on the development of highly qualified health human resources in localities 6.2 Practical significance (i) The thesis gives experience learned for Son La province in state management on development of highly qualified health human resources through the study of state management experience in development of highly qualified health human resources in some localities in the country has similar characteristics (ii) carry out an assessment of the status of state management on the development of highly qualified health human resources in Son La province with content and measurement criteria; (iii) analyze the situation of factors affecting the state management of the development of highly qualified health human resources in Son La Province.(iv) synthesize and propose key viewpoints and solutions to improve state management on the development of highly qualified health human resources in Son La Province on the basis of summary on successes, limitations and causes leads to limitations; research and development orientation of Son La province's health sector; The goal of developing highly qualified health human resources for the health sector in Son La Province is up to 2025 and a vision to 2030 Organization of the thesis In addition to the introduction, conclusion, references, appendixes, the thesis is divided into chapters: Chapter 1: Theoretical basis and experience on state management of the development of highly qualified health human resources in localities Chapter 2: Current situation of state management on development of highly qualified health human resources in Son La province Chapter 3: Some solutions to perfect the state management on development of highly qualified health human resources in Son La Province CHAPTER THEORETICAL BACKGROUND AND EXPERIENCE IN STATE MANAGEMENT FOR HIGH-LEVEL MEDICAL HUMAN RESOURCE DEVELOPMENT IN LOCAL 1.1 Overview of developing highly qualified health human resources in locality 1.1.1 Highly qualified health human resources - Definition + Medical human resources is a group of people with professional qualifications and medical ethics suitable to professional characteristics who directly participate in people's health care activities + Highly qualified health human resources are people with a college degree or higher, with professional qualifications and medical ethics suitable to professional characteristics who directly participate in people's health care activities - Classification of highly qualified health human resources: There are many criteria for classifying highly qualified health human resources, for each classification criteria are shown as follows: By job title, by route, by training specialty, by job nature, by qualification, according to source In addition, Medical human resources is also classified by gender, ethnicity, seniority 1.1.2 Basic characteristics of highly qualified health human resources It is a special profession, therefore, it has specific characteristics: Firstly, highly qualified health human resources carries out work directly related to people's health, the lives of patients so they should be humane; Secondly, highly qualified health human resources has its own ethical characteristics Thirdly, highly qualified health human resources carries out work that requires a lot of labor; Fourthly, health human resources does its job with risks and uncertainty Fifthly, highly qualified health human resources needs large investment and close, planned coordination in education and training Sixthly, highly qualified health human resources carries out work with the advantage of the market but is controlled 1.1.3 Development of highly qualified health human resources in local - Definition: Development of highly qualified health human resources in local is the increase of the quantity and quality, appropriately creating the structure of training college degree or higher from improving the professional and medical capacity of people directly involved in the activities Health care for people in the locality - Content: Some basic contents of locally qualified health careers development are identified as: (i) attracting, recruiting and allocating highly qualified health human resources ( should be calculated, forecasted scientifically and closely followed the practical implementation organization in terms of identifying needs, the process of attracting, recruiting and using; forms of attraction, placement, recruitment and use); (ii) training and retraining of highly qualified health human resources; (iii) remuneration for highly qualified health human resources 1.2 State management on development of highly qualified health human resources in locality 1.2.1 Concept, characteristics of State management on development of highly qualified health human resources in locality - Definition: State management on development of highly qualified health human resources in locality is the use of the State's power to adjust the process to increase the quantity and quality, to create a rational structure of health human resources with a college degree or higher degree from the improvement of professional and medical ethics of people directly involved in health care activities of local people - Characteristics: Firstly, the objectives of State management on development of highly qualified health human resources Secondly: The subject of state management depends on political institutions Thirdly: Object of State management on development of highly qualified health human resources activities Fourthly: The content of