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Nghiên cứu mô tả cắt ngang kết hợp định lượng, định tính về thực trạng và nhu cầu nguồn nhân lực bác sỹ trong hệ thống y tế dự phòng tại các tỉnh miền Trung và Tây Nguyên Việt Nam năm 2013. Tác giả: Võ Văn Thắng, Lê Đình Dương, Đoàn Vương Diễm Khánh, Hoàng Đình Huề, Nguyễn Hoàng Thùy Linh, Hoàng Đình Tuyên, Trần Bình Thắng. Hội nghị khoa học quận Thủ Đức, thành phố Hồ Chí Minh. Y học thực hành (880).
THU'C TRANG vA NHU cAu NGUON NHAN LU'C BAc st TRONG 'HE THONG V Tt: DU' PHONG TAl cAc TfNH MIEN TRUNG , vA TAv NGUYEN VII;T NAM NAM 2013 VQ VAN THANG, LE DiNH DU'O'NG, DoAN VU'O'NG DIEM KHANH, HOANG DiNH HUE, NGUYEN HOANG THUY LlNH HOANG DiNH TUYEN, TRAN BiNH THANG TrU'iYng fJ{Ji h9C Y DU'C)'c Hue TOM TAT Ml,lc tieu: Nghitm cou mo ta tnuc trgng nguon nMn 1l)'C,cac nang lire va k9 nang can thiet cue cac bac s9 lam viec trong h~ thang y te dl)' phOng va nhu ceu tuyim dl,mg, cIao teo nguon nMn 1l)'Cnay tet khu V(J'c mi~n Trung va Tay Nguyen, Vi~t Nam. PhU'O'ngphap nghien CLPu:Sif dl,mg phU'ong pheo nghien cuu ket hop. Nghien cou ajnh 1U'Q'ng auoc thl,fChi~n tren 423 bsc s9 (76,8%). Bo ceu no! tir ai~n aU'Q'csif dl,mg ae thu tMp cac thOng tin v~ a~c cIi~mdan toc hoc, tinh trgng cong viec va cac k9 nang lam viec. Nghien cou dinh tinh aU'Q'ctien bent: tren 27 bac s9(3 phOng van seu va 3 tMo lu~n nh6m). Ket qua: Do tu6i trung binh cue aai tU'Q'ngnghien cou 46,6 ± 6,5; sa nam lam viec trung binh la 13,26 ± 8,39;namchiem 69,7%), nCf: 30,3%. Nhi~m VI,I va cong viec chfnh cue cac bee s9 chu yeu la quen 19va giam sat chung (59,8%); cong tee chuyen mon dl)' phong (20,1%); aieu trj (19,4%); quen 19cae cturonq trinh, df,J'an y te (11,8%); I~p ke hoect: chi agO tuyen (10,4%); t6ng hQ'p va beo cao (6,1%). C6 Sl)' thieu h1,ltcIangke nguon nMn 1l)'Cbee s9 lam viec trong M thang y te dl)' phong a tat ca 6 tinh;chi c6 17,7% (9/51)cIonvi tuyen tinh c6 au ajnh moc bien cM bee s9 theo quy dint: Khao sat tren 182 k9 nang chia thBnh 2 nh6m nang 1l)'C: nh6m nang lire chung (9 nh6m vo! 98 k9 nang), nh6m nang lire CI,I tM (11 nh6m voi 84 k9 nang). Tan suat sif dl,lng thU'ong xuyen cac nh6m nang II,fCchung la49,6%; nh6m nang 1l)'CCI,I the la 38,2%. Ket lu~n: C6 sir thitJu hut aang ke nguon nMn lire Mc s9 lam viec trong M tMng y ttJ dl)' phOng tel khu VI,fCmi~n Trung va Tay Nguyen. Nghien cou cho tMy can thitJt tang cU'ong aao teo va aao teo Igi cho h~ th6ng y te dl)' phOng te! khu VI)'C nay. TIPkh6a: Nguon nnen 1l)'C,M thang y te dl)' phOng, bee s9, nang lire, k9 nang. SUMMARY Objectives: This study describes the real situation of human resource and needs of recruiting doctors workingin the preventive medicine system in central and highland areas of Vietnam. Methodology: The study used a mixed method approach. A total of 423 doctors (response rate=76,8%)participated in the quanlitative survey, of which provincial levels occupied 64.8% and district levels were 35.2%. A self-administered questionnaire was used to collect information about demographic characteristics,job conditions and technical competencies. 27 doctors participated in in-depth qualitative interviewsand focus group discussions. Results: The average age of the doctors was 46.6 years (s.d=6.5) and the majority (69.7%) 'were male. On average, they had worked in this role for 13.3 years (s.d.=8.4). The main roles of the doctors included program management and staff supervision (59.8%), duties! major of preventive medicine (20.1%), managing treatment services (19.4%), and medication management (11.8%). Further tasks includedmaking plans and guidelines for disease control (10.4%), data analysis and report writing (6.1%). In-depthinterviews revealed a lack of doctors in preventive medicine systems in all six provinces. Only 17.7% (9/51) provincial units had enough doctors to meet service requirement.