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Researches Human resources for health

 Nguyễn Thế  Hùng*, Vũ Thị Minh Hạnh, Vũ Văn Hoàn et al.

* Personnel Department, MoH
Place of publication: Ministry of Health
Year of publication: 2011
In the past years, many legal documents on allowances for health staff like hardship, mobility, danger, professional responsibility, unique career, preferential and others were enacted, mainly in 1993 – 1994 and revised in 2003 and 2004. After years of implementation, these policies have shown limitations and obstacles that need revision and supplement. 
Laborers in the health sector are unique with high working pressure due to direct contact with patients, infectious diseases as well as toxic chemicals and radioactive substances. The above features require relevant incentive policies to encourage health care professionals to love their job, contribute to maintain health personnel at grassroots level in rural areas, prevention network and health facilities, which provide treatment for social diseases and dangerous epidemics. The Politburo also direct: “allow appropriate allowance scheme for healthcare professionals (in immediate future, similar to teachers) by region, areas and sub-sectors that may cause hardship and risks to health of healthcare personnel.”
In such context, the Department of Organization and Manpower (DOM) and Health Strategy and Policy Institute (HSPI) jointly conduct the study: “Analysis of current situation and recommend revision to some allowance schemes for government permanent staff and employees in the health sector”.
Objectives: To assess the current situation and recommend revision and supplement to the unique allowance scheme for government permanent staff and employees in health sector to maintain and further develop health personnel, meeting the increasing requirements of the health care, protection and promotion for the people.
Specific objectives:
To review and analyze policies on allowances for government permanent staff and employees in health sector.
To evaluate the implementation of above-mentioned policies: mechanism, resources, methods, advantages and disadvantages in implementation and impacts of these policies on the maintenance and development of health personnel at levels.
To recommend revision, supplement to policies on allowances for government permanent staff and employees in health sector.
Target groups
The target groups include institutions, individuals related to the implementation of allowance policies for government permanent staff and employees in health sector, and beneficiaries being government permanent staff and employees in health sector at levels; Leaders of related sectors: Department of Home Affairs, Department of Education and Training, District Division of Education and Training, Secondary Schools, Lower Secondary Schools, Primary Schools in study locations.
 Study time and locations 
The study is implemented from December 2008 to December 2010 in most professional sub-sectors and at all 4 levels: 13 MOH-attached institutions representing different sub-sectors, technical areas and health facilities at levels in 5 provinces of Ha Giang, Bac Ninh, Ha Tinh, Kon Tum and Kien Giang. 
Study design 
A cross-sectional descriptive study with combination of quantitative and qualitative method. 
Data collection methods
Quantitative study: Collect information by statistical table and secondary data analysis. Data is collected by to-fill-in questionnaires to learn health professionals’ comments of allowance policies and some related issues as well as their level of contents with current jobs and recommendations to the policy revision with sample size of 3,200 at 4 levels. 
Qualitative study: The study conducts in-depth interviews, group discussions with related target groups at survey institutions and units at 4 levels, private health facilities in 5 study provinces. 
Key Findings 
In the past years, many allowance policies for health personnel are revised, supplemented and enacted. Besides 6 types of allowances promulgated like other sectors, the health sector has 9 additional preferential allowances (of which 4 especially for the health sector). This has reflected the concern of the Government and society for health professionals according to the spirit of Politburo Resolution 46 “Medical career is a special profession” and needs “special treatment”. However with the unique features, incentive policies are not fully satisfied, yet to ensure equity between dedication and compensation by health professionals compared with others, for example the education and training.
Policies on salaries and preferential allowances for health personnel have been seriously carried out by units in the health sector. Allowance policies have been timely and fully applied at most health facilities. Some facilities have favorable conditions due to existence of sufficient resources (from State budget allocation and financial independence). However during implementation of policies on preferential allowances for health personnel there are obstacles to address, both in legal documents and regulations as well as financial distribution mechanism and monitoring. Particularly, after several revisions and adjustments most allowance policies are outdated, unable to catch up with economic growth and inflation. Therefore it is time to continue adjustment, revision and supplement. 
Existing allowanced policies have direct impact on income and living conditions of the majority of health personnel. About 80% of interviewees have main income from salaries and allowances. About half of them (43.2%) only have salaries and allowances, and no other additional incomes. Thus up to 73.5% interviewees believe that the monthly incomes provided by their institutions can only help to cover part of living needs. Particularly about 1/4 (24.2%) interviewees frankly remark that the current incomes are not significant compared with expenses to cover. Due to low incomes in health sector institutions, nearly one third of interviewed health professionals have to work extra hours. Of which 42% work in professional fields and the remaining 58% work outside professional major. Despite ways of managing, incomes from extra work by health personnel are commonly low compared with incomes provided by their institutions. Staff working at upper levels (central and provincial), treatment areas with high qualifications often have chances to work in professional areas with incomes much higher compared with the remaining groups. This has proven the disadvantages and difficulties in incomes, living and work by health personnel in prevention network, facilities delivering treatment to unique diseases as well as health facilities at grassroots level. There is a potential difficulty in attracting and recruiting new staff to work at these facilities. 
