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ĐỀ ÁN TĂNG CƯỜNG Y TẾ CƠ SỞ TRONG TÌNH HÌNH MỚI PowerPoint PPT Presentation


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ĐỀ ÁN TĂNG CƯỜNG Y TẾ CƠ SỞ TRONG TÌNH HÌNH MỚI. Hà Nội, ngày 10 tháng 12 năm 2013. Nội dung. Khái niệm, vai trò của YTCS Kết quả đạt được Khó khăn, vướng mắc Kinh nghiệm từ một số mô hình YTCS Đề án Tăng cường YTCS trong tình hình mới Mục tiêu Quan điểm Giải pháp.

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N t ng c ng y t c s trong t nh h nh m i

N TNG CNG Y T C S TRONG TNH HNH MI

H Ni, ngy 10 thng 12 nm 2013


N i dung

Ni dung

  • Khi nim, vai tr ca YTCS

  • Kt qu t c

  • Kh khn, vng mc

  • Kinh nghim t mt s m hnh YTCS

  • n Tng cng YTCS trong tnh hnh mi

    • Mc tiu

    • Quan im

    • Gii php


Ph n 1 kh i ni m v vai tr c a ytcs

PHN 1KHI NIM V VAI TR CA YTCS


Health service delivery system

Health service delivery system

39

Cen hos.

  • - 150 hospitals

  • 35.000 clinics

  • 39.000 phar, drug outlets

Central level

382

Prov hosp.

63 Provinces

561 Dist hosp.

686 Poly-clinics

698 Districts

11.112 CHCs

96.534 VHWs

11,138 Communes

Public Private

(199.011 beds, 95%) (9.611 beds, 5%)


Kh i ni m vai tr c a ytcs

Khi nim & vai tr ca YTCS

  • Y t c s l nn tng ca h thng y t VN

  • Tuyn y t gn dn nht, ngi dn d tip cn (nht l vng nng thn, min ni, vng kh khn)

    • Gii quyt c a s cc nhu cu CSSK thng thng.

    • Chi ph hp l, cc khon chi gin tip thp.

    • Bo m cho mi ngi dn c CSSK c bn (bao ph CSSK ton dn).

    • Gp phn thc hin cng bng y t v cng bng x hi.

    • Gii quyt trit v bn vng tnh trng qu ti BV


Ph m vi tuy n ytcs

Phm vi tuyn YTCS

  • T tuynxtr xung, v:

    • Hinnaynhiu BV huyn thchinckthutchuynkhoa, v mt s dch v y tchuynsu.

    • D thoQuy hoch: BV spxptheocmdnc + Xp hng BV (BV huyncththng 2, hng 1).

    • Nu bao gm c tuyn huyn th phm vi n rt ln, khng c tnh kh thi v thiu ngun lc.

    • Q 58/TTgngy 03/02/1994 quynhr YTCS baogmttuynxtr xung (BYT angxydng NCP thay th Q 58, thngnhtchungtrongccn, YTCS ctnhttuynxtr xung).

    • Trongqutrnhxin kin, huhtccB, ngnhvccaphngunghvphm vi YTCS lttuynxtrxung.


Ph n 2 m t s k t qu t c

PHN 2MT S KT QU T C


1 m ng l i ytcs ph t tri n r ng kh p

1. Mng li YTCS pht trin rng khp

  • 11,112 TYT x trn ton quc

  • 98,9% x c TYT

  • Gn 100.000 NVYTTB

    • X t chun quc gia v y t tng t 35,7% (2005) gn 80% (2011). Cc vng kh khn nh Ty Bc cng c 40,2% TYT x t chun, Ty Nguyn l 57,6% (chun c).


2 ph t tri n nh n l c ytcs

2. Pht trin nhn lc YTCS

  • Sau 10 nm, s lng CBYT x tng 11%; s lng CBYT c trnh chuyn mn cao (BS) tng 40%.

  • 74,4% s x c BS lm vic (gm c lm vic >3 ngy/tun)

  • 95,3% s x c NHS hoc YSSN

  • 88% thn bn c NVYT hot ng (min ni: 96,9%).

    • T l x/phng c cn b chuyn trch DS-KHHG trong bin ch TYT x cng t 82,1%.

    • Ch ph cp i CBYT c s c ci thin ng k.


