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Do chua nhan tbiic dupc vai trd va tfnh cin thiet ciia viec hpe tap cung nhu cham sdc, bao ve siic khoe nen nhidu gia dinh khdng mudn cho con em minh den trudng ma mudn chiing d nha phu [r]
(1)NGHIEN CL/U - TRAO OOI NANG CAO VI$C TIEP C^N D|CH VU GIAO DVC VA Y it CUA DONG BAO DAN TOC THilu SO d H\i6C TA PHUNG THI PHONG LAN D dng bao dan tdc thieu sd (DTTS) li mdt bd phan khdng the tich rdi cdng ddng cac dan tdc Viet Nam, ddng vai trd bet siic quan trpng qui trinh phit trien kinh te - xa hdi, tao nen sir da dang vd van hda cung nhu sir viing vang, on dinh vd chinh tri va an ninh qud'c phdng C) nudc ta, ddng bao DTTS chiem khoang 13,8%, sdng rai ric d vung niii, cao nguyen, vung sau, vung xa, miic sdng thap, didu kien sdng gap nhidu khd khan Bdi vay, cham sdc vd giio due, y td cho ddng bao DTTS khdng chi la bien phip nang cao chit lupng sdng cho ddng bao mi cdn li dudng phat trien kinh te - xa hdi vimg chic cho qud'c gia Tuy nhidn, kha nang tidp can ddi vdi hai loai hinh dich vu dae biet ciia ddng bio DTTS cdn ban ehe, chua dip iing dupc yfiu eiu cho su phat tridn cung nhu chua dat dupc bieu qui cao Dong bao dan toe thieu sd vdi viec tiep can djch vu giao due, y te a Vi' tii'p can dich vu gido due Dupc sir quan tam ciia Ding va Nhi nudc, nhirng nam gin day, ddng bio DTTS ngiy cing dupc tidp can nhidu hon vdi dich vu giio due Con em cic DTTS dupc thu hudng dich vu tai dia bin minh cu trii Ca hdi cing dupc md vdi nhidu su lira ehpn ban, nhidu loai hinh phong phii phti hop vdi didu kien ciia ttmg hoc sinh Cd nhirng trudng hpe Idn d nhung trung tam tinh ly dip ting nhu eiu dich \'u giio due chat lupng cao, d bac hpe cao nhung cung cd ca mdt be thdng trudng TAP CHI Q U A N LY NHA NUdc - S6 159 (4-2009) bin trii dan nudi, trudng "cim ban", trudng tieu hpe, tham chi li ldp hpe ddng tai ttmg dia bin ca sd, dip ung nhu eiu dich vu giio due hing ngay, don giin, dd tridn khai cho cic ddi tupng, dd thu hiit hpe sinh Tfnh den thing 3-2008, ca nudc da cd 42 tinh, phd dupc cdng nhan dat chuan phd cap giio due tidu hpe, dd nhidu tinh cd ddng hpe sinh DTTS Tfnh den thing 12-2007, ci nude da cd 39/64 tinh, phd dat chuin phd cap giio due THCS; dd, Ddng Bic cd 7/11 tinh, Tay Bic cd 1/4 tinh dat chuin Viec diy manh qui trinh tiep can djch vu ciia ddng bao DTTS da dat dupc mdt sd tuu quan trpng Sd lupng ngudi, sd lupt ngudi dupc sir dung djch vu (sd tre den trudng) ngiy eang tang \ di chit lupng dupc cai thien rd ret Quy md hpe sinh tieu hpe khdng chi phit tridn vd sd lupng ma ci ve chit lupng Ti le hpe sinh DTTS tren tdng sd hpe sinh tieu hpe ca nudc nam gin day tang 0,53% Quy md hpe sinh THCS, THPT d cic vting DTTS tang ti le cao ban so vdi miirc tang trung binh cua ci nudc Trong nam (2002-2006), quy md hpe sinh THPT tren pham vi ci nudc cung tang nhanh, tdc dp trung binh dat gin 6%/nam; dd, cao nhit li cic vung Tay Bic (12,9%), Tay Nguyen (12%) Trong qua trinh ngudi dan tiep can dich vu, nhung rio cin vd thdi gian, dia diem, bit ddng ngdn ngu, da duoc cii thien rd ret khien ngudi dan dd ' HQC vi0n Hdnh chfnh 43 (2) NGHIEN CL/U - TRAO OOI dang ban dd cd the sir diing cic dich vu, dip ling nhu eiu cua minh Nhim nang cao ca hdi tiep can vdi viec hpe tap cho em ddng bao DTTS, Nha nudc da ip dung nhirng bien phip dae biet nhu tang sd nam ciia mdt cap hpe, day song song chuang trinh bing tieng ciia ttmg DTTS (tidng me de) va tieng Viet, thudng xuyen van ddng b i cho tre den trudng va tiep tuc den trudng (ddi vdi nhirng em bd hpe), nganh Giao due phdi hop vdi quan dpi de "nhung thay giio mang quan ham xanh" hing mang inh sing tri thiire tdi tirng ban ling Tuy nhien, cd the thay qui trinh tiep can dich vu giio due ciia tre em DTTS cdn nhidu diem ban ehe: - Miic dp tiep can dich vu ciia tre em ttmg vung midn, tiing tdc ngudi la khdng ddng ddu Tre em dan tdc Tay, Thii (nhirng dan tdc ddng dan vi trinh dp phit trien kinh te - xa hdi cao han) tiep can vdi viec hpe tdt nhit, vdi ti le cao nhit nhung tre em mdt so dan tdc khie ( du, Brau) tbi viec tiep can cdn d miic rit thip Vung Tay Bic, Tay Nguyen cd miic dp tiep can thip hon nhiing vung khie Trong mdt so DTTS cd ti le tre nhap hpe tieu hoc ngang bing ngudi Kinh (93,4%) nhu dan tdc Tay (ban 90%) thi nhidu dan tdc khie ti le tre nhap hoc cdn thip: Kha-me 76,3%, Ba Na 57,8%, Gia-rai 66,4%, Mdng 41,5% Giai doan 2000-2006, cic tinh vting DTTS cd ti le nhap hpe diing dp tudi d THCS va THPT thip ban nhidu so vdi miic ehung cua ca nudc: Lai Chau 55,3% va 22,6%; Kien Giang 53% va 24%; Ca Mau 58% vi 28% (ca nudc la 82,6% va 48,2%) Ben canh dd, viec tiep can va sir dung dich vu giio due ciia em DTTS cdn bieu hien khdng bdn vung Nhidu em bd hpe didu kien thdi tiet va sin xuit ndng nghiep ciia gia dinh rai vao tinh trang khd khan hoac ket qua hpe tap khdng tdt Mdt hien tupng phd bien la da sd gia dirih chi mudn cho di hoc bac tieu hoc de 44 biet chir ma chua nhan thiic dupc tam quan trpng ciia ci 12 nam hpe Cang len bac hoc cao, su chenh lech ve gidi tinh hoc sinh cing tang (hoc sinh nu bd hoc nhidu) Ti le hpe sinh hoan cip hoc viing DTTS thip ban ti le ehung ciia ca nudc Nam hoc 2005-2006, ti le ddi vdi cip THCS ciia cac vung Tay Bic, Tay Nguyen, dong bing sdng Cim Long dat binh quan khoang 58%, ca nudc la 78% Sd nam trung binh hoan cac cap hoc ciia hpe sinh DTTS d cip THCS va THPT cao hon nhidu so vdi toan qudc, cung nhu cd su chenh lech giira cic vung Sd nam trung binh hoan cip hoc THCS nam hoc 2003-2004 cua toan qudc la 4,88; cua DTTS la 5,56 Trong nam hoc 2005-2006, neu nhu ti le luu ban trung binh cua toan qud'c la 1,37% thi dong bing sdng Cihi Long li 2,05% vi Tay Nguyen 2,37% Nhu vay, hieu qua cua dich vu giio due cho tre em midn niii chua cao, chua tuong xung vdi sir diu tu cua Nha nudc va nd lire ciia nganh Giio due cung nhu