· The survey identified a total of 182 skills. These were grouped within "general competencies" (9 groups with 98 skills) and 'specificcompetencies" (11 groups with 84 skills). However, less than half of the doctors reported using thegeneral and specific competencies (49.6% and 38.2% respectively). Conclusion: There was a serious shortage of human resources for preventive medicine in the central highlandareas of Vietnam. There should be increased recruitment. The findings of this study also will be used to enhance professional training for preventive medicine at pre-service and in-service levels. Keywords (3-5): Human resource, preventive medicine system, doctor, competency, skill YHTH(880)- HOI NGH! KHOA HQC B~NH VI~N QUAN THO one TP. H6 CHf MINH 9 I.DATVAND~ Y t~'dl,J'phOng la cau noi gili'a y hoc va y t~ cong cOng. Trong khi y hoc quan tam d~n chan dean va d tri benh cho mot benh nhan thi y t~ cong cong quan tam nhieu hon d~n phOng benh va nanq cao SLYCkt cho cong dong. Theo bao cao cua WHO - 2006, tinh tranq thi~u hut nquon nhan tuc y t~ dang ton tal a quoc gia, th~ gi6'i dang thieu khoanq 4,2 trieu nhan vien y t~. U'6'c tinh tai khu Vl,J'CDong - Nam A co 50% cac quoc gia thieu can bo y t~ voi so ILI'Q'nghon 1 trieu nhan vien y t~ [5]. Theo So Y t~, ViEiltN dLl'Q'cxep vao nuoc nhli'ng nuoc co ty IEilnhan vien y t~ cao (> 5 bac 59 tren 10.000). Tuy nhien, ngl nhan Il,J'C X t~ ViEiltNam lai p~an ~o mat can doi gili'a c~c ~ung, mien, gili'a cac chuyen nganh[1]. DOi.r can bo y te dl,J'phonq vua thieu ve so ILI'Q'ngvua han che ve trinh do chuyen men, so ILI'Q'ngcan bo y te phonq tai cac tuyen tlnh co trlnh do DH va SDH chiern ty IEilchua t6'i 50%. Hau het bac 59 dang lam v trong hEilthong y t~ dl,J'phonq hien nay la bac 59 da khoa khong duoc dao t<;10chlnh quy ve linh Vl,J'Cy t~ phong rna chu y~u qua mot so kh6a dao t<;10ng~n han, cac lop tap huan va kinh nghiEilm lam viec cua t than. HEilthong Y t~ dl,J'phonq tai cac tlnh Mien Trung va Tay Nguyen cOng dang a trong tinh tr<;1ngchi cua hEilthong y t~ dl,J'phong ca nuoc, Muc tieu nghien CLYUcua de tai nharn: 1. Tim hifJu tturc trenq ngu6n nhen IIIC bee s9 clang lam viec trong M th6ng y ttJ dll phOng tei J V(.fCmien Trung va Tay Nguyen. 2. Mo ta cong viec, nang IIIC va k9 nang c~n thiM cue cac bee s9 hi~n clang lam viec trong M the y ttJdll phOng 3. Tim hifJu nhu c8U clao t<;30va tuyfJn dl,Jnflcl6i voi bee s9 trong ITnhvue y ttJdll phOng t<;3ikhu V(.J'I II. D01 TU'Q'NG vA PHU'O'NG PHAp NGHIEN cuu Thi~t k~ nqhien CLYUrno ta cat ngang. Sli dunq phuonq phap nqhien CLYUk~t hop gili'a dinh ILI'Q'ng dinh tlnh. PhLl'O'ngphap nqhien CLYUdinh ILI'Q'ng:Sli dunq thang do danh gia cac nanq luc va ky nang BS YT voi bo cau hoi tl,J'dien d~ thu thap so liEiludua tren 10 nh6m nang luc chung va 10 nh6m nang luc CI,Jthe thi~u cua 1 bac s9 YTDP ViEiltNam duoc phat trien trong nqhien CLYUnhu cau dao t<;10bac s9 y hoc phOng tal cac trLl'cmg dal hoc Y ViEiltNam cua Dl,J'an Nuffic narn 2008 [3]. Mot bac si dLl'Q'cdanh gia la dl,Jngthuonq xuyen mot nh6m nang hrc khi co sli dunq it nhat 50% so nang hrc trong nh6m nang luc al rmrc dO thLl'ong xuyen tra len. Nqhien CLYUtham do d~ hieu chlnh bOcong CI,Jduoc thuc hien tal trung tal t~ dl,J'phonq thanh pho Hu~ va tham van cua cac chuyen gia, ngLl'oi quan Iy trong hEilthong y t~ dl,J'pho Nghien CLYUdLl'Q'ctien hanh tal 6 tlnh: Quang Sinh, Quang Tri, ThCYaThien Hu~, Quang Ngai, Sinh Dinh Daklak voi 116 don vi tham gia nqhien cuu (tuyen tlnh 51, huyen 65); Chon mau toan bo co t6ng cong ~ bac s9 tham gia nqhien cuu ty IEilla76,8% (tuyen tinh la 64,8%, tuyen huyen/thanh pho 35,2%). Nghien cuu dinh tinh duoc thuc hien tal 3 tinh: ThCYaThien Hue, Quang Ngai va Daklak co t6ng c~ 27 bac s9 tham ,gia ,(3 p'h6ng v_ansau lanh dao va 3 thao luan nh6m). III. Kt::T QUA VA BAN LUAN 1. Th,!c tr~ng ngu6n n'han I,!c bac si dang lam vi~c trong h~ thong y t~ d,! phonq tal 6 ti mi~n Trung va Tay Nguyen (s6 lieu beo cao cue cec sa y ttJ 1212012) Tu ~n tinh Tuyen huyen ~~~~~ 4S0 4001 ,· 3S0 3M 2S0 2M 150 100 50 o Quang QlI<ing IT Hue QU4ng einh {)ilk Sinh Tri Ngai Ojnh Uk 4S0 400 350 300 2.50 lO{) lS0 100 50 {) euo (fo 1: Phan bo so lU'9'ng CBYT va BS lam vi~c t~i cae tuytm YTDP 100% cac tlnh co ty IEilbac s9 1 CSYT a tuyen tlnh cao non so voi tuyen huyen. 4/6 tlnh co ty IEil bac lam viec tal tuyen tlnh cao hon so v6'i tuyen huyen d~c biet ty IEilnay tal TT-Hu~ la 3,6/1 10 YHTH (880) - HOI NGH! KHOA HQC B~NH VI~N QUAN THO BaC TP. H6 CHIMil Bang 1: Thuc tranq ngubn nhan Il,I'cy te hien nay Stt Dan vi Can bo v te Bac s- 1. Tuven tinh So tinh thieu TVI~% So tinh th~u TVI~% 2. TTYTDP tinh 2/6 33,3 4/6 66,7 3. Chi Cl,lcVSAITP (-) (-) (- ) (-) 4. IT PC benh xii hoi 1/3 33,3 2/3 66,7 5. IT PC HIV/AIDS 5/6 83,3 4/6 66,7 6. ITCS-SKSS 2/6 33,3 5/6 83,3 7. Chi CI,ICDS-KHHGD (-) (-) (-) (-) 8. TT Truven thonQ GDSK 2/6 33,3 6/6 100 9. TT PC Sot ret noi tiet- CT 2/5 40,0 4/5 80,0 10. TT Kiem dich quoc te 1/1 100,0 1/1 100,0 11. TT