State management on development of highly qualified health human resources includes: Fifthly: Method of management Sixthly: Management tools 1.2.2 Content of State management on development of highly qualified health human resources in local * Content 1: Develop plans and promulgate policies for development of highly qualified health human resources - Developing plans, strategies for development of highly qualified health human resources: A plan sually has vision of 5-10 years The human resources development strategy plays an important role as a component of the socio-economic development strategy, while the strategy for development of highly qualified health human resources constitutes the development strategy of the health sector; - Issue policies to develop highly qualified health human resources: Policies for developing highly qualified health human resources are listed as: - Policies to attract, recruit and use highly qualified health human resources; 10 - Training - Improving highly qualified health human resources policy; - Remuneration policy for highly qualified health human resources Main contents: Objects and scope of application of attractive policies; Attractive policy targets; Solutions of policy attract; Funds to implement policy attract; Organize the implementation of policies to attract Usually those policies are integrated into the laboratories or general irrigation facilities * Content 2: Execute state management on the development of highly qualified health human resources - Organize state management apparatus: The state management apparatus for the development of highly qualified health human resources in the locality is set up under a unified system ensuring the principle of transparency - Carry out activities of highly qualified health human resources development activities + Attraction, recruitment, arrangement and use of highly qualified health human resources: State management agencies must focus on the key activities: Elaborate employment placement schemes in local health stations; Forecast of demand for highly qualified health human resources in accordance with health care needs; Identify sources of attraction, recruit highly qualified medical human resources; Design and implement procedures to attract, recruit science and regulations; Comply with the principles of attraction and recruitment according to the following stages: Before recruitment, prequalification, formal recruitment, after recruitment; Arranging and using highly qualified health human resources appropriately + Organize training courses for highly qualified health human resources: Training - Improving activities is intended to reduce the time and effort of apprentices in learning by themselves and drawing out the rules and experiences of phenomena In which: Content of Training Improving: Appropriate (ethical qualities; professional knowledge and skills; soft skills); Form of training and education: There are many forms (full-time and part-time training; long-term, short-term and specific training courses; direct and indirect training.) In addition, forms of selftraining and self-study are also featured) + Organization of treatment of highly qualified health human resources: Two basic groups of instruments: financial and non-financial remuneration *Content 3: Examine and supervise the development of highly qualified health human resources: - Regarding the content of test and inspection: Examining and supervising input and output resources of high-level health human resource development activities - Regarding the form of test and inspection: To be held regularly 11 according to plans and irregularly 1.2.3 Criteria for evaluating state management on highly qualified health human resources in localities Inheriting from the research of scientists, the criteria for evaluating "State management on development of highly qualified health human resources" include: * Efficiency: Measure the efficiency by comparing the results of the implementation of state management contents of agriculture and forestry development and resettlement with the set goals Determining the efficiency of state management on development of highly qualified health human resources is answering two questions: Firstly, are the objectives of state management for agriculture and rural development, is it correct? Secondly, how is the implementation of state management on highly qualified health human resources? *Effectiveness: The effectiveness of state management on development of highly qualified health human resources is assessed through the achievement of the goal with the lowest cost of input resources Accordingly, the effectiveness of state management on development of highly qualified health human resources is measured by quantitative and qualitative indicators * Suitability: It is expressed through a number of indicators such as: (i) State management on Development of highly qualified health human resources in local in accordance with the policy framework, the law on Development of highly qualified health human resources; (ii) consistent with the goals of using highly qualified health human resources; (iii) in accordance with the national strategy for highly qualified health human resources; (iv) suitable to local socio-economic conditions (v) suitable to local cultural and social conditions; *Sustainability: Reflecting the ability of state management to maintain the efficiency criteria of the state management on Development of highly qualified health human resources Some of the criteria