Public Service Units and Policy on Organizational Reform of District-Level Health Service Units

The two authors DS Meter and CE Van Horn believe that there are many factors affecting the effectiveness of policy implementation, including both internal and external factors (environment). According to them, there are 6 factors affecting the effectiveness of public policy implementation, which are: 1) Are the goals and content of the policy specific and feasible? 2) Are the policy resources, that is, the resources (human resources, material resources, financial resources, information, etc.) serving the policy implementation adequate? 3) The exchange and coordination between organizations and members of the organization during the implementation process; 4) The capacity of the policy implementation agency; 5) The economic, political, cultural and social environment; 6) The awareness and attitudes of policy implementation staff

The two authors Paul A. Sabatier and Daniel A. Mazmanian believe that there are three main factors affecting the effectiveness of policy implementation, which are: 1) the nature of the policy problem; 2) the quality of policy, resources for policy, interaction and coordination between agencies in policy implementation, the capacity of policy implementation staff, and social participation; 3) external environmental factors such as the economic environment, participation of the mass media, the level of support and participation of the public and social organizations.

In the book "Public Policy Implementation" (1980), George C. Edwards argued that the impact of four main factors directly and/or indirectly affects the effectiveness of public policy implementation, which are: 1) policy propaganda and communication to make policy implementers understand the policy; 2) resources for policy implementation (human resources, information, material resources, etc.); 3) attitude, support and determination of policy implementers; 4) organizational structure and operating mechanism of state administrative agencies. [7]

1.2. Public service units and Policy on reforming the organizational structure of district-level health service units

1.2.1 Public service units, characteristics of public service units

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According to Clause 1, Article 9 of the Law on Civil Servants 2010, a public service unit is an organization established by a competent State agency, political organization, or political organization.

A socio-political organization established in accordance with the provisions of law, with legal status, providing public services, serving State management in the fields of: Education, training, healthcare, scientific research, culture, sports, tourism, labor - war invalids and social affairs, information and communication and other career fields prescribed by law.

Regarding characteristics: Public service units under state agencies, political organizations, and socio-political organizations are invested and built by the state for operation. Depending on the type of public service unit, the state provides budget support at different levels. Decree No. 16/2015/ND-CP dated February 14, 2015 of the Government regulating the autonomy mechanism of public service units has divided public service units into 4 types:

- Unit self-insures regular and investment expenditures;

- Unit self-insures regular expenditure;

- Unit self-insures part of regular expenses;

- The unit is guaranteed regular expenditure by the State.

Public service units are established with the purpose of providing public service in the field that the state is responsible for providing to the people. Personnel at public service units are mainly recruited according to job positions, under contracts, and are managed and used as civil servants.

1.2.2. The basis of the policy of reforming the organizational structure of district-level health service units

District-level health service units are public health facilities that perform the function of advising the District People's Committee on health care and protection for people in the district, and at the same time provide professional and technical services in preventive medicine, medical examination, treatment, rehabilitation and other health services.

The organizational structure of district-level health service units includes: District General Hospital, District Health Center, District Population - Family Planning Center.

The policy of reforming the organizational structure of district-level health service units was formed on the basis of implementing Resolution No. 20-NQ/TW dated October 25, 2017 of the 6th Conference of the 12th Party Central Committee on strengthening the work of protecting, caring for and improving people's health in the new situation, which determined: "Improving both physical and mental health, stature, longevity, and quality of life of Vietnamese people. Building a fair, quality, effective and internationally integrated health system. Developing scientific, ethnic and mass medicine. Ensuring that all people are managed and cared for in their health. Building a team of health workers "Doctors must be like gentle mothers", with solid professional capacity, approaching international standards. Improving competitiveness in the production and supply chain of pharmaceuticals and health services".

Main tasks and solutions:

- Strengthen the leadership of the Party, the management of the State, promote the participation of the Vietnam Fatherland Front, socio-political organizations and the whole society in protecting, caring for and improving people's health.

- Improve people's health: Focus on raising awareness, changing behavior, promoting the responsibility of the entire political system, the whole society and each person; develop and organize the synchronous implementation of projects and programs on improving the health and stature of Vietnamese people. Pay attention to the conditions for each person to be protected and improve their health, especially in rural, mountainous and island areas. Improve the capacity to prevent and control epidemics associated with innovation in grassroots health care.

