1 MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH
NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOG
_________________________ TRINH YEN BINH CURRENT SITUATION OF HUMAN RESOURCES,
CONTINUOUS TRAINING NEED FOR TRADITIONAL
HEALTH STAFF AND EFFECT OF INTERVENTION
MEASURES

Speciality: Social Hygiene and Health Management
Code: 62 72 01 64

SUMMARY OF PhD THESIS

3

PUBLISHED ARTICLES RELATED TO THESIS:
1. Trinh Yen Binh, Ngo Van Toan, Phung Dac Cam, Tran Thi Hong
Phuong (2011), “Traditional medicine and pharmacy human resources in
Vietnam”, Journal of Preventive Medicine, Vol. XXI, No. 7, 103 – 108.
2. Trinh Yen Binh, Ngo Van Toan, Phung Dac Cam (2011), “Continuos
training need of traditional medicine and pharmacy staff”, Journal of
Preventive Medicine, Vol. XXI, No. 7, 110 – 116.
3. Trinh Yen Binh, Tran Thi Hong Phuong, Nguyen Thi Phuong Lan
(2012), “Human resources of the traditional medicine and pharmacy at


4 ABBRIVIATION TMP Traditional Medicine and Pharmacy
HS Health Staff
TMPS Traditional Medicine and Pharmacy Speciality
SB State Budget



2. New findings of the thesis
2.1. This is a new thesis studies the distribution and quality of traditional health staff
in provincial traditional medicine hospitals in Vietnam and at the same time thesis
provides the continuous training need in traditional medicine for traditional health
and pharmacy staff.

2.2. Effects of the intervention to improve knowledge and skills in producing,
recognizing and distinguishing traditional medicines at provincial traditional
medicine hospitals. Thesis also provides effects of training traditional health and
pharmacy staff of the provincial traditional medicine hospitals. With a short time of
training (3 days), the knowledge of staff improved a lot in producing, recognizing and
distinguishing traditional medicines to improve quality of care.
6

2.3. The findings will be used for implementation of decision 07/2008/TT – BYT
dated 28/5/2008 (guidance of the countinuous training for health staff).

3. Science and practical meaning
3.1. Science meaning:
By using statistical software SPSS 10, the continous training need in traditional
medicine for health staff at provincial hospitals is big and necessary. The distribution
of traditional health and pharmacy staff is not equal and relevant for all areas. In
many provinces, there is no staff at professor/associate professor and PhD level.

3.2. Practical meaning and policy implication:
Findings of the thesis will help policy makers and planners to develop and
improve the quality and quantity of traditional medicine. It also help them to orient
and develop contents of continuous traditional training.


1.3. TRAINING AND RESEARCH IN TRADITIONAL MEDICINE
The training of human resources for traditional medicine mainly carriy out by
the Traditional Medicine Unversity and 2 Dept. of Traditional medicine of Hanoi
Mecical University and Ho Chi Minh City University. In some secondary medical
schools, the traditional Medicine Dept. did not fulfil their duty in training of
traditional medicine assistant physicians.
Some traditional medicine staff have been trained in some other university such
as Military Medical University, Hospital 103, Military Traditional Medicine hospital
and National Traditional Medicine Hospital, National Accupanture Hospital.
However, there are not enough traditional medicine staff as compared to requirment.

1.4. COUNTINUOUS TRAINING
The continuous training in traditional medicine is conducted mainly based on
the contribution of the trainees. There is no fund from government paying for the
continuous traditional medicin training. CHAPTER 2
SUBJECTS AND METHOD

The thesis used two kind of study designs: cross-sectional study and
intervention study.

2.1. CROSS-SECTIONAL STUDY
2.1.1. Subjects
● Directors of the provincial traditional medicine hospital
● Head of Dept. of traditional medicine, provincial traditional medicine hospital
● Physicians at provincial traditional medicine hospitals.
● Pharmacists, provincial traditional medicine hospital.
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provincial traditional hospitals.