for assessing sustainability are: (i) Policy of Development of highly qualified health human resources locally is competitive; (ii) The appropriateness of the quantity, structure of highly qualified health human resources infrastructure with the sustainable development strategy of the local health sector; (iii) The appropriateness and improvement of the quality of highly qualified health human resources with the sustainable development strategy of the local health sector; (iv) Inspection and supervision in Development of highly qualified health human resources in local work is carried out regularly and promptly to detect errors and shortcomings 1.3 Several factors influence the state management on Development of highly qualified health human resources locally 12 1.3.1 Subjective factors Firstly, economic conditions in the locality: As an important factor, in the context of state management of an area in a locality, when considering the impact of economic conditions to analyze: (i) The situation of economic growth in the locality; (ii) Financial resources are determined for the local health sector; (iii) The proportion of the local service sector facilitates the development of the health sector Secondly, cultural and social characteristics in the locality Thirdly, capacity of State management officials on the development of highly qualified health human resources in the locality: All studies on state management consider the impact of the capacity of state management staff on state management, indicating that if the state management staff has: (i) knowledge to meet the requirements of performing functions and duties; (ii) Skills to meet requirements of performing functions and tasks; (iii) Qualities that meet the requirements of performing functions and duties; (iv) Perform functions and duties well; (v) Properly exercising authority positively affecting state management If the state management officials are incompetent, lack of accountability will hinder the construction of the policy Fourthly, physical conditions, local medical equipment: Most researches on state management have shown the influence of the factor of science and technology development on the state management; The effectiveness of state management is strongly influenced by the conditions of facilities, equipment and the application of scientific and technological achievements In the era of technology 4.0, the sustainable development and development of health depends on grasping and mastering advanced science and technology so that professional activities are highly effective and not fall behind Therefore, health human resources must promply adapt to survive 1.3.2 Objective factors Firstly, policies and laws of the State: Develop and promulgate policies legal policies on human resource development in general and developing highly qualified health human resources in particular is an important task at the national level, which has a decisive influence on state management on development of highly qualified health human resource in locality The more comprehensive, consistent and transparent state laws and policies are ensured, the more motivational will be created to promote the development of highly qualified health human resources in the locality Secondly, health sector development strategy: For the health sector, the central state management plans the strategy of the health sector so that the local health sector develops in line with the trajectory and common 13 health goals of the whole society The planning and implementation of strategies and policies on agriculture and forestry development in localities must ensure compliance with the general development strategies and plans of the region and the whole country; At the same time, it must be suitable with the needs of deeper and wider integration into the world economy in association with the country's development process Thirdly, the system of training medical human resources: The quality of the health human resource training system is the decisive factor in the quality of highly qualified health human resources; The number and distribution of the system of health human resource training facilities create barriers or motivations for the development of highly qualified health human resources in the locality To have a reputable highly qualified medical human resource training facility is a serious and formal investment process with huge funding 1.4 Experience in state management on development of highly qualified health human resources in localities 1.4.1 Experience of some localities Firstly, experience of Quang Nam province: Considering the following factors: Regarding training policies, attraction policies, Secondly, experience of Quang Ninh province: Considering some outstanding solutions such as: (i) Reserving payroll quotas for recruiting doctors; (ii) Training of Highly qualified health human resources; (iii) Transfer technical packages and Highly qualified health human resources for Medical specialties: Thirdly, experience of Hoa Binh province: (i) About policies to attract and recruit; (ii) Regarding training policies: Training scale, type of training and place of training, conditions, criteria of training subjects, regime of payment of training expenses, training funding 1.4.2 Lessons learned through study of experiences Firstly, defining the key viewpoint of Development of highly qualified health human resources, building a leading team of experts, preserving ethics is a key factor to improve the quality of Medical