- Improve the quality of medical examination and treatment, fundamentally overcome the situation of hospital overload. Innovate service style and attitude, improve medical ethics; build a green - clean - beautiful, safe, civilized hospital, aiming to provide comprehensive care for patients.

- Promote the development of pharmaceutical and medical equipment industry.

- Developing human resources and medical science and technology. Fundamentally and comprehensively innovating medical human resource training, meeting both medical ethics and professional requirements in the context of proactive and active international integration.

- Innovation in the health service management and provision system: continue to innovate and perfect the health organization system towards streamlining, effectiveness, efficiency and international integration. Ensure consistent direction on expertise and profession from the central to local levels nationwide, while ensuring leadership and direction from local Party committees and authorities.

- Strongly innovate health finance, increase investment and accelerate the process of restructuring the state budget in the health sector to have resources to comprehensively implement the work of protecting, caring for and improving people's health, especially for policy beneficiaries, ethnic minority areas, mountainous areas, border areas and islands.

Strongly innovate the management and organization of public health service units. Promote the implementation of autonomy in professional tasks, organizational structure, personnel and finance, associated with accountability, publicity and transparency.

- Proactively and actively integrate and improve the effectiveness of international cooperation.

To implement the above tasks and solutions, Resolution No. 08/NQ-CP dated January 24, 2018 of the Government on the Action Program to implement Resolution No. 19-NQ/TW dated October 25, 2017 of the 6th Conference of the 12th Central Executive Committee on continuing to innovate the organization and management system, improving the quality and efficiency of public service units, has determined: "Uniformly implement the model of each district level having only one multifunctional medical center (except for districts with hospitals of grade II or higher), including preventive medicine, population, medical examination, treatment, rehabilitation and other medical services; The center directly manages the commune health station and regional polyclinic (if any)". From that practice, to achieve the goal of Resolution 20-NQ/TW dated October 25, 2017, Resolution No. 08/NQ/TW dated January 24, 2018 of the Government ...8 of the Government on continuing to innovate the organization and management system, improving the quality and efficiency of public service units, ensuring the quality and efficiency of public service units, ensuring the quality and efficiency of

In 2017, the 6th Conference of the 12th Party Central Committee needs to have effective policies to reform the organizational apparatus towards streamlining, effectiveness and efficiency, promoting the role of caring for and protecting people's health in the new situation.

1.2.3. Policy objectives for reforming the organizational structure of district-level health service units

Organize and rearrange district-level health service units in a streamlined, effective and efficient manner to concentrate health resources (including: health economy and finance, health human resources, infrastructure and medical equipment, health information...) in the district; improve the operational capacity of health centers to improve the quality of health services in the coming time.

1.2.4. Policy content on reforming the organizational structure of district-level health service units

The policy of reforming the organizational structure of district-level health service units is the concretization of the implementation of Resolution No. 19-NQ/TW dated October 25, 2017 of the Central Executive Committee on "Continuing to innovate the organizational and management system, improving the quality and efficiency of operations of public service units" specifically: arranging and reorganizing the apparatus of district-level public health facilities with a model of 3 units including: District Health Center, District General Hospital, District Population - Family Planning Center into a multifunctional district-level health center in the direction of streamlining, operating effectively and efficiently to meet the requirements of people's health care in the new situation.

1.2.5. Principles for implementing policies on organizational arrangement of district-level public service units

Ensure the leadership of the Party, strengthen state management, promote the supervisory role of mass organizations, civil servants, public employees and people in the implementation process.

The process of organizing and rearranging district-level health service units must be suitable to local conditions, have a legal basis, be highly feasible, and at the same time "Ensure consistent direction on expertise and profession from the central to local levels nationwide" according to Resolution No. 20-NQ/TW, dated October 25, 2017.

The arrangement and consolidation must ensure that the medical services previously provided by the three units: Medical Center, General Hospital and Population - Family Planning Center in the district are still fully, stably, conveniently and easily accessible for people after the establishment of the multi-functional medical center.

Unify awareness and action in units of the health sector and civil servants, public employees, and workers in the units. The settlement of regimes for civil servants, public employees, and workers must ensure compliance with regulations and ensure legitimate interests for workers; Linking the arrangement with streamlining the payroll according to Decree No. 108/2014/ND-CP on streamlining the payroll, Decree No. 113/2018/ND-CP dated August 31, 2018 amending and supplementing a number of articles of Decree No. 108/2014/ND-CP dated November 20, 2014 of the Government on streamlining the payroll policy, Decree No. 158/2007/ND-CP of the Government on job position conversion for civil servants and public employees and Decree No. 150/2013/ND-CP of the Government on amending and supplementing Decree No. 158/2007/ND-CP.

