TRNG I HC Y T CNG CNG

B MN QUN L H THNG Y T

BI GING QUN L Y T
(Ti liu ging dy cho C nhn Y t cng cng)

H Ni - 2010

DANH MC CH VIT TT

BPRS
BYT
CL
CLB
CPR
CSSKSS
TTV
GDSK
H
KH
KHHG
KT XH
PTH
SDD
TCHC
TCKT
TTT
TP
TT
TTPC HIV/AIDS
TTYT
T
UBND
VPP
VSMT
WHO
YTCC

Phng php xc nh u tin theo thang im c bn

B Y t
Chin lc
Cu lc b
Cc bin php trnh thai
Chm sc sc khe sinh sn
i tng t vn
Gio dc sc khe
Hot ng
K hoch
K hoch ha gia nh
Kinh t - x hi
Phn tch hot ng
Suy dinh dng
T chc hnh chnh
Ti chnh k ton
Trao i thng tin
Thnh ph
Trung tm
Trung tm phng chng HHIV/AIDS
Trung tm y t
Trung ng
y ban nhn dn
Vn phng phm
V sinh mi trng
T chc y t th gii
Y t cng cng

MC LC
TNG QUAN V LP K HOCH .....................................................................4
PGS. TS. Phm Tr Dng
ThS. Mai Hoa
THU THP THNG TIN NH GI TNH HNH .........................................13
ThS. Mai Hoa
XC NH VN U TIN CAN THIP ....................................................27
PGS. TS. Phan Vn Tng
ThS. Mai Hoa
ThS. Nguyn c Thnh
PHN TCH VN TM NGUYN NHN GC R...................................34
PGS. TS. Phan Vn Tng
ThS. Mai Hoa
ThS. L Bo Chu
XY DNG MC TIU CAN THIP ................................................................44
PGS.TS. Phm Vn Thn
ThS. Mai Hoa
LA CHN GII PHP.......................................................................................50
ThS. Mai Hoa
VIT K HOCH HNH NG........................................................................55
PGS.TS. Phm Vn Thn
ThS. L Bo Chu
TRIN KHAI THC HIN CAN THIP ...........................................................62
ThS. L Bo Chu
GIM ST H TR TRIN KHAI CAN THIP .............................................91
ThS. Mai Hoa
THEO DI V NH GI CAN THIP .........................................................110
GS. TS. Trng Vit Dng
ThS. Mai Hoa

TNG QUAN V LP K HOCH

MC TIU HC TP
Sau khi hc xong bi ny, hc vin c th:
1. Trnh by c khi nim c bn v lp k hoch y t
2. Trnh by c cc loi k hoch
3. M t c cc cu phn ca lp k hoch chin lc
4. M t c cc k nng lp k hoch
5. Trnh by c cc nguyn tc trong lp k hoch
NI DUNG
1. Khi nim v lp k hoch
Lp k hoch l mt trong cc chc nng c bn ca qun l, nhm nh ra
chng trnh, mc tiu, chin lc m qun l cn t c.
K hoch l mt bn trnh by c th v cc hot ng, ngun lc v mc thi
gian cn thit t c mc tiu. Lp k hoch l vic xc nh cc mc tiu v tm
ra cch thc t c nhng mc tiu . Vy mc tiu l g? Mc tiu l tnh trng
tng lai m mt c quan/t chc mong t c. Nh vy, mc tiu l im n ca
tng lai cn k hoch l phng tin hin ti i n im n .
Cc hot ng ra trong bn k hoch cn phi xp xp theo mt cch thc,
trnh t, nht nh nhm t c mc tiu ra. Lp k hoch l mt hot ng rt
thng xuyn trong cuc sng v trong cng vic nhm vch ra k hoch hot ng cho
chnh mnh v cho nhng i tng m mnh qun l.
Lp k hoch cn l qu trnh tm kim cu tr li cho cc cu hi sau:
- Mc tiu cn t l g?
- Nn lm ci g, lm nh th no th c th t c mc tiu mt cch thun li
nht?
- Lm khi no l tt nht?
- Cn c nhng iu kin g? Nhng yu t no? Bao nhiu?
- Ai lm?
- Lm u?
Nh vy: Lp k hoch l qu trnh tm ra cc bc i ti u nhm t c
cc mc tiu ra da trn c s tnh ton mt cch y v khoa hc v cc
iu kin, cc phng tin, cc ngun lc hin c hoc s c trong tng lai.
2. Cc loi k hoch
2.1. Theo thi gian
- K hoch di hn: thng c xy dng cho 10-15 nm
- K hoch trung hn: thng l 3-7 nm, ph bin l 5 nm
4

K hoch ngn hn: di 3 nm, thng l 1 nm

Vic phn chia k hoch thi gian c th nh trn ch l v d v mang tnh
tng i. Ty cp hay n v xy dng k hoch s c phn loi ring v khong
thi gian cho tng loi k hoch di hn, trung hn v ngn hn
2.2. Theo cp
- K hoch v m: l k hoch hoch nh cho thi k di, mang tnh chin
lc v tp trung cao, do cc nh lnh o, qun l cp cao xy dng. V d: k
hoch pht trin nhn lc y t n nm 2010.
- K hoch vi m: l k hoch mang tnh chin thut, dng trin khai k hoch
v m, chin lc, gii php ca cc cp lnh o v thng do cc nh qun l
iu hnh ca n v, t chc xy dng. V d: k hoch o to cn b ti trung
tm y t d phng huyn A.
2.3. Theo phm vi
- K hoch tng th: l k hoch xy dng cho quy m ln, phm vi vn rng,
thng mang tnh chin lc. V d: K hoch pht trin mng li y t c s
n nm 2010
- K hoch b phn: l k hoch xy dng cho quy m nh v nhng lnh vc c
th. V d: K hoch pht trin cng tc vin phng chng HIV/AIDS ti trm y
t x.
2.4. Theo tnh cht ca k hoch
Mt trong cc tiu ch ca lp k hoch tt l s linh hot v p ng c s
thay i xung quanh. C mt s cch tip cn trong lp k hoch nh sau:
2.4.1. Lp k hoch theo vn /Qun l da trn mc tiu (management by objectives)
Lp k hoch theo vn c thc hin theo bn bc ca s di y:
Bc 1. Xc nh
mc tiu

Bc 2. Xy dng k
hoch hnh ng

Mc tiu chin lc t chc

Mc tiu ca tng b phn
Bc 4. nh
gi vic thc
hin

K hoch
Hnh ng

Mc tiu ca tng c nhn

nh gi vic thc hin chung

Xem xt tin

iu chnh k hoch

Bc 3. Xem xt tin

M hnh qu trnh qun l da trn mc tiu

(Richard Daft v Dorothy Marcic)
5

2.4.2. K hoch mt ln (single-use plans)

K hoch 1 ln c xy dng t c nhng mc tiu m dng nh l ch
xut hin mt ln. K hoch c th l k hoch cho chng trnh hoc cho d n. K
hoch chng trnh nhm nhm t mc tiu ca t chc ch mt ln, c th cn vi
nm hon thnh v c phm vi ln. K hoch d n cng l cc k hoch cng nhm
t mc tiu 1 ln, c phm vi hp hn, thi gian ngn hn chng trnh. Chng trnh
c th lin quan n mt vi d n v d n thng l mt phn ca mt chng trnh
ln hn. V d trong chng trnh phng chng suy dinh dng (SDD) c th, c d n
Bin son gio trnh Phc hi dinh dng cho tr em SDD.
2.4.3. K hoch thng xuyn (standing plans)
Cc k hoch c s dng thc hin nhng nhim v thng xuyn trong t
chc. K hoch thng xuyn bao gm
Cc chnh sch/qui ch ca c quan: k hoch ny c phm vi rng- l hng
dn chung, da trn mc tiu v k hoch chin lc v a ra nhng gii hn
c th quyt nh. V d: qui ch v ci thin cht lng lin tc, qui ch v
phng trnh quy ri tnh dc ni cng s
Cc qui nh: c phm vi hp hn, xc nh ra nhng hnh ng c th cn thc
hin v c th ch p dng trong mt s bi cnh c th. V d: Khng ung
ru trong gi lm vic
Cc qui trnh: l nhng bc thc thi cng vic c th, xc nh mt lot cc
bc cn tun th t c mc tiu nht nh. V d: Qui trnh khm thai,
qui trnh , qui trnh x l dng c kim loi
2.4.4. K hoch khn cp/tnh hung (contingency/senario plans)
K hoch khn cp xc nh nhng iu t chc cn lm trong tnh hung khn
cp/c s thay i ln ca mi trng hoc khi mun gii thiu mt s thay i ln
trong t chc. V d k hoch hot ng khi c bo l xy ra trn a bn bnh vin
hot ng. xy dng c k hoch ny, t chc cn thc hin nhng bc sau:
Xc nh nhng yu t khng kim sot c, v d, lm pht, s pht
trin ca cng ngh, thin tai
D on cc tnh hung c th xy ra, k c tnh hung xu nht
Lp cc k hoch x tr kp thi cc tnh hung
2.5. Theo phng php xy dng k hoch
2.5.1. Lp k hoch t trn xung (top down) hay qu trnh chuyn cc k hoch v m
thnh k hoch hot ng ca c s: l qu trnh hin thc ha cc ch trng, chnh
sch, k hoch hnh ng v m ca nh nc trong lnh vc chm sc sc khe thng
qua cc hot ng c th ti c s. Qu trnh hin thc ha ny cng c th c th
hin qua cc ch tiu v c phn b t trn xung di, t trung ng xung tnh,
tnh xung huyn, huyn xung x. Da trn cc ch tiu c phn b, cc n v s
xy dng k hoch hot ng ca mnh nhm t c cc ch tiu . Nh vy,
phng php lp k hoch ny khng da vo nhu cu v ch do mt nhm ngi
6

khng trc tip thc hin xy dng nn tnh hiu qu ca nhng k hoch ny thng
khng cao.
2.5.2. Lp k hoch t di ln (bottom up) hay lp k hoch da trn la chn u tin
ca c s: l phng php lp k hoch da trn thc t ti c s, c xy dng khng
ch bi nhng ngi lnh o m cn c s tham gia ca nhng ngi trc tip thc
hin (nhn vin y t) v c cng ng. Li ch ca vic lp k hoch ny l xc nh
c cc vn cn gii quyt mt cch c th, thit thc hn phng php trn, ngoi
ra cn trao trch nhim v quyn ch ng gii quyt cho tuyn di, cp di, huy
ng c ngun lc v sng kin ca cn b, nhn dn. Quy trnh lp k hoch da
trn la chn u tin gm c 6 bc s c trnh by chi tit trong cc bi tip theo.