ciia cic dja phuang O nhidu nai, viec cung iing rat tdt, trudng ldp, giao vien sin sang nhung lai khdng cd hoc sinh nen mot vai xa mdi tap hop dupc mdt ldp vdi trinh dp, Ma tudi hpe sinh chenh lech (trong mdt ldp ma mdt giao vien phai day ca hoc sinh ldp cho den ldp 5) Chat lupng giio due chua cao Theo ket qua nghien ciin ciia Bd Giao due va Dao tao phdi hop vdi Td chire ciiu trp tre em Anh thi ti le hoc sinh ldp ngUdi DTTS dpc chua thdng, viet chua thao tieng Viet chiem tdi 30% b Viec tii'p can dich vu y te Ben canh giao due, y te cung la mdt loai hinh dich vu dupc Nha nudc dae biet quan tam cho ddi tupng dong bao DTTS Cung vdi su diu tu rit Idn tir phia Nha nudc, cac dia phuang cung nhu su chii ddng, tich cue tir phfa ngudi dan, viec tiep can dich vu cham sdc sure khoe cua ba DTTS da dat duprc nhiing ket qua tich cue TAP CHi QUAN LY NHA N U C - S 159 (4-2009) (3) NGHIEN CL/U - TRAO OOI Tren binh dien bao quat, cd the thiy ngudi DTTS da va dang dupc quan tam, cham sdc nhieu ban xi mat sure khoe Sd lupt ngudi dupc cham sdc bdi cic djch vu thude ITnh vuc y te cing dupc tang len va md rdng vd cic dia bin vimg sau, vimg xa Ba cung dupc tiep can vdi nhidu loai hinh cham sdc siic khoe ban, nhit la ddi vdi cdng tic y te du phdng Thude dupc cip phit midn phf kem theo su hudng din sir dung ciia y, bic sT nen ba cd the tu chira trj nhirng benh thudng gap Tuy vay, sir tiep can dich vu y te cua ddng bio DTTS d nudc ta cdn nhidu vin dd cin quan tam: - Ngudi dan chua chu ddng viec tiep can djch vu y te vi nhidu nguyen nhan khien cho viec cung iing dich vu ciia cic CO sd y te chua dat dupc hieu qua tich cue Hp chua cd dii thdng tin de lira ehpn loai hinh djch vu cung nhu chii the cung ung phti hpp Viec tiep can dich vu ddi theo kieu "dupc chang hay ehd" chii chua trd thinh thdi quen, y thii'c chii ddng bang ngiy - Ngudi dan rit ban ehe viec tidp can vdi djch vu y td, hp chi den ca sd y te (cd nhu eiu sir dung djch vu y te) "cd benh" de doa den siic khoe, tfnh mang cua bp, chir khdng thuc bien "phdng benh" thudng xuyen va cd nhung cham sdc siic khoe bang theo hudng din ciia chuyen gia y te (nhu mic di ngii, ve sinh ci nhan sach se, tiem phdng ddi vdi tre em ) - Sir tiep can khdng ddng ddu: -t- Giiia dan cu cic dja ban: Nhiing ngudi d cing xa trung tam xa vi co sd y td thi CO hdi tiep can cing ft di ve ca sd lin lin chit lupng djch \'u + Giira cic nhdm lira tudi: Ddi vdi mdi lira tudi cin cd sir quan tam khie Tuy nhien, da so cic gia dinh chi chii trpng vao cham sdc tre em la chinh Cic ddi tupng khie nhu ngudi trung nien, ngudi TAP CHi Q U A N LY NHA NUOC - SO 159 (4-2009) gia cung cin dupc cham sdc sire khoe theo nhidu ehe dp vi yeu eiu song cd benh lai thudng theo xu budng "chju dung", ehd cho benh tu khdi hoac phd mac, nhit la vdi ngudi gia -I- Chj em phu nir la ddi tupng cin dupc quan tam dae biet, vi bp phii dam duong thien churc lam \p lam me va \ai trd quan