Da lieu (-) (-) (- ) (-) 12 Tuven huven 2/6 33,3 5/6 83,3 (-): Cac don vi khOng c6 dinh moc bien cha theo Thong tir 08 Tat ca cac tinh tham gia nghie!n CLPUd~u thieu nhan Il,I'c & cac don vi true thuoc.chl c6 17,7% (9/51) don vi tuyen tinh c6 du dinh rmrc bien che bac sy theo quy dinh; trong d6 cu thll tlnh tranq thieu BS & cac don vi nhu' :TTGDSK (6/6); TTCSSKSS (5/6); TTYTDP tlnh, HIV/AIDS, PCSRNT (4/6). Ket qua tli nqhien CLPU dinh tlnh cOng cho thay c6 su thieu hut ro ret ngubn nhan Il,I'cCBYT va bac si lam viec trong h$ thong YHDP & hau het cac don vi tham gia nqhien CLPU: "Ttwc tr<;lngngu6n nhan tuc bee s9 n6i chung, bee SI YTOP n6i rieng thiau rc1tnhieu so vo! nhu c8U. vd: chi Cl)C v~ sinh A TTP chi c6 1 bee s9, chi Cl)C ka boect: h6a gia dinh cb! c6 1 as, can cac trung tam kMc chi c6 2-3 as Trung tam y ta Tay Tre, vue lam a mang dieu tri vue lam a mang dl! phong chi c6 3 as' (PVS-QN). "so vai nhu c~u tnuc ta a tren, tinh thiau khoang 30% as cho h~ dl! phong. C6 nhCmg huy~n can hon nhung em tinh trung binh la khoang 40%" (PVS-DL) . • 2. Cong vi~c, nang IIfC va ky nang celn thi~t cua cac bac 5y hi~n dang lam vi~c trong h~ thong y tf! dlf phong 100 90 80 70 60 50 40 30 20 10 o • Tuyen huy~n - • Tuyen tinh Quang Sinh Quang Tri Thira Thien Hu~ Quang Ngai Sinh Dinh Dak lak Bieu do 2: Phan bo not cong tsc cua bac sy YTDP theo tuyen cham see Phong van tren 423 bac sy dang lam viec trong h$ thong y te dl,l' phOng cho thay dO tuoi trung blnh cua cac doi tU'Q'ngnghien CLPU46,6 ± 6,5; so narn lam viec trung blnh 11313,26 ± 8,39; Nhiern VI,J va cang viec chfnh cua cac bac sy chu yeu 113quan 19va giam sat chung (59,8%); cang tac chuyen man dl,l' phonq (20,1 %); di~u tri (19,4%); quan 19cac chuonq trlnh, dl,l' an y te (11,8%); lap ke hoachchi dao tuyen (10,4%); tong hop va bao cao (6,1%). Nghiencuu ky nang bac sy dua tren 2 nh6m nang Il,I'Cchfnh 113nh6m nang Il,I'cchung (9 nh6m), nh6m ni:lngIl,I'c CI,J the (11 nang luc); tong cong c6 182 ky nang. Nghien CLPUtan suat Slf dl,lng cac nh6m nang Il,I'ccho thay: ty 1$SLYdl,lng thU'ang xuyen nh6m nang Il,I'c chung 11349,6%; nh6m nang Il,I'c Cl,l thll 113 38,2%va c6 Sl,I'khac nhau gilia tuyen tinh va huyen (p < 0,01). YHTH(880) - HOI NGH! KHOA HQC B~NH VI~N QUAN THO one TP. H6 CHr MINH 11 100 90 80 70 60 50 40 30 20 10 o Ho~t~vi. Oi&odl,l<t:u~ ch~t.dnhy thongvi.ning ti quoc ~a cao.u.: kh"e Quanlyvi.t3 chu.:yti Chlnh .achvi. lu~tyti N!!PiencUu Cangvi~clrong khoa hoe ph/mglhl n!!Pi~m .TYl~ % SD NL tlnrongxuyen ill TYl?Al danh gia dn tlll~t BitJU do 3: Phan bo tan suat va m{PC;de) can thiet cue nh6m nang It,J'cchung 100 90 80 70 60 50 40 30 20 10 o Ve chat Iuvng nguon nhen ./t,J'C:Phan lon cac don vi dap ling dU'Q'c yeu cau nhiern VI,! ve YTDP dU'Q'c giao. Tuy. v$y, nang luc heat dong, chat. 1U'Q'ngva hieu qua conq viec chua cao, con b] dong trong cong taco "Dap (mg hi~n nay theo muc a(> no! chung la, n~u me chia theo mire a(> thi cOng la trung binh hay gQi la aap Ifng tioen thent: nhiem VI) thOi, moc hoen tnenh nhi~m VI) ctur cture th~ not la t6t bon duoc mfa chi moi a<;ltaU'Q'c mire t6i thi~u cho la tioen thenh nhiem VI) cnir cnue auoc non mfa Kinh phi khOng co, ngu6n nnen iuc khOng au thi co lam theo ki~u aoi co diet: atJn la ta ch6ng, khong a~cno d;ch Ian xay ra. chUng ta moi chi lam atJn aU'Q'cmoc a(> khi co diet: atJn thi chung ta kMng chtJ va d{)p t~t duoc n6."(PVS-EJL) "Nang tuc cong tee mang YTOP a mire trung binh Du thl)'c hi~n va hoen tnent: nhiem VI), tuy nhien kha nang a~aap Ifng kh6i 1U'Q'ngcong viec Quan Iy An toan va Sirekhoe Dinh dirong Sirekhoe Sirekhoe Nhan khAuDich tS hoe Th&ngke Nhan hoe nang life h6 tham hoa va sire khoe m6i tnrong va an roan cac liratubi hoe duong hoe va kiem sinh hoc/he va y xiihOi tro phong nghSnghiep thtrc pham va sirekhoe soat benh thong thong hoe chong sinh san t~t tiny tS tlurong tieh Bieu do 4: Phan bo tan suat va m{PC;de) can thiet cae nh6m nang It,J'CC(.l the trong tinh hinh b~nh diet: pturc t<;lPhi~n nay thitJu nhieu.