Nghin cu vn
bn cp trn

T chc trin khai

thc hin

C th ha cc
mc tiu ca cp
trn v xc nh
yu cu thc hin

Trnh duyt
k hoch

Hnh thnh d
tho k hoch ca
n v, c s

Quy trnh chuyn cc k hoch v m thnh cc hot ng

ca n v, c s
Nhng phn loi trn y v cc loi k hoch ch c ngha tng i ty theo
quan im m c cc cch phn loi khc nhau. Ty theo tng hon cnh c th, cng
c khi cc c s, n v phi hp cc phng php, hnh thc lp k hoch hoch khc
nhau nhm gii quyt vn mt cch hiu qu nht trong iu kin cc ngun lc c
hn ti c s, n v mnh.
Xu hng mi trong lp k hoch bao gm lp k hoch t di ln, lp k
hoch c s tham gia ca mi nhn vin/ b phn v lp k hoch da trn bng chng.
7

iu ny gip cho cc bn k hoch ph hp vi thc t nhu cu cng nh iu kin

ca a phng. Hin nay cc chng trnh/d n y t ang c gng p dng lp k
hoch da trn vn v qun l da vo mc tiu.
3. Lp k hoch chin lc
mt t chc c th pht trin ln mnh trong mt x hi, t chc cn c
mc tiu v k hoch. Mc tiu c chia lm nhiu cp : tm nhn, s mnh, mc
tiu chin lc, mc tiu trung gian v mc tiu ngn hn.
Tm nhn l s m t v nhng g t chc mun hon thnh sau khi thc hin
cc chin lc v cng vic. Tm nhn c xy dng da trn mong i ca
nhng thnh vin trong t chc v nhng ngi c lin quan trong x hi i vi
t chc, l hin thn ca nhng gi tr v vn ho t chc, gip khuyn khch v
lin minh mi ngi v mc tiu chung. V d: bnh vin A mun tr thnh mt
bnh vin hng u v cht lng phc v trong ton khu vc min Trung.
thc hin tm nhn, cc t chc xy dng s mnh - l do mt t chc tn
ti. V d: m bo mi ngi dn trong khu vc c iu tr v phc hi chc
nng nu b tai nn thng tch. S mnh gip khch hng, ngi ti tr, cng
ng) c nhn nhn ng n i vi t chc; gip nhn vin cam kt vi t
chc, n l ngun ng vin v cam kt, gip nhn vin hiu ti sao t chc v
cc b phn chnh ca t chc tn ti. v gip nhn vin nhn bit cn thc hin
nhng hot ng g v lm th no t c mc tiu. Bn cnh , n nh
hng cho mi c gng ca t chc theo mt hng v gip nh hng cho
vic ra quyt nh cng nh nh gi vic thc hin cng vic.
Mc tiu chin lc l nhng g t chc mong mun t c. C th bao gm
cc lnh vc nh v tr ng ca t chc trong x hi/th trng, s ci thin v
pht trin t chc, sn phm/dch v, ngun ti chnh v c s h tng, li nhun
v s thc hin cng vic v thi ca nhn vin
K hoch chin lc xc nh nhng hnh ng m c quan d nh thc hin
t c mc tiu chin lc, bin mc tiu chin lc thnh hin thc. K
hoch chin lc thng di hn t 3-5 nm.
V d v chin lc pht trin ca trng i hc Y t cng cng (H Ni, Vit
Nam) l tp trung vo tng cht lng o to vi quyt tm sau 5 nm, mt mi
trng o to chun mc s c hnh thnh v vn hnh hon chnh. iu ny s a
nh trng tr thnh mt a im o to quc t ng tin cy v YTCC trn th gii.

Thng ip vi
bn ngoi

Nhn nhn
S mnh

Thng ip
vi ni b

Mc tiu/K hoch
chin lc cho c
t chc

Ngun
ng vin

Mc tiu/K hoch trung gian

cho cc b phn chnh

nh hng

Mc tiu/K hoch thc hin c th cho cc

n v v c nhn

nh gi

Cc cp mc tiu v k hoch (Richard Daft v Dorothy Marcic)

Cch thc xy dng mc tiu k hoch chin lc: thc hin nh gi mi
trng bn ngoi v vn bn trong t chc sau s dng kt qu xy dng mc
tiu v k hoch chin lc theo s sau:
Xem xt
mi trng
bn ngoi:
Chnh sch
Kinh t
X hi
Cng ngh
nh gi
thc trng:
S mnh
Mc tiu CL
Cc chin
lc

Xc nh cc
yu t
chin lc:
C hi
Thch thc

Xy dng
S mnh v
Mc tiu CL
mi

Xem xt
mi trng
bn trong

Xy dng
CL mi: nh
Dch v
Cht lng
Hp tc

Thc hin v
nh gi
chin lc mi
thng qua
nhng thay i
nh:
Lnh o
C cu
Nhn s
H thng
Thng tin

Xc nh cc
yu t chin lc:
im mnh
im yu

Qu trnh qun l chin lc (Richard Daft v Dorothy Marcic)

9

4. K nng lp k hoch
Trong phn ny chng ti xin gii thiu tm tt v 6 k nng thng c ng
dng trong cc loi lp k hoch. Cc k nng ny thc cht cng l cc bc thng
c s dng lp k hoch p ng vi vic lp k hoch gii quyt vn c
la chn u tin ca c s. Chi tit tng k nng s c trnh by k trong cc bi tip
theo.
4.1. Thu thp thng tin nh gi tnh hnh sc khe
Thu thp thng tin ng vai tr rt quan trng trong qun l v lp k hoch.
Ngay t bc u tin ny, chng ta cn thu thp thng tin nh gi tnh hnh hin
ti, gip tr li cu hi Chng ta ang u?. c th tr li c cu hi chnh
xc, ta cn phi xc nh r nhng thng tin cn thu thp, bit cc phng php v cc
ngun thu thp thng tin, m bo thu thp ng v cc thng tin cn thit. Bn
cnh , ta phi bit phn tch thng tin c th chuyn i cc s liu th thnh cc
s liu ta cn, phi trnh by cc thng tin thu thp c mt cch r rng, d hiu v
bo co cc thng tin thu thp c ny nu cn thit.
4.2. Xc nh vn sc khe u tin
Sau khi thu thp thng tin cn thit v phn tch tnh hnh, chng ta c th pht
hin ra rt nhiu vn cn gii quyt. Tuy nhin chng ta khng th tin hnh gii
quyt tt c nhng vn c pht hin ngay lp tc v cng mt lc c. Vy s
dng ngun lc mt cch hiu qu, chng ta phi xem xt vn no cn gii quyt
trc, vn no cn gii quyt sau bng cch p dng cc phng php khoa hc
xc nh u tin.
la chn u tin chng ta s phi cn nhc ti rt nhiu yu t nh vn
c quan trng khng, c khn cp khng, c th gii quyt c khng, ngun lc ca
chng ta ra sao... quyt nh. Cch la chn u tin s c trnh by chi tit trong
bi Xc nh vn u tin.
4.3. Xy dng mc tiu
Sau khi xc nh c vn u tin cn gii quyt, giai on tip theo ca
chng ta l phi xc nh c nhng vn c th gim i hoc gii quyt c
n chng mc no. Ngay c gii quyt nhng vn mt cch trit cng phi c
nhng mc tiu cho tng giai on, gii quyt theo tng nc t ti ch cui cng.
V d nhng mc tiu di hn nh loi tr mt s bnh ly nh bnh si hay gim t l
t vong tr em, u phi n nh mt s mc tiu gia chng cn thit t mc tiu
cui cng.
Xc nh mc tiu khng ch cn thit cho vic lp k hoch m cn gip nh
gi vic thc hin k hoch. c c mt mc tiu tt th trc ht mc tiu phi
c xy dng da trn c s khoa hc r rng v tin cy. Mc tiu cng phi m
bo y cc tiu chun nh c i tng, hot ng r rng, c th, c thi gian, a
10

im, phi ph hp, kh thi v o lng c. Chi tit v cch xy dng mc tiu s
c trnh by trong bi Xy dng mc tiu cho cc chng trnh/k hoch y t.
4.4. Phn tch vn sc khe
Phn tch vn l mt bc rt quan trng tip theo cc bc trn. C th so
snh tm quan trng ca bc ny nh sau: trc mt trn nh nu ta khng phn tch
k cc vn , cc yu t ca ch v ca ta th chng ta kh c th nh thng c
qun ch v nu c chin thng th ci gi phi tr c th l rt ln.
Mc tiu ca phn tch vn l tm ra cc nguyn nhn gc r, nguyn nhn
trc tip, nguyn nhn gin tip, nguyn nhn c th can thip c, nguyn nhn
khng th can thip c cn c vo chng ta c th c cc gii php thch hp
(phn ny s c trnh by r trong bi Phn tch vn sc khe).
4.5. La chn gii php
Sau khi bit c cc nguyn nhn gc r v xc nh c mc tiu cn t ti,
chng ta cn phi tm cch gii quyt cc nguyn nhn . Cch gii quyt cc vn
c gi l cc gii php v c thc hin thng qua cc phng php thc hin c
th. thc hin c mt gii php th c th c mt hoc nhiu phng php thc
hin khc nhau. Sau khi la chn c cc gii php v phng php thc hin, chng
ta phi tin hnh phn tch kh khn-thun li ca cc phng php thc hin la chn
lng trc nhng kh khn v tn dng c nhng thun li, xy dng c k
hoch hnh ng ph hp nhm t c cc mc tiu ra.
Phn ny s c trnh by r trong bi La chn gii php.
4.6. Vit k hoch hnh ng
Sau khi quyt nh la chn nhng gii php/phng php thc hin c th,
Chng ta cn xy dng k hoch hnh ng t c cc mc tiu, gii quyt c
cc nguyn nhn gc r tm ra. Trc khi lp k hoch cn lu xem xt, cn bng
gia kh nng v nhu cu, d tnh xem nhng ngun lc hin c v nhng ngun lc c
th huy ng c (nhn lc, vt lc, ti lc, thi gian .v.v), nhng kh khn v thun
li hin ti v tng lai xy dng c k hoch hnh ng ph hp.
5. Cc nguyn tc trong lp k hoch
5.1. Tnh mc tiu
Trn c s xc nh ng v r mc tiu cn t, ngi qun l cc cp khc
nhau s c kh nng la chn cc gii php, phng php thc hin cng nh cc iu
kin h tr mt cch ph hp v xc nh v th u tin cho tng mc tiu (trong nhng
chng trnh/k hoch c nhiu mc tiu). Tnh mc tiu trong lp k hoch gip m
bo c hiu qu hot ng, trnh lng ph hoc s dng ngun lc khng ph hp,
lm c s cho theo di, gim st v nh gi.
11

