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Researches Human resources for health
RESEARCH ON DOCTORS AND NURSES AFTER GRADUATING

 Lê Quang Cường, Trần Thị Mai Oanh, Đậu Thị Hà Hải,

Khương Anh Tuấn, Vũ Văn Hoàn et al.

Place of publication: Ministry of Health
Year of publication: 2012 
 
Objectives
 
1. Describing the current situation and utilization needs of medical doctors and university level nurses; 
2. Describing the procedures to recruit and utilize medical doctors and university level nurses after graduation in some health facilities; analyzing factors influencing the recruitment, utilization and maintenance of medical doctors and university level nurses by health facilities; 
3. Describing the job finding process by medical doctors and university level nurses after graduation in 2005-2007 in some medical universities; 
4. Analyzing factors that impact on the job finding process by medical doctors and university level nurses.
 
Methods
The study was carried out in six provinces of Lao Cai, Thai Nguyen, Thai Binh, Nam Dinh, Dak Lak and Kien Giang. The audience includes health policy makers at central and provincial levels, health human resources employers at local level – being managers of health facilities at provincial, district and commune levels, as well as medical doctors and university level nurses graduated in 2005-2008.
 
Key findings 
1. In the past years, the number of medical doctor increased fundamentally, from 50,106 physicians in 2006 to 56,661 in 2009. The indicator of medical doctors/10,000 population also raised steadily by year, from 6.03 in 2003 to 6.59 in 2009. However, such figures in most regions were much lower than the national average. Particularly in the Mekong Delta, the indicator of medical doctors/10,000 population was lowest, only at 4.7 followed by the Southern East, at 4.7. The shift of health professionals out of public health sector tended to grow by year. 
2. However, the number of medical doctor and university level nurses were far to meet the actual needs. 
The total number of medical doctors and university level nurses to be supplemented according to Circular 08 in both curative and preventive sectors at provincial and district levels nationwide in 2007 was 8,006, at commune level was 4,079 (totaling at 12,519 medical doctors for all three levels). Following the master plan on health sector development of Vietnam by 2010 and vision 2020, in 2010 to reach the target of 7 medical doctors/10,000 population, there were a shortfall of 17,719 medical doctors for all three provincial, district and commune levels. 
In terms of university level nurses, the number to be supplemented throughout the country to meet the regulations by Circular 08 was 20,726. To reach the stipulation of the health sector development master plan, 66,211 nurses should be added in 2010.
Reasons of physician shortage included the followings: (1) actual training capacities did not meet the human resources needs. With the current number of annually trained medical doctors, by 2016 there would be sufficient quantity to satisfy the need of 2010, to reach the target of 7 medical doctors/10,000 population according to the health sector development master plan; (2) staff turnover due to relocation, resign and retirement. 
3. The number of newly recruited physicians were much lower than the actual need, while the quantity of medical doctors moving out and retiring accounted for significant rates  (about 37%-40% compared with the new recruits). Health facilities facing difficulties in recruitment could be named as specialized facilities, district health facilities, district preventive medicine centers, especially in disadvantaged areas.
4. The recruitment procedures were implemented in different models: Some provinces did not comply with regulations of currently existing legal documents. In many provinces, health staff recruitment were still dependent on the Provincial Department of Home Affairs. In some localities, the Provincial Health Department was delegated with the task of staff recruitment and the department then passed on to health facilities. The implementation of Government Decree 43 partially impacted the recruitment of human resources in health facilities, as they had policies to limit recruiting permanent staff or prefer more contracted staff to reduce hospital expenditures. 
5. There were many factors influencing the maintenance of medical doctors and university level nurses: Working conditions and environment, development opportunities was the most important factor to maintain medical doctors and university level nurses. For married physicians, income was one of the factors that had maintaining impact, especially in disadvantaged areas.
6. For new graduate physicians and nurses: a large percentage of physicians and nursed graduated in 2005-2008 had jobs. Of which, most worked at public health facilities.
79.6% physicians and 87.5% university level nurses graduated in 2005-2007 had jobs; only a small percentage was not employed (14 medical doctors, equal to 3.1%), of which the majority graduated in 2008 (10 out of 14 cases)
85.6% officially trained physicians and 93.3% university level nurses had job at public health facilities. Only 6.7% of officially trained physicians and 4.3% university level nurses worked in private health facilities. 
About 47% officially trained physicians worked at provincial level after graduation, 22.5% worked at district level and 21.4% worked at central level. For officially trained of university level nurses, most worked at central and provincial levels (about 48% at central and 43% at provincial level). Only 2% of them worked at commune level.
Criteria for employment seeking by newly graduated physicians: The first criteria that medical doctors and university level nurses considered when seeking for jobs were good working environment and opportunities for career development (accounting for more than 98%); followed by “working in public agencies, training opportunities and promotion chances” (71.5% of officially trained medical doctors and 85.7% of officially trained university level nurses mentioned when being interviewed), and then income (47.6% medical doctors and 38.6% university level nurses).
 
Recommendations
1. Policies on enforcement and attracting health human resources for some specialties and disadvantaged areas 
- Study, recommend and revise, supplement polices on salaries, professionally preferential allowances to attract health staff to work in specialties of TB, leprosy, mental health, HIV/AIDS, pediatrics and preventive medicine.
- Issue a special mechanism to encourage students to study specialties of TB, leprosy, mental health, pediatrics and preventive medicine. 
- Develop and implement policies, incentives and regulations on “Social obligations and responsibilities of health professionals for socio-economic difficult areas”; policies and regulations to ensure students from disadvantaged areas to return to their localities to work after graduation, especially those having university degree (including economic and non-economic incentives).

2. Improve working conditions for some specialties and disadvantaged areas
- Increase investment to improve working conditions at commune and district health facilities via investment to construct commune health centers in disadvantaged areas in period 2008-2010 according to Decision 950/2008/QG-TTG; Project to support the development of district preventive medicine centers in period 2007-2010 according to Decision 1402/2007/QĐ-TTg; Project on investment in construction, rehabilitation and upgrading of inter-district general hospitals using capital from Government bond and other legal sources period 2008-2010 according to Decision 47/2008/QĐ-TTg. 
- Study the recurrent budget for operations of commune health center, district hospital and district health center.
3. Increase the number of medical doctors trained annually and diversify training forms; continue and strengthen the implementation of selective training to increase human resources for disadvantaged provinces.
4. Strengthen examination and supervision of the implementation of regulations and policies on recruitment, utilization and maintenance of human resources for health.
 
 

03/12/2013
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