(TLN-QN). Mot so can bo chua yen tam conq tac va con tU'cYng chu quan, thieu y thirc hoc hai, cau "nnin chung noet a(>ng r~t t6t ntumq co 1 86 ng khOng an tam voi cong viec cur phOng, c6 ngU'oi aa chuy~n sang M aieu tri. "(PVS-QN) "Vi va ctiem va eo Il)'c a cong tee YTDP kh nhieu nen nhieu as ctiu quan, it muon hQc nang cao trinh a(> a6i vo! cong tee YTDP" (~ QN) '3. Nhu c&u dao tao va tuy~n dl,lng nhan y t~ dlf phong tilli cac tinh Nghien cuu cho thay nhu cau tuyen dl,mgn luc can bo y te, d~c blet la nhan Il,I'C bac si viec cho h$ thong y hoc dl,l' phonq 113rat Ian a ca 6 tlnh. 95,5% cac don vi y te dl,l' phong c6 cau tuyen dunq tCr 1 - 12 bac sy (trung binh bac sy/dO'n vi). Phang van sau mot lanh dao 12 YHTH (880) - HOI NGH! KHOA HOC B~NH VI~N QUAN THO BaC TP. H6 CHIM H PHU HO'PGILYADAo TAO vA KHA NANG DAp lrNG CONG VIEC CUA SINH VIEN TOT NGHIEP CHUYEN NGANH . ., A ~ A _ ~ CU' NHANY TE CONG CONG TRU'O'NG DAI HOC Y DU'O'C HUE . VQ VAN THANG, NGUYEN MINH TAM Khoa Y te Cong c9n9, T!U'iYng D~i h9C Y DlJ'9'C Hue TRAN BINH THANG Trung tam Nghien CLPU S(PC khoe c9n9 dong, TrU'iYng D~i h9C Y DlJ'9'C Hue MICHAEL P DUNNE TrU'iYng Y te Cong c9n9, D~i h9C Cong ngh~ Queensland, Uc TAT c tieu: M6 ta noi lam viec cue sinh vien Y te Cong cong (YTCC) sau khi t6t nghi~p, nhCmg cong C(I tM dang aam nh~n, tint: phu hop cue noi dung aao teo vo! kha nfmg dap (fng cong viec hi~n tei dlnMn Yte Gong cong (GN YTCC) da t6t nghi~p cDng ntur xac dinh cac nang lire dap (fng t6t trong V$c hi~nt9i. PhU'O'ng philp: Thiet ktJ nghi{m cou c~t ngang, ket hOp nghi{m cou dinh ILfO'ng va dinh d6itllr;mgla GN YTCC da t6t nghi~p tei TrLflyng f)H Y DLfO'CHue dang lam viec tren toen qu6c va Inh c1~0 cac don vi tuyen dl,mg tlf thang 4/2012 den 1/2013. Ket qua: Noi cong tee chu yeu cue CI,J'U ~n la M y te dl)' phOng (60,9%), 9,1% 6' M dieu tri. Cec mon hoc phu hO'Pvoi nhCmg yeu ceu trong ~ cua no (ap dl,mg dLfO'ctrong cong viec tren 70%) ntur: quen 19 y te, chinh sect: y te va kinh te y "i~n ctiu khoa hoc; diet: te hoc va th6ng ke. Co m6i lien quan co 9 nghTa th6ng ke giCl'a chLfong daot~ovai muc 00 ep dl,mg trong cong viec. Hau het cac CN YTCC deu tir tin trong cong viec hang chi~mty I~ tren 80%, d~c bi~t ur tin d6i voi cac nhom nang luc ve quen 19 YTCC, nghien cuu - lam nh6m/giao tiuc truyen thOng. Tuy nbien, gan 50% 'CI,J'Usinh vien cho ding chuonq trinh dao t90 cture nMt nhieu voi tiurc tien, con n~ng ve 19thuyet bon tturc hanh. Ket lu~n: Pben b6 noi lam viec cue sinhvif:ntren ca 3 mien cue Vi~t Nam, xa hoi co nhu ceu tuyen dl)ng CN YTCC cao, m~c du, mot s6 VI tuydndl)ng van cture hieu ra vai tro va cnoc nang ciie CN. YTCC. Noi cong tee cM ytJu la h~ Y te phOng,co sa aao t90 va b~nh vien. Cec nhom nang tuc chinh lien quan den cong viec hi~n tei la ouen yM. nghif:ncuu khoa hoc - lam viec nh6m/ giao tiuc truyen thong ve cac ITnh vue y te cong congo Tilkh6a: Cif nMn y ttJcong cong, CI,J'Usinh vien, chLfong trinh dao t 9 0, nang lire UMMARY Correspondence between training and the functions performed at work by Bachelor of Public graduates from Hue University of Medicine and Pharmacy, Vietnam Objectives: The study objective is to identify the distribution of Bachelor of Public Health (BPH) atesin the health care system and their job. descriptions, to assess the relevance and adequacy of know/edgeand skills acquired during the BPH program and to identify the relative importance of a of public health competencies performed by alumni in their present work. Methods: This cross- al study was conducted with public health alumni (121) and leaders between April 2012 and ary 2013 and used a combination of quantitative and qualitative data collection methods. Results: "I BPHgraduates work in Preventive Medicine Centers (60.9%) and the clinical field (9.1%). The ntsubjectsof the BPH program that applied to their job (70%) include: Health management, health and health economics; scientific methods in public health; epidemiology and Biostatistics. Most ni agreed that the BPH curriculum corresponded with the working requirements of public health ionals. Many BPH alumni reported feeling confident performing competencies in normal work es (80%), especially in public health management, scientific research, health education and ork.However, nearly 50% of participants reported that the curriculum of the program has not been tedandplaces too much emphasis on academic theory and lacks field practice sufficient to achieve leaming.Conclusion: Hue University BPH alumni are distributed across the 3 regions in Vietnam. tal needs have increased recruitment for BPH graduates, but some health agencies still lack rstandingof the role and functions of BPH. The competencies most strongly related to their current am in public health service management, scientific research, health promotion/education and