5.2. Tnh khoa hc

Mi sn phm ca qu trnh lp k hoch (cc vn bn, k hoch hot ng)
ch c hiu qu nu n t n nhng mc nht nh v cn c khoa hc. Tnh khoa
hc chnh l yu t m bo cht lng v tin cy ca cc k hoch c tho ra.
5.3. Tnh cn i
Tnh cn i l mt nguyn tc xuyn sut qu trnh lp k hoch m bo k
hoch t c cc mc tiu ra. Cn i y khng ch cn i gia nhu cu v
kh nng trong lp k hoch m cn l s cn i gia cc yu t, cc b phn, cc lnh
vc v qu trnh trong h thng t chc m bo thun li nht cho vic thc hin
mc tiu la chn
5.4. Tnh chp nhn
K hoch c lp ra phi c s chp nhn ca khng ch chnh quyn, cc
cp lnh o, nhng ngi lp k hoch m c nhng ngi trc tip thc hin v i
tng can thip (cng ng). Chp nhn y bao gm c chp nhn v chnh tr, vn
ha, o c .v.v. gip m bo cc k hoch tho ra l hiu qu, kh thi v ph hp
vi tnh hnh thc t ca a phng.

12

THU THP THNG TIN NH GI TNH HNH

MC TIU HC TP
Sau khi hc xong bi ny, hc vin c th:
1. Trnh by c khi nim v tnh cht (yu cu) ca thng tin y t
2. M t c cc phng php v cc ngun thu thp thng tin
3. Phn tch c cc bc s dng thng tin phn tch tnh hnh hin ti
NI DUNG
1. Khi nim v thng tin y t:
Thng tin y t l nhng tin tc m t v cc yu t lin quan n sc kho con
ngi v cng ng. Thng tin y t c th m t cc lnh vc khc nhau trong ngnh y
t v c nhng lnh vc ngoi ngnh y t c lin quan vi y t.
V d:
- T l cht, t l mc bnh ca a phng
- S cn b y t/1000 dn
- T l h gia nh c h x hp v sinh
- T l h gia nh ngho trong mt thn/x/huyn
- Tnh trng hc vn ca ngi dn ti mt thn/x/huyn
2. Nhng yu cu i vi thng tin:
2.1. Thng tin phi y v ton din
Ngi lp k hoch cn thng tin ca mi hot ng y t v c nhng lnh vc
ngoi y t c lin quan:
- Thng tin v cc loi bnh tt: T l mc, t l cht, t l dn c nguy c mc...
- Thng tin v mi trng: h x khng hp v sinh, nhim t, nc, khng kh,
s dng ho cht gy nhim ...
- Thng tin v trang thit b y t, nhn lc y t, chnh sch ch , mc tiu k
hoch ...
- Thng tin v kinh t, vn ho, x hi, dn s.
- Thng tin v s ng h ca cc t chc x hi vi y t ...
V d: phng, chng bnh st rt ti mt huyn th cn cc thng tin y
v ton din v st rt v mt s lnh vc lin quan nh:
- Bnh st rt: s ngi mc st rt, s ngi cht do st rt, s ngi b bin
chng, phn loi cc s liu trn theo tui v gii, ...
- Cc thng tin v dch v y t c th dng cho phng, chng bnh st rt: s
ging bnh, s thuc, phng tin vn chuyn bnh nhn, s cn b, trnh
cn b, kinh ph, ...
- Kinh t: ngun lc sn c v huy ng c cho phng, chng bnh st rt
13

- X hi: cc thi quen v phong tc tp qun ca ngi dn a phng: nm

mn, nui c trong b nc dit b gy, chn nui gia cm v sc vt, ...
- Mi trng: c nhiu ni tr n ca b gy v mui nh ao t, cng rnh, bi cy
khng? Chng loi mui v b gy ti a phng , ...
2.2. Thng tin phi chnh xc
Thng tin phi phn nh ng tnh trng thc t: T l mc st rt ca huyn M
thc t l 2,5% tng s dn trong nm 2005, nu bo co cao hn hay thp hn t l
u l sai vi t l thc, dn ti lp k hoch khng chnh xc.
2.3. Thng tin phi cp nht
S dng nhng thng tin ca giai on hin ti lp k hoch, khng dng
thng tin qu c ca nhng giai on trc lp k hoch. Khi cn thit, ch nn tham
kho thng tin c rt ra bi hc hay kinh nghim cho vic lp k hoch ln sau
2.4. Thng tin phi c tnh c hiu
Khi lp k hoch gii quyt vn no , cn thu thp nhng thng tin phn
nh c hiu cho vn .
V d: Lp k hoch v phng bnh tr s sinh th cn ly thng tin v t l b
m c thai tim AT. Ngc li lp k hoch v bo v sc kho ph n ni chung m
ly thng tin t l tim AT cho ph n c thai l khng c hiu, v thng tin ny khng
phn nh vic chm sc sc kho ph n ni chung.
2.5. Thng tin phn nh c v s lng v cht lng
Nn c bit ch cc thng tin phn nh cht lng ca cng vic/hot ng,
khng nn ch ch thng tin v s lng. V d:
Thng tin

S lng

o to cho nhn S lp c m
vin y t thn bn
S ngi c o to

Cht lng
S ngi c nng cao kin
thc qua o to
S ngi s dng thnh tho
cc k nng c dy trong
kho hc

Cp pht Oresol cho S tr b tiu chy c S tr b tiu chy ung ORS

tr b tiu chy
cp ORS
ng quy nh.
H x hai ngn

T l h gia nh c h T l h gia nh s dng h

x hai ngn
x hai ngn ng quy nh.

14

2.6. Cc thng tin cn c lng ho (nu c th)

Cc thng tin nn c biu din thnh s lng v t l phn trm. Trnh dng
thng tin cha lng ho. V d:
Thng tin

Cha lng ho

c lng ho

Phong tc tp qun a s h gia nh cng 78% s h cu cng khi b m

ca ngi dn ti x ma khi b m au
au
X
S ng h ca cc Hu ht cc ban ngnh
ban ngnh on th on th ng h k
hoch ca s y t tnh A
nm 2005

6/8 ban ngnh on th ng h

k hoch ca s Y t tnh A
nm 2005, trong c UBND
tnh.

3. Cc nhm thng tin

Mi loi k hoch cn cc thng tin khc nhau tu theo mc tiu, mc ca
tng chng trnh. Song nhn chung lp k hoch cho mt chng trnh sc kho
cng ng cn c nhng thng tin sau:
3.1. Nhng s liu c s: thng c thu thp khi dch v sc khe c cung cp
ln u tin cho cng ng. iu ny cho php nh gi cc loi dch v sc khe no
l cn thit v c tnh s lng ngi nhn cc loi dch v y t. N cng cho php o
lng qu trnh thc hin ca chng trnh sau khi dch v c a vo phc v.
Nhng thng tin c s bao gm:
3.1.1. Thng tin v sc kho v cc vn lin quan n sc kho:
a) Thng tin v bnh tt:
- T l mc
- T l c iu tr
- T l cht
- T l bin chng
- S t vong tr di mt tui /s thai cht lu trong nm qua
- Nhng nguyn nhn c th ca t vong
- Nhng bnh truyn nhim thng gp nht
- v..v..
b) Thng tin v phng bnh
- T l dn c gio dc sc kho v phng chng bnh
- T l dn s dng cc bin php phng bnh: V d: ung/tim thuc
phng/vaccin
- v..v..
15

c) Thng tin v thc hin cc dch v y t

- T l dn ti khm, cha ti cc c s y t nh nc, t nhn, khm iu
tr bng y hc c truyn
- Khi b m, ngi dn thng ti u?
- T l ph n c chng (15-49 tui) s dng cc bin php trnh thai
- v..v..
3.1.2. Thng tin chung khc:
a) Kinh t:
- Thu nhp bnh qun ngi/ nm
- T l h giu ngho
- T l dn lm cc ngh chnh trong cng ng
- v..v..
b) Dn s:
-

Tng dn s
T sut sinh th, cht th v pht trin dn s t nhin
S lng v t l dn theo nhm tui
T l cc dn tc trong cng ng
v..v..

c) Vn ho - x hi - a l - kh hu mi trng phong tc tp qun

- T l dn c trnh vn ho: tiu hc, trung hc, i hc, cao ng
- T l ngi ln m ch
- T l dn c ti vi, c bo hng ngy
- T l h gia nh cu cng khi au m
- Ngun thc phm sn c trong lng l g?
- Vic s dng ngun thc phm ra sao?
- Cch ch bin v d tr thc phm
- Thc hnh nui v chm sc tr
- T l dn c phng tc tp qun lc hu nh: bn phn ti, ung nc
cha un si, n gi tht c sng ...
- Bn a l khu vc ny
- Tp qun i v sinh
- T l h gia nh s dng h x hp v sinh, nc sch
v..v..
3.2. Thng tin v ngun lc
Ngun lc khng phi ch l kinh ph, m c th l bt c mt yu t no c
s dng tin hnh cc hot ng nhm t c mc tiu. Khi la chn tin trnh
16

cho hot ng, ton b cc loi ngun lc phi c xem xt mt cch h thng.
Nhng loi ngun lc chnh l:
- Con ngi: v d: ngi c o to, ngi c k nng, hoc nhng
ngi khc c quan tm ti nhng dch v y t.
- C s vt cht: v d: nh iu dng, trung tm y t, bnh vin
- Trang thit b, vt liu, phng tin vn chuyn.
- Thng tin: s sch ghi chp v bo co, kt qu ca nhng cuc iu tra
hay nghin cu cng ng.
- Yu t x hi v mi trng khc: kin cng ng, s h tr ca chnh
quyn, nhng ngun lc k thut nh in, kh hu
- Kinh ph: t ngn sch nh nc, t vin tr, t huy ng cng ng
- Thi gian: cn phi c thi gian hon thnh k hoch.
V d:
Thng tin v ngun lc ti ch hoc ti c s y t:
- S cn b y t hot ng/1000 dn
- Trnh cn b y t
- S lng tng loi thuc
- S lng v cht lng cc c s t vn, phng bnh, iu tr cng
- S lng phng khm t nhn, hiu thuc t ...
- S lng v cht lng hot ng y hc c truyn
Thng tin v s h tr ca y t tuyn trn:
- S ch o, ng li chnh sch
- S kinh ph s c h tr
- S c s vt cht, thuc v trang thit b s c h tr
- S nhn lc (ngy cng) s c h tr
- Mc tiu hay ch tiu k hoch trn giao...
Thng tin v s h tr ca cng ng:
- S cc ban ngnh, on th v t chc x hi ng h
- S t chc ng h nhn lc: s ngy cng
- S t chc ng h kinh ph: s tin
- S t chc ng h c s vt cht: s lng v tn c s vt cht
- T l v s lng dn ng h gii quyt vn sc kho ...
3.3. Thng tin gii thch nguyn nhn ca mt vn
hiu r mt vn xy ra hoc tm hiu nguyn nhn ca mt vn ,
thng tin thng c thu thp theo nhiu cch.

