| TONG QUAN & NGHIEN CU |

Nhng ton tai cua he thong cung cap dch vu

phuc hoi chc nang tai cac c s y te cong lap
Nguyen Th Minh Thuy

at van e: Nhu cau phuc hoi chc nang (PHCN) cua ngi khuyet tat (NKT) ngay cang tang va
c cung cap qua hai he thong y te t nhan va y te cong lap. He thong y te cong lap c la chon
nhieu hn nhng con nhieu han che. Muc tieu: Phan tch nhng ton tai cua he thong cung cap dch
vu PHCN thuoc he thong y te cong lap. Phng phap: Nghien cu nh tnh tm hieu nhng ton tai
trong cung cap dch vu PHCN cho NKT tai c s y te cong lap tai vung ong bang song Hong. Ket
qua: Cung cap dch vu PHCN tai c s y te cong lap cho NKT cha ap ng c nhu cau cua NKT;
thieu s ch ao xuyen suot cua cac c quan chc nang; kien thc ve tnh hnh khuyet tat cua can bo
y te cac cap cha ay u va s cung cap dch vu khong ong eu gia cac a phng. Khuyen ngh:
Can tang cng nang lc PHCN cho can bo y te tuyen xa va huyen ve phat hien khuyet tat va ky thuat
PHCN n gian. Ngoai ra, can tang cng au t nguon lc va nhan lc cho he thong PHCN t tnh
en huyen va xa.
T khoa: He thong dch vu PHCN, c s y te cong lap, PHCN

Drawbacks of rehabilitation service system

at public health facilities
Nguyen Thi Minh Thuy

Background: The need of getting access to rehabilitation service among People with Disability
(PWDs) is increasing and that service is provided by public and private health systems. Public health
system offers more options but it has several limitations. Objective: To analyze drawbacks of
rehabilitation service delivery within public health system. Method: Qualitative research was used
to understand the drawbacks of rehabilitation services for PWDs in public health facilities
representing different geographical areas in the Red River Delta. Results: Rehabilitation services in
public health system for PWDs have not met the needs of PWDs; lack of direction given by the
regulatory agencies throughout the system; and insufficient knowledge on disability and
rehabilitation needs among healthcare staff at all levels and different localities. Recommendation:
It is necessary to enhance capacity of rehabilitation, especially on disability identification and simple
rehabilitation techniques for healthcare staff at commune and district levels. In the meantime,
increase of investment in human resources and rehabilitation service system from provincial to
district and commune levels should be made.
Key words: Rehabilitation service system, public health facility, rehabilitation.
Tac gia:

Trng ai hoc Y te Cong cong

Tap ch Y te Cong cong, 9.2013, So 29 (29)

Ngay nhan bai: 15.7.2013

Ngay phan bien: 20.7.2013

Ngay chnh sa: 30.7.2013

Ngay c chap nhan ang: 10.8.2013

17

| TONG QUAN & NGHIEN CU |

1. at van e
Cung theo c tnh cua To chc Y te The gii
(TCYTTG), ty le NKT can dch vu PHCN hien nay
la 1,5% dan so, cac nc ang phat trien ty le nay
la 2% - 3% tng ng vi khoang 100 - 120 trieu
ngi [1]. So NKT tren the gii noi chung va cac
nc ang phat trien noi rieng ngay cang tang khien
cho nhu cau PHCN cua NKT cung tang len [2]. Tai
An o, cac nghien cu cho thay co rat t NKT nhan
c cac dch vu PHCN, 1/3 so NKT co nhu cau
PHCN tai cong ong va 1/3 so NKT co nhu cau
PHCN tai cac c s y te cong lap [6]. Tai Viet Nam,
theo bao cao cua uy ban cac van e xa hoi cua Quoc
hoi, nam 2008 co 52,4% NKT i kham benh, PHCN
nhan c ho tr kinh ph (giam vien ph). NKT van
gap kho khan trong viec tiep can cac dch vu y te,
nhat la NKT vung sau, vung xa kho khan, ieu
kien i lai khong thuan tien. Nhieu a phng do
ieu kien kho khan nen cong tac cham soc sc khoe
tai cong ong cha c quan tam thc hien [3].
Hien nay, dch vu PHCN phan ln c cung
cap tai hai he thong chnh la y te t nhan va cac c
s y te cong lap. Do chnh sach tang cng mang
li y te t nhan nen rat nhieu c s y te t nhan a
ra i nham ap ng nhu cau cua ngi benh. Tuy
nhien, mot thc te la cac c s y te t nhan hoat
ong nhng con ton tai rat nhieu han che nh: thieu
nhan thc ve nhng van e quan trong, chan oan
sai va chuyen benh nhan khong ung tuyen, thao
luan va t van vi gia nh NKT khong ay u[4].
V vay, phan ln s la chon cua NKT la cac dch
vu PHCN tai cac c s y te cong lap. Tuy nhien, do
nhu cau PHCN cua NKT tang ang ke nen van e
cung cap dch vu PHCN tai cac c s y te cong lap
gap nhieu kho khan. Do o, chung toi a tien hanh
nghien cu: "Nhng ton tai cua he thong cung cap
dch vu PHCN cho NKT tai cac c s y te cong lap
tai mot so iem dan c vung ong bang song Hong
e tm hieu ro hn ve nhng ton tai cua he thong
cung cap dch vu PHCN tai cac c s y te cong lap.
ay se la tien e hu ch e xay dng ke hoach can
thiep phu hp trong lap ke hoach va hoach nh
chnh sach.
2. Phng phap nghien cu
ay la nghien cu cat ngang c tien hanh tai
8 xa/phng thuoc Ha Noi (gom ca 2 xa thuoc Ha
Tay cu), Hai Phong, Nam nh ai dien cho cac
vung a ly cua ong bang song Hong. Nghien cu
18

Tap ch Y te Cong cong, 9.2013, So 29 (29)

nh tnh c s dung e tm hieu nhng ton tai cua

he thong cung cap dch vu PHCN cho NKT tai cac
c s y te cong lap ai dien cho cac vung a ly khac
nhau tai ong bang song Hong bao gom vung thanh
th, vung mien nui, vung ban sn a, vung ven
bien, hai ao va vung ong bang.
Nghien cu chon chu nh cac can bo trong he
thong y te e phong van sau (PVS), bao gom: 12
cuoc phong van sau can bo lanh ao cap tnh va 16
cuoc phong van sau can bo cap huyen va xa.

3. Ket qua nghien cu

3.1. Hieu biet ve tnh hnh khuyet tat va nhu
cau dch vu PHCN cua NKT
- Can bo tuyen tnh:
Khi c hoi ve loai dch vu can thiep y te can
thiet cho NKT, can bo cua hai trong so 4 s y te cho
biet cu the ve dch vu. Tuy nhien, van con can bo
lanh ao cung nh can bo phong Nghiep vu Y cha
nam c cac thong tin nay nen tra li con chung
chung.
"Nhng dch vu ve nhng ngi tam than va
nhng ngi iec th chung toi thay can phai cham
soc v hien nay la ieu kien phuc vu chung cho ho la
khong co, tren a ban la khong co" (PVS lanh ao
S Y te Ha Tay).
Thao luan nhom cac can bo cong tac tai cac
khoa PHCN tuyen tnh va benh vien ieu dng PHCN cho thay hau het can bo co chuyen mon ve
PHCN tai cac c s y te tnh (benh vien ieu dng,
khoa PHCN) biet rat ro ve cac dch vu PHCN can
co cho NKT. Tuy nhien, cac c s nay ch chu yeu
la PHCN cho nhom kho khan van ong nen thong
tin ve PHCN cho cac dang tat khac (kho khan ve
nhn, kho khan nghe noi, ong kinh, tam than) con
ngheo nan.
- Can bo tuyen huyen:
Nhan thc ve tnh hnh khuyet tat tren a ban
huyen cua cac can bo y te huyen khong ay u.
Hau het ngi tra li phong van eu a so lieu
NKT a nhan c ho tr t chng trnh can thiep
y te nh mo chnh hnh, cung cap dung cu tr giup
nh may tr thnh, xe lan... ma khong co so lieu
ieu tra chung tren a ban huyen, trong khi o 7
trong so 8 huyen tham gia nghien cu nay eu a
co thong tin ve NKT. Dng nh viec tiep can vi
cac chng trnh PHCN a giup can bo y te huyen

| TONG QUAN & NGHIEN CU |

co hieu biet tot hn ve dch vu PHCN can thiet cho

NKT. "Qua qua trnh ma chung toi theo doi th NKT
cung rat can nhieu cac dch vu nh ngi bnh
thng. V du: Hien nay oi tng a hoa nhap th
ngi ta rat can von e phat trien lam anvi nhng
ngi ang tan tat th ngi ta cung rat can cac
phng tien e phuc hoi. V du nh nang, xe lan, may
tr thnh, chan tay gia Vi nhng ngi b ong
kinh hay tam than th ngi ta cung can co thuoc e
ho tr nhng luc ngi ta len cn" (PVS can bo
phong y te huyen My Loc).
- Can bo tuyen xa:
Tam xa tham gia nghien cu (tr xa thuoc
huyen hai ao Cat Hai va xa vung ban sn a) a
thc hien ieu tra khuyet tat thong qua chng trnh
PHCN da vao cong ong, cac chng trnh ho tr
nhan ao cua to chc phi Chnh phu hoac cua cac
ban nganh oan the (Uy ban Cham soc thieu nien
nhi ong, chat oc da cam), cac nghien cu ieu
tra khuyet tat hoac do S Y te yeu cau. Tuy nhien,
trng tram y te cua xa mien nui, ban sn a, vung
hai ao khong nam c so NKT tai a phng
mnh mac du xa a tien hanh ieu tra ve khuyet tat.
Nhn chung, kien thc ve tnh hnh khuyet tat va
nhu cau dch vu PHCN cua cac can bo y te cac cap
cha ay u va khong ong eu gia cac a
phng. Can bo tram y te xa co kien thc ve nhu cau
dch vu ong thi nam c tnh hnh khuyet tat
tren a ban xa tot hn can bo y te tuyen huyen va
tuyen tnh. Can bo chuyen nganh PHCN hieu ve cac
dch vu can thiet cho NKT cha c ay u nh
can bo y te xa.

3.2. Cung cap dch vu y te can thiet cho

ngi khuyet tat tai cac c s y te
- Tai tuyen tnh
Cac can bo S Y te khi c phong van eu
thong nhat rang cong tac phat hien va phan loai
khuyet tat a c thc hien kha tot nhng cung
cap dch vu y te cho NKT tren a ban tnh hien con
s sai va cha ap ng vi nhu cau cua NKT.
"Kha nang cua can bo y te trong phat hien, tiep
can, phan loai cac dang tat a c cai thien ang
ke va a c phu kn... Tuy nhien, kha nang cung
cap dch vu phat hien va PHCN cho nhng ngi
khuyet tat con han che" (PVS lanh ao S Y te).
Hau het cac S Y te khong co bat ky mot nguon
au t nao rieng cho cong tac cung cap dch vu

PHCN cho NKT, tr S Y te Ha Noi la co kinh ph

rieng cho hoat ong cua chng trnh PHCN da
vao cong ong nhng cung rat han che (khoang 100
- 150 trieu ong/nam, tng ng vi chi ph
2.000/NKT/nam).
Hau het cac can bo S Y te c phong van eu
the hien s lung tung trong cong tac ch ao trien
khai cac tieu ch quan ly va cung cap dch vu PHCN
tai tram Y te (theo chuan y te xa cua Bo Y te) va e
xa "t xoay" la chnh.
"ieu kien cho ho thc hien la hi kho nhng ma
chung toi van co c cac hng dan... mnh ch ao
bang cac cong van cua s, bang cac tap huan chuyen
mon bnh thng co long ghep vao PHCN" (PVS
lanh ao S Y te).
Tnh trang thieu nhan lc la rat pho bien trong
cac c s PHCN tuyen tnh. Thong thng khoa
PHCN tuyen tnh ca bon a ban nghien cu eu
ch c bien che 1 - 2 bac sy va so lng ky thuat
vien chuyen nganh cung rat han che.
"Chung toi suot ngay phai lam, phai kiem nhiem
nhieu th ch khong phai la khong lam se co ngi
khac len thay. Cac khoa khac thieu, chung toi phai
i tang cng. Rieng khoa chung toi thieu, tham ch
bay gi chenh lech hn 40 benh nhan khong bao gi
co tang cng bi v ngi khac khong the lam thay
c"(TLN can bo chuyen nganh PHCN).
Theo thong tin nhan c t cac cuoc phong
van, viec au t trang thiet b cho cac c s PHCN
tuyen tnh cung con s sai. "Con ve trang thiet b th
hai nam nay c mua them hai may... Con suot t
nam 1990 en gi trang thiet b eu la cu (may t
thi ong c). T trc cac dung cu tap PHCN eu
do chung toi t lam, tat ca cac chan en eu lam theo
mau nc ngoai, Viet Nam gia cong" (PVS can bo
chuyen nganh PHCN). "May moc toan la vien t mua
t nam 1996 toan la tap the hnh la chnh" (TLN can
bo chuyen nganh PHCN).
- Tai tuyen huyen
Hien tai, Phong Y te hau het tat ca cac huyen
nghien cu eu a co ch ao cap xa ieu tra, ra soat
va lap ho s ve NKT nhng mc o khac nhau
tng a phng.
"Phong Y te ch ao quan ly cac xa. Cac xa
th a m nhng he thong so sach e quan ly va theo
doi toan bo cac oi tng NKT, nhng cung ch tren
c s quan ly" (PVS can bo y te huyen Giao Thuy,
Nam nh).
Tap ch Y te Cong cong, 9.2013, So 29 (29)

19

| TONG QUAN & NGHIEN CU |

Theo cac can bo y te huyen, cong tac cung cap

dch vu PHCN cho NKT cua cac c s y te huyen la
rat han hep, hau nh cha co, chu yeu tap trung
tuyen tnh va tuyen xa.
"Neu ma can phuc hoi th chung toi cung ng tai
lieu hoac chung toi van ong cong ong ong gop
nhng cai vat lieu e lam sao cho NKT tap luyen"
(PVS can bo y te huyen My Loc, Nam nh).
Viec quan ly cong tac PHCN cho NKT tai
huyen cha co au moi giao viec ac biet trong
hoan canh c cau phc tap hien nay cua nganh y te
tai tuyen huyen.
"Viec trien khai PHCN xuong tuyen huyen cung
gap nhieu kho khan v cha co mot van ban nao cua
Trung ng cho van e giao nhiem vu, giao viec theo
doi, quan ly PHCN cho n v nao: cho benh vien
huyen, trung tam y te d phong hay la phong y te.
Chung toi cha co s phan cong cu the va ro rang"
(PVS lanh ao S Y te).
- Tai tuyen xa
NKT sau khi c phat hien se c phan loai
e gii thieu cho cac dch vu khac nhau. Cac can bo
tuyen xa to ra hieu biet ve cac dch vu can thiet cho
NKT.
"nhng NKT th tuy tng nhom ma can cac dch
vu PHCN khac nhau. V du ngi kho khan ve van
ong th ngi ta can cai xe lan chang han. Roi
nhng ngi kho khan ve nhn, ngi ta cung muon
co cai knh e eo. Nhng ngi co hanh vi xa la hay
ong kinh th ho cung muon ho tr ve thuoc men"
(PVS can bo y te HB).
Qua phong van cho thay viec cung cap dch vu
PHCN cho NKT tai xa co lien quan en cac chng
trnh can thiep y te quoc gia va t cac ban nganh
oan the. Cac xa eu co chng trnh quan ly va cap
thuoc cho benh nhan ong kinh va tam than v ay
la chng trnh muc tieu quoc gia. Dch vu kham va
mo mat trong chng trnh phong chong mu loa
cung c trien khai tren c s phat hien tai xa.
Nhng oi tng nay c cac bac sy chuyen khoa
mat tuyen tnh hoac tuyen trung ng ve kham e
ch nh mo mien ph. Vi ngi kho khan van
ong, tai tuyen huyen va xa viec PHCN mi ch
dng thc hien ieu tr noi khoa. Vi dch vu dung
cu tr giup th chu yeu phu thuoc vao cac chng
trnh ho tr xe lan cua Uy ban dan so, gia nh va
tre em va chng trnh can thiep cua cac to chc phi
chnh phu. "mot so chng trnh c tai tr bi mot
20

Tap ch Y te Cong cong, 9.2013, So 29 (29)

so ca nhan va to chc nhan ao mot so nhng kho

khan ve van ong, v du cut chi th cung co chng
trnh e ngi ta nhan c cai chan gia. Mot so
chau bai nao th nhan c xe lan" (PVS can bo y
te GH). oi vi ngi khiem thnh va cham phat
trien tinh than hau nh tram y te mi ch dng
khau phat hien, con cung cap dch vu phu thuoc chu
yeu vao gia nh. "Cai iec cung nh cac van e
khac th mnh phat hien, con cung cap dch vu chc
nang hay khong th a phan ngi ta t en c s
kham va ni nao ma co trang thiet b, ban may tr
thnh th ngi ta mua" (PVS can bo y te KN). "Cham
phat trien tr tue th hau nh cha co" (PVS can bo
y te HB).

4. Ban luan
Qua phong van sau, hau het can bo y te cac
tuyen eu tha nhan viec cung cap dch vu y te cho
NKT hien cha ap ng c nhu cau cua NKT.
Nhieu nguyen nhan a c can bo y te t tuyen
tnh, huyen en tuyen xa e cap en trong o c
nhac en nhieu nhat la thieu s ch ao xuyen suot
cua cac c quan chc nang va han che trong nhan
thc cua can bo y te cung nh cua ngi dan. Theo
ket qua ieu tra mau Quoc gia tai An o nam 2002,
han che trong nhan thc ve khuyet tat la mot trong
nhng rao can ln ve hieu qua cung cap cac dch vu
cho NKT va 54,7% NKT mu ch [5].
Theo Lien Hiep Quoc (LHQ), cac dch vu PHCN
thng bao gom cac loai sau ay [4]: (1) Phat hien,
chan oan va can thiep sm; (2) Cham soc va cha
tr y te; (3) Cung cap cac loai t van va giup khac
nhau ve tam ly va xa hoi; (4) ao tao ve cac hoat
ong t cham soc, bao gom s van ong, giao tiep
va ky nang sinh hoat hang ngay, co chu y en nhng
nhu cau ac biet nh ngi khiem thnh, khiem th
hoac b thieu nang tr nao; (4) Cung cap cac thiet b
tr giup s van ong va cac dung cu thiet b khac;
(5) Cac dch vu giao duc chuyen mon hoa; (6) Cac
dch vu PHCN hng nghiep, ao tao nghe, sap xep
viec lam trong nha hoac ngoai tri. Neu ch xet cac
dch vu lien quan en y te, qua ket qua trnh bay
tren co the thay rat ro rang he thong y te cua chung
ta hien nay mi ch ap ng c mot phan cac yeu
cau cua NKT. Hau het cac xa co phat hien va lap
danh sach NKT nhng viec chan oan xac nh va
can thiep lai phu thuoc vao cac chng trnh y te
quoc gia, chng trnh ho tr nhan ao cua cac ban
nganh oan the va ca to chc phi Chnh phu trong

| TONG QUAN & NGHIEN CU |

nc va quoc te. Tai cac c s ieu tr noi tru, NKT

c cham soc va cha tr y te. Viec huan luyen
NKT va thanh vien gia nh ve cac hoat ong trong
sinh hoat hang ngay hien nay chu yeu thc hien
cong ong trong chng trnh PHCN da vao cong
ong. Dch vu nay phu thuoc vao nguon kinh ph cua
chng trnh do chnh phu hoac cac to chc thc
hien, do vay chng trnh khong thng xuyen. Khi
chng trnh ket thuc, hoat ong se co lai. Cung cap
thiet b tr giup van ong va cac dung cu tr giup
khac (may tr thnh, knh thuoc...) hien nay chu yeu
phu thuoc vao cac chng trnh nhan ao. Nh vay,
co the noi, he thong cac dch vu PHCN la a co e
ap ng cho NKT nhng viec NKT co tiep can c
vi cac dch vu nay khong lai la van e khac.
Tom lai, ket qua nghien cu cho thay, viec cung
cap dch vu PHCN tai cac c s y te cong cho NKT
hien cha ap ng c nhu cau cua NKT va gia
nh NKT. Co nhieu nguyen nhan a c e cap,

trong o c nhac en nhieu nhat la thieu s ch

ao xuyen suot cua cac c quan chc nang; han che
trong nhan thc cua cua ngi dan, nguon lc ve
kinh ph va con ngi danh cho cong tac PHCN con
rat han che. Ben canh o, kien thc ve tnh hnh
khuyet tat va nhu cau dch vu PHCN cua cac can bo
y te cac cap cha ay u va khong ong eu gia
cac a phng cung la mot nguyen nhan quan trong
dan en nhng ton tai tren.
Da tren nhng ket qua thu c, nghien cu
cho thay rang can tang cng nang lc ve PHCN
cho cac can bo y te tuyen xa va huyen ve phat hien
khuyet tat va ky thuat PHCN n gian nh mot kenh
t van trc tiep va cung cap dch vu PHCN c ban
can thiet cho NKT. Ngoai ra, can tang cng au t
ve nguon lc va nhan lc cho he thong PHCN t tnh
xuong huyen va xa. Cac tnh can xay dng ke hoach
ong bo ve cung cap dch vu PHCN cho NKT tren
a ban tnh.

Tai lieu tham khao

Tieng Anh
Tieng Viet
1. Ngh quyet 37/52 - ai hoi ong Lien hiep quoc thong
qua 03/10/82 (2001), "Chng trnh hanh ong quoc te v
NKT" trong Thap ky NKT khu vc Chau a - Thai Bnh
Dng 1993-2002, Nha xuat ban Chnh tr Quoc gia, Ha Noi,
tr.35-81.
2. Nguyen Quoc Anh (2010) "Thc trang NKT va ket qua
thc hien cham soc NKT", Tong cuc dan so - ke hoach hoa
gia nh, Tap ch so 1 (106). http://www.gopfp.gov.vn/so-1106;jsessionid=217E0C51C1DFB68CF93EDBFF25345D78
?p_p_id=62_INSTANCE_Z5vv&p_p_lifecycle=0&p_p_sta
te=normal&_62_INSTANCE_Z5vv_struts_action=%2Fjour
nal_articles%2Fview&_62_INSTANCE_Z5vv_version=1.0
&_62_INSTANCE_Z5vv_groupId=18&_62_INSTANCE_
Z5vv_articleId=2416

3. Allen-CC (1984), "Prevention" In Rubin IL and Crocker

AC Developmental Disabilites: Delivery of Medical Care
for Children and Aldults. Lea & Febiger, US. pp:475-482
4. Crocker-AC, Sules-SB, Staub-RU, Culliane-M,
Shishmanian-E (1989), "The Systems of Health Care
Delivery" In Rubin IL and Crocker AC Developmental
Disabilites: Delivery of Medical Care for Children and
Aldults. Lea & Febiger, US. pp:30-47.
5. National Sample Survey Organization. A report on
disabled persons. New Delhi: Department of Statistics,
Government of India; 2003
6. S Ganesh Kumar, Gautam Roy, Sitanshu Sekhar Kar
(2012) "Disability and rehabilitation services in India:
Issues and challenges".

Tap ch Y te Cong cong, 9.2013, So 29 (29)

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