2.1.5. Time: 06/2009 – 12/2010.
2.2. INTERVENTION STUDY
2.2.1. Subject
• Chairmen of Medicine committte of hospitals;
• Head of Pharmacy Dept.
• Staff who produce traditional medicine
9

2.2.2. Subject selection
Staff worked at the hospitals at least 6 months.

2.2.3. Subject selection out
Staff worked at the hospitals but being absent at the time of study.
Subjects did not collaborate.
10

2.2.4. Methodology
2.2.4.1. Design:


2
: Sample size after intervention
Z
(1-∝/2)
: Confidence 95% (=1,96)
Z
(1-β)
: Power (=80%)
p
1
: % of staff who have knowledge and skill in traditional medicine before
intervention (p = 30%).
P
2:
% of staff who have knowledge and skill in traditional medicine before
intervention (p = 70%).
P: (p
1
+p
2
)/2
n
1
= n
2
= 30 staff. With Design effecf = 2. Thus, 60 staff interveiwed.
2.2.4.3. Intervention principle
- Content of training focused on improving knowledge and skill in traditional
medicine
- Easy to carry out in hospital.

years in teaching
* Curriculum:
- One course in Tuyên Quang.
- Time: 10 days, from 06/01/2011.
Including 3 days in theory and 7 days in practices.
- Number of participants: 60.
2.2.4.5. Intervention effect evaluation
+ Pretest:
- Contents of training;
- Importance of training
- Time;
- Relevant level to daily working.
+ Assess the capacity of staff.
- Distinguish some traditional medicines: Questionnaire included 20 questions,
each question for 1 point. Four levels:
• Excellence: >=17 points;
• Good: 14- 16 points
• Average: 10 -14 points
• Poor: < 10 points
- Producing some traditional medicine: Questionnaire included 45 questions,
each question for 1 point, the assesment are divided into 4 levels:
•
Excellence: >=38 points;
• Good: 32-38 points
• Average: 22-31 points
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• Poor: < 22 points
+ Effect evaluation after one year was carried out by using effect index: (EI):
EI (%) =


CHAPTER 3
RESULTS

3.1. DISTRIBUTION OF TRADITIONAL STAFF AT PROVINCIAL
TRADITIONAL MEDICINE HOSPITALS
3.1.1. Traditional health staff at province level

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Table 3.1. Distribution of traditional health staff by training
Degree Number %
Physician 1086 17.2
University level Pharmacist 104 1.6
Secondary pharmacist 595 9.4
University nurse 32 0.5
Secondary nurse 1376 21.8
Asst. Physician 1284 20.4
Traditional healer 23 0.4
Others 1807 28.7
Total 6307 100.0
Among 6307 staff, doctor occupied 17.2%; University pharmacist was Dược sỹ
đại học chiếm 1.6% and Asst. Physicians was 20.4%
.
Table 3.2. Distribution of traditional health by scientific position

Position Number %
Prof/assoc.profesor 2 0.1
PhD
6 0.2

15.9%. There was statistic significant (p < 0.01).
Percentage of university pharmacist at hospital level II and III was 1.6% and
1.7%. There was no statistic significant (p > 0.05).

Table 3.5. Distribution staff by hospital level
Traditional health
staff
Hospital level
P
II III
Number
%
Number
%
Prof/assoc.profesor 2 0.1

PhD/doctor grade II
4 0.2 1 0.1
< 0.05
Pharmacist grade II 17 0.9 7 0.4
< 0.05
Master
42 2.2 13 0.8
< 0.05
Pharmacist/Pharmacist 111 5.9 89 5.2
< 0.05
Traditional health
staff
Hospital level p
II III

frequently than that in hospital lev III ( p < 0.05).
57.6
55.8
20.5
25.7
21.9
18.5
0
10
20
30
40
50
60
70
Hospital level II Hospital level III
%
Traditional
General
Others

Figuue 3.1. Distribution of staff by training speciality and hospital level

Percentage of trained traditional medicine staff in hospital level II is less than
that in hospital level III (p > 0.05).
Percentage of trained general medicine staff in hospital level II is more than that
in hospital level III (p > 0.05).