Unsatisfactory salaries and allowances, leading to low incomes are the key reasons causing negative influences on the working mood of crowed health professionals. Up to 39% of interviewed health personnel admit that they are not content with current job. Of which nearly two third reveal that the main reason is unsatisfactory incomes and no chance for additional work for income generation while only 1% feel secure with their work. It is easy to see that more than 83% interviewees say they have plans to generate more incomes in the future. Of which nearly 60% plan to study to improve skills for more extra work opportunities; 11% plan to move to other sectors, localities and non-public health sector. The intention of extra work in professional fields and moving to other sectors by staff in treatment areas and high-qualified employees is at higher level compared with other groups. There is a potential risk of brain drain from lower to upper levels, from public to non-public sector. 
Lack of health personnel, especially physicians and university-level pharmacists is most popular in most institutions, regardless of working areas or levels. The trend of shifting more qualified health personnel from provinces to central level, lower to upper levels, less to more attractive specialties, public to private health facilities, and rural, mountainous areas to large cities keeps increasing. The key reason is inappropriate salaries and incentive allowances for health professionals at public health facilities. 
Quickly carry out revision, supplement and issue additional incentive allowances for health professionals to be suitable with the reality, more satisfactory to the unique features of the health sector and to ensure that attractiveness to maintain health personnel working in less comparative advantages sectors like prevention, unique specialties and health facilities at grassroots level and disadvantaged areas. 
Issue additional incentive allowances that health personnel have yet to enjoy, including:
Experience allowances;
Allowances of responsibilities, mobility, initial allowance, area shifting for health professionals in disadvantaged areas;
Professional risk insurance for health personnel upon contracting epidemics, epidemics related mortality;
Financially support policies like support training expenditures to improve professional qualification, extra income support, priority for earlier salary increase, support for land or house procurement for staff working in less advantaged sub-sectors.
Revise, supplement current policies on preferential allowances
Professional allowances: Expand target groups so as all staff in the health sector can enjoy professional allowances; increase preferential levels: minimum at 30% and maximum at 70%. Depending on the level of incentives for each professional area, area and working level the norms should be appropriately adjusted. Norms should be increased for unique area like autopsy, pathology, psychology, TB, leprosy, infectious diseases, X-ray, testing, pediatrics and preventive medicine. Professional allowances should be provided also for the time health professionals attending training to improve skills and qualification according to institutions’ needs. 
Duty allowances 24/24 hours: The name of “duty allowances” should be changed to “duty paid” and 24/24 hours should be taken out to ensure relevant compensation for people, right according to the true meaning of “being on duty” at hospital. The duty allowance rate should be adjusted according to each specialty, hospital grade and actual number of patient beds. The present payment by absolute money value should be replaced by current salaries and allowances (norm: equal to one day salary and allowance). It is needed to add allowances for cases when institutions cannot arrange for compensate leave, health staff will be paid with 100% of salaries and allowances/day excluding compensated day off.
Epidemic prevention and control allowances: Increase epidemic containment allowances (to be equal to 0.3 minimum salary/day); regulate working hour/day and on-duty  when taking part in epidemics containment equal to 8 hours/day. It is needed to distinguished the concepts of “epidemic source” and “epidemic area” with relevant epidemic control allowance level. The norm for epidemic source places should be higher than the epidemic area (twice higher). Dangerous epidemics are subject to same allowance level.
Allowances for surgery, minor procedures: Increase the norm twice according to the draft. Review the list of operations and minor procedures subject to allowances in addition to appropriate classification.
Allowances for mobility: Increase mobility allowances to 1.5 basic salary coefficient. Besides mobility allowances, it is needed to pay for travel and accommodation expenses according to current regulations.
Guiding circulars on the implementation of incentive allowances should be developed in details, accuracy and close to actual conditions for easy application by institutions. It is needed to develop an appropriate financial mechanism (timely allocating state budget for payment right after enactment of revision decision) to ensure that health personnel can enjoy allowances timely and fully, as soon as the legal document is in effect.
Strengthen the effectiveness of monitoring and supervision on policy implementation for health personnel in all institutions in the whole sector via developing an information receiving and feedback, in which there are clear regulations on accountabilities of stakeholders, diversified forms of feedback (via special pages on health sector newspapers, magazines, newsletter, web-based forum of MoH departments, administrations, HSPI and Trade Union) to timely advise for adjustment of obstacles in current regulations. 

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