  • 3 c s v t ch t v ttb c c i thi n

    3. C s vt cht v TTB c ci thin

    • 2010: 55% s TYT l nh mi bng kin c; 39% TYT nh mi ngi; cc TYT l nh tm chim 6%.

    • Mt s a phng c cc t chc quc t h tr xy dng TYT x 2 tng, khang trang, sch p.

    • Ci thin v TTB y t, khc phc mt phn tnh trng thiu TTB y t trm trng trc y.

    • Mt s TYT c cp siu m, in tim, my xt nghim mu, xt nghim nc tiu, xt nghim sinh ha, my o ng huyt, gh rng n gin...


    4 tri n khai c c ho t ng

    4. Trin khai cc hot ng

    • Cc ni dung CSSKB c trin khai hiu qu VN.

    • Nhiu CTYTQG c trin khai hiu qu cao (TCMR, PC SDD, CSSKBM-TE, DS-KHHG...). Khng ch dch bnh kp thi.

    • V KCB, ti mt s tnh c YTCS pht trin, mi ngy 1 TYT khm khong 50-100 bnh nhn. Trung bnh ton quc, t l KCB ti tuyn x chim n 30-50% tng s lt KCB.

    • Khong 80% s TYT trin khai KCB BHYT, khong 20% s th ng k KCB ban u ti tuyn x.

    • Ti cc a phng c YTCS pht trin th khng xy ra tnh trng qu ti trm trng cc BV tuyn trn.


    5 ch s s c kh e

    5. Ch s sc khe

    • Tui th trung bnh tng (73,2 tui).

    • Cc ch s sc khe tt

      • Mt trong 8/74 quc gia t tin thc hin mc tiu MDGs v gim t vong tr em;

      • Mt trong s 9/74 quc gia t tin thc hin mc tiu MDG v gim t vong m

      • Mt trong 3 nc t c mc gim trn 75% t s t vong m trong giai on t 1990 2010.


    Ph n 3 t n t i h n ch

    PHN 3TN TI, HN CH


    1 s quan t m l nh o ch o ch a cao

    1. S quan tm lnh o, ch o cha cao

    • Quan tm ch o cha thng xuyn v ton din.

    • YTCS cha c u tin phn b ngun lc tha ng.

    • Nhiu a phng cha ch ng huy ng ngun lc cho YTCS, cn trng ch vo ngun vn u t t trung ng.

    • Cha phn cng r trch nhim ca cc bn lin quan, c ch kim tra gim st cha cht ch.

    • S tham gia ca cc ban ngnh, on th v ca ngi dn cn hn ch, ch yu l giao khon cho ngnh y t.

    • M hnh t chc v phng thc hot ng ca ban CSSKND ti c s thuc cn hnh thc, thiu hiu qu.


    2 m h nh t ch c nhi u bi n ng

    2. M hnh t chc nhiu bin ng

    • M hnh qun l TYT x cha thng nht, c ni do TTYT huyn qun l, c ni do Phng y t huyn qun l.

    • TYT cha c t cch php nhn, khng con c du, khng c ti khon Khng k c hp ng vi BHYT.

    • Cha c s phn nh v chc nng nhim v v nh hng u t cho YTCS gia cc vng min Phn b nhn lc v u t ngun lc dn tri.


    3 i ng cbyt thi u v y u

    3. i ng CBYT thiu v yu

    • S lng CBYT tuyn c s cha theo nh bin.

    • Phn b v c cu CBYT tuyn c s cn bt cp

    • T l NVYTTB c o to theo quy nh cn thp.

    • Nhn vin y t khu ph, th trn khng c hng ph cp theo Q75/2009/Q-TTg.

    • Tn ti song hnh nhiu chc danh chuyn mn y t: NVYTTB, cng tc vin dn s, c thn bn, cng tc vin mt s CTMTQG v y t

    • T l bao ph c thn bn ti cc vng kh khn cn thp, mi p ng c khong 1/5 nhu cu thc t.

    • Ph cp u i cn b YTCS cn thp.