workskills. Keywords:Bachelor of Public Health, alumni, curriculum, competencies (880)·HOINGH! KHOA HOC B~NH VI~N QU~N THO one TP. 86 CHf MINH 51 I. DAT VAN Dt: He thong Y te Cong cong (YTCC) dang van hanh trong boi canh rna nhieu bien dong xay ra lien tuc, gay nhieu ap hrc len he thong y te [3]. Tren T<;Ipchi Lancet, Robert Seaglehole da phan tlch ro nhCmg su thay doi nay bao gom do 113Sl,l' thay doi nhanh chong ve tinh hinh sue kh6e tren toan cau von da phuc tap nay lai dang dien ra trong boi canh ma Il,I'c1U'Q'ngcan bo y te cong cong chua san sang de dU'O'ng dau vot nhCrng thli thach do. Sl,I' chua s~n sang nay phan nao 113do cac thli thach do ton va phuc tap, do luc 1U'Q'ngcan bo va ha tang co sa cua nqanh y te cong cong da b] lang' quen, va do con thieu cac chuonq trinh dao tao chuyen sau ve linh vue nay. vfln de canq tram tronq hon bai viec tap trung kinh phi cho cac nqhien cuu y sinh hoc va su khonq thanh cong khi giai quyet va lam viec voi cac van de can quan tam co lien quan den sue khoe, va dieu nay duy trl va thuc day phat trien nhCrng rno hinh hanh vi co hc;li cho sue kh6e va mat conq b~ng trong y te. Mot van de gop phan lam han che nhCrng chuc nang cua nhCrng ngU'oi dang cong tac trong linh vue Y te thi nhCrng can bo ve YTCC thU'ong chua duo'c xem trong trong linh vue ho phu trach bai he thong dieu tri luon dU'Q'Cde cao trong he thong y te. f)e lam dU'Q'c dieu nay, tam nhin ve y te cong cong khOng chi dU'Q'c truyen ba den nhCrng ngU'oi lam cong tac y te conq cong ma can pho bien cho cong dong nhCrng ngU'oi hoach dinh chinh sach, do 113 nhCrng ngU'oi rna hanh dong cua ho 113yeu to thiet yeu de cai thien sue kh6e cho cong chunq. f)lrng truoc nhCrng thach thuc va co hoi trong linh vue Y te Cong cong, chunq toi tien hanh khao sat cac cong viec, nhCrng nhom nang Il,I'Cva ky nang cua cac Cli nhan YTCC dang phu trach. Muc dich cua nqhien ctru nharn xac dinh ro hon ve chuc nang cua Cli nhan YTCC va ra soat lai chtronq trinh dao tao cua doi tU'Q'ng nay nharn co nhCrng dieu chinh thich hop trong boi canh co nhieu thach thtrc doi voi linh vue YTCC. Khoa YTCC cua trU'ong f)H Y DU'Q'CHue 113co sa dao tao cung cap chuonq trinh dao tao va thuc hien cac nqhien cuu cOng nhu pho bien cac chinh sach ve YTCC, v&i nhiem VI,Ichinh 113dao t<;lOnhan vien y te cho khu Vl,l'Cmien Trung va Tay Nguyen cua Viet Nam. Vao nam 2005, theo Sl,l'chi d<;locua So Y te, Truong da b~t dau dao t<;lOchuyen nganh Cli nhan YTCC (h$ chinh quy hoc 4 nam). Vao nam 2012, co 3 khoa sinh vien da tot nghi$p v&i tong cong 136 CN YTCC tot nghiep. Ml,lc tieu nghien Clru: 1. Mo ta nO'i lam vi$c cua sinh vien YTCC sau khi tot nghiep va nhCrng cong viec CI,I the ma hO dang dam nh$n; 2. Mo ta tinh phu hQ'p cua noi dung dao t<;lOv&i kha nang dap lrng cong viec hien t<;licua CN YTCC da tot nghiep; 3. Xac dinh cac nang Il,I'cdap lrng tot trong cong tal cua CN YTCC da.tot nghiep , II. PHU'O'NG PHAP NGHIEN CU'U 1. Thi~t k~ nghien cu>u Thiet ke nqhien cuu ket hop dong thai ap dunq, va day 113kieu thiet ke trong do dlnh 1U'Q'ngva dinh tlnh duoc thu th$p so phan tlch rieng sau do dU'Q'c tlch hQ'p, nghien cuu nay, nqhien cuu dinh 1U'Q'ng dU'Q'cthiet ke thu thap de rno ta tinh phil chuonq trinh hoc va lrng dunq trong cO rno ta cac nhorn chuc nang va nang Il,I'C CN YTCC duoc ap dl,lng trong trong cong ho. Thiet ke nqhien cuu dinh tlnh (ph6ng (PVS) , thao luan nhorn (TLN)) se k nhCrng van de : tlnh phu hop cua chU'O'ng tao CN YTCC, nhCrng kh6 khan ho g~p P qua trinh lam viec va tlnh chap nhan cua n dl,lng CN YTCC. 2. Dbi tU'Q'ng nghien cu>u f)oi tU'Q'ng nqhien ctru la cac CN YT nghiep va cac can bo tanh dao dang sli YTCC. Tflt ca cac CN YTCC trong 3 nghiep la 136 (2005 - 2009; 2006 - 2010 2007 - 2011) dang conq tac a cac trnhtha ca nuoc. TY Ie tham gia nqhien CLYU (121/136). csc CN YTCC Ve gi&i Nam Nit b~ng nhau trong nghien cuu nay (Nam 43, 56,2%). Khoa sinh vien 2007-2011 chiern voi 46%; khoa 2006 -2010: 20,6%; Kh6a 2009: 33,9%. Cac can bo lanh dao (5 ngU'oi) dang cac CN YTCC a cac tuyen y te: Sa y I tam y te dl,l' phong Tlnh, Senh vien. 3. PhU'O'ng phap thu th~p dQ>Ii~u Nghi{m cou dinh 1U'Q'ng:So cau h6i dU'Q'c chuyen t&i 135 cli nhan tot ngh' tru>ong f)H Y DU'Q'CHue. Mot cli nhan tot tro Iy nghien ctru cua nghien CLrUnay n tham gia vao khao sat dU'Q'C.Cac doi tU'Q' gia dU'Q'ctiep fuc lien lac thong qua email thoai de tang tl Ie tra loi. Tong cong c6 YTCC tham gia nqhien ciru va 14 