The problematic human resources on converting medical station functions

The effectiveness of operating the moveable medical station system is just the same as making the most of the health sector's resources; however, the current situation of medical staff, doctors, and grassroots medical staff leaving the sector is still a story of great puzzle. What is the fundamental solution for the province's health sector to gain strong and qualified human resources to convert the functions of moveable medical stations into a fixed ones?

Medical staff leave the stations

Because of work pressure, after the Covid-19 pandemic, a series of grassroots medical staff quit their jobs. Incomplete statistics showed, at the grassroots level, that about 300 employees have quit their jobs at medical stations and moveable medical stations. The main reasons were low income, unsuitable working environment, no opportunity to improve skills, difficult family situation, and overloaded work but the most problematic reason was low salary to cover living expenses.

Staff at Thu Dau Mot city's moveable medical station participates in injecting children with COVID-19 vaccines

Typically, in Ben Cat town, in 2021 and early 2022, up to 35 employees quit their jobs. During the peak time of COVID-19 epidemic prevention and control, An Dien commune health station was always overloaded with work. Doctor D.H.K, used to hold the position of deputy health station of An Dien commune for many years, in early 2022, had to write a letter of resignation because of work pressure. Mr. K. said: “An Dien is a large area with a large population. The work of medical staff at the station is plenty including infectious disease prevention, vaccination, child health care, pregnancy management, parenting, family planning, and management of the mentally ill patients. As the COVID-19 epidemic broke out, the workload surged and made medical staff work intensively at 2-3 times more than usual but the salary was just the same as before the epidemic. Currently, the COVID-19 epidemic has decreased, but staff are facing pressure to propagate and monitor infectious diseases of dengue fever and hand, foot and mouth diseases. The case of doctor N.T.U., head of mobile medical station in Cau Sat hamlet of Lai Hung commune in Bau Bang district was a similar example. Mr. U. quit his job because the salary was too low, which was only about VND 6 million a month with allowance benefits while the work pressure was great; he quit his job to move to a private hospital. Doctor U. said: "For such salary, if I have a family and children, it is very difficult for me, so I want to find new job opportunities to lead a more stable life."

Medical staff leave a lot of work positions, so when converting the moveable medical stations into fixed ones, the health sector would faces a shortage of staff who are mainly doctors and midwives. According to statistics, the province currently lacks 593 staff, which is more than 470 at the commune level. At many meetings, leaders of Department of Health and other branches in the province agreed on the view of retaining grassroots health workers that the province needs to supplement human resources, increase staffing quotas, and ensure living standards and income and further improve the professional capacity of the grassroots health care level.

To improve professional capacity and increase income

In the face of a shortage of human resources in the provincial health sector and the problem that employees leaving their jobs, the provincial People's Committee issued Decision No. 06/2022/QD-UBND of "supporting local health workers and staff to carry out COVID-19 epidemic prevention and control" to retain and attract recruitment. Accordingly, the provincial People's Committee provides monthly allowances for contract staff working at moveable medical stations in communes, wards and townships of VND 5 million for the title of doctor, VND 3 million for the title of medical professional, VND 2 million for other titles without medical expertise. Also in this decision, the provincial People's Committee provides a monthly allowance of VND 3 million for officials working at health stations and general clinics in communes, wards and townships for the title of doctor, VND 2 million for the remaining positions. With such support, doctors working at moveable medical stations could earn more than VND 10 million a person a month, doctors and nurses about VND 8 million a persona month. The support contributes to improvement of lives and incomes of medical staff and motivates them to stay.

In addition to increasing salaries to attract human resources, the Department of Health also proposed the provincial People's Committee to increase the staffing of fixed medical stations in the spirit of converting moveable medical stations to fixed medical ones with the policy of 1 medical station per 15,000 people. The increase in staffing for health stations in communes, wards and townships is considered an effective solution to contribute to transforming the function of moveable medical stations and strengthening the health system in the new situation. From this direction, the Department of Health boldly proposed to the provincial People's Committee to assign the department to review and prioritize the recruitment of health workers right in July 2022. “The Department also proposed the provincial People's Committee to allow an increase of about 470 staff for the medical station under 3 options. In the case of communes, wards and townships with 15,000 inhabitants or less, the number of staffs per station shall be increased by 3, by 5 for 15,000 to 50,000 people, and by 10 for over 50,000 people in the such locality," said Dr. Huynh Minh Chin, Deputy Director of the Department of Health.

Although the province has issued preferential policies to attract health workers, the income disparity between domestic and non-public medical facilities is still high. The story of two doctors with equal qualifications and skills, but the doctor who works at a non-public health facility earns VND 30-50 million a month and the public doctor who earns VND 10-20 million a month would be great inadequacy of the health sector. In addition, a problem persists that a part of medical staff, doctors and medical staff do not want to get back to work but want to stay in the city to improve their skills and develop techniques.

Making in-depth analysis of policies to create resources for grassroots health care, Associate Professor Doctor Nguyen Lan Hieu, Director of Hanoi Medical University Hospital, aka Director of Binh Duong provincial General Hospital said: "Currently, the medical station needs to be enhanced in terms of pay in the health sector itself and in people's thoughts by improving professional capacity. This will create momentum for grassroots healthcare to develop. For staff who are doctors, pharmacists, nurses, and midwives in high school  working at health stations, the health sector needs to encourage and offer conditions for connecting to colleges and universities in and around. Currently, Binh Duong health sector is coordinating with Hanoi Medical University Hospital and Hanoi Medical University to organize training and transfer urgent techniques to supplement the list of techniques and scope of professional activities for practitioners at 91 health stations in communes, wards and townships of the province.”

Recently, the provincial health sector cooperated with Hanoi Medical University Hospital to organize distance training and online training for grassroots medical staff to improve medical service delivery at three levels of expertise and development of emergency system in the community before entering the hospital. In particular, the sector has also built a network of commune and ward medical stations to receive technology transferred from higher-level hospitals.

From the above approaches, it is shown that the provincial health sector needs to adequately address the human resource needs and professional qualifications of the medical staff. With its position as a large industrially developed province, Binh Duong urgently needs to affirm its roots in all aspects for sustainable development in the way ahead including the health sector. In this regard, grassroots health human resources play a decisive role in the quality of local health care system.

Reported by Kim Ha – Translated by Vi Bao