17

V d: Theo s liu c ghi chp t cc bo co hng thng cho thy: T l mc

bnh tiu chy ti mt vng c chiu hng tng ln. Khi , quan st v phng vn
ngi dn trong cng ng l nhng phng php cn thit tr li nhng cu hi
sau:
- Ngun nc c an ton khng? Nu khng, ti sao?
- Nhn dn c s dng nh v sinh khng? Nu khng, ti sao?
- Nhn dn c hiu ti sao phi gi v sinh tt khng?
- Thi v thi quen gy ra vn sc kho l g?
Thng tin thu thp c t quan st v phng vn ngi dn trong cng ng s
c th gii thch vn t l bnh tiu chy tng r rng v chnh xc hn nhng
thng tin c ghi chp trong bo co thng. T nhng thng tin thu c, cn b y t
chu trch nhim c th lp ra k hoch can thip gii quyt hoc gim bt cc vn
ang din ra.
Ba nhm thng tin ny c th c thu thp theo nhiu cch khc nhau. thu
thp c y nhng thng tin cn thit, ngoi vic s dng cc thng tin sn c t
cc bo co, s sch, chng ta c th phi tin hnh nhng cuc iu tra v ngi dn
trong khu vc . Chng ta c th chn nhng ngi tnh nguyn trong lng thu thp
thng tin. Nu vy, nn t chc cc cuc tp hun gii thch vi nhng ngi tnh
nguyn ti sao li phi tin hnh iu tra, cuc iu tra s c tin hnh nh th
no, v nhng thng tin no cn thit phi c thu thp.
4. Phng php v ngun thu thp thng tin
4.1. Thng tin t ti liu v cc ngun sn c
Loi thng tin ny c th thu thp c t nhng ghi chp, bo co, s sch, tin tc trn
cc phng tin thng tin i chng... thng l nhng thng tin thng thng,
chnh thc v c cng b.
V d:
-

Nin gim thng k

Bo co ca trm y t x, ca chnh quyn x, ca trung tm y t huyn
S khm bnh, s tim chng, s khm thai, s , s theo di cc bin php
k hoch ha gia nh (KHHG), s theo di nguyn nhn t vong, v..v..

Ngoi ra, cc thng tin c th v chng trnh/dch v nh cc bn bo co tin

, bo co theo di ca cc chuyn thc a, bo co gia k, kt qu iu tra, nghin
cu... Nhng ti liu ny s gip cho ngi nh gi bit c v lch s, bi cnh,
mc tiu v kt qu ca chng trnh/dch v c th v nhng chuyn bin, thay i
quan trng khi thc hin chng trnh/dch v. Vic xem xt cc ti liu sn c c th
l cch hu ch a ra nhng cu hi s dng khi iu tra, phng vn.
18

Hin nay, vn cn nhiu bt cp trong vic s dng cc loi thng tin ny, v vy
cn lu mt im l cc ti liu sn c c th khng m bo cung cp cc cu tr
li ng v ton din cho nhng vn c th, bi v cc ti liu ny c th c khng
cha ng cc thng tin chng ta cn hoc c nhng khng chnh xc. Cc ti liu ny
cn phi c s dng mt cch thn trng v phi hp vi cc loi s liu khc.
4.2. Thng tin thu c t cc cuc hp hoc gp g cng ng
Nhng thng tin thu c bng cch ny thng l thng tin khng chnh thc.
Cc thng tin c th thu thp c thng qua vic tip xc vi nhng nhm khc nhau
nh:
- Nhng ngi lnh o cng ng,
- Nhng ngi hnh ngh y hc c truyn,
- Ph n trong cng ng, v..v..
Nhng ngi ny c th cho chng ta bit nhu cu ca cng ng v cc vn
sc kho khng c gii quyt ti a phng, trong khi cc cn b y t c th khng
bit nhng vn ny. Ngoi ra, cc thng tin cn thu thp c t cc cuc hp, trao
i vi cc cn b ti mt c s y t hoc cc cn b cng tc ti cc ban ngnh khc
nhau.
4.3. Thng tin thu c t cc cuc iu tra/nghin cu
Phng php ny i hi ngi thu thp thng tin c kinh nghim thit k
nghin cu m bo c tnh khoa hc cho nghin cu. Phng php ny thng
mang li cc thng tin chnh xc, y cho vn nghin cu qun th nht nh nu
c thit k v thc hin ng. C rt nhiu loi nghin cu khc nhau, c chia ra
lm hai loi chnh:
4.3.1. Nghin cu nh lng: thng s dng b cu hi uc thit k sn
Phng php thu thp:
- Bn hi t in: trc tip pht ra v thu li hoc thng qua bu in
- Phng vn: trc tip, qua in thoi, qua th in t
- Khm lm sng
- Kt qu cc xt nghim
- Bng kim quan st
Cc hnh thc:
- Nghin cu kin thc, thi , thc hnh (KAP) hay kin thc, thi , k nng
(KAS), v..v..
- Cuc iu tra ct ngang (ti mt thi im)
- H thng iu tra/gim st lin tc
19

V d:
- Phng vn ngi dn trong cng ng nh gi v trnh hiu bit, thi ,
v thc hnh v phng chng HIV/AIDS
- Dng thc dy o vng cnh tay cho tr 1-4 tui pht hin suy dinh dng
v nguy c suy dinh dng
- Xt nghim bnh st rt, thiu mu, HIV/AIDS
- Dng bng kim nh gi cht lng ca cc ging nc n ca mt thn.
v..v..
4.3.2. Nghin cu nh tnh:
Phng php thu thp:
- Quan st
- Phng vn su
- Tho lun nhm
- Nghin cu trng hp
- Nghin cu c s tham gia ca cng ng
Cc hnh thc:
- Nghin cu trn phm vi nh
- Nghin cu kt hp gia nh tnh v nh lng
V d:
- Nghin cu nh tnh v bnh ph khoa i vi cc ph n nng thn, ngi ta
c th t chc cc cuc tho lun nhm vi cc ph n, ngoi phng vn su
ph n, cn c th phng vn su nam gii hay cn b y t, quan st iu kin
n sinh hot ca h, v..v..
- Tho lun nhm vi nhng ngi c lin quan nh cn b y t, cn b ph n,
lnh o cng ng. Cc cuc tho lun ny c th gip cho nghin cu vin
hiu thm v tnh hnh sc kho, cc kh khn, tr ngi, cc thun li, cc quan
im khc nhau trong cng ng v cc vn c lin quan v cch gii quyt
thc t do chnh cng ng xut. Trong khi tho lun c th s dng mt s
cch lm sinh ng nh sau:
o
V bn a phng v cc chi tit lin quan, cc thi im khc
nhau
o
Lp biu thi gian ca cc s kin lin quan
o
Lp bng xp loi cc s kin.

20

4.3.3. So snh phng php nghin cu nh lng v nh tnh:

Phng php
-

nh lng

nh tnh

u im
Cung cp cc s liu nh lng
chnh xc chng minh s tn ti
ca mt vn .
C th kim tra mi quan h thng k
gia vn v cc nguyn nhn
C th a ra mt bc tranh tng th
rng ln v ton b qun th.
C th dng so snh.
Thit lp b thng tin c bn ban u
c th s dng nh gi tc
ng ca mt chng trnh can thip
Hu ch khi lp k hoch cho mt
chng trnh/dch v gn vi nhng
thay i v mt x hi.
Cung cp s hiu bit k cng v bi
cnh ca chng trnh/dch v nhm
phin gii c cc s liu nh
lng.
Cung cp ci nhn su sc v thi ,
nim tin, ng c, hnh vi ca mt
nhm nh qun th.
Hu ch trong nhng trng hp hn
ch v ti chnh v thi gian.
Hu ch c c s phn hi ca
cc bn c lin quan n chng
trnh/dch v.

Hn ch
- C th khng o
lng ng ci d
nh o lng
- Khng th gii thch
c nhng nguyn
nhn su xa ca tnh
hung, vn

- Khng i din v
khng cho php khi
qut ho.
- D b nh hng bi
s thin lch ca
ngi phng vn,
ngi quan st v
ngi cung cp
thng tin.