ngU'Oi tham gia vi cac Iy do khac nhau. Cong cv chlrc nang, nang Il,I'c sli dl,lng trong ngh' dU'Q'cxay dl,l'ng dl,l'a vao chuan dau ra eN sli dl,lng cac nhom nang Il,I'c theo nhCrng cao cua M<;Ing 1U'&icac cO' sa dao t<;lO y cong cua CMu A- Thai Sinh DU'O'ng(8 va mot so nghien ClrU ve Cl,l'Usinh vien Australia [3, 7]. Cac nang Il,I'c sli dl,mg scale theo 5 mU'c tll' 0-4 de danh gia t~m q va mlrc do tl,l' tin trong cong viec. Nghi{m CtfU dinh tinh: Ph6ng van saud hanh tren 5 CN YTCC de kiem tra l<;Ii bO trU'&c c4.0c khao sat chinh. Trong ngh' 52 YHTH (880) - CONG TRINH NCKH CUA VI~N DAo TAO Y HQC DI,1PHONG & Y T~ cO phOngvan sau duoc thvc hien vai 7 CN tham~ia nghieln cuu, 113nhCl'ng ngU'ai da capnhieuthong tin khi tra lai bO cau h6i tl,l' hl'tngngU'oi nay 113dai dien cho cac nhorn nghi~pchinh rna cac Clr nhan cOng tac sau hi~p.Chung toi cOng thuc hien ph6ng van Wi 51Anh dao hoac nquoi quan 19 cua cac Clr YTCC{S6' Y te, Trung tam YTDP va benh v6 tam quan tronq cua cac chirc nang cua vacac ky nang duoc ling dunq rna cac Clr naythl,J'chien trong bOi earth cOng viec hien bo. XiP Iy thOng ke: Nghien CLPU djnh 1U'Q'ng: thongke mo ta va kiem dinh phi tham sO h tY I~Fisher Exact Test. Cac phep thOng ke ng phan rnern Stata 12 phan tlch. Nghien d1nhtinh: PMn tlch cac bang ma tran phan nll6mchu de bo sung cho ket qua cua nqhien dlnhIU'O'ng. K~T QuA vA BAN LU~N • Ncri lam viec cua sinh vien YTCC sau khi hitp va. nhiPng cong vi~c clJ th~ mil hQ dim nhan n bo riO'i lam viec cua cac Clr nhan tOt cJAchi ra r~n~ trU'ang DH Y DU'O'c Hue da ~ nhan II,I'Cve CN YTCC cho nhieu vung khacnhau 6' Viet Nam va nhCrng Clr nhan khitotnghiepdang lam viec tai nhieu noi khac a ca 3 mien Bac (12,4%), mien Trung )va mien Nam (12,4%) dat nuoc. Tap trung thongy te tuyen tinh va tuyen huyen chiern ty ,8% va 31,4%. Cong tac tai don vi y te dl,l' chiemty Ie cao nhat 60,9%, sau d6 113cac scHao tao 16,5% va chiern ty Ie sO can bo lam d~y6' cac co sa giao due Cao d~ng, d<;lihoc nhatso vai 2 trU'ong khac (DH YTCC Ha NOi , t)H Y DU'Q'cTPHCM 5,5%). 7,5% lam viec c:6cto chLYC NGO va dang quan tam la c6 den 'Cl,rU sinhvien cong tac a he dieu tr] [1]. Tlnh phu hop cua nQi dung dilo tao vai ning dip (Png cong vi~c hi~n t~i cua clJ'u viin C6cmOnhoc trong chU'O'ng trlnh dao t<;lOCN (!U'O'cxem la phu hO'p vai nhCl'ng yeu diU cOngviec cua hO nhU': To chlic quan 19y te, sachy te va kinh te y te. Thl,l'c te day 113 mOnhoc dU'Q'cdap ling trong chU'O'ng trlnh ~n 80%. TY Ie ap dl,lng trong cOng viec la caohO'nkhi so sanh vai nghien cliu cua Le UnhvaCs nam 2007 [5]. C6cnh6mmon hoc ve Dich te hoc, Nghien cliu hocva Thong ke tin hoc, Giao dl,lc slic kh6e nAngcao SLYCkl16e: 4 nhOm noi dung ma CN CC hai16ngve chU'O'ng trlnh dao t<;lOcang nhU' cJOquan trong trong cOng viec cua ho hang . t)ieu nay cho thay cac van de giai quyet va quan 19 me hlnh benh tat, dich te hoc g6p phfln quan tronq trong cOng viec hien tal va hflu het cac 9 kien cho r~ng cac man hoc tren la mot trong nhCrng noi dung cOt 10icua nqanh Y te cOng cOng. NMn xet nay tuonq tl,l' voi phat hien tCrnqhien cuu cua nhorn N.T. Hal va Cs ve vlec xac dinh tarn quan tronq cua man hoc Dich te hoc [2] "Theo em thi thay man Djch t~ hoc quan trong va (mg dl,mg ph6 bi~n khi di lam nhat, nhat te nhCmg ph;jn Ii{m quan d~n benn truyrm nhi~m. Man d6 em tMy la (fng dl,mg nhitJu nMt va cech d~y cOng chi ti~t nifa"[Nam, Khoa kiem soat benh truyen nhiern va vac xin sinh pharn, TT YTDP, TLN] - Tuy nhlen, cau true chung cua chuonq trlnh dU'ang nhu chua dU'O'choan thien va can duoc cal tien, khi c6 toi tren 50% cac Clr 'nhan cho r~ng giang day 19thuyet can giam tai va nen tang thai IU'O'ngthuc hanh va nang cao cac ky nang nghe nghiep. [Phu luc bang] " ctnronq trinh hoc con n~ng vtJ 19 thuy~t nhitJu qua NQi dung aeo t90 vtJdjch t~, t6 cnoc y t~, dinh dU'cmg,.giao due sue kh6e cac man hoc dung la man chuy{m nganh cue minh d6 nhU'ng thai Iwng it qua. Va ceu true chU'O'ngtrinh cen 6' day la d 9 y ca 19 thuy~t va ttnrc hent: luon, ch(f hi~n t9i con nghi{mg vtJ 19 thuy~t nhitJu qua'INCI',Trung tam phong chOng HIV/AIDs, Ph6ng van sau]. 