    4 c s v t ch t tyt x xu ng c p

    4. C s vt cht TYT x xung cp


    Nh gi t nh h nh th c hi n ch c n ng nhi m v tyt x c a 11 t nh vi n clcsyt 2012

    (nh gi tnh hnh thc hin chc nng nhim v TYT x ca 11 tnh, Vin CLCSYT, 2012)

    5. Thiu thuc thit yu


    Theo quy nh t i q 1022 byt 2004 nc v th c tr ng kcb bhyt t i tyt x 4 t nh hspi 2012

    6. Thiu TTB y t thit yu

    Theo quy nh ti Q 1022, BYT, 2004 (NC v Thc trng KCB BHYT ti TYT x 4 tnh, HSPI 2012)


    7 u t cho ytcs r t thi u

    7. u t cho YTCS rt thiu

    • D c CT 06 (2002), Q TTg 950 (2007), nhng trong nhiu nm qua, khng c ngun u t no ng k cho YTCS.

    • Ch yu da vo ngun u t rt hn hp ca cc a phng

    • Mt s DA vin tr (AP, GAVI, QTC, EC), nhng mi c mt s a phng v mt s ni dung u t.

    • Chi thng xuyn rt thp (>10 triu ng/TYT/nm)


    8 cung ng v s d ng dvyt

    8. Cung ng v s dng DVYT

    • Kh khn trong trin khai cc CTMTQG v y t, c bit l cc hot ng cng ng v d phng.

    • V KCB: Trung bnh mi ch cung cp c 52,2% trong s l08 dch v theo phn tuyn k thut.

    • 47,8% cc dch v cha cung cp c, ch yu l do thiu cn b hoc cn b cha c o to (52,7%), khng c TTB, TTB c, hng (45,8%).

    • Cht lng dch v TYT x cn nhiu hn ch, ngi dn cha tin tng nn thng b qua TYT vt ln tuyn trn khm, cha bnh.


    Ph n 4 b i h c kinh nghi m

    PHN 4BI HC KINH NGHIM

    u t cho YTCS c mang li hiu qu g khng?


    Th a thi n hu

    Tha Thin Hu

    • Nh trm khang trang

    • TTB c bn (siu m, in tim, sinh ha...)

    • C cn b (5-7 cn b, c BS, c trm c BSCK1)

    • Khm 50-70 bnh nhn/ngy

    • 50% lt KCB l tuyn x

    • Khng c tnh trng qu ti BV tuyn trn


    Kh nh h a

    Khnh Ha

    • Nh trm khang trang

    • TTB c bn (siu m, in tim, sinh ha...)

    • C cn b (5-7 cn b, c BS gia nh)

    • KCB BHYT

    • 50% lt KCB l tuyn x

    • Khng c tnh trng qu ti BV tuyn trn


    Tyt x qu ng ng i

    TYT x Qung Ngi

    Mt TYT x Ninh Bnh


    B i h c kinh nghi m

    Bi hc kinh nghim

    • u t cho YTCS v CSSKB l chin lc CSSK trc mt cng nh lu di, tn km, hiu qu v bn vng nht.

    • Vai tr lnh o, ch o ca cc cp y ng, chnh quyn ng vai tr then cht trong tng cng YTCS; ngnh y t c vai tr u mi v chuyn mn, k thut; cn c s tham gia ca cc ban ngnh, on th v ca tng ngi dn.

    • Mun pht trin YTCS, phi c u t tha ng v ton din v c s vt cht TTBYT cn thit i ng CBYT c trnh ph hp C ch ti chnh v hot ng ph hp

    • Nhng a phng c YTCS pht trin, trin khai tt CSSKB, qun l sc khe ti cng ng, ti h gia nh Khng c qu ti bnh vin.


    Ph n 5 n t ng c ng y t c s trong t nh h nh m i

    PHN 5 N TNG CNG Y T C S TRONG TNH HNH MI


    M c ti u

    Mc tiu

    To bc chuyn bin t ph v ton din v t chc, c s vt cht, TTB, i ng cn b v c ch hot ng ca y t c s nhm nng cao cht lng dch v CSSKB, p ng nhu cu CSSK ca ngi dn ngay ti cng ng, gp phn gim qu ti bnh vin tuyn trn, m bo cng bng, hiu qu v pht trin s nghip bo v, chm sc v nng cao sc khe nhn dn.


    C c nhi m v gi i ph p ch y u

    Cc nhim v, gii php ch yu


    1 t ng c ng nh n th c v tr ch nhi m l nh o ch o c a c c c p u ng ch nh quy n

    1. Tng cng nhn thc v trch nhim lnh o, ch o ca cc cp u ng, chnh quyn

    • Nng cao nhn thc ca cc cp u ng t T n a phng v tm quan trng c bit ca YTCS.

