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Researches Health System

Vũ Thị Minh Hạnh, Trần Thị Hồng Cẩm, Trần Vũ Hiệp, Hoàng Thị Mỹ Hạnh, Vũ Thị Mai Anh, Hoàng Ly Na

Place of publication: Ministry of Health
Year of publication: 2011
To continue creating changes in the sense of law respect and compliance through law propaganda, dissemination and education on 12 March 2008 the Prime Minister signed Decision 37/2008/QD-TTg to approve the Program on law dissemination and education in 2008-2012. To ensure effective implementation of Decision 37/2008/QD-TTg in the health sector, on 23 March 2010 the National Commission for Ideology and Propaganda (NCIP) and Ministry of Health (MOH) signed the “Program on cooperation to implement political missions and resolve sensitive and urgent issues in terms of ideology among staff and people in health care, protection and promotion”. The key contents of this program are to boost dissemination and education to raise awareness among leaders of Party committees at levels, government authorities, staff and people in health care, protection and promotion. MOH assigns the Health Strategy and Policy Institute (HSPI) to cooperate with the MOH Cabinet and Legislation Department to conduct the study “Evaluating current situation of resources and needs of training propaganda staff on policies in the health sector” at 77 units/institutions attached to MOH and 63 provincial health departments. The aim is to learn about current situation of resources and needs of training propaganda staff on policies in the health sector and thereby identify training needs for propaganda personnel.

To describe the current situation of propaganda (dissemination and education of Party and Government policies on health care, protection and promotion for the people) at Party Committees at grassroots level in the health sector.
To identify needs of training propaganda personnel in the whole sector to help them carry out their duties systematically, practically and efficiently.
Study design: cross-sectional descriptive survey in combination with quantitative and qualitative data collection methods. 
Data collection methods: Review, analyze available data. Collect information by statistical tables and forms from 77 MOH attached institutions and units (according to Government Decree 188/2007/NĐ-CP dated 27/12/2007) and 63 provincial health departments. However only 37 units (48%) and 20 provincial health departments (32%) provided information. Semi-structured interviews are conducted with 163 staffs. There are 80 group discussions (32 groups of unit leaders, 32 groups of staff, 7 groups of patients and 9 groups of students and school children).