3. Xac dinh cac chLPC nang, nang hfC dap LPng tOt trong cong vi~c vi~c hi~n tal cua CN YTCC da tOt nghi~p 3.1. Cae cturc niing cu« CN YTCC: Qua vlec rno ta tlnh phu hop cua noi dung dao tao vai kha nang dap ling cOng viec hien tai cua CN YTCC da tot nghiep cho thay rO non ve mot gO'i 9 cho chunq ta thay r~ng chuc nang quan 19 va dieu hanh ta cue ky quan tronq dOi vai cOng viec cua ho. Trong cac thao luan nh6m, ph6ng van sau voi cuu sinh vien CN YTCC va lanh dao don vi tuyen dl,lng, ket hop ket qua dinh ·1U'O'ng (a Bieu do 1) cho thay: cOng viec va ky nang can thiet thU'ang dU'O'cthvc hien hanq ngay lien quan hO<;ltdong cua cac dl,l' an y te; dl,l' an quOc te hay trong cOng viec t<;licac cO' sa y te nhU': I$p ke hO<;lchcho cac chien dich; xay dl,l'ng ke hO<;lchva bao cao cac hO<;ltdong; xay dl,l'ng ke hO<;lchcua dO'n vi; trien khai va giam sat chU'O'ng trlnh y te; xay dl,l'ng ke hO<;lchcho cac hoi thao cua cO' quan va chlrc nang tham mU'u cho lanh d<;lo; thOng ke va bao cao; giam sat dich te hoc Ket qua nghien ClrU tCrcac cac tac gia Betty J. Ruth a My ve Khao sat ve chU'O'ng trlnh dao t<;lO cho cac nMn vien YTCC va COng tac xa hOi [7] hay nghien ClrU ve cac chlrc nang ve YTCC a Uc [6] cang xem cac ky nang chung nhU' viet bao cao, dieu phOi dl,l' an va tat ca cac khla c<;lnhcua cOng tac len ke hO<;lchva quan 19deu rat quan trong . (880)·HOINGH! KHOA HOC B~NH VI~N QUAN THO m1c TP. H6 CHf MINH 53 40 '38,8 35 25 20 15 10 5 o QUllnly clnroug trjnh, d\r an Tlrvin chinh sach Ho"ch djllhk~ ho,dl 38 """,5", 1,7 - Dao tao Tri~ QlIanly QuanlY Trllye.l Nghien khai cac vii daub vii daub th6ngy eiru chuong gii cac gii djch ta, giao trinh y t~ djch \7\1 vu ~n d\lcvil kham lam sang uaug cao c1Ifta ffirckhoe b~ Lam c6ng vi~ hauh chinh (nll8n "",tai chinh ) Bifw do 1: cac nhom chLPCnang thll'CYng dU'g'c s& dl,mg cue cuu sinh vien Ngoai ra, cac nh6m chuc nang ve Kinh te y te cOng 113 mot trong nhCl'ng diem dU'Q'C phat hien chinh trong nghien cuu nay. Robert Seaglehole da de nghi, trong bai bao ve te cong cong trong thap nien mol, can cOng c6 nh6m ve van de kinh te y te de phat trien bao hiem y te va quan Iy tlf cac quy m6'i d~u tU' sue kh6e toan cau [3]. Dieu nay l<;1imot Ian nCl'a cho thay r~ng cac nh6m chuc nang lien quan den kinh te y te can duoc tang cU'ong trong qua trlnh giang day thong qua cac rnon hoc va can c6 co hOithuc tien de sinh vien c6 the lam t6t conq viec sau ra trU'ong. " cir nhan YTCC thi nen diw teo them v~ kitJn thoo tai chinh, kMng c~n ktJ toen, thi cec em tham muu r~t t6t v~ tei chinh y ttJ, beo hiilm y ttJ, hi{jn nay la cei linh VI)'C d6 la minh v~n con thitJu Hi{jn nay thi cong tee tet chinh - ktJ toen cue minh, thU'ong thi minh I~y nhCmg anh chi hoc ktJ toen re, nhCmg anh chi nay c6 kitJn tiurc r~t ky v~ thanh toen, h~ch toen, nhU'ng me kitJn tnoc v~ tai chinh la ngu6n 6' aeu, phan ttcn ngu6n, phan b6 dl)' phOng bao nhieu, di~u tri bao nhieu, linh nay bao nhieu, linh VI)'C kMc bao nhteu dil dam pMn cho tuytJn qu~n huy{jn [NCI',PVS lanh d<;1OSa Y tel. G~n lien voi chuc nang ve lap ke hoach d6 113 viec trien khai cac chuonq trlnh giao due SUC kh6e. Cac chuc nang ve giao due truyen thong g6p phan kha quan tronq trong cac linh VI,I'Crna CN YTCC dang cong tac: Y te du' phonq (11 %); Dich Vl,Jlam sang (9,1%). Ket qua cho thay r~ng cac chuc nang nay phu hop v6'i nhCl'ng ket qua cua nqhien cuu Le VO Anh ve xac dinh chuc nang Cung dpdjch ""him sang Khac va nhiern Vl,JY te cong cong do Dai hoc Y' hop voi WHO narn 2004 [4]. M~c du 100% nhan da c6 viec lam sau t6t nghiep tron~ cuu nay nhU'ng ho phai d6i m~t voi nhl khan ban d~u d6 113 mot 56 co sa tuyen dUI phan cong vi trl viec lam dung v6'i chuc n CN YTCC. SI,I' hieu nharn ve nghe nghi$p YTCC 113 Iy do thU'ong dan den m¢t 56 ( vien CN YTCC duoc cac don vi tuyen d xep nhCl'ng nhiern Vl,J khonq phu hop vaI toan khong hai long voi 51,1'phan cong nhlJ 3.2. Cac nhom nang II,I'C: Dei vai nqanh YTCC, c6 nhieu he th6ng danh gia I khac nhau, nqhien cuu nay SLY dl,lng h$th SEAPHEIN 2,3,4 (113 he thonq cua CaGtn! hoc YTCC cua Ch~1U A - Thai Sinh DU'on! hieu rrurc dO SLY dl,Jng va 51,1'tl,l' tin khi ! nhCl'ng nang luc nay. T6ng 56 co 34 n duoc liet ke theo 4 nh6m chinh: nhornnan quan IY', nh6m nang luc dao t<;10 It$p huA nang Il,I'c ve nqhien cuu danh gia va nh( II,I'Cve lanh d<;1Ova lam viec nhom/giao dy thong. Sang dU'&i cho thfiy ro cac ky na cac nh6m nang Il,I'c deu duoc (rng dl,lng trong conq viec va hau het cac CN YTC( tin va rfit tl,l' tin chiern ty Ie deu tren 80~ cac nh6m nang Il,I'c ve quan Iy YTCC, ngl va l.anh d<;1O- Lam viec nh6ml giao dU thOng. Ket qua nay tU'O'ng tl,l' voi ket qUI cuu ve nhan hrc y te cua Truong DH Y NOi [1] va cua nh6m tac gia Le Cl,l'Lil nqhien cuu tren CI,I'Usinh