    • a cc mc tiu, ch tiu, nhim v c th v tng cng YTCS vo KH pht trin KT-XH ca c nc v ca tng a phng.

    • u tin phn b ngun lc tha ng.

    • C s phn cng trch nhim r rng

    • Thng xuyn kim tra, gim st, nh gi.

    • Huy ng s tham gia v phi hp ca cc ban, ngnh, on th, ca cng ng v tng ngi dn vo cc hot ng tng cng YTCS v CSSKB ti a phng


    2 c ng c t ch c i m i c ch ho t ng

    2. Cng c t chc, i mi c ch hot ng

    • TYT x c thnh lp theo n v hnh chnh x, phng, th trn v theo cm dn c (x c a bn rng, dn c ln c th thnh lp phn trm).

      • TYT x/phng do TTYT huyn qun l.

  • Phn loi TYT thnh 3 nhm: Min ni, vng su, vng xa; ng bng-trung du; khu vc th c CS u t ph hp.

    • Xy dng chc nng, nhim v cho ph hp cho tng nhm TYT.


  • N t ng c ng y t c s trong t nh h nh m i

    • Cng c v pht trin y t trng hc, y t cc c quan, doanh nghip, cng-nng-lm trng, x nghip

    • Nhn rng m hnh TYT qun dn y kt hp cc khu vc bin gii, hi o; pht trin mng li bc s gia nh nhng ni c iu kin.

    • Thc hin ch trng Phng bnh hn cha bnh, ly CSSKB v tng cng YTCS l chin lc nn tng;

    • m bo CSSK ton din, gn phng bnh, NCSK vi KCB, phc hi chc nng.

    • Khu vc thnh th, gn cc BV: y mnh cng tc YTDP, trin khai cc CTMTYTQG, truyn thng-GDSK.

    • Khu vc min ni, nng thn: Thc hin tt chc nng v YTDP + nhim v s, cp cu v KCB ban u.


    3 ph t tri n nh n l c cho y t c s

    3. Pht trin nhn lc cho y t c s

    • Xc nh nhu cu nhn lc (s lng, cht lng v c cu) cn b ph hp vi tng vng, min.

    • a dng ha cc loi hnh o to da trn nng lc cn b ph hp vi tng v tr cng tc, chc nng, nhim v v hon cnh c th.

    • Tng cng o to bc s gia nh, o to NVYTTB, c thn bn cho YTCS vng c bit kh khn, u tin ngi a phng, ngi dn tc thiu s.

    • T chc o to li, o to lin tc cp nht, nng cao trnh chuyn mn cho CBYT tuyn c s.


    N t ng c ng y t c s trong t nh h nh m i

    • B Y t xy dng ban hnh chng trnh khung, trn c s SYT cc tnh, thnh ph xy dng chng trnh c th, ph hp vi nhu cu v trnh CBYT a phng; ph hp vi chc nng, nhim v ca CBYT x, tp trung vo cc ni dung chuyn mn thit yu cho tuyn x.

    • B sung v hon thin ch v CS thu ht CBYT lm vic ti YTCS, c bit ti min ni, vng su, vng xa.

    • Khuyn khch lng ghp cc chc nng ca cng tc vin dn s, cng tc vin dinh dng, c thn bn, cng tc vin mt s CTMTQG vo chc nng y t thn bn.

    • Tng cng huy ng s tham gia ca y t t nhn, cn b y t ngh hu tham gia vo cc hot ng CSSKB ti a phng.


    4 t ng c ng u t t o b c t ph v c s v t ch t v trang thi t b cho y t c s

    4. Tng cng u t, to bc t ph v c s vt cht v trang thit b cho y t c s

    4.1. Tng cng u t c s vt cht

    • V xy mi cc TYT x:

    • u tin 1: (i) Cc x cha c TYT; (ii) X c TYT tm b, dt nt, xung cp nghim trng cc x thuc vng kh khn, vng su, vng xa, vng bin gii, hi o.

    • u tin 2: Cc x c TYT nhng tm b, dt nt, h hng, xung cp nghim trng cn phi xy dng li cc x thuc vng khc.

    • u tin 3: Cc TYT x cn hot ng c, nhng cn u t sa cha, nng cp, m rng

    • Nng cp, sa cha TYT x: Ty theo cc bo co nh gi v hin trng c s vt cht, nh trm, cc a phng quyt nh


    N t ng c ng y t c s trong t nh h nh m i

    4.2. Cung cp trang thit b y t

    • Trn c s danh mc TTB do BYT ban hnh, cc tnh xc nh nhu cu cung cp TTB da theo m hnh bnh tt; iu kin c s vt cht lp t TTB v kh nng s dng TTB.

