District and city health centers were initially district-level preventive health centers established under Decision No. 1586/QD-UBND August 11, 2006 of the Provincial People's Committee and on the basis of Decision No. 26/2005/QD-BYT dated September 9, 2005 of the Minister of Health on the regulation of functions, tasks, powers and organizational structure of district, town, and provincial city preventive health centers and district-level preventive health centers were renamed district and town (city) health centers under Decision No. 1987/QD-UBND dated September 13, 2011 of the Provincial People's Committee. Commune, ward, and town health stations were transferred in their original state from the Health Department under the District People's Committee to the Health Center under the Department of Health from September 1, 2011 (Decision No. 1988/QD-UBND dated September 13, 2011). September 13, 2011).
District and city general hospitals are organized and operate basically according to Decision No. 1587/QD-UBND August 11, 2006 of the Provincial People's Committee and on the basis of Decision No. 1895/1997/QD-BYT dated September 19, 1997 of the Minister of Health on promulgating hospital regulations; In addition, the organization and operation of a number of specialized departments and functional rooms stipulated in the Hospital Regulations have also been abolished or adjusted by a number of legal documents issued later, specifically: Regulations on Emergency, Intensive Care and Anti-Poisoning (Decision No. 01/2008/QD-BYT), guidelines for organizing the implementation of infection control (infection with pathogenic microorganisms) in medical examination and treatment facilities (Circular No. 18/2009/TT-BYT), regulations on the organization and operation of the hospital Pharmacy Department (Circular No. 22/2011/TT-BYT), guidelines for nursing care of patients in hospitals (Circular No. 07/2011/TT-BYT)...
The District and City Population and Family Planning Center was established under Decision No. 1414/QD-UBND dated August 11, 2008 and operates under Decision No. 357/QD-UBND dated March 3, 2009 of the Provincial People's Committee and on the basis of Joint Circular No. 03/2008/TTLT-BYT-BNV, Circular No. 05/2008/TT-BYT dated April 25, 2008 of the Ministry of Health. The District and City Population and Family Planning Center is currently under the direct management of the Cao Bang Provincial Department of Population and Family Planning.
Currently, in 12 districts and Cao Bang City, there are 26 public service units (Health Centers, General Hospitals) under the Department of Health and 13 Population - Family Planning Centers under the Department of Population - Family Planning under the Department of Health, specifically as follows:
- General Hospital (12 districts and cities): 1,031 people / 1,108 staff, including:
Ha Quang District General Hospital
Hoa An District General Hospital
Thong Nong District General Hospital
Ha Lang District General Hospital
Tra Linh District General Hospital
Trung Khanh District General Hospital
Phuc Hoa District General Hospital
Quang Uyen District General Hospital
Thach An District General Hospital
Nguyen Binh District General Hospital
Bao Lac District General Hospital
Bao Lam District General Hospital
Cao Bang City General Hospital
- District and City Medical Centers (13 units): 303 people/327 staff working at the Medical Center; for commune, ward and town medical stations under the Center, there are 941/995 staff (staff of 199 commune, ward and town medical stations) including:
Ha Quang District Medical Center (19 commune and town medical stations)
Hoa An District Medical Center (21 commune and town medical stations)
Thong Nong District Medical Center (11 commune and town medical stations)
Ha Lang District Medical Center (14 commune and town medical stations)
Tra Linh District Medical Center (10 commune and town medical stations)
Trung Khanh District Medical Center (20 commune and town medical stations)
Phuc Hoa District Medical Center (9 commune and town medical stations)
Quang Uyen District Medical Center (17 commune and town medical stations)
Thach An District Medical Center (16 commune and town medical stations)
Nguyen Binh District Medical Center (20 commune and town medical stations)
Bao Lac District Medical Center (17 commune and town medical stations)
Bao Lam District Medical Center (14 commune and town medical stations)
Cao Bang City Medical Center (11 commune and town medical stations)
- District and city Population and Family Planning Center (13 units): has 88/91 staff (under direct management of the Department of Population and Family Planning)
Ha Quang District Population and Family Planning Center
Center for Population - Family Planning of Hoa An district
Thong Nong District Population and Family Planning Center
Ha Lang District Population and Family Planning Center
Tra Linh District Population and Family Planning Center
Center for Population - Family Planning of Trung Khanh district
Phuc Hoa District Population and Family Planning Center
Quang Uyen District Population and Family Planning Center
Population and Family Planning Center of Thach An district
Nguyen Binh District Population and Family Planning Center
Bao Lac District Population and Family Planning Center
Bao Lam District Population and Family Planning Center
Cao Bang City Population and Family Planning Center. [32]