vien 2 trU'6'ng f) 54 YHTH (880) - CONG TRINH NCKH COA VI~N DAo TAO Y HQC DlJ PHONG & Y T~ cO~ 9H Y Duoc TP HCM [2]. Mot Iy do giai thich k6tqua nay c6 the la do cli nhan YTCC chu lAm vi~c trong cac co quan cong I$p noi 9 xuy~n phai slf dl,mg cac nang Il,l'c nay, do hQ cam thay tl)' tin hon voi cac nang luc nay IvcMng] .K~TLU~N 1.Nailam viec cue sinh vien CN YTCC • Saukhi tot ~ghi$p va nhCrng cong viec Cl,Jthe hQ aang dam nhan trai deu cac tlnh thanh a 3 aat nuoc, tap trung lon a Mien Trung 4%) va chu yeu cong tac trong tuyen y te dl,l' (67%). GOngvi$c cua cac CN YTCC dang dam nhan: nh6mcong viec (chirc nang) dang dam nhan Tntn khai cac chuonq trinh y te (39%); truyen giao due va nang cao sire kh6e (38%); quan IIOngtrinh, dl)' an y te (30%); hoach dinh ke (27%); Dao tao (20,7%); Nqhien cuu 4%); Lam cong viec hanh chinh (nhan sv, tai ) 16,5%. 1 Tlnhphil h9'P cua niji dung CIao t~o vcy; ning crap (Png cong vi~c h;~n t~; cu« CN da tot nghi~p • Tlnh phu hoop cua noi dung dao tao: phu hop y6utau cong viec va chuc nang cua nhan vien vi~ trong linh Vl)'CYTCC (hon 60% hai long). trUcchung cua chuonq trinh la hop Iy va can aa s6 khOng hai long v&i chuonq trinh da b6 tri ky thuc tap 1 thanq a cac co sa y te thit6t nghi$p. Muc do quan tronq cac noi dung c11lQ'c aao tao tai trU'cmg (sap xep theo nh6m hOC)va Sl)'ap dunq trong conq viec hien tal. 4 mOnhoc da de C$P: Ouan Iy va chinh sach y Giao cue sue kh6e va nang cao sire kh6e; Dich va Nghien cuu khoa hoc; Thong ke y te. 3. cae nhOm nang II,I'C Clap (Png tot vcy; cong hlfn tiJictia c~u sinh vien + Quan 19 y t~ Cong cong (Lap ke hoach va lycacchU'O'ng trinh y te (74,6%); Theo doi va sat dich te hoc cac van de sue kh6e cOng (74,1%)). + Dao rao.Phat triem ke hoach va IU'O'cxay dl)'ng nang Il,l'c (41,2%) + Nghif1n cOng c16ng: O'ng dl,Jng cac ky nang may tinh h th~o, ky nang ve tin hoc thong ke, co ban cOngvi$c (93,4%); Thu thap thong tin sue trong cong dong (77,4%); Danh qia va phan tlnh hinh sue kh6e cua mot cOng dong ,5%). + Lanh agO - lam viec nnom: Giao tiep, aOngSl)' tham gia cua cong dong trong cac aOngbao v$ suc kh6e (76,6%); Giao tiep hi$u vai cOngdong bang viet va noi trong nhieu boi h khac nhau (75%); Tien hanh cac hO<;ltdong truyen thong ve cac van de sue kh6e cong dong (74,2%) - Nh6m nang II!C khec: Giarn sat phOng chong nhiem khuan benh vien, chi dao tuyen va phonq chong djch tai benh vien, ky nang viet bao cao, nghien cuu van ban y te, ky nang tieng Anh va cac ky nang rnern khac. V. KI~N NGH! Ra scat chuonq trlnh dao tao di sau cac noi dung ve quan Iy - chinh sach y te, Kinh te y te, -quan Iy thOng tin y te, qiao due sue kh6e, Dich te hoc - Thong ke, cac ky nang ve Nghien cuu khoa hoc va chuonq trinh thuc tap cong dong. Can co cac _chU'O'ng trlnh tu van co hoi viec lam cho cac CN YTCC long ghep cac noi dung quanq ba vai tro cua CN YTCC khOng nhCrng doi voi nhCrng ngU'CYilam conq tac y te conq cong rna can pho bien cho cong dong nhCrng ngU'CYi hoach dinh chinh sach. Xay dl,l'ng mot moi trU'cyng tU'O'ng tac nhu cong thOng tin dien tli la rat can thiet nharn tan dl,Jng dU'ooc nguon Il,l'c ve tai li$u va nang Il,l'c tU' van cua trU'cyng cang nhu nhCrng dong gap hi phia cac CN YTCC da tot nqhiep. TAl Lieu THAM KHAo 1. Le va Anh (2012) £)tmh gia hi~n trgng aao teo nhen II,fC Y t~ tei Vi~{Nam, Truocyng Dal hoc Y te cong cong, Dl,l' an nqhien cuu 2. Nguyen Thanh Hal, Bui Tu Ouyen va cong Sl,l' (2007)"ChU'O'ng trinh dao tao clf nhan y te cong cong: Nhan dinh cua cuu sinh vien hai truocyng D<;li hoc Y Duoc tal Viet Nam". Tep chi Y t~ Gong cong, 8 (8), tr. 8- 16. 3. Ruth Bonita (**) Robert Beaglehole (*), Orvi! Adams (****) Richard Horton (***), Martin McKee (*****) (2007)"Y te cong cong trong ky nquyen rnoi: Nang cao sue kh6e thOng qua cac hanh dong tap the". Tep chi Y t~ cong cong, 9 (9), tr. 4-9. 4. Le va Anh va cOng Sl,l' (2004)"Chuc nang va nhiern Vl,Jy te cong conq". Tep chi Y (~ cong cong, 2 (2), tr. 4- 7. 5. Le, L. C. , Bui, Q. T. , Nguyen, H. T. , Rotem, A. (2007)"Alumni survey of Masters of Public Health (MPH) training at the Hanoi School of Public Health". Hum Resour Health, 5, 24. 6. National Public Health Partnership (2000) National Delphi Study on Public Health Functions in Australia: Report on the findings", Melbourne, Australia. 7. Ruth, B. J. , S. Sisco, Wyatt, J. , Bethke, C. , Bachman, S. S. , Piper, T. M. 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