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Secondary nurse 20.6 22.3 19.3 20.0 18.5 16.4
< 0.05
Asst. physician 16.6 26.5 22.3 17.1 24.1 22.1
< 0.05
Others 31.0 25.9 27.4 32.0 28.9 35.8
< 0.05
Total 100 100 100 100 100 100 Percentage of doctor in the region I was hisghest (19.2%) and lowest in the
region II (13.1%) (p < 0.05).
Percentage of university pharmacist in region I was highest (1.8%), lowest in
the region III and VI (p < 0.05).
Percentage of university nurse was so different between regions, highest in the
region I (1.3%); lowest in he region III (0.2%), (p < 0.01).

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Table 3.7.Distribution of specialized traditional medicine staff by geographical region

Traditional health
staff
Region P

I (%)
n = 752
II (%)
n= 724
III (%)
n= 640

(2.8%), region V (2.4%) and lowest in region II (0.6%) (p < 0.05).
Percentage of university specialized traditional medicine in the region I is
highest (11.8%), lowest in the region III (6.2%) (p< 0.05).

Table 3.8. Distribution staff by specialized by region
Specilalized Region P
I (%)
n= 1251
II (%)
n= 1254
III (%)
n= 1051
IV (%)
n= 796
V (%)
n= 965
VI (%)
n= 990
Traditional
medicine
60.1 53.8 60.9 47.1 58.2 55.2
< 0.05
General 28.9 20.6 23.3 24.3 22.8 15.3
< 0.05
Others 11.0 25.6 15.8 28.6 19.0 29.2
< 0.01
Total 100 100 100 100 100 100 Percentage of traditional medicine staff in region III is highest (60.9%), region I

255 56.8

In the last 5 years, there were 56.8% staff who were not receive any continuous
training course. Other staff who received continuous training course but they also
need to be updated knowledge and skills.

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Table3.10. Contents of training for specialized traditional medicine staff
Contents Number %
Improve knowledge and skill in diagnosis of
traditional medicine 253 27.4
Improve knowledge and skill in treatment of
traditional medicine 393 42.5
Improve knowledge and skill in diagnosis in
general medicine 128 13.8
Improve knowledge of traditional medicine 440 47.6
n = 925
There was 27.4% of staff who need to be updated in diagnosis of traditional
medicine; 42.5% of staff who need to be updated in treatment of traditional medicine;
13.8% of staff who need to be updated in diagnosis of general medicine.

Table 3.11. Contents of training for pharmacist
Contents Number %
Distinguish some traditional medicines 242 78.8
Producing some traditional medicines 206 67.1
Producing some other traditional medicine 12 3.9
n = 307

There is 78.8% pharmacist who have training need in distinguish some

100 100 100 100 100 100

Traditional
medicine in the
last 5 years
36.0 24.5 29.6 34.3 24.0 22.9
< 0.05
64.0 75.5 70.4 65.7 66.0 77.1
< 0.05
100 100 100 100 100 100 Percentage of staff who did not receive any knowledge in traditioan medicine in
the region VI was highest (73.6%), lowest in region I (57.7%) (p < 0.05).
Percentage of staff who did not receive any knowledge in traditioan medicine in
the last 5 years in the region VI was highest (77.1%), region II (75.5%), lowest in
region I (64.0%) (p < 0.05).
Table 3.13. Training need in traditional medicine by region

Contents
Region P
I (%)
n = 139
II (%)
n = 75
III (%)
n = 90
IV (%)
n = 24
V (%)

< 0.05

Percentage of staff who need training in improving knowledge and skill to
disgnosis was less than 50%, in which highest in region I (43.3%), lowest in region
IV (20.8%), (p < 0.05).
Percentage of staff who need training in improving knowledge and skill to treat
and care was more than 50%, in which highest in region I (72.2%), lowest in region II
(53.5%), (p < 0.05).
Percentage of staff who need training in improving knowledge in traditional
medicines is highest in region II (70.7%), lowest in region VI (36.5%), (p < 0.05).
Percentage of staff who need training in improving knowledge and skill to treat
and care without using medicines is highest in region V (4.8%), lowest in region IV
and VI (0%), (p < 0.05).