Examination and Treatment Satisfying and maintaining the trust of the people, empowering the local health sector to create destinations for people to always choose Secondly, focusing on building a Master Plan for Health Human Resources Development Program, international integration is a strategic activity, with both synchronous and key investment and development with breakthrough, ensuring training, using and coordinating local Health Human Resources Thirdly, concretizing the project with specific policies in accordance with local conditions and characteristics to develop Highly qualified 14 health Human Resources Fourthly, innovating and organizing the state management apparatus of the local health sector to ensure leanness and efficiency Fifthly, organizing specific programs and activities to bring the project and Policy on Developing Highly qualified health human resources into life; Sixthly, doing well the inspection and supervision activities of Health Human Resources Development at High Level periodically Implement reporting, synthesizing and keeping data on Health Human Resource Development CHAPTER CURRENT SITUATION OF STATE MANAGEMENT ON DEVELOPMENT OF HIGHLY QUALIFIED HEALTH HUMAN RESOURCES IN SON LA PROVINCE 2.1 Overview of Son La province's health sector 2.1.1 The process of forming and developing the medical industry in Son La province Son La Department of Health Care was established in February 1949 Throughout the journey of formation and development, Son La Health Sector has made constant efforts, making an important contribution to the care, protection and improvement of People's health, achieving great strides with comprehensive innovation, creating a new face for the industry 2.1.2 Organization structure of the health sector in Son La province Son La's health system is managed by industry, from province to grassroots level has been gradually strengthened and reorganized in a synchronized manner, focal points have been reduced 2.2 Situation of state management on development of highly qualified health human resources in Son La province 2.2.1 Situation of content of state management on development of highly qualified health human resources in Son La province - Develop planning, plans and promulgate policies - Organize the implementation of State Management for Highly qualified health human resources development: Organize the apparatus, execute development of highly qualified health human resources activities - The situation of inspection and supervision on the development of highly qualified health human resources in Son La province 15 Figure 2.3: Number of inspections, tests of development of highly qualified health human resources in Son La Source: Son La Department of Health 2.2.2 Evaluation of the development of highly qualified health human resources in Son La Province through criteria Firstly, efficiency: Survey results of the postgraduate’s survey on "State management’s Effect on development of highly qualified health human resources in Locality" shows that: The average value is assessed at a score of 3, 22 out of 5.0 points mean "Neutral" Secondly, effectiveness: There is an increase in the number but there is a shortage of Doctors and especially postgraduate doctors and in-depth specialties; a team of leading experts in a number of fields; human resource structure by region and field is not consistent with the regulations; Number of doctors on annual work throughout the province has not met the health sector development plan Consider by factors: The total number of health workers and the increase in the number of healthhighly qualified personnel; Degree of increasing the rationality of each type of Highly qualified health Human Resources (By title; By prevention and treatment division, by route); Increased level of capacity of Health Human Resources (qualifications; seniority) Thirdly, suitability: The survey results "The appropriateness of state management on the development of highly qualified health human resources in the locality", with average values with quite good assessment at a score of 3.56 / 5.0 points which means "Agree" to the statements Fourth, sustainability: The average value is rated at medium low with a score of 2.66 / 5.0 From the above analysis, it can be seen that the work of development of highly qualified health human resources in Son La province in the past years has achieved certain successes, but it is still slow, unclear and unsustainable in all aspects of quantity, structure and quality 2.3 Analysis of the situation of factors affecting the state management on the development of highly qualified health human resources in Son 16 La province 2.3.1 Subjective factor situation - Economic conditions in Son La province - Socio-cultural characteristics of Son La province - Capacity of State management officials on Health Human Resource Development in Son La Province: There is a big gap in management capacity of current officials compared to the needs The State Administration of Health is mainly a doctor with good expertise, who is involved in Medical Examination, so the time and experience for management is limited That explains the reasons for the limited planning, planning and human resource management at all levels Monitoring and management of human resources has not been standardized Lack of adequate, accurate and specific information on Health Human Resources in general, Development of Health Human Resources in particular; Lack of evaluation information The impact of Health Human Resources