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Researches Human resources for health

 Vũ Thị Minh Hạnh,  Phạm Thị Nga*, Nguyễn Thị Hồng Yến**, Trần Thị Hồng Cẩm,Vũ Thị Mai Anh,

Trần Vũ Hiệp, Hoàng Thị Mỹ Hạnh, Trịnh Thị Sang, Nguyễn Việt Hà, Nguyễn Trọng Quỳnh,  Nguyễn Văn Hùng, Hoàng Ly Na

* Personnel Department, MoH;  ** Administrative of Medical Services, MoH
Place of publication: Ministry of Health
Year of publication: 2011
On Mar. 25, 2010, the government endorsed Project 32/2010/QĐ-TTg on “Development of social work profession for 2010-2020”. On July 15, 2011, the Ministry of Health further approved the “Development of social work profession in the health sector for 2011-2020” Project, aiming to formulate and develop social work as an occupation in the health sector to help improve the quality and efficacy of people’s health protection, care and development. This study seeks to explore the status and development need for the social work (SW) profession in medical practices and recommend human resources development plan for this specialized field in the near future.
1. Review current challenges and gaps in terms of the health workforce at medical practices in trying to improve patients’ satisfaction; 
2. Identify needs on SW specialized staff training in health care for the immediate future; 
3. Recommend specific actions and pathways for sustainable development of the social work profession in the health system. 
Methods: This is a cross-sectional study, combining quantitative and qualitative methods.

Findings and discussions
Background of participating institutions and individuals: 16/26 hospitals currently having more in-service beds than their designated capacity; Nurse to doctor ratio: only 32% of the hospitals qualify for the norms set by Circular 08, with the remaining only achieving ratios of 1-2.9. 
Health workers (n=942): the combination of sex, age, health system levels, qualifications, line of work of the respondents was basically comparable to that of the health workforce in medical practices in the entire system. Social workers (n=151): women accounted for 78.1% (health sector: >60%). More than half of them (50.3%) were working in central hospitals. Only 2% of them had regular training on SW discipline. Patients (n=899): the participating patients are selected in a number that match the hospital bed size. Most of the patients were female of an average age of  over 40; 77.6% of them paying their health care expenses with health insurance cards.
Existing human resources constraints and challenges for health facilities in meeting the patients’ needs for health services delivery
Health care facilities: 61.3% of the hospitals had in-service bed numbers higher than the designated bed capacity. Bed use was frequently at overload level at 91.3% hospitals, most seriously at the Administrative area clinical wings, and consulting area. Half of the hospitals were understaffed according to the average benchmark of Circular 08. Health workers were constantly under huge pressure in their daily work from large number of patients they served each day, lack of cooperation from the patients and their families, and so on. Nearly one third of the medical workers were not satisfied with the quality of daily health services delivered, especially at the consulting, clinical and subclinical areas.
Improperly met patients’ need for health care services: Consulting area: most patients reported to have received only directly associated services while many other supporting services were not met. Subclinical area: A number of essential services were provided to patients at relatively high percentages, including 68.5% of patients receiving advice on testing and diagnostic imaging procedures; 66.1% receiving advice on test specimen extraction/diagnostic imaging procedures; and 66.2% having their queries answered. Clinical wing: A relatively high percentage of patients commented positively on the essential services they had received. Nevertheless, supporting services such as living support, rehabilitation assistance, referral advice for both in-house and external services in this area seemed to remain lackluster. 
As observed by health workers, patient overcrowding resulted to less than optimal service delivery by health facilities. Reasons for patients’ non-satisfaction were mostly long waiting time (66.78%) and complex paperwork (57.6%). From the patients’ feedback, the underlying causes of their non-satisfaction included health workers’ refusal to provide more detailed instructions, cursory explanations and unfriendly attitude, which seemed to mount to a high level of concern at all phases of service delivery.
Community-based execution of national targeted health programs: National targeted health programs being rolled out in community were becoming increasingly pluralistic. National Target Program in Health (NTPH) implementing staff at the commune level mostly worked on a part-time basis. As patients at the community level were increasing in number, the need for health education, counseling, therapeutic support and reintegration was growing.
Current status of social work at health facilities in the surveyed sites
At hospital: While 22.7% of the institutions outsourced their social work (SW), the organizational model of these specialized focal points remained inconsistent. 72.7% of the hospitals incorporated SW dimensions in every affiliated department/division. Most hospital-based social workers are female. Only 2% of hospital-based social workers had regular training on the SW discipline. Dedicated social workers at hospitals accounted only for a modest proportion (18.5%), most of them doing this concurrently with other regular work (41.8%) or as associate workers (39.7%). Finances needed to maintain SW activities were raised from various sources, but mostly from hospitals (81%) and benefactors (61.2%). SW activities included provision of instructions and advice on paperwork and clinical procedures, living support for patients and guidance of discharge formalities. 85.7% of social workers had no official training. SW activities faced major challenges including operational funding constraints (78.6%), lack of a consistent legal framework for organizational and staffing arrangements in this regard (71.4%), lack of patients’ cooperation (34.67%), among others. 
At the community: Community-based SW, though very much needed, remained largely unattended to. 
The need for SW specialized staff training for the immediate future: 16/26 of the participating hospitals reported that having had an independent SW division in their system was essential. 79.3% of the health workers, 94% of the social workers and 74.4% of the patients interviewed confirmed the need for SW activities in the hospital. Professional social workers nationwide as expected by the hospitals might be estimated at about > 3,000 individuals and another > 12,000 part-time personnel. In the early stage of introducing SW activities, a portion of health workers might be mobilized to work on a part-time basis, especially hospitals at lower tiers. As much as 94.6% of people doing social work at hospitals felt the need for training and capacity building to do their work.
Overload was common at most the surveyed hospitals, except a few district level hospitals. The overload had also placed huge pressure on medical staff, particularly at the outpatient and subclinical sections of higher level hospitals. The service quality of the hospitals were, generally speaking, less than expected. At the community level, as national targeted health programs were underway in an increasing variety, more and more patients were participating in these programs, while a large part of the current workforce were part-time employees, therapeutic and social support for patients were obviously not properly catered to. While a few hospitals had SW mechanisms in place, these activities were underway in a spontaneous manner, with varied organizational models, staffing arrangements and operations. Hospital-based SW was facing various challenges. The need for development of SW profession was confirmed by most senior officials of health facilities and field staff of national targeted health programs in the surveyed sited, and was also welcomed by a significant proportion of health workers and patients. 

There needs to be a roadmap for SW profession development in the health sector tailored to the need and affordability of individual entities. From now to 2015, formation and development of SW profession should be focused on at national and provincial level hospitals, before scaling up at district level hospitals. SW focal points should work as independent units of hospitals. SW tasks and requirements need to be disseminated and rolled out in a more holistic way at hospitals and communities alike, to avoid confusing SW and charity. Training of permanent and part-time SW workforce in hospitals needs to be underscored, as well as for community-based primary health care. Guidelines on standards, compensation arrangements, policies and a professional title system for social workers in the health sector are needed. Education on the necessity, role and value of social workers as part of the clinical teams at hospitals and communities should be accelerated.

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