Table 3.14. Training need in traditional medicine for pharmacist by region
Contents

Region P
I (%)
n = 55
II (%)
n = 112
III (%)
n = 47
IV (%)
n = 11
V (%)
n = 37
VI (%)
n = 50

some traditional medicines is high (>50%), highest in region I (82.1%), region VI
(78.9%), lowest in region IV (70.3%), (p> 0.05).

3.4. EFFECTS OF TRAINING TO IMPROVE CAPACITY FOR
PHARMACIST

Table 3.15. Effects of training to distinguish some traditional medicines

Effects
Before intervention After 1 year of intervention
Effect index
(%)
P
Number % Number %
Excellent 5 8.3 37 61.7 643.4
< 0.05
Good 8 13.3 11 18.3 27.3
> 0.05
Average 25 41.7 12 20.0 (- 108.5)
> 0.05
Bad 22 36.7 0 0.0 -
-
Total 60 100 60 100 After one year of intervention, the effect of distinguish some traditional
medicines increased significantly with high effect index (643.4%), good (27.3%).

23


4.1. DISTRIBUTION OF HEALTH STAFF IN PROVINCIAL TRADITIONAL
MEDICINE HOSPITALS BY REGIONS
4.1.1. Distribution of traditional medicine staff by hospital level

Currently, there is only 0.03% professor and associate professor and 8.02% staff
with post graduated levels working in the provincial traditional medicine hospitals. It
is shown that there is a lack of of them ta provincial tarditional medicne hospitals.
According to decision 03/2004/TT – BYT dated 03/03/2004 of the Minister of Health
in the classification of the hospital, percentage of post graduated staff needs to be
increased to strengthen quality of the hospitals. Percentage of the post graduated staff
at central hospital is higher than that in provincial traditional medicine. There is only
9 professors and associate professors at all traditional medicine hospitals working at
central hospitals. In the whole traditional hospitals there are only 27 PhD, in which
there are 6 PhD working at provincial traditional medicine hospitals. It shows that
there is a big different qualified staff between central traditional medicine hospitals
and provincial traditional medicine hospitals in Vietnam. 24

4.1.2. Distribution of traditional medicine staff by geographical regions
There is an equal of traditional medicine staff between geographical regions
both quality and quantity. About quantity of staff, the staff are physician in the region
I mainly (19.2%), percentage of university nurses is hghest (1.3%); in
Haiphongnumber of physicians are 31/145 (21.4%). In the region II, percentage of
physician is lowest (13.1%), secondary nurse is (22.3%) and assistant physician
(26.5%). In the region III, the distribution of traditional medicine staff is same as
region I. In the region V, traditional medicne staff is distributed rather equal,
percentage of university nurse is low (0.9%).
About the quality of staff, in all provincial traditional medicine hospitals there is

hospitals, in the region I is 82.1 %, region IV is 70.3%. The training need in provision
of traditional medicines and distinguish some traditional medicnes.

4.3. EFFECTS OF TRAINING
- After one year of intervention the knowledge in recognition some traditional
medicines is increased significantly. After one year, 61.7% of the traditional
medicine staff recognised correctly some traditional medicines as compared to 8.3%
before intervention (effect index=643.4%).
- After one year of intervention the knowledge in distinguish some traditional
medicines is also increased significantly.
- After one year of intervention the skill of prodicing some traditional medicines
is also increased significantly (5.06% before training and 53.3% after training) with
effect index is 966.0%. After one year of intervention no staff with bad skill of
producing traditional medicnes. CONCLUSION

1. Distribution of traditional medicine staff by geographical region
- The distribution of staff by geographical regions is not appropriate and equal,
in the region I, percentage of physician is highest (19.2%); lowest in the region II.
Percentage of pharmacist is low in all region.
- In all regions at provincial traditional medicne hospital, there is no profesor
and associate professor in specialised traditional medicine and PhD. There is i small
number of them work in the region I (0.3%). Percentage of university physician is
high and rather equal and appropriate. In all region, there is a big proportion of staff
with university, secondary and primary llevels.

2. Continuous training need for traditional medicine staff
- The training need in updating knowledge for physicians is high, contents of the