Policies impedes the ability to effectively plan and develop them - Medical facilities, equipment in Son La province + Regarding medical facilities at all levels: The Director of Son La Department of Health said: "Overall, the Son La public health care system is quite adequate, although it has completed the organizational structure, but the infrastructure and Medical equipment at the Son La Province Health Care is still in need, especially at the Commune Health Care " + Regarding equipment, medical equipment: Basic equipment provided with all essential lists; few hospitals participated in the Satellite Hospital Project 2.3.2 The situation of objective factors - Policies and laws related to the development of Vietnam's highly qualified health human resources: The law is the Law on Examination and Treatment; Health Insurance Law, Pharmaceutical Law,… State policies are very diverse: (i) In terms of attracting, recruiting, arranging and using Highly qualified health human resources have a lot of policies have been issued (see Appendix 8); (ii) In terms of Training-Fostering Highly qualified health human resources; (iii) In terms of treatment of highly qualified medical human resources Although there have been changes but slowly, the current law and Policy on Developing Human Resources for High-Level Health still have many inadequate regulations that are not commensurate with the dedication and nature of special work of human resources of Health professionals with High Level Health - Vietnam health sector strategy: On January 10, 2013, the Prime Minister approved the Strategy for Health Sector Development with the 17 name "National Strategy for protection, care and promotion of People's Health for the Period of 2011-2020, with a Vision to Year" 2030 " To accomplish that goal, the main solutions are proposed including: + Rearrange the network of training institutions for development of highly qualified human resources for health + Upgrade medical staff training facilities + Develop criteria for evaluating and evaluating the quality of training medical staff + Expand forms of Training - Nursing to develop the contingent of Health Officers, giving priority to the training of local medical cadres Ensure enough staff titles for health facilities, especially for mountainous, deep-lying, remote, disadvantaged, border and island areas; + Promote postgraduate training for provincial and district levels + Improve hospital management capacity + Deploy effective solutions, suitable to the local socio-economic conditions In addition, strengthening the state management of health Step by step standardize the professional and managerial capacity for each position of the staff at both central and local levels Develop a system of standards and standards for the fields of Health sector - The system of grassroots medical human resources training institutions Survey results show that the assessment is all "neutral" with the average point of the scales: Firstly, the base system of Medical Human Resources Training is lacking in both quantity and quality Secondly, the work of Training Highly qualified health human resources still has shortcomings about the Training program and the teaching staff Third, there is no regulation on national examination before issuing practice certificates to ensure that practitioners gain necessary competencies 2.4 General assessment 2.4.1 Success In the period of 2014-2019, Son La province has achieved remarkable results in the State management on development of highly qualified health human resources: (i) Policies to attract, recruit, train, foster and treat highly qualified health human resources gradually synchronize, stabilize and improve the legal corridors, create motivation for the develop the Health sector, including Highly qualified health human resources (ii) Policies to attract, recruit and use; Training - Fostering and treating High Qualified Health Human Resources in Son La has attracted 18 a large number of Highly qualified health human resources, expressed in scale, number of Health Human Resources increasing per day (iii) The quality of Highly Qualified Health Human Resources in Son La province has been increasingly improved, reflected in the increasing proportion of Health Professionals with university and higher qualifications (iv) Inspection and examination are carried out in collaboration with ministries and departments from the central to local levels 2.4.2 Limitation Restrictions on State Administration of Highly qualified Health Human Resource Development in Son La Province Also revealed many limitations, which are: (i) The work of developing and implementing the health plan and development plan of the health sector in general, development of highly qualified health human resources in particular has not kept up with the development requirements Some plans have shown signs of inadequacy, contradictions and lack of feasibility; (ii) The organizational structure of the State Management System for development of highly qualified health human resources is still fragmented, lacking concentration and unity; (iii)The inspection, operation inspection and handling of violations in the development of highly qualified health human resources have been interested in directing, but generally sparse, handling after the inspection bar each time, each place is not definitive; (iv) The effectiveness, efficiency, suitability and sustainability of the State management on the development of Highly qualified health human resources in the