4.4. Cch la chn phng php thu thp s liu

Trong nhiu trng hp, chng ta cn phi hp nhiu phng php thu thp s
liu nh xem xt cc s liu thng k, cc iu tra trn quy m nh, phng vn v quan
st thu thp cc thng tin cn thit. Quan st l mt phng php rt c gi tr thu
thp s liu m iu tra v phng vn khng th thu thp c mt cch chnh xc. V
d, quan st l cn thit lng gi s trao i qua li gia khch hng v ngi cung
cp dch v hoc gia thy c gio v hc sinh v nhng ch nhy cm nh tnh dc
tui v thnh nin, s dng cc bin php trnh thai, ra quyt nh trong gia nh...
Trong khi , iu tra nh lng khng th khm ph c nhng nguyn nhn su xa.
V vy, kt hp cc phng php s cho php thu thp c cc thng tin y v
ton din v vn no . Bng cch , chng ta c th lm tng tin cy ca cc
21

thng tin v s liu thu c v da trn c s a ra cc kt lun v khuyn ngh

ph hp cho chng trnh can thip.
5. Thu thp thng tin
Sau khi xc nh c cc thng tin cn thu thp, cc phng php thu
thp s liu, xy dng cc cng c thu thp s liu (bng kim, cc biu mu thu thp
s liu, cc b cu hi...), ta tin hnh thu thp s liu theo k hoch ra. Lu l
cc cng c thu thp s liu cn c kim tra trc din hp (pretest) hon chnh
v chnh sa cho ph hp trc khi chnh thc s dng thu thp s liu. ng thi
cn son tho ti liu hng dn cho nghin cu vin, gim st vin v phi tp hun
cho h. Vic hng dn ny rt quan trng nhm m bo mi ngi u thu thp s
liu cng mt phng php.
6. Tng hp v phn tch thng tin
Sau khi thu thp thng tin, chng ta cn tng hp v phn tch chng a cc
thng tin v s liu v dng c th s dng c, nhm gip cho vic a ra kt lun
xy dng cc chng trnh can thip thch hp.
Phi chn lc cc thng tin c ch v sp xp theo cch m nhng thng tin ny
c th em so snh vi nhng thng tin khc. Ch ghi chp sao cho d nh, d tm
bt c khi no cn, ta u c th cung cp cho nhng ngui cn nhng thng tin .
6.1. Tng hp d liu
Bn thn d liu trong cc phiu iu tra, s ng k v biu mu thng rt kh
s dng. Cc nh qun l chng trnh li cn mt bn tng hp nhng d liu ny
c th a ra c nhng quyt nh ng n cho chng trnh can thip. Cc s sch
vi nhng ct di d liu thng kh s dng tr khi chng c tng hp thnh mt
ch s phn nh c tnh hnh v mt lnh vc c th no v d nh tnh hnh sc
kho ca mt cng ng hay s lng ngi n nhn cc dch v ti mt phng khm
no .
Kh nng tng hp d liu l v cng quan trng. iu quan trng trong vic
tng hp d liu l lp bng, ngha l in thm s liu v s dng tng s tnh phn
trm v mc trung bnh. Vic ny i hi chnh xc cao, nhng ngi chu trch
nhim v vic ny cn phi c nhng k nng tnh ton v s dng my tnh c bn.
Vic thit k cc phiu ghi, s sch v biu mu cha tt c th dn n nhng sai st
v kh khn trong vic tng hp s liu. V vy, vic xy dng cc biu mu hay cc
phiu iu tra ng tiu chun v hp l l iu ht sc quan trng.
6.2. Phn tch v x l d liu
Tng s, t l phn trm, v cc s trung bnh thng l nhng thng tin qu bu
v cn thit a ra c cc quyt nh ng. Tuy nhin, cc nh qun l cng cn
22

c thm cc thng tin khc m t c th hn v chng trnh quan tm v h tr gii

thch ngha ca cc ch s cng nh trong vic a ra cc quyt nh.
7. Vit bo co
D l thu thp v phn tch thng tin cho bn thn hoc cho ngi khc s dng,
ta cn ht sc cn thn trong khu chun b bo co. Cc thng tin lin quan n vic
thc hin chng trnh hoc cc ch s hot ng cn c trnh by r rng, d hiu.
Cn c bit ch n phn lp bng v tp hp d liu t nhng hot ng d n l
cc bc u tin trong vic chun b bo co. C th s dng bng kim di y
trnh b st cc cu phn quan trng ca mt bn bo co tt:
Cc yu cu ca mt bn bo co:
- Bo co c r ngy thng
- Mc ch ca bo co r rng
- Ch r nhng ai s nhn c bo co v bn bo co s c s dng ra sao
- Bn bo co tr li r mc tiu hay cc thnh phn ca chng trnh
- Bo co xc nh r a im (cc lng, cc phng khm, hay cc dch v) m n
cp ti
- Bo co ch r thi gian c thc hin
- Thng tin c lin quan ti cc ch s chng trnh la chn
- Cc phng php phn tch d liu r rng, c th
- C trnh by cc kt qu phn tch
- Mc chi tit ph hp yu cu
- Thng tin v d liu nn c trnh by di dng bng, biu, th bo co
c hp dn, d hiu
- Phn tho lun c trnh by trong bo co l cn thit gii thch thng tin

Trnh by d liu
Khi vit bo co, hy c gng s dng th v biu trnh by nhng
thng tin quan trng. Cc th v biu c th lm cho thng tin tr nn d hiu
hn, c bit l khi nhn vo nhng thay i theo thi gian hay khi so snh
Vic hiu mt cch d dng cc thng tin a ra c nhng li ch quan trng
sau:
- To ra hng th vi vic s dng thng tin trong khi ra quyt nh.
- Khi mi ngi hiu v quan tm n thng tin, h s cn thn hn khi thu
thp chng v nh vy cc d liu s chnh xc hn.

23

V d: Kt qu iu tra cng ng dn c huyn Ch Linh, tnh Hi Dng do

Trng i hc Y t cng cng tin hnh trong nm 1999 c trnh by di nhiu
hnh thc khc nhau nh:

Trnh by kt qu theo bng:

Cc loi hnh ngh nghip ca ngi dn huyn Ch Linh (1999)
Ngh nghip
Nng dn
Cn b nh nc
Bun bn nh
i hc/Cn nh
Th th cng
Ngh hu/Ch
Khng ngh/Khc
Tng cng

Tn s
2.615
331
113
1.621
39
425
68
5.212

T l %
44,4
5,6
1,9
36,6
0,7
7,3
3,5
100,0

Trnh by kt qu theo s hnh bnh:

Nguyn nhn chn thng ti huyn Ch linh (1999)

24

Trnh by kt qu theo s hnh ct:

300

St rt

250

a chy

200

Bnh v da

St, ho, cm cm
au lng, khp
au u
Tim mch/huyt p

150

Bnh v mt
Bnh v rng

100

Bnh ph khoa
Tai nn, vt thng

50

Bu c
ARI

Khc/khng r

Phn b bnh tt trong 2 tun ti Ch Linh (1999)

a ra thng tin phn hi
Khng c bo co no c coi l y m khng c phn hi. Thng qua vic
cho cc thnh vin bit bo co c lm tt nh th no v cc thng tin c ch ra
lm sao lm cho nhn vin bit hiu rng nhng c gng ca h trong vic thu thp
v trnh by thng tin c nh gi cao. Phn hi cng nu ln ch li v tm quan
trng ca cc bn bo co i vi ngi qun l. l mt trong nhng cng c mnh
nht ca nh qun l nhm thc y cc nhn vin ca mnh. V d: Cc bn bo co
c th c pht hnh trong mt bn tin ni b trnh by so snh v kt qu hot ng
chng trnh ti cc a im khc nhau. Bn tin ny c th c dng khuyn khch
cc thnh vin ci tin cng vic ca h hoc duy tr mc thc hin cc hot
ng.
Phn hi c hiu qu hn khi n c thc hin mt cch h thng. iu ny v
cng quan trng trong vic hon thnh chu trnh bo co. C ngha l nh qun l phi
kim tra xem c phi tt c cc quyt nh hoc hnh ng u v ang c thc
hin da trn nhng thng tin c cung cp hay khng. Khi xem xt cc bo co, hy
t ra cc cu hi nh sau:
- C phi thng tin c bo co da trn nhng ch s quan trng khng?
- C phi tt c cc im thiu st hoc cha y u c nu ra
khng?
- Thng tin trong cc bn bo co c chnh xc v ng tin cy khng?
- C phi cc d liu c nu ra u c gii thch v kt lun khng?
- Bo co c ch ra nhng quyt nh hoc hnh ng c tin hnh da
trn nhng thng tin c thu thp khng?
25

Do cc chng trnh y t lun thay i v tin trin theo thi gian, cc nh qun
l lun phi r sot li cc ch s cn phi thu thp, gii thch c l do ti sao phi
thu thp cc ch s , v m bo cc thng tin thu c l cp nht, ng tin cy v
chnh xc.

26

XC NH VN U TIN CAN THIP

MC TIU HC TP
Sau khi hc xong bi ny, hc vin c th:
1. Trnh by c khi nim v vn can thip v vn u tin can thip
2. Trnh by c u im v hn ch ca cc phng php xc nh vn u
tin
3. S dng c phng php thang im c bn xc nh vn u tin ti
cng ng
NI DUNG
1. Khi nim v vn cn can thip v vn u tin can thip
1.1. Vn cn can thip
Sau khi thu thp c cc thng tin, ch s v tnh hnh sc kho ca cng
ng, cc nh qun l, cc cn b y t cn da vo cc thng tin, ch s xc nh
cc vn sc kho v ang tn ti trong cng ng.
Trc ht chng ta phi thng nht v khi nim vn sc kho. C nhiu cch
hiu khc nhau, tuy nhin chng ti s a ra mt khi nim c nhiu ngi chp
nhn v d p dng nht.
Vn cn can thip l: Khong cch gia tn ti thc t v tnh trng sc
kho/cc vn lin quan n sc khe v ch tiu/tiu chun/s mong mun ca con
ngi. S tn ti ny c th l mt tnh trng sc kho khng theo c mun ca
ngi dn trong cng ng cng nh ca cc cn b y t. V d nh trong cng ng c
nhiu ngi b bnh tiu chy. Mong mun ca ngi dn trong cng ng v cc cn
b y t l khng c ngi no b bnh tiu chy. Hoc l trong cng ng c ngi cn
b bnh st rt, st xut huyt m ngi dn v cc cn b y t mong mun khng ai b
st rt, st xut huyt. Vn c th trng thi tha v d nh: ng trong nc tiu
cao hn so vi bnh thng, huyt p cao hn bnh thng, bnh bo ph do cn nng
tng vt mc bnh thng...
Tuy nhin, vi thc t hin nay, chng ta khng th loi b hon ton mt s
bnh nh: st rt hay st xut huyt... Do , cc nh lp k hoch chin lc ch c th
t ra tiu chun/ch tiu mc bnh cho tng loi bnh c th. V d: t nm 2000-2005,
chng trnh phng chng st xut huyt quc gia t ra mc tiu gim s ca mc st
xut huyt cn 110 ca/100.000 dn. Nhng thc t, hng nm s mc st xut huyt ca
chng ta lun vt qu con s 110.
Nh vy vn sc kho l s bt bnh thng v c th con ngi ni ring v
ca cng ng ni chung.