Current situation of propaganda:
Organizational structure: 
The focal point is the Party Committee. Implementers are Party branches, groups/sections responsible for policy and legal document dissemination, department of political education and student affairs division. Presently only 19.3 units have propaganda section. 
There is no uniform organizational structure for implementation in the whole sector. 75.5% of interviewees remark that such structure is not relevant.
Human resources: 
Most are part-time staff. Percentages of units with responsible staff are low (5.3%). 63.8% of propaganda staff are male; 73% over 40 years old; most have secondary political reasoning level (35.7%) and high level (34.4%); time of working experience is mainly more than 10 years (40.3%); 46.5% have been to technical training.
The major source of information is upper level Party Committee (81.4%); upper level agencies (69.9%) NCIP (49.1%); TV (57.7%); and Internet (54%).
Facilities, equipment and budget: 
92.9% of units have facilities for propaganda. 70% of units use expenditures from the recurrent budget, 20.9% from other sources. The allocated budget basically cannot meet the demand (16.3%), and only partially respond to the actual need (55.8%).
Dissemination, propaganda: 
93% units have annual plans, of which 43.4% develop separate plans and the remainder integrate into other plans.
Unit leaders are responsible for planning (58.5%); Party Committee (7.9%); part-time staff (66%). Contents of dissemination include directive documents (93%), legal documents (89.5%) and sectoral document (100%). Dissemination form is via workshop, regular meetings, letter dispatch and document announcement.
Action plan development:
Hospitals:  Develop project on medical care socialization, improvement of health insured medical care, overcrowding limit by synchronized measures, improving medical ethics, working towards grassroots health level, etc.
Research institutes: Pay special attention to new emerging issues in community health care, resolve problems of grassroots health level.
Schools: Expand training and education majors, training types, introduce new subjects, and renovate training approach.
Provincial health departments: Project on human resources development, health organizational model at district level, health socialization project, medical ethics and code of conducts in health institutions.
Monitoring and supervision:
93% units carry out monitoring and supervision. 62.3%  units are subject to monitoring by upper level Party Committees; 73.6% apply self-monitoring; 70.2% monitor via reports; 59.6% conduct direct monitoring.
Monitoring has not been carried out regularly and systematically due to lack of concrete regulations.
Gained results:
Perception of Party members and related groups:  
Basically Party members have certain knowledge of major policies by the Party, legal documents and sectoral documents directly related to working areas.
Students of schools initially know some major policies of the Party, Government and sector but not to the detail level.
Patient also have certain knowledge of basic health care policies but at limited level.
Results of the campaign on learning and following President Ho Chi Minh example: Units have prepared plans, established steering committees and organize primary review, annual review meetings. Most Party members, government employees, staffs and students at unit have participated in the contest of telling stories about Uncle Ho, written some articles with high prizes at levels. There are many example of excellent individuals recognized inside and outside the health sector.
Developing powerful and transparent Party bases: develop and enhance the belief for government employees and staffs in the leadership by the Party Committees to carry out technical duties; support and educate the public to raise awareness, train political qualities and ethics; create sources for new Party members. Grading Party Committees of units, all reach the level of powerful, transparent and successful implementation of given duties.
Changes in technical duty performance:  
Hospitals: Medical care indicators improve; positive changes in medical ethnic and behavioral culture; patients’ satisfaction keep increasing; technical qualifications of each staff gradually improves; physical infrastructure and medical devices keep improving.
Research institutes: Many studies on grassroots health level have been effectively applied into reality; more evidences are provided for improving and developing policies on health care, protection and promotion for the people.
Schools: training curriculum keep expanding, meeting the actual needs; training target groups keep diversifying; training methods improve; students are better trained, not only in technical fields but also in socio-political and legal aspects.
Provincial health departments: ensure network organizational structure with flexible development; human resources for health are maintained and developed; quality of health care services in the localities improves; population’s health indicators change positively.
Difficulties, obstacles
Organizational structure: There is a lack of consistency in organizational structure, collaboration mechanism.
Human resources: Lack of responsible staff; limitations in propaganda staff’s skills, lack of attractive policies.
Resources for implementation: Limited budget, unclear budget allocation mechanism; equipment only at essential level.
Implementation methods: Rigid, lack of flexible application into real situation at the unit; dissemination forms slowly change, failing to adapt to changing tastes of beneficiaries; lack of activeness in updating new legal documents.
Part of leaders, Party members, government employees and staff have incorrect understanding of the importance of the dissemination on policies on health care and protection for the people.
Pressure in technical duty performance to each individual, unit.
Impacts from objective, unfavorable factors: Lack of concrete, detail instructions on implementation methods associated with specific document; taste and preference of information receiving by beneficiaries keep changing.
Units have implemented the dissemination of policies on health care and protection for the people however it remains passive, not systematic, comprehensive and intensive. 
Many units lack flexibility and creativeness in applying documents into technical duties.
In general, staffs, Party members and students have righteous outlook, firm belief and no complications.
Medical ethic education in some hospitals and schools remains formality, lack of concreteness and practicalness.
The campaign on mobilization and following President Ho Chi Minh example in some units are not intensive, lack of application suitable with technical aspects.
Ministry of Health and Central Committee for Ideology and Propaganda: should have consistent guiding documents on the responsible and standing section for disseminating Party polices and legal documents on health care and protection for the people among units in the whole sectors. Issue guidelines on criteria to select propaganda staff and associated incentives; collaboration mechanism between the propaganda section under the Party Committee and functional sections. Organize training for propaganda staff.
Skills to train: organization for implementation, planning, document preparation, communication skills, monitoring and evaluation, writing, document update; training duration: 2-3 days.
Training type: TOT for units with crowded staffs and Party members.
Units: Identify the importance of the dissemination on policies on health care and protection in the unit; arrange sufficient human resources and resources for implementation, giving priority to select fully competent staffs; actively access and retrieve new documents; routinely maintain monitoring and supervision.

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