province has improved, although there are still many shortcomings 2.4.3 The cause of the limitations About subjective reasons:(i) The capacity of the State management on development of highly qualified health human resources in Son La province has not kept up with the great local needs affecting the quality of advisory work; (ii) The economic development conditions associated with the industry transition are not strong, have not created strong financial resources for the Development of Highly qualified health Human Resources; (iii) Traditional cultural and social conditions still exist, low levels of education among ethnic people are major barriers to the development of highly qualified health human resources in Son La; (iv) Infrastructure and equipment for preventive medicine at district and commune levels are inadequate to facilitate the development of agricultural and rural development in Son La On objective reasons: (i)The legal and policy system governing the development of highly qualified health human resources has been in effect for a long time, is now outdated, and does not match changes in the new 19 context of world medicine; (ii) The health sector development strategy has not been updated to fit the context and challenges of the complex integration and disease development process; (iii) The basic training system for highly qualified health human resources is lacking in quantity, limited in quality and unreasonable in structure CHAPTER SOME SOLUTIONS TO PERFECT THE STATE MANAGEMENT ON DEVELOPMENT OF HIGHLY QUALIFIED HEALTH HUMAN RESOURCES IN SON LA PROVINCE 3.1 Health Sector Development Goals and Orientations for Developing Highly qualified health human resources Son La Province to 2025, Vision to 2030 3.1.1 Goal to develope the health sector of Son La General goal: Build and develop the health system of Son La step by step modern, perfect, and synchronous from province to commune Specific goal: (i) Invest in developing preventive medicine network; (ii) Invest, arrange the medical examination and treatment; (iii) Develop pharmaceutical industry; (iv)Strengthen and improve the grassroots of local health network 3.1.2 Goal and orientations to develop the medical human resource – high qualification of Son La province Firstly, Strengthening the protection, care and improvement of people's health in the new situation Secondly, develop highly qualified health human resources based on practical basis, inherits and promotes achievements, experiences, overcome inadequacies and weaknesses Thirdly, , develop highly qualified health human resources based on the necessity, urgency, feasibility and suitability among socio-economic regions Fourthly, Medical ethics education is parallel with professional training, simultaneously with the development of medical science research capacity Fifthly, enhance cooperation, attract financial resources and absorb advanced technology 3.2 Viewpoint of perfecting the state management on medical human resource development with high quality in Son La province 3.2.1 Perfect the state management on medical human resource development with high quality Towards ensuring target coverage To ensure the goal of health capacity coverage on all aspects of quantity, quality and structure 3.2.2 Improve the state management on medical human resource development wit high quality the towards capacity to providde 20 Vocational standards and training standards must be promulgated by state management agencies at all levels and concretized as a basis for the development of quality of medical human resource with high quality 3.2.3 Improve the state management of the development of highly qualified health human resources towards motivational goals 3.3 Proposing solutions to improve state management on development of highly qualified health human resources in Son La province - Reviewing, amending and supplementing plannings, plans, and policies for developing highly qualified health human resources in Son La province - Completing the policy for developing highly qualified health human resources in Son La, including: Completing the policy of attracting, recruiting, arranging and using highly qualified health human resources 3.3.2 Improve the state management organization for development of highly qualified health human resources in Son La province Firstly: Raise awareness of levels, sectors and the whole society about human resource development Secondly: Improve the quality of advisory work, proposing Thirdly: Innovating management methods Fourthly: Improve and enhance the coordination among levels, sectors and entities involved in human resource development Fifthly: Early establishment of a provincial-level Human resource Training Council Sixth: Son La Medical College has an appropriate solution to improve the quality of training 3.3.3 Strengthen inspection and supervision on the development of highly qualified health human resources in Son La province Firstly, strictly implement the legal system of inspection and examination in Health activities, management and development of highly qualified health human resources Secondly, strengthen the contingent of health inspection officials Thirdly, strengthening the inspection and regular inspection Fourthly, publicize and make transparent the information related to the implementation of Health tasks, strengthen the handling of violations related to highly qualified human resources Fifth, renovate and perfect the information supply and processing system Sixth, control the use of budget and finance 3.4 Proposing solutions to improve subjective factors to facilitate the completion of state management of the development of highly qualified health human resources in Son La Province 3.4.1 Improve the capacity of State management officials on the 21 development of health human resources in Son La province Firstly: Research and promulgate standards for state management personnel on human resource The second is: Implementing the work of planning and planning State management personnel on human resource Thirdly: Innovating the recruitment and selection of State management officials on human resources Fourthly: Strengthen training of State management officials on human resource Conduct additional training and retraining for state management officials at Son La Department of Health Fifthly: Performing the arrangement and use of State management officials on human resource Health science Sixlthly: Innovating the work of assessing State management officials on human resource Seventhly: Improving regimes and remuneration policies for State management officials on human resources; 3.4.2 Promote the strengths in economic development of Son La province to create resources for the development of human resource health- high quality in Son La province In general: To substantially restructure economic sectors, improve productivity, quality and competitiveness of industries and fields, promote growth and economic restructuring Gradually transforming the growth model in depth, applying modern technology, based on investment and export In each sector: Investment promotes the strengths of each industry 3.4.3 Remove cultural and social barriers to stimulate the development of highly qualified health human resources in Son La Province Promote communication to raise awareness of ethnic minorities on the values of the People's Health Care system, the benefits of scientific examination and treatment, and the harmful effects of traditional practices Hau in the treatment of disease Improving people's intellectual standard, creating a sustainable source for human resource of health - high level 3.4.4 Strengthen ensuring that medical facilities and equipment meet the development requirements of human resource - high quality at the grassroots level Firstly, evaluate the current status of medical equipment at health facilities Second: Review and update the list of essential medical equipment; building database and equipment Thirdly: Supplement and upgrade medical facilities and equipment for health facilities to ensure the requirements of technical division, priority of grassroots levels and disadvantaged areas; Fourthly: Strengthen the maintenance and repair of medical equipment; 22 improve the quality of human resources involved in the maintenance and repair of medical equipment; allocate sufficient funding to the unit for maintenance and repair of medical facilities and equipment; Fifthly: Strengthen the province's network of calibration and testing of medical equipment 3.5 Some recommendations to create favorable conditions for the completion of state management of the development of health- high quality human resources in Son La Province 3.5.1 Perfecting policies and laws in line with changes from environment and international integration to make a change in state management of development of health-highly qualified human resource Firstly, the Government submitted to the National Assembly to supplement and amend a number of laws related to to renew training and develop high-quality human resources for the health sector Secondly: The Government will soon develop and approve the Master Plan for the development of the Vietnam Health System by 2025, with a vision to 2035 Thirdly, the Government soon approved the Scheme on strengthening the grassroots health system to build infrastructure, upgrade equipment and train human resources according to the Ministry of National Criteria of Commune Health for the period to 2020 , associated with building a new countryside (criterion 15 on Health) Fourthly: The Government soon approved a number of new decrees, supplementing and amending a number of important current decrees to implement laws and projects related to human resources human resources Fifthly: The Government directs the Ministry of Education & Training Ministry of Health implements the planning of human resource of health - Highly qualified at Training facilities and Health facilities; directing the Ministry of Planning and Investment, the Ministry of Finance and the Ministry of Home Affairs to research, review, develop and promulgate policies to encourage non-state organizations to participate in human resource training activities international - high level; Sixthly: The Ministry of Health is the focal point for coordinating the development, adjustment and proposal policies in training and recruiting remuneration for human resource health - high quality in accordance with the views of the Central Resolution No 20 Course XII "Medical profession is a special job that needs special training, recruitment, employment, and remuneration" Seventhly: Ministry of Education and Training strengthens coordination with Ministry of Health Eighthly: Ministry of Labor and Social Affairs strengthens coordination with Ministry of Health to issue a Policy on management of 23 vocational education activities with Health Sector Training schools 3.5.2 Developing the training system of human resource health- high quality in Vietnam - Arranging and developing the training system of