xuyen gia dinh Hp cung cd nguy co mic nhidu can benh nguy hiem Tuy nhien chj em phu nir ngudi DTTS cung chua dupc tidp can dich vu y tediing mii'e Chfnh Vl vay, hiu bet nhirng chi sd \'e sue khoe ciia bi cdn thap ban nhidu so vdi mat bing ehung Vf du ti le tre DTTS bj suy dinh dudng rit cao: d Tay Nguyen li 49,1%, ddng bing sdng Hdng la 33,8%, ca nudc la 36,7% Ti le tir vong ciia cic ba me d Tay Nguyen va mien niii phfa Bic cao gip 4-8 lin so vdi \ ting ddng bing Trong phin Idn phu nir dupc cham sdc y te (88%) thi chi cd khoang 44% phu nir d mien niii phia Bic nhan dupc sir cham sdc Nhu \ay, khoang 56% phu nir cdn lai phai tu minh cham lo cho sire khoe ciia minh, ciia cai va toan the gia dinh bdi hp ddng vai trd chinh viec cham sdc va giao due cai Tuy nhien, thieu thdng tin, kien thiire, y thiic cham sdc sure khoe, thieu xi phuong tien bd trp (thude men) nen hon "70% ba me sinh nd tai nha bj tai bien sin khoa; nhung can benh thudng gap nhu sdt ret, sdt xuit huyet, budu cd, khd mit, viem ming nao, cac benh vd dudng bd hip, cam sdt, cic benh thie'u vitamin, can- xi, cac benh ngd ddc vin rit phd bien Dae biet chit lupng y td chua cao nen ba mic benh thudng de lai nhidu di chii'ng Mot sd nguyen nhan - Nguyin nhdn khdch quan: Khu \irc midn niii, cao nguyen- noi ba DTTS sinh sdng li noi cd didu kien tu nhien bet sure khie nghiet, kem thuan lpi Day biu het la nhirng dja bin xa dd thj xa 45 (4) NGHIEN CL/U - TRAO OOI cac vting phit trien vd kinh te- xa hdi Do vay, sir phan bd mang ludi ca sd giio due, y te cung mdng, thieu va kem lien ke't ban so vdi cic vimg khie Ben canh dd ddi sdng kinh te - xa hdi va co sd ting kem phit trien cung li lire cin cho viec tiep can cac djch vu ciia ngudi dan Hiu het cac dudng ddu bi xudng cip nghiem trpng va bi hu hdng nang, nhit li bi sat Id mua mua bao Nudc sach thieu thdn gay nen hang loat nhirng benh thudng gap vd dudng tieu hda, benh phu khoa, cic benh vd mit, Co sd ting kem phat trien khdng chi ban ehe viec di lai, tiep can vdi cic djch vu giio due, y te ma cdn lim giim CO hdi dupe diu tu bdi cic du in, chuang trinh hd trp va ngoai nudc khdng dim bao cic didu kien kha tbi cho du an Viing DTTS la vung cdn tdn tai nhidu phong tuc, tap quin lac bau, kem phit tridn Tap quan du cu, du canh khien cho cudc sdng cua bi thieu tfnh dn dinh, ehd d tam bp, tre em vi the khd cd cp bdi gin bd dn djnh vdi mdt mii trudng, sinh tinh trang that hpe phd bien Mat khie, cac gia dinh thudng sinh nhidu nen khd cd the dam bao viec hpe hanh, sire khoe cho tit ca cic Nhidu gia dinh chi cho trai di hpe nen cing Ien cic bac hpe cao, ti le hpe sinh nir eang giam - Nguyin nhdn chii quan: Nhan thire, hieu biet ciia ddng bao DTTS cdn han ehe Do chua nhan tbiic dupc vai trd va tfnh cin thiet ciia viec hpe tap cung nhu cham sdc, bao ve siic khoe nen nhidu gia dinh khdng mudn cho em minh den trudng ma mudn chiing d nha phu giiip viec nha; cd ngudi bj dm thi khdng udng thude tan dupc (da dupc cip phit midn phf va hudng din sir dung), khdng dua di kham va didu trj d cic co sd y td ciia Nhi nudc ma lai tu chiia d nha bing kinh nghiem udng, dip cic loai la thude tren rirng, tham chi la mdi thiy mo, thiy Cling vd chira benh 46 Ngudn nhan luc (cin bd quan ly, cin bo chuyen mdn, ) mdng khien cho so lupng cin bd bi dan trai tren mdt dien rdng, ngudi dan cd nhu eiu, nhit la cd hien tupng bit thudng (benh dich, thien tai, ), hoac vdi nhirng ca benh phire tap, cin sir ling phd lap tire, cin bd y te vung DTTS thudng khdng du ca vd sd lupng lin nang lire de giai quyet tinh hinh, dam bao tinh mang va siic khoe cho ngudi dan Ddi vdi giio vien, nhidu ngudi d trinh dp rit ban ehe, biu nhu chi dam duang dupc viec day chir, tap dpc hay lim nhiing phep tfnh thdng thudng Hp cung ft cd ca hdi trao ddi, hpe hdi nang cao trinh dp Cudi ciing, sir bit ddng, ban ehe ve ngdn ngii la mdt nguyen nhan ca bin ban ehe qui trinh tiep can dich vu cua ngudi dan Didu xiy ddi vdi ci hai phfa: ngudi dan khdng biet tieng Viet (tieng thdng), can bd giio due, y te lai khdng biet tieng DTTS hoac chi biet so sii Do dd, ca bai ben khd cd the hidu neu khdng co ngudi "phien dich" Do bit ddng vd ngdn ngir, ngudi dan khdng nim dupe cic thdng tin \e dich \ai ma Nhi nudc cung cip, khdng hieu thiu dio nhirng cich thurc va didu kien sir dung cua chiing nen hp khdng den dupc vdi cac dich vu nay, hoac khdng tiep can dupc hoin toan, khdng dat dupc hieu qua nhu da dd Mot sd giai phap nang cao kha nang tiep can djch vu giao due, y te ciia dong bao dan toe thieu sd a nudc ta hien Mot Id, tuyen truydn, phd bien, quan triet quan diem ciia Dang vd phat trien giao due, y te cho ddng bao DTTS Day dupc coi la giai phip cd tinh quan trpng bac nhat, bdi vi, nhirng quan diem da va dang dupc thd ehe hoa thinh nhung chfnh sich, quy djnh phap luat dd di vao thuc tidn cudc sdng, cd tic dung tfch cue viec nang cao ddi sdng kinh td- xa hdi cho ba Quin triet sau sic nhiing quan didm niy giiip di diing djnh hudng phit tridn, budng tdi mue tieu ehung ciia TAP CHi QUAN LY NHA NUdc - S6 159 (4-2009) (5) NGHIEN Cll/U - TRAO OOI SU phat trien qud'c gia cung nhu sir phat tridn rieng cho ddi tupng ddng bao DTTS Diy manh cdng tic tuyen truydn, phd bidn, cung cip thdng tin vd djch vu giao due y te cho ddng bao DTTS Nang cao nhan thiic ciia ddng bao DTTS de bp cd sir hieu biet diing din, kjp thai va thiet thuc vd cdng tic giao due, y te, giiip hp chii ddng \ a tfch cue viec tidp can nhung djch vu giio due, y te cin thiet Tang cudng trang thiet bj cho cdng tic truydn thdng, da dang hoi cic binh tbiic tuyen truydn, md rdng cic kenh thdng tin bing tieng ciia cic DTTS, tien hanh thudng xuyen, lien tuc, sau rdng va thiet thuc Hai Id, ddi mdi he thdng chfnh sach, phip luat ddi vdi ddng bao DTTS d nudc ta cho phu hop trudc yeu eiu thuc tidn theo hudng be thdng boi, soit lai, sira ddi, bd sung ciing nhu ban binh mdi cac chinh sach, van bin phap luat nhim hd trp, khuyen khfch, tao didu kien cho ddng bao DTTS tu chii xay dung cudc sdng ciia minh Cic chfnh sach thay vi trp giiip theo kieu "bao cip" cin dupe thay ddi de hudng tdi mue tieu nang cao nang lire cho ngudi dan, bao gdm nang luc ve nhan tbiic (nang cao bieu biet) va nang lire vd tai chinh (tang thu nhap dd diu tu cho giio due, y td) Ba Id, nang cao tidm luc kinh td- tai chfnb cho hoat ddng giio due, y td vting DTTS tu phfa cic co sd cung ung lin ngudi sir dung djch vu, bao gdm chuyen djch ca eiu kinh td, xda ddi giam ngheo, diu tu vao CO sd tang, trang thiet bj, tang cudng diu tu tii chfnh, giai quyet viec lam, tang thu nhap cho ngudi dan \ a can bd nganh giio due y te Bdn Id, nang cao chat lupng cin bp nginh Giio due, y te midn niii (ca can bd quan ly va chuyen mdn), cu the la nang cao trinh dp chu\ en mdn, dao diic va tinh thin trach nhicm Di hp gin bd vdi cdng viec va dja ban cdng tac, cin cd khung phap ly cho \ ice dao tao, bdi dudng xay dung quy hoach kc hoach dao tao cu TAP CHI Q U A N LY N H A N U C - SO 159 (4-2009) the da dang boa cac binh thirc dao tao bdi dudng cho hieu qui xa phti hpp gin \di viec day tieng DTTS de hp chii ddng cdng viec Dae biet phii xay dung chinh sach, ehe dp dai ngd lipp ly Chii trpng khai thic va sir dung ngudn nhan luc tai ehd, bao gdm ngudn nhan luc dja phuang cung nhu lire lupng quan dpi ddng quan tren dja ban Day la lire lupng chinh va cd nhirng tac ddng tfch cue, true tiep den viec tidp can djch \'u giao due, \ te ciia ddng bao DTTS Chfnh \'i the khai thic va sir dung ngudn nhan luc tai ehd dupc coi la hudng di dung din va hpp ly Ndm Id, xa hdi hda boat ddng cung cap djch vu giao due, y techo ddng bao DTTS Ben canh viec ciing cd vai trd chinh va chii yeu ciia Nha nudc quan ly \a cung irng djch vu thi phai cd cac chinh sach thu but, khuyen khfch cac ngudn lire ttr ben ngoai cdng tac niy nhim tang them ngudn lire, giam bdt ganh nang cho ngan sach nha nudc Sdu Id, tang cudng cdng tac tra kiem tra dd vira bao dam boat ddng ticp can djch vu giao due, y te ciia ddng bao DTTS di diing budng, dat bieu qua va mue tieu da de vtra kjp thdi phat hien nhung vin dd phat sinh nhim dd bien phap xir ly thich hpp Ben canh viec xir ly nghiem nhirng sai pham tieu cue thi cung cin tuyen duong, khen thudng nhOng ca nhan xuit sic, nhan rdng nhirng md hinh tien tien Tai lieu tham khao: - Bo Giao due va Dao tao (thang 4-2008;: Bdo cdo ve tinh hinh gido due ddn roc lucii vd phuang liudng phdt trien den ndm 2020 Hoi nghj Giao due dan toe toan qude - Bo Giao due \a Dao tao (4-2008) Bao eao tham luan (Hpi nghj Giao due dan toe loan qude) - Nguon: Tdng eue Thong ke - Dang Qude Viet (Trung tam Truyen thong gicio due sii'e khoe- Bo Y le): Gidi phdp ndng cao chdt luang cdng tdc clidin sdc si(c khoe ddng l?do cdc ddn tdc it ni>Udi Tap ehi l.v luan chfnh tri sd 12-2004 47 (6)