    • Cc loi trang thit b u t cn ph hp vi chc nng, nhim v, ca TYT x, ph hp vi nng lc ca CBYT, m bo KCB hiu qu v an ton cho bnh nhn.

    • Cung cp ti y t YTTB cho i ng NVYTTB v ti sch cho i ng c thn bn khu vc min ni, vng su, vng xa, vng hi o, bin gii.


    5 i m i c ch t i ch nh

    5. i mi c ch ti chnh

    • Nh nc chu trch nhim m bo ngun kinh ph u t v chi thng xuyn cho YTCS.

    • y nhanh tin trnh pht trin BHYT ton dn, m rng nhanh din bao ph BHYT; m rng KCB BHYT tuyn c s.

    • i mi phng thc chi tr DVYT, chuyn i t phng thc thu ph theo dch v sang khon nh sut v DRG.

    • p dng cc c ch ti chnh ph hp khuyn khch ngi dn s dng DVYT tuyn c s, trnh lm dng DVYT.

    • Tip tc h tr CSSK cho ngi ngho, h cn ngho, ng bo DTTS v cc i tng chnh sch x hi

    • Tng cng huy ng ngun lc quc t (ODA, NGO), khuyn khch cc t chc, c nhn trong v ngoi nc u t cho YTCS.


    6 n ng cao hi u qu truy n th ng gdsk

    6. Nng cao hiu qu truyn thng, GDSK

    • Tng cng cng tc truyn thng, i mi ni dung, phng php TTGDSK; to s chuyn bin r rt v nhn thc ca ton b h thng chnh tr i vi YTCS,.

    • Tng cng truyn thng nng cao nhn thc ca mi ngi, mi gia nh v hnh vi phng bnh, bo v v NCSK, ng thi nng cao nhn thc ca nhn dn v quyn c chm sc sc khe.

    • Nng cao nng lc truyn thng gio dc sc kho cc tuyn. Tp hun, bi dng v kin thc v k nng truyn thng GDSK cho cc truyn thng vin, cn b y t x v y t thn bn.

    • Cc trm y t x c phng truyn thng GDSK-T vn lng ghp, c ti liu v trang thit b cn thit p ng yu cu hot ng.


    Nhu c u v c ch u t

    Nhu cu v c ch u t


    Nhu c u v c ch u t1

    Nhu cu v c ch u t

    • V ngun vn

      • Hot ng u t xy dng CSVC, cung cp TTB v dng c y t, o to, nng cao nng lc: S dng ngun vn t NSNN

      • Hot ng truyn thng, kim tra, gim st; kin ton m hnh, hon thin c ch qun l v ch chnh sch: S dng ngun kinh ph t CTMTQG, cc d n vin tr v cc ngun vn hp php khc.

    • C ch h tr

      • NSNNTW d kin 2 mc h tr: 50% i vi cc tnh/thnh ph c iu tit v NSTW di 50%, 100% i vi cc a phng iu kin kh khn.

      • Kinh ph h tr o to, bi dng chuyn mn v cung cp ti y t thn, bn c cn i bng ngun NS hng nm ca a phng.

      • Ngun ngn sch huy ng t cc ngun vn hp php khc, bao gm cc D n vn vay, vin tr khng hon li, h tr t cc c nhn, t chc trong v ngoi nc s c p dng theo quy nh ca vn kin D n hoc ti liu Hip nh k kt.


    T ch c th c hi n

    T chc thc hin

    • ngonQuchi.

    • Ban CnsngChnhph.

    • MttrnTqucVit Nam vcctchcthnhvin.

    • Ban TuyngioTrungng.

    • Cccpung, BCS ngvngonccb, ngnh, onth:

      • B Y t

      • B K hoch v u t

      • B Ti chnh

      • B Vn ha Th thao v Du lch

      • B Thng tin Truyn thng

      • B Gio dc v o to

      • B Nng nghip v Pht trin Nng thn

      • y ban dn tc

      • UBND cc tnh, thnh ph trc thuc Trung ng

      • Ban CSSKnhndncccp


    N t ng c ng y t c s trong t nh h nh m i

    Xin trn trng cm n!


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