highly qualified health human resources to create conditions for Son La province and Northern midland and mountainous provinces Firstly, ensure the process and strict review, accreditation to ensure the quality of training for newly established training institutions and health training institutions in the field of Health Care Secondly: Deploying the scheme of arranging and developing a number of training facilities into the University of Health Sciences The model of the University of Health Sciences includes many of its existing universities in Vietnam like the Hanoi National Universities, Ho Chi Minh National University, and regional universities in Thai Nguyen and Hue Da Nang, has been specified in the Law amending and supplementing a number of articles of the Law on Higher Education Thirdly: Reviewing and selecting the plan to build an investment project to establish a medical human resource training university at Son La, providing human resources - high-quality human resources for the Northwest region and a number of provinces of Laos - Comprehensively renovate training programs and improve the quality of teaching staff at health human resource training institutions with high qualifications - Innovatd the comprehensive training program on health sector - Actively renovate active training methods and invest in facilities for training human resources for health - with high levels: training methods and facilities for training - Improve the quality of teaching staff to meet innovation at health human resource training institutions: Develop plans and plans for a contingent of highly qualified human resources for health human resources teaching force, Supplementing teaching staff, Developing policies to attract and use highly qualified health workers, Improve the quality of life of teaching staff - Organize national examinations before issuing practice certificates to ensure that practitioners gain necessary competencies: In order to improve the quality of medical school training and the quality of human resources for health - with high qualifications, a comprehensive renovation of the practice of issuing medical practice certificates is required in the direction of implementing national examinations and regulations Validity period of certificate The method of implementation is as follows: Purpose, object of application, organization unit, deployment time, form of examination 24 CONCLUSION In the field of health, highly qualified health human resources is the most important resource, which determines the scope and quality of health services and plays a decisive role in the implementation of medical examination and treatment tasks and take care of local people's health Due to the importance of this human resource, management levels, domestic and foreign scientists have made many policies, scientific research projects on solutions to improve the quality of highly qualified health human resources, especially from a local state management perspective To evaluate the content of state management on developing highly qualified health human resources in Son La province, the thesis has used criteria of effectiveness, efficiency, suitability and sustainability The practical research results show that in the state management of the development of health human resources at high level in Son La province, there are still limitations such as planning work has not kept up with development requirements, organizational apparatus State management of highly qualified health human resource development is fragmented, and examination work in this area remains sparse The effectiveness, efficiency, suitability and sustainability of state management on the development of high quality health human resources in Son La province still have many shortcomings The dissertation has also identified factors influencing the state management of developing high-quality health human resources; The impact of these factors on the development of high quality health human resources in Son La province has been carried out in practice and found that the impact of these factors is very large To overcome the inadequacies of the state management in developing high-quality health human resources in Son La province, the thesis has proposed solutions and recommendations to focus on completing the contents of home management feasible and practical guaranteed water The conclusions of the assessment of the current situation and the solutions and recommendations proposed in this thesis can be useful for many other localities with similar socio-economic conditions in the country to refer and apply Despite their best efforts, the research topic is relatively wide and the research experience of the graduate student is limited, so the research results are definitely lacking We hope to receive comments from lecturers, scientists, colleagues so that postgraduate can develop further research in the future  ... for management is limited That explains the reasons for the limited planning, planning and human resource management at all levels Monitoring and management of human resources has not been standardized... requires a lot of labor; Fourthly, health human resources does its job with risks and uncertainty Fifthly, highly qualified health human resources needs large investment and close, planned coordination... region and locality for the development of the health system and health human resources under the following angles degrees and degrees vary.Fourthly: a number of works and documents have relatively