Table 2.1: Organizational model and functions of district-level health service units before implementing the policy of reforming the organizational apparatus
STT
UNIT NAME | FUNCTIONS AND TASKS | |||
Medical examination and treatment, rehabilitation | Preventive | Population - Family planning | ||
Hoa An District | ||||
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1
Hoa An Medical Center | X | |||
2 | Hoa An General Hospital | X | ||
3 | Hoa An Population and Family Planning Center | X | ||
Ha Quang District | ||||
4 | Ha Quang Medical Center | X | ||
5 | Ha Quang General Hospital | X | ||
6 | Ha Quang Population and Family Planning Center | X | ||
Thong Nong District | ||||
7 | Thong Nong Medical Center | X | ||
8 | Thong Nong General Hospital | X | ||
9 | Thong Nong Population and Family Planning Center | X | ||
Nguyen Binh District | ||||
10 | Nguyen Binh Medical Center | X | ||
11 | Nguyen Binh General Hospital | X | ||
12 | Nguyen Binh Population and Family Planning Center | X | ||
Bao Lac District | ||||
13 | Bao Lac Medical Center | X | ||
14 | Bao Lac General Hospital | X | ||
15 | Bao Lac Population and Family Planning Center | X | ||
Bao Lam District | ||||
16 | Bao Lam Medical Center | X | ||
17 | Bao Lam General Hospital | X | ||
18 | Bao Lam Population and Family Planning Center | X | ||
Ha Lang District | ||||
19 | Ha Lang Medical Center | X | ||
20 | Ha Lang General Hospital | X | ||
21 | Ha Lang Population and Family Planning Center | X | ||
Chongqing District | ||||
22 | Chongqing Medical Center | X | ||
23 | Chongqing General Hospital | X | ||
24 | Chongqing Population and Family Planning Center | X | ||
Quang Uyen District | ||||
25 | Quang Uyen Medical Center | X | ||
26 | Quang Uyen General Hospital | X | ||
27 | Quang Uyen Population and Family Planning Center | X | ||
Phuc Hoa District | ||||
28 | Phuc Hoa Medical Center | X | ||
29 | Phuc Hoa General Hospital | X | ||
30 | Phuc Hoa Population and Family Planning Center | X | ||
Thach An District | ||||
31 | Thach An Medical Center | X | ||
32 | Thach An General Hospital | X | ||
33 | Thach An Population and Family Planning Center | X | ||
Tra Linh District | ||||
34 | Tra Linh Medical Center | X | ||
35 | Tra Linh General Hospital | X |
36
Tra Linh Population and Family Planning Center | X | |||
Cao Bang City | ||||
37 | City Medical Center | X | ||
38 | City General Hospital | X | ||
39 | City Population and Family Planning Center | X | ||
Total | 13 | 13 | 13 |
[Source: Data compiled by the author] Financial mechanism of district-level medical service units in the province
Cao Bang
- In the period of 2011-2016, implementing Decree No. 43/2006/ND-CP and Decision No. 2884/QD-UBND dated December 29, 2011 of the Provincial People's Committee, 13 district-level general hospitals have become public service units that partially cover operating costs; while 13 district-level medical centers (public service units with revenue below 10%) and 13 Population - Family Planning Centers (public service units with no revenue) are public service units whose regular operating costs are covered by the state budget.
- In the period of 2017 - 2020, implementing Decree No. 16/2015/ND-CP and Decision No. 1898/QD-UBND dated October 27, 2017 of the Provincial People's Committee, 13 district-level general hospitals will be self-sufficient units for part of their regular expenses; while 13 district-level medical centers and 13 Population - Family Planning Centers (non-revenue public service units) will be public service units with regular expenses guaranteed by the state. [33]
Assessment of organizational model and financial mechanism before implementing organizational reform
In the period from 2006 to 2011, the district-level health service units in Cao Bang province had an organizational model including the District Health Center (including two functions of medical examination and treatment and preventive medicine) and the Population - Family Planning Center. From 2011 to 2019, the District Health Center was divided into the District Preventive Medicine Center (later renamed the District Health Center) and the District General Hospital. With the above organizational model, the provision of health services in the district has advantages such as: preventive medicine activities and medical examination and treatment are separated, helping to provide specialized preventive medicine and medical examination and treatment services, gradually improving the quality of services and serving, meeting the increasing needs of the people; Facilities
Infrastructure and equipment are invested in accordance with needs and expertise; Human resources are trained in depth according to their specialties; Units focus on increasing the ability to provide and access medical and population services for the people. Thereby, contributing to the health sector in fulfilling its assigned tasks in the context of increasing non-communicable diseases, the emergence of many dangerous epidemics such as influenza A (H5N1) (H1N1), measles, hand, foot and mouth disease... the population aging process is taking place rapidly, the needs and demands for quality medical services of the people are increasing, under the pressure of implementing partial financial autonomy due to salaries and allowances for direct work, procedures, and surgeries being included in the price of medical services according to the roadmap for medical examination and treatment.
The district health center, the general hospital and the district population and family planning center have proactively coordinated and well organized the implementation of disease prevention and control activities, preventing major epidemics from occurring in the area. Effectively implementing projects and target programs on health and population, receiving and implementing many high-tech services such as endoscopic surgery. The quality of the population has been improved, and population and family planning activities have been implemented synchronously and widely in 12 districts and the city. Medical staff at district and commune levels have been trained, fostered, updated with professional knowledge, and received technical transfer, thereby meeting the requirements and tasks of providing medical services and population services to people in the district. The conversion of operating mechanisms and implementation of financial autonomy according to Decree No. 43/2006/ND-CP in the period of 2011 - 2016 and the conversion of operating mechanisms and implementation of financial autonomy according to Decree No. 16/2015/ND-CP in the period of 2017 - 2020 for medical examination and treatment units have initially achieved certain results.
However, in addition, the organization and operation of medical service units at the district level before implementing the organizational reform still have limitations and shortcomings: medical service provision activities require close and close coordination between departments and specialties, but the current form of medical organization at the district level has 03 units (Health Center, General Hospital, Population and Family Planning Center) with separate headquarters, dispersing resources (facilities, equipment, human resources, funding), qualified human resources, specialized skills in the field of medicine and pharmacy, especially doctors,
University pharmacists at the district level are difficult to recruit and often do not work long-term, especially in districts with particularly difficult socio-economic conditions that are always in a state of shortage of human resources...
The functions and tasks of some activities between the District Health Center and the General Hospital; between the District Health Center, the District General Hospital and the health stations have not been clearly defined, leading to poor coordination, lack of closeness, timeliness, and low efficiency; the direction and professional support between the District Health Center and the General Hospital for the health stations sometimes overlap and are not unified; the quality of medical service provision is uneven and limited, especially at some health stations.
The three district-level health service units have inconsistent scales, with some small-scale units such as the Population - Family Planning Center, which has affected investment, development and operation (there are 05 district health centers: Ha Lang, Nguyen Binh, Thach An, Bao Lam, Tra Linh and the Population - Family Planning Center: Ha Lang, Bao Lam currently do not have headquarters). The financial management level of some district-level health units has not met the requirements, the district health center has not promoted the management of the health stations under the center in implementing the revenue from medical services from medical examination and treatment; Some general hospitals, although having revenue sources, have not been proactive in exploiting and managing the revenue sources well, still mainly relying on the budget for additional funding if there is a shortage; Some district-level health service units have not yet realized the inevitable trend of public health service units to be autonomous, self-responsible in professional activities and self-balancing to ensure a part of regular expenses; The mindset of some leaders and officials in some district-level health service units and commune health stations still has the mindset of waiting and relying on the State's subsidies, is slow to innovate, and does not fully recognize the State's shift from directly allocating budget for medical examination and treatment activities to supporting beneficiaries through health insurance; activities are stagnant, not dynamic and creative; Some service units are not proactive in restructuring the team of civil servants and public employees.
according to ranks, professional titles, training levels to suit functions, tasks, recruitment, planning, training, promotion of professional titles; Leaders of some units have not yet fully grasped and separated unit management from professional management...
From the above reality, the reorganization of Medical Centers, General Hospitals and Population - Family Planning Centers in 12 districts and Cao Bang City (hereinafter referred to as district level) to unify the model at the district level with only one multifunctional Medical Center is a very necessary requirement and suitable to the reality of Cao Bang province.
2.2. Implementing the policy of reforming the organizational structure of district-level health service units in Cao Bang province
2.2.1. Objectives of implementing the policy of reforming the organizational structure of district-level health service units in Cao Bang province
The implementation of the policy of reforming the organizational structure of district-level health service units needs to ensure the following goals:
Organize and rearrange medical service units at district and city levels in the province into multi-functional medical centers, including preventive medicine, population, medical examination, treatment, rehabilitation and other medical services according to Resolution No. 19-NQ/TW dated October 25, 2017 of the 6th Conference of the 12th tenure of the Politburo; Resolution No. 139/NQ-CP dated December 31, 2017 and Resolution No. 08/NQ-CP dated January 24, 2018 of the Government; Plan No. 202-KH/TU dated February 21, 2018 of the Standing Committee of the Cao Bang Provincial Party Committee on implementing Resolution No. 19-NQ/TW dated October 25, 2017 of the 6th Conference of the Central Executive Committee (12th tenure); Project No. 12-DA/TU dated November 8, 2018 of the Cao Bang Provincial Party Committee on rearranging and reorganizing public service units under the state administrative system in Cao Bang province according to Resolution No. 19-NQ/TW dated October 25, 2017 of the 12th Central Committee is an urgent requirement, not only to meet the requirements of a market economy, socialist orientation and the process of international integration but also to concentrate health resources (health economics and finance, health human resources, infrastructure and