VietNamNet Bridge - The gap in the level of expertise among physicians is increasingly widening, breaking the structure of the current health care system in Vietnam, which is divided by levels.
Workforce crisis is one of the biggest challenges that Vietnam's health system faces. Doctor shortage occurs at all levels (especially at district and provincial level.) The imbalance in the qualification of doctors, equipment and facilities has encouraged patients to flock to big hospitals in cities.
Serious "thirst" for human resources
Observing the health care system (including preventive and treatment systems), Mr. Tran Tuan, Director of the Research Centre for Community Training and Development made the first statement, it is a human crisis.
This crisis is evident when the health sector is in shortage, serious imbalances in the human resources in the whole system, which makes the system work ineffectively.
Let’s take medical workforce for preventive health as a specific example.
The Ministry of Health (MOH) targeted that "preventive health must go ahead, before treatment," but in fact the work of human resources for preventive medicine is still very weak and inadequate.
The MoH’s statistics show that medical personnel for preventive medicine only meets 76 percent of demand at the central level, 55 percent and 43 percent at the provincial and district levels (the personnel of preventive medicine accounts for only 15 percent of the total workforce of the health sector, failing to meet the social needs.)
Now there are nearly 20,000 preventive medical staff in the country, while the demand estimated for 2020 is up to nearly 58,000. The majority of staff work in preventive medicine have not been trained, especially in epidemiology, so they lack the ability to analyze and evaluate the pathogen...
Therefore, the diseases like dengue fever, diarrhea and rash fever still break annually in the community, causing a series of burden to the people and treatment work in hospitals.
Yet, the specialized wards like leprosy and tuberculosis, psychiatry, forensic medicine, surgery are also in shortage of human resources. Ass. Prof. Dr. Vu Xuan Phu, Deputy Director of the National Lung Hospital, said right at a central-level hospital as his hospital, some wards still lack doctors, for example the surgery, bio-chemical, laboratory, tuberculosis inpatient physician, etc.
In the area of treatment, which is always overloaded because of poor disease prevention task, human resource is also a big problem. According to statistics of the Ministry of Health, there are more than 141,000 workers while the need is nearly 190,000.
This is also the reason why the rate of physicians/residents in Vietnam is at nearly 7/10,000, which is very low compared to other countries in the region.
"Sitting in the wrong place" and attending meetings throughout the day
Mr. Tran Tuan said the medical workforce in Vietnam is only at a certain level, so the goal is to organize that resources at optimal level to generate it to the highest efficiency. However, that weak and small human resource is being seriously wasted.
At the grassroots level, surveys show that the district–level health system is distributed, with most of good doctors working as leaders, not doctors. At the commune level, each health station has only 4-6 staff. These people have to do everything so they do not have time to focus on their expertise.
Also at the central level, the state in which health workers "sit in wrong places" is also very common, reducing the efficiency of the human resources organization.
In a hospital or a medical facility, not all positions needs to use a doctor (while we lack specialized doctors for medical care). Mr. Vu Xuan Phu pointed out a fact: There are people who are trained from 6-9 years to work as doctors but after graduation, they are recruited to the positions that need those who are trained for four years.
Yet, the key positions at hospitals are assumed by the best doctors. "This is a huge waste of human resources in the health sector," Phu emphasized.
Excellent doctors holding leadership positions are not only a waste of expertise, but also not good for hospital management because these people are not trained of hospital administration.
Health Minister Nguyen Thi Kim Tien said: "Each hospital director must be a CEO, who is capable and qualified to manage the hospital, not necessarily to be a professor or an associate professor. If a hospital director is busy with studies and giving lectures, he should be returned to be a teacher."
Shortage and redundancy
Mr. Tran Tuan said Vietnam exists in both overproduction and shortage crisis.
"How many medical students graduating from medical schools all across the country and how many health workers retire each year? Looking at those numbers we can say that we do not lack medical workers but we lack the people who meet the requirements of the health care work," Tuan emphasized.
At the grassroots level, there is a serious shortage of doctors, especially good doctors because most of doctors are appointed as leaders. That's not to mention the macroeconomic healthcare policies are very unreasonable that doctors only want to work at hospitals of the central level, which makes the shortage of doctors at the grassroots level and the redundancy at the central level.
According to statistics of the Ministry of Health, while the urban population accounts for about 30 percent of the national population, the number of health professionals working in urban areas account for 50 percent of the sector's workforce . The urban areas are also home to the best doctors. The mountainous and remote regions severely lack doctors.
This fact makes the gap in the level of expertise among physicians in different levels is increasingly widening, breaking the structure of the health care system. This causes a variety of problems such as overload, medical ethics, disease increases because the health system does not have the sufficient qualifications for undertaking preventive medicine.