1.2.6. Policy implementation entities

Policy making entity: The State with a unified and synchronous system of administrative agencies from the central to local levels.

Policy implementation entity:

The Ministry of Health is responsible for issuing guiding documents, planning, and plans for the development of the network of medical facilities in the next period, regulating the functions, tasks, and organizational structure of district-level medical centers; and setting the number of employees as a basis for localities to organize and implement policies on reorganizing the apparatus of district-level public service units.

Provincial Party Committees and People's Committees at all levels direct and organize the implementation of the contents of Resolution No. 20-NQ/TW dated October 25, 2017 of the 6th Conference of the 12th Party Central Committee on strengthening the protection, care and improvement of people's health in the new situation; Resolution No. 08/NQ-CP dated January 24, 2018 of the Government on the Action Program to implement Resolution No. 19-NQ/TW dated October 25, 2017 of the 6th Conference of the Party Central Committee.

The 12th Central Executive Committee on continuing to innovate the organization and management system, improving the quality and efficiency of public service units.

People's Councils at all levels supervise the implementation of policies on organizational arrangement of district-level public service units in the area;

The Department of Health is the standing agency, advising on the implementation of policies and organizational arrangements for district-level health service units;

District-level medical service units: develop plans to organize and implement policies to reorganize the apparatus at the unit according to regulations.

People's Committees of districts and cities; relevant agencies and organizations: coordinate and organize the implementation of policies to reorganize the apparatus of district-level health service units according to assigned functions and tasks.

1.3. Steps to implement the policy of reforming the organizational structure of district-level health service units

1.3.1. Develop a plan to implement the policy of reforming the organizational structure of district-level health service units.

The policy implementation plan is the basis and important tool for implementing policies into practice. In developing a policy implementation plan, it is necessary to accurately and specifically identify the contents and tasks in the organization and operation plan; in the plan to provide material resources for policy implementation; in the plan to inspect and urge policy implementation and determine a reasonable time for policy implementation. Along with the policy implementation plan, it is necessary to develop internal regulations and rules for organizing and implementing policies. The capacity to develop a policy implementation plan is demonstrated and measured by the accuracy and feasibility of the plan. The capacity to develop a good policy implementation plan is the ability to develop a policy implementation plan with high accuracy and feasibility, without having to make adjustments during the implementation process. Therefore, it is required that the staff of staff members who advise on the development must understand and grasp the objectives, contents, tasks, scope, objects,

scale and importance of the policy. On that basis, determine the objectives, content, tasks, human and material resources, time and solutions for organizing the implementation of the policy.

To implement the policy of reforming the organizational apparatus of district-level health service units, relevant agencies must develop a policy implementation plan and accurately and specifically identify the contents and tasks in the organizational and operational plan; in the plan to provide material resources (including financial resources and facilities) for implementing the policy of reforming the organizational apparatus of district-level health service units; in the plan to inspect and urge the implementation of the policy and in determining a reasonable time for implementing the policy. Along with developing a policy implementation plan, it is necessary to develop a regulation on organizing and implementing the policy. On that basis, determine the objectives, contents, tasks, resources (human and material resources), time and solutions for implementation.

1.3.2. Disseminate and propagate the implementation of policies on reforming the organizational apparatus of district-level health service units.

After the policy implementation plan is developed and approved, the agencies in the State apparatus will organize and implement it according to the plan. Dissemination and propaganda of policies is a necessary step because it is an important step, of great significance to State agencies and policy implementation subjects. Doing this well will help policy subjects and people participating in implementation understand the purpose and requirements of the policy; the correctness of the policy in certain circumstances; and the feasibility of the policy. Thereby, they will be aware and voluntarily implement according to the requirements of the State management agency. For policy dissemination and propaganda to be effective, State agencies need to increase investment in technical equipment; in terms of professional qualifications and political qualities for the team of cadres and civil servants implementing the policy.

Propaganda and advocacy work for policy implementation must be carried out regularly and continuously, even when the policy is being implemented so that all parties can benefit.

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