27

Tiu chun khi nu mt vn : Nhm phi nu c tnh trng hin ti ca

vn (s bt bnh thng, yu km hay thiu ht) ngha l phi tr li c 5 cu
hi:
- Vn g?
- i tng no (Ai)?
- Din ra u?
- Xy ra khi no?
- Bao nhiu?
Nh vy nu c mt vn y v ng k thut, cn thu thp y
thng tin tr li c 5 cu hi trn v c bng chng, s liu khng nh rng
y thc s l mt vn sc khe.
V d v nu vn : T l suy dinh dng tr em di 5 tui ti x X huyn Y
tnh Z vo thng 6/2005 cao (22%)
- Vn g:
suy dinh dng
- i tng no: tr em di 5 tui
- u:
x X, huyn Y, tnh Z
- Khi no:
thng 6/2005
- Bao nhiu:
22%
1.2. Vn u tin can thip
Sau khi xc nh c cc vn sc kho ca cng ng, cc cn b y t s lp
k hoch gii quyt cc vn . Tuy nhin, trong thc t ngun lc gii quyt cc
vn sc kho lun lun c hn, do vy cc cn b y t cn phi xc nh u t
ngun lc ca h gii quyt vn no trc, vn no sau. Ni cch khc, y
chnh l qu trnh xc nh vn sc kho u tin.
2. Cc phng php xc nh vn u tin can thip
2.1. Phng php Delphi
Mt nhm chuyn gia cng nhau tho lun thng nht xc nh cc vn
sc kho u tin ca cng ng.
- u im: vic xc nh vn sc kho u tin c da trn s hiu bit ca
nhng ngi c kinh nghim v tnh hnh sc kho ca cng ng.
- Hn ch: y l cch lm hon ton nh tnh v mang nng tnh ch quan,
khng da vo mt thng tin/s liu c th no. Do vy, sai s gp phi l khng
trnh khi.

28

2.2. Phng php da trn gnh nng bnh tt

Phng php ny da hon ton vo cc con s, t l mc bnh xc nh vn
sc kho u tin.
- u im: vic xc nh vn sc kho u tin c cn c vo cc thng
tin/s liu v t l mc bnh c th, r rng.
- Hn ch: khng s dng cc thng tin nh tnh, thng tin khng ton din,
khng phn nh c cc kha cnh ca vn sc kho. Ngoi ra, cc con s,
t l c th khng chnh xc, dn ti vn sc kho u tin ca cng ng b
xc nh sai.
2.3. Phng php cho im
Phng php ny cho im da vo 4 tiu chun:

Cc ch s vt qu mc bnh thng

Cng ng bit tn ca vn v c phn ng r rng

c d kin gii quyt ca nhiu ban ngnh, on th

Ngoi cc cn b y t, trong cng ng c mt nhm ngi thng tho

vn
- u im: vic xc nh vn sc kho u tin da vo nhng tiu chun c
th
- Hn ch: kh nh gi mt s cc tiu chun, nh lm sao c thng tin chnh
xc l cc ban ngnh on th c d kin hnh ng; lm sao bit c ngoi
cc cn b y t c mt nhm ngi thng tho vn sc kho. Vic cho
im cc tiu chun ny cng theo cm tnh v d b sai s.
2.4. Phng php ca T chc Y t Th gii (WHO)
Phng php ny cng cho im da vo 6 tiu chun c T chc Y t Th
gii khuyn co nh sau:

Mc ph bin ca vn (nhiu ngi mc hoc b tc ng)

Gy tc hi ln (T vong, tn ph, tn hi n kinh t, x hi...)

nh hng n tng lp ngi kh khn (ngho kh, m ch, vng ho

lnh...)

c k thut, phng tin gii quyt

Kinh ph chp nhn c

Cng ng sn sng tham gia gii quyt

Thang im c t ra thang 10 hoc 5 v cc yu t ny sau khi chm im
c nhn vi nhau v vn no c tch s cao nht s c chn l vn u tin
can thip.
- u im: cng ging nh phng php cho im trn, vic xc nh vn
sc kho u tin da vo nhng tiu chun c th
29

Hn ch: kh nh gi mt s cc tiu chun, nh lm sao c thng tin chnh xc

l c kinh ph gii quyt; lm sao bit c cng ng sn sng tham gia gii
quyt... Vic cho im cc tiu chun ny nhiu khi cng theo cm tnh v d b
sai s.

2.5. Phng php xc nh u tin theo thang im c bn

Phng php ny da trn nhng yu t cu thnh tiu chun ca h thng thang
im c bn xc nh vn sc kho u tin (BPRS: Basic Priority Rating
System).

Yu t A = Phm vi ca vn (Size of the Problem)

Yu t B = Tnh nghim trng ca vn (Seriouness of the problem)

Yu t C = c lng hiu qu ca gii php can thip (Estimated

effectiveness of the problem).

Cc yu t khc = Tnh ph vi chc nng v nhim v m c nhn hoc

t chc c giao, s tc ng v mt kinh t ca vn sc kho, tnh
chp nhn c, s c sn v ngun lc, tnh php l.
Cc yu t ny c chuyn i vo trong mt cng thc, da vo cng thc
ny chng ta s tnh c im cc vn sc kho v xc nh c vn sc kho
u tin. Cng thc tnh theo thang im c bn xc nh u tin - Basic Priority
rating system (BPRS)
BPRS = (A + 2B) x C
-

u im: vic xc nh vn sc kho u tin da vo nhng tiu chun c

th, r rng, lng ha c.
Hn ch: cng nh mt s phng php khc, vic thu c thng tin chnh xc
i vi tng yu t khng phi l n gin. Tuy nhin y l mt phng php
c nh gi tt hn cc phng php khc, hay c s dng xc nh vn
sc kho u tin. Do vy trong bi ny, chng ti s trnh by chi tit cch s
dng phng php ny.

3. S dng phng php h thng thang im c bn xc nh vn u tin

can thip
Cng thc tnh:
BPRS = (A + 2B) x C
Yu t A - Phm vi ca vn
Cho im yu t ny chng ta da vo t l ngi dn b nh hng trc tip ca
vn . Phm vi ca vn c th c xem xt trong ton b cng ng hoc trong
30

mt qun th ch (hay qun th mc tiu: Target population) ri cho im theo thang

im t 0 n 10, s im t l thun vi t l ngi dn trong cng ng/t l qun th
ch b mc bnh hay ang gp phi vn sc kho ny. C th, cng nhiu ngi
trong cng ng hay trong qun th ch b nh hng th im cng cao.
Di y l mt gi cho im v phm vi vn :
T l dn chng/qun th ch b tc ng
ca vn sc kho
25% hoc ln hn
10% n 24,9%
1 n 9,9%
0,1 n 0,9%
0,01 n 0,09%
t hn 0,01%

Phm vi ca vn
(Thang im)
9 hoc 10
7 hoc 8
5 hoc 6
3 hoc 4
1 hoc 2
0

Mt cch khc c th p dng bng cch cho im cc vn sc kho c t l

mc cao nht 10 im v vn c tn s xut hin thp nht im 0 hoc l 1, v cc
vn khc th tu theo v tr tng i ca n vi cc vn ph bin nht (10 im)
v vi cc vn t xy ra nht (0-1 im) m cho im.
Cch cho im: C 2 cch cho im. Cch th nht l cc thnh vin trong nhm
cng tho lun v thng nht mt im chung lm im ca nhm. Cch th hai l tng
thnh vin cho im ri cng li chia trung bnh lm im ca nhm.

Yu t B - Tnh nghim trng

Tnh nghim trng ca vn c xem xt trn cc kha cnh sau:

Tnh cp thit: vn i hi phi gii quyt ngay, nu khng s gy hu

qu nng n.

Hu qu ca vn sc kho: vn sc kho gy hu qu nh th no
i vi cng ng, nh gy cht yu, tui th b gim i, tn tt.

Thit hi kinh t: vn nu khng c gii quyt s gy thit hi v

kinh t nh th no i vi cng ng v ca t chc, ban ngnh.

Tc ng n nhiu tng lp cng ng: vn nu khng c gii

quyt s tc ng n nhiu i tng.
V d: so snh tnh nghim trng ca 2 vn sc kho, l: cm g H5N1 v
suy dinh dng tr em. R rng, cm g H5N1 cn c gii quyt trc so vi suy
dinh dng. Nu khng gii quyt kp thi th tc ly lan s nhanh chng, s ngi
31

mc ngy cng nhiu v s ngi c nguy c t vong s ngy cng nhiu. c bit l
ngi dn nng thn vi s dn chim 80% dn s, nhng ngi tip xc trc tip
vi ngun ly. Hu qu s thit hi v kinh t trong thi gian ngn s ln hn so vi suy
dinh dng
cho im tnh nghim trng ca vn sc kho, chng ta s dng thang
im t 0 n 10; vn cng nghim trng th s im cng cao. Trong qu trnh xc
nh u tin, tnh nghim trng ca vn c xem l quan trng hn l phm vi ca
vn ; v l do ny, trong tnh ton cui cng, im s v tnh nghim trng s c
nhn vi h s 2. Cch tnh im cng theo mt trong hai cch nh trn.
Di y l mt v d gi lng ha tnh nghim trng ca vn :
Tnh nghim trng ca vn
Tnh nghim trng
(Thang im)
Rt nghim trng
(v d: t l cht rt cao, cht yu, c nh
9 hoc 10
hng ln i vi ngi khc...)
Nghim trng
6 7 hoc 8
Tng i nghim trng
3 4 hoc 5
Khng nghim trng
0 1 hoc 2
Yu t C - Tnh hiu qu ca can thip
Tnh hiu qu ca can thip l mt yu t quan trng nht trong qu trnh xc
nh cc u tin (ch cn mt im 0 ca yu t ny cng lm cho thang im tng hp
ca vn tr thnh 0). Ni mt cch n gin, chng ta cn phi xem xt gii php t
ra c gii quyt c vn sc kho khng v c hiu qu khng. V d: xt tnh hiu
lc v hiu qu gia vic dng khng sinh ni v ngoi iu tr nhim khun h hp
cp. Chng ta thy rng c 2 loi khng sinh nu dng ng phc th u cha c
bnh: c 2 loi thuc u c hiu lc, nhng thuc khng sinh ni li r hn so vi
thuc ngoi: nh vy dng thuc ni s hiu qu hn dng thuc ngoi.
chm im hiu qu chng ta cng s dng thang im 1-10, hiu qu cng
cao th cho im cng cao. Cch cho im c th s dng 1 trong 2 cch nh trn. Tnh
hiu qu ca chng trnh can thip c th c cho im theo cc thang bc sau y:
Hiu qu ca cc can thip sn c trong phng bnh
Rt hiu qu
Hiu qu t 80% n 100% (v d tim chng)
Tng i c hiu qu. Hiu qu t 60% n 80%
Hiu qu
32

Hiu qu
(Thang im)
9 hoc 10
7 hoc 8

Hiu qu t 40% n 60 %
(v d dng Laze iu tr cho vim mt do i ng)
Tng i hiu qu
Hiu qu t 20 n 40%
Tng i khng c hiu qu
Hiu qu ch t 5% - 20%
(v d cc can thip vn ng b ht thuc l)
Khng c hiu qu g c

5 hc 6
3 hoc 4

1 hoc 2
0

Sau khi c kt qu tnh im cho 3 yu t A, B, C, in kt qu vo bng tnh

tng hp. Theo cng thc tnh kt qu cui cng, vn no c s im cao nht l vn
u tin th nht cn chn gii quyt.

STT

Vn

Bng tng hp: Chn vn u tin

Cc yu t
A
B
C
BPRS
Th t
(0 - 10) (0- 10)
(0 - 10) (A + 2B) x C u tin

1.
2.
3.
4.

4. Mt s lu trong xc nh u tin
Vic chm im cc vn sc khe theo cc tiu ch nh trn nhm mc ch
lng ha mc u tin can thip ca cc vn ny. Trn thc t, cc thang im
lm c s cho vic chm im cng ch l nhng gi mang tnh chnh xc tng i
v vic cho im nhiu khi mang tnh ch quan kh kim sot. Do , vic xc nh u
tin theo nhm, c s tham gia y ca cc bn lin quan (cn b y t, cng ng,
qun th ch, chnh quyn, ban ngnh on th...) l ht sc quan trng, gip tng
cng tnh chnh xc v khch quan ca qu trnh la chn.
Bn cnh cn ht sc lu rng khng phi lc no vic xc nh u tin
cng cn thit. Trong mt s trng hp, vn cn gii quyt c xc nh r cn
c vo tnh hnh thc t ca a phng, chin lc u tin ca chnh quyn, i tng
ch ca nh ti tr V d, nu ti a phng hin ang xy ra v dch cm gia cm
H5N1 th khng cn xc nh u tin m chnh quyn a phng v ngnh y t s phi
u tin gii quyt vn ny trc. Hay nu a phng nhn c ngun ti tr ch r
mc ch ci thin tnh trng vim nhim ng sinh sn ph n trong tui sinh
th nh vy vn u tin xc nh r ri m khng cn la chn na.

33

PHN TCH VN TM NGUYN NHN GC R

MC TIU HC TP
Sau khi hc xong bi ny, hc vin c th:
1. M t c li ch ca phn tch mt vn
2. Trnh by c cc phng php phn tch mt vn
3. p dng c phng php cy vn phn tch tm nguyn nhn gc r ca
mt vn
NI DUNG
1. Li ch ca phn tch mt vn
Sau khi xc nh c vn u tin can thip, bc tip theo cc nh qun l
hay cc cn b y t cn phi lm l phn tch vn xc nh cc nguyn nhn
gy ra vn . Vic phn tch vn c nhng li ch sau:
-

Pht hin c nhng nguyn nhn gy nn vn , nguyn nhn no l nguyn

nhn trc tip, nguyn nhn no l nguyn nhn gin tip, nguyn nhn no l
nguyn nhn chnh, nguyn nhn no l nguyn nhn ph tr...
Vic phn tch mt cch khoa hc, ng k thut s gip xc nh c cc
nguyn nhn mt cch h thng, logic, trnh b st nguyn nhn
Thng qua phn tch vn , cc nguyn nhn gc r s c pht hin, vic ny
gip cho vic u t ngun lc vo cc chng trnh can thip c hiu qu, c
trng im v ph hp vi tnh hnh thc t.

Tm li phn tch vn l bc rt quan trng quyt nh vic thnh cng ca

chin lc can thip. Ch c xc nh chnh xc cc nguyn nhn gc r gy nn vn
chng ta mi c th tm ra cc gii php ph hp c th ci thin vn sc khe
.
2. Cc k thut phn tch mt vn
C nhiu k thut phn tch vn . Trong khun kh bi ny chng ti tp trung gii
thiu 2 k thut phn tch thng gp v d s dng l:
1. S khung xng c (Fishbone Diagram)
2. Cy vn (Problem tree)
C 2 k thut trn u s dng cch t cu hi nhng ti sao (But why
technique) nhiu ln xc nh cc nguyn nhn ca vn thng qua mi quan h
nhn-qu.
34

Mi quan h nguyn nhn-kt qu din ra theo chui. Trong trng hp n

gin, A c th dn ti B, v B dn ti C nh hnh di y.

A
Nhn/qu

B
Nhn/qu

C
Nhn/qu

A l nguyn nhn ca B v C.
C l kt qu ca c A v B.
V d, khi pht hin thy s lng bnh nhn khng chu tr vin ph cao, cu
hi ti sao ln 1 c t ra v cu tr li l v bnh nhn khng mun tr vin ph.
Nu chng ta ch dng vic phn tch nguyn nhn y th gii php ci thin ph hp
s l thc hin truyn thng nng cao tinh thn trch nhim, thay i hnh vi ca
khch hng v gii php ny kh tn km, cn thi gian di. Nu t cu hi ti sao ln
2 c th tm ra cu tr li l do cc ha n in ra b sai v nu can thip y th
cch can thip s l sa cc ha n v cng mt kh nhiu thi gian cng sc. Nu t
cu hi ti sao thm ln na (ln 3) ta thu c cu tr li l do k ton vo nhm s
liu v gii php c th l ui vic k ton hoc a k ton i o to thm.
Nhng nu hi thm ti sao ln na, ln 4, cu tr li l do phn mm nhp s liu c
trng nhp s liu khng ph hp vi biu mu v cch gii quyt va n gin va
r tin l chnh li trng nhp s liu khng thch hp ca phn mm. Qua v d ny
chng ta c th thy vi cch thc t cu hi ti sao nhiu ln tm c nguyn
nhn c th chng ta s tit kim c rt nhiu chi ph, thi gian gii quyt v vic
nng cao cht lng s hiu qu.

35

Vic thanh ton vin ph b chm tr

Ti sao?
Ngi bnh t chi thanh ton
Ti sao?
Ha n in ra khng chnh xc
Ti sao?
K ton nhp nhm s liu

Ti sao?
Phn mm nhp s liu c trng nhp s liu
khng ph hp vi biu mu

Nh th no l nguyn nhn gc r ?
Cng qua v d trn chng ta c th t hi rng s phi hi bao nhiu ln "ti
sao" c th tm c nguyn nhn gc r. iu ny hon ton rt linh hot v nguyn
nhn gc r c nh ngha l nguyn nhn gy nn vn v c th can thip, gii
quyt c trong iu kin thc t ti a phng. Nh vy, cng mt vn nhng ti
cc a phng khc nhau trong nhng hon cnh khc nhau m li xc nh cc
nguyn nhn gc r khc nhau. V d, cng l vn tiu chy tr em cao th c ni
nguyn nhn gc r tm ra l "hiu nc sch" trong khi ni khc li xc nh "vic ch
bin thc n cho tr cha m bo v sinh" l nguyn nhn gc r. Kinh nghim cho
thy c th xc nh c nguyn nhn gc r, thng thng chng ta cn hi cu
hi "ti sao" t 3-5 ln, tuy nhin khng phi l quy nh bt buc. Bn cnh ,
vic xc nh cc nguyn nhn vn cn da trn cc thng tin, s liu thc t ch
khng nn ch da vo cc suy lun mang tnh ch quan. i khi, chng ta phi thu
thp thm thng tin c y c s khng nh mi quan h "nhn-qu" trong qu
trnh phn tch cng nh khng nh nguyn nhn tm ra thc s l nguyn nhn gc
r ca vn . Vic tm ra chnh xc cc nguyn nhn gc r s gip u t ngun lc
hiu qu vo cc can thip ph hp, trnh c s lng ph, km hiu qu khi gii quyt
36

dn tri tt c cc nguyn nhn hay gii quyt cc nguyn nhn khng thc s gy nn
vn hay nhng nguyn nhn khng th gii quyt c trong hon cnh hin ti.

2.1. S khung xng c

S khung xng c l mt cng c phn tch vn n gin v hiu qu. S
khung xng c l mt bc tranh m t mi quan h logic gia mt vn v cc
nguyn nhn gy ra vn , gip nhm lm vic d thng nht cch phn tch tm
ra nguyn nhn ca vn cn gii quyt.
2.1.1. Cch v s khung xng c
Bc 1: V m hnh khung xng c, gm u c v trc xng chnh, trc xng
chnh v t tri qua phi.
Bc 2: Vit tn vn cn can thip vo u c (nn nu r s liu c th)
Bc 3: Xc nh cc xng chnh: Cc xng chnh ca khung xng l cc yu t
ch yu lin quan n vn . C 2 cch xc nh cc xng chnh ny:
Cch 1: Phn loi chung da trn cc yu t:
1. Con ngi
2. Phng php
3. My mc
4. Nguyn liu
V d: Vic phn phi thuc, trang thit b y t ca c quan X n cc c s y t b
chm tr. Cc yu t chnh gy ra vn c a ra nh sau:
Phn loi chung
1. Con ngi
2. Phng php
3. My mc
4. Nguyn liu

Yu t chnh
1. Ngi li xe
2. Qu trnh phn phi thuc
3. t vn chuyn
4. Thuc, trang thit b y t

Cc yu t: Ngi li xe, qu trnh phn phi thuc, t vn chuyn, thuc trang thit
b y t n cc c s y t c coi l cc xng chnh ca S khung xng c.
S phn tch khung xng c vi 4 nhm nguyn nhn chnh nh vy cn c gi
l s Ishikawa. y l mt dng s khung xng c v c p dng rng ri
trong sn xut.
37

 Cch 2: Dng phng php ng no lit k tt c nhng nguyn nhn c th gy

ra vn . Sau khi a ra danh sch cc nguyn nhn ta sp xp li nhng kin c c
tnh ni bt gn ging nhau thnh mt nhm nguyn nhn v t tn cho nhm ny, ri
coi mi nhm l mt xng chnh.
V d: Sau khi xc nh vn cn gii quyt l S ngi c hnh vi nguy c cao
c nhm tip cn cng ng gii thiu n phng VCT thp.
Bng phng php ng no, cc thnh vin a ra tt c nhng nguyn nhn c
th lm cho nhm tip cn cng ng gii thiu c t i tng nguy c cao n
phng VCT:
1. Ngi c hnh vi nguy c cao s b k th
2. Ngi c hnh vi nguy c cao khng bit phng VCT
3. Nhn vin tip cn cng ng hot ng km
4. Thiu cn b gim st
5. Cha c k hoch gim st hp l
6. Kh tip cn ngi c hnh vi nguy c cao
Sau ta ghp nhng nguyn nhn ny li thnh nhm c c im chung, c th nh
sau:
1. Ngi c hnh vi nguy c cao
2. Nhn vin tip cn cng ng
3. Gim st
4. Mi trng
Sau khi ghp cc nguyn nhn vo cc nhm, c th b sung thm cc
nguyn nhn da trn cc nhnh xng chnh ny. Theo cch th hai s trnh b st cc
nguyn nhn.
Bc 4: Sau , xc nh cc nguyn nhn chnh trong mi nhnh xng bng cch
cng tho lun trong nhm: r sot li cc nguyn nhn lit k thng nht cc
nguyn nhn chnh trong mi nhnh xng
Bc 5: Phn tch nhng nguyn nhn chnh tm ra bc 4 tm nguyn nhn gc r
bng cch lin tc t cu hi Ti sao?
* Ti sao iu ny xy ra?
* Ti sao vn ny tn ti?
Khi phn tch ta phi phn tch mt cch ht sc logic theo c hai chiu:
38

 Ti sao vn xy ra? Bi v a1. Ti sao a1 xy ra ? Bi v a2? Hi tip ti sao

a2 xy ra? Bi v a3.
V sau phi hi ngc li: c phi a3 gy ra a2 khng? c phi a2 gy ra a1
khng? C phi a1 gy ra vn khng?

a1
a2
a3 22
3n 2

Vn

nn
33
33
33
33

Khi phn tch theo c hai chiu nh trn ta s trnh c nhng suy lun phi
logic, v nh vy ta kt thc vic phn tch c mt chui logic. Sau phn tch
cc xng chnh cn li theo cch phn tch logic nh trn
Bc 6: Xc nh nguyn nhn gc r: Trong s cc nguyn nhn gc r c tm ra
bc 5, da vo cc ngun thng tin v s liu, chng ta phi xc nh nhng nguyn
nhn thc s gy ra vn v l nhng nguyn nhn c kh nng gii quyt trong phm
vi ca nhm. Sau nh du nhng nguyn nhn bng cch khoanh trn hoc v
hnh m my.
Ch : Trong trng hp s khung xng c qu phc tp, ta nn tch mt xng
chnh thnh mt s khung xng c mi, ri tin hnh phn tch theo cc bc
nu trn
Bc 7: Xc minh li nguyn nhn gc r: Sau khi hon thnh xong s khung
xng c, nhm cn da trn nhng s liu sn c xc minh li xem nhng nguyn
nhn c khoanh c l nhng nguyn nhn thc s gy ra vn . Nu nh cha y
s liu nhm s phi tho lun a ra quyt nh c cn thit tin hnh thu thp
thm cc s liu chng minh nguyn nhn gc r hay khng.

39

2.1.2. V d v S khung xng c

Gim st

Nhn vin TCC

Hot ng km

Thiu cn b

Thiu gim st
K hoch gim st
cha hp l

Kh tip cn ngi c NCC

Ngi c NCC ri rc,
a bn rng

Thiu k nng t vn
NV mi cha c
hng dn v t vn
Thiu nhit tnh

S ngi
c HVNCC
c nhm
tip cn
cng ng
gii thiu
n phng
VCT thp

Cha c ch thng, pht

Thiu thng
tin v P.VCT
Cha hiu li ch ca VCT

S b k th

Thiu phng tin

i li
Khng bit phng VCT

Mi trng

Ngi c HVNCC
HVNCC: Hnh vi nguy c cao
TCC: Tip cn cng ng

2.2. Cy vn
Cy vn l mt k thut phn tch vn thng c s dng gip m t
mi quan h gia cc nguyn nhn mt cch logic, ton din. Ngoi mc ch phn tch
vn tm nguyn nhn (problem analysis), cy vn cn c s dng phn tch
mc tiu (objective analysis) v phn tch chin lc (analysis of strategy).
2.2.1. Cch v cy vn trong phn tch tm nguyn nhn
Bc 1. Nu vn : Nu vn cn phn tch mt cch y , r rng.
V d: T l tim chng cho tr em di 2 tui nm 2006 ti x X huyn Y tnh Z ch
t 72%
Bc 2. Lit k cc nguyn nhn c th nh hng/gy ra vn
Tt c cc thnh vin cng ng no lit k tt c nhng nguyn nhn c th gy ra
vn . Sau khi lit k ht cc nguyn nhn, c nhm cng xem xt li v loi b cc
nguyn nhn trng nhau.
V d: vi vn trn mt s nguyn nhn c lit k ra nh sau:
- Khng c phng tin c gii i xung x, bn xa
- Khng c kinh ph h tr
40

Thiu s phi hp lin ngnh

Cha c i tim chng lu ng
Ngi dn cha tin vo hiu qu ca tim chng
.

Bc 3: Xc nh mi quan h gia cc nguyn nhn theo quan h nhn-qu:

nguyn nhn no xy ra trc (nhn), nguyn nhn no xy ra sau (qu). Sau khi sp
xp li cc nguyn nhn theo logic ny chng ta s nhn thy c nhng nguyn nhn
chnh l cc nguyn nhn trc tip gy nn vn . Cc nguyn nhn khc (cn gi l
cc nguyn nhn nh) l cc yu t nh hng gy ln nguyn nhn chnh, gp phn
gy nn vn .
V d: Vi vn trn cc nguyn nhn c sp xp nh sau:
- Mt nguyn nhn chnh gy nn vn l: Thiu s tr gip ca chnh quyn
- Cc nguyn nhn nh gy nn: Thiu s tr gip ca chnh quyn l thiu s
phi hp lin ngnh v khng c kinh ph h tr. Nguyn nhn gy nn
thiu s phi hp lin ngnh l do nhn thc cha ng: cho rng tim chng
l nhim v ca y t v ngnh y t cha ch ng phi hp vi cc ban ngnh
khc
Bc 4: V cc mi tn (mt chiu hoc hai chiu) biu din s lin h gia cc
nguyn nhn nh minh ho s di y:
Vn

Nguyn
nhn 1

Nguyn
nhn 2

Bc 5: Xc nh cc nguyn nhn gc r
Da vo cc ngun thng tin v s liu, chng ta phi xc nh nhng nguyn nhn
thc s gy ra vn v l nhng nguyn nhn c kh nng gii quyt trong phm vi
ca nhm. Sau nh du nhng nguyn nhn bng cch t m hoc v hnh m
my
Bc 6: Xc minh li nguyn nhn gc r: Tng t nh s khung xng c, sau
khi hon thnh xong cy vn , nhm cn da trn nhng s liu sn c xc minh
li xem nhng nguyn nhn c khoanh c l nhng nguyn nhn thc s gy ra vn
41

. Nu nh cha y s liu nhm s phi tho lun a ra quyt nh c cn

thit tin hnh thu thp thm cc s liu chng minh nguyn nhn gc r hay khng.
2.2.2. V d v cy vn (xem trang tip theo)
3. Mt s im cn lu trong phn tch vn
- Cc nguyn nhn nu ra cn c th, trnh qu rng. V d thay v khng c c s h
tng c th ni r l cha c ng cho xe c gii i ti bn
- Trnh nu cc nguyn nhn theo hng b tc, khng gii quyt c. V d thay v
hc sinh khng i hc v khng c tin c th phin gii li thnh mc hc ph qu
cao ngoi kh nng ca gia nh hc sinh
- Trnh nu cc nguyn nhn ti ngha hoc khng th phin gii c. V d trnh nu
cn b y t li bing m cn vit r li bnh nhn phi ch lu c khm
bnh
- Khng nn chn nguyn nhn gc r l nhng iu c th bin ngay thnh gii php
nh nguyn nhn truyn thng khng hiu qu hoc cha c o to nh nhiu
s xng c hoc cy vn gp trn thc t v s dn n cc gii php chung
chung, khng hiu qu. Khi , cn t thm cu hi cng ng thiu hiu bit v
nhng g ri ti sao tm ra nhng nguyn nhn c th khc cch gii quyt ti
u hn v nhiu khi khng phi do ngi ta thiu hiu bit, thiu kin thc m cn do
nhiu nguyn nhn khc ngn cn ngi ta thc hin ng. Hy xem li v d v
khch hng khng chu tr vin ph trang 35 ca ti liu ny.

42

T l tim chng cho tr <2 tui ch t 72%

Thiu s hng
ng ca ngi dn

Cc
b m
cha
hiu r
v TC

Tp
qun
lc
hu

Truyn
thng
yu km

Phng
thc
truyn
thng
cha
ph hp

Ngi
dn
cha
tin vo
hiu
qu
ca
TC

CBYT
khng
gii
thch v
cc
phn
ng ph
sau tim

B m
thiu
quan
tm
CSSK
cho tr

Do iu
kin
kinh t
kh
khn

Thiu s tr gip
ca chnh quyn

Thiu
s phi
hp
lin
ngnh

Khng
c kinh
ph h
tr

CBYT kh tip cn c
i tng cn tim chng

Phng
thc
tip cn
cha
ph hp

Cha
c i
TCL

Nhn thc
cha ng:
TC l
nhim v
ca Y t

CBYT
khng
gii
thch v
cc
phn
ng ph
sau
tim

Ngnh y t
cha ch
ng hp
tc vi cc
ban ngnh
on th

K nng
truyn
thng
yu
Ti liu
cha
ph hp

43

Nhn lc
trin khai
chng
trnh
thiu,
yu

Giao
thng
qu
kh
khn

CBYT t
c
tp
hun
chuyn
mn
Y t thn
bn mng
Thng
xuyn
thay i
CB
chuyn
mn

Mt s
x cha
c ban
ch o
v CB
chuyn
trch
TCMR
(50%)

Trang
thit b
thiu

ti
nh, m
vn
.
Khng
cho tip
xc vi
tr

Khng
c
phng
tin c
gii i
xung
x, bn
xa
Khng
c in
nhiu
ni
vn
hnh t
bo
qun
vc xin

XY DNG MC TIU CAN THIP

MC TIU HC TP
Sau khi hc xong bi ny, hc vin c th:
1. Trnh by khi nim v phn loi mc tiu
2. Gii thch c cc c tnh (tiu chun) ca mc tiu can thip
3. Xy dng c mc tiu can thip
NI DUNG
1. Khi nim v tm quan trng ca vic xy dng mc tiu
Sau khