1 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 MEASURES Speciality: Social Hygiene and Health Management Code: 62 72 01 64 SUMMARY OF PhD THESIS HA NOI - 2012 2 Thesis implemented: - Department of National Traditional Medicine and Pharmacy - Friendship Hospital; - National Institute of Hygien and Epidemiology Supervisors: 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 3 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. 4 ABBRIVIATION TMP Traditional Medicine and Pharmacy HS Health Staff TMPS Traditional Medicine and Pharmacy Speciality SB State Budget 5 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. 6 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 3.1. Science meaning: By using statistical software SPSS 10, the continous training need in traditional medicine for health staff at provincial hospitals is big and necessary. The distribution of traditional health and pharmacy staff is not equal and relevant for all areas. In many provinces, there is no staff at professor/associate professor and PhD level. 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 - District: Health C - Sở Y tế; • Traditional hospitals: 59 - Central: 3 - Provincial: 53 - 3 hospitals from militery and police sector 7 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. 8 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. 2.1.4.2. Saple size - Traditional medicine physicians: each hospital: 10 persons: 10 x 54 hosptals= 540 - Traditional medicine assistant physicians and nurses each hospital: 10 persons: 10 x 54 hospitals= 540. - 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 9 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. 10 2.2.4. Methodology 2.2.4.1. Design: Figure 2.1. Intervention study chart 2.2.4.2. Sample size and sampling [] 2 21 2 22111 2/1 2 21 )( )1()1()1(2 PP PPPPZPPZ nn − −+−+− == − − β α Where: n 1 : Sample size before intervention n 2 : Sample size after intervention Z (1-∝/2) : Confidence 95% (=1,96) Z (1-β) : Power (=80%) p 1 : % of staff who have knowledge and skill in traditional medicine before intervention (p = 30%). P 2: % of staff who have knowledge and skill in traditional medicine before intervention (p = 70%). P: (p 1 +p 2 )/2 n 1 = n 2 = 30 staff. With Design effecf = 2. Thus, 60 staff interveiwed. 2.2.4.3. Intervention principle - Content of training focused on improving knowledge and skill in traditional medicine - Easy to carry out in hospital. 2.2.4.4. Content of intervention * Content of training: - 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 need in updating knowledge for physicians is high, contents of the training need are traditional medicines, improving skill of diagnosis and treatment - The training need in updating knowledge for pharmacists is high, contents of the training need are distinghuish and producing some traditional medicines 3 Effects of intervention of training 26 - After training, knowledge of staff in recognition and. .. other side, trained staff need to be updated new infromation and technologies This prove the continuous training need for staff at provincial hospitals 4.2.1.2 Contents of the continuous training needs + For traditional medicine physicians: contents of the training are knowledge and skills in diagnosis (31.8%); treatment (42.4%) 25 + For pharmacist: training need in knowledge in traditional medicines... 4.2 CONTINUOUS TRAINING NEED FOR STAFF IN PROVINCIAL TRADITIONAL HOSPITALS 4.2.1 Continuous tarining need for traditional medicine staff in provincial hospitals 4.2.1.1 Continuous training In the last 5 years, there is a big part of traditional medicine staff trained continuously However, there is a big number of staff without re -training to improve thier professional (64.2%) In other side, trained staff. .. knowledge of traditional medicine 440 47.6 n = 925 There was 27.4% of staff who need to be updated in diagnosis of traditional 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 Contents Number Distinguish some traditional medicines 242 Producing some traditional. .. graduated staff at central hospital is higher than that in provincial traditional medicine There is only 9 professors and associate professors at all traditional medicine hospitals working at central hospitals In the whole traditional hospitals there are only 27 PhD, in which there are 6 PhD working at provincial traditional medicine hospitals It shows that there is a big different qualified staff. .. medicne hospital, there is no profesor and associate professor in specialised traditional medicine and PhD There is i small number of them work in the region I (0.3%) Percentage of university physician is high and rather equal and appropriate In all region, there is a big proportion of staff with university, secondary and primary llevels 2 Continuous training need for traditional medicine staff - The training. .. post graduated levels working in the provincial traditional medicine hospitals It is shown that there is a lack of of them ta provincial tarditional medicne hospitals According to decision 03/2004/TT – BYT dated 03/03/2004 of the Minister of Health in the classification of the hospital, percentage of post graduated staff needs to be increased to strengthen quality of the hospitals Percentage of the post... Effect evaluation after one year was carried out by using effect index: (EI): EI (%) = p 2 − p1 x 100 p1 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... received the continuous traning Table 3.9 Training need for staff in future Contents Staff received continuous training Staff did not receive continuous training Staff received continuous training in the last 5 years Staff did not receive continuous training in the last 5 years Number 440 788 % 35.8 64.2 194 43.2 255 56.8 In the last 5 years, there were 56.8% staff who were not receive any continuous training. .. one year of intervention, the effect of producing some traditional medicines increased significantly with high effect index (966%), good (52.6%) CHAPTER 4 DISCUSSION 4.1 DISTRIBUTION OF HEALTH STAFF IN PROVINCIAL TRADITIONAL MEDICINE HOSPITALS BY REGIONS 4.1.1 Distribution of traditional medicine staff by hospital level Currently, there is only 0.03% professor and associate professor and 8.02% staff with . who need to be updated in diagnosis of traditional 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. 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. staff at provincial hospitals is big and necessary. The distribution of traditional health and pharmacy staff is not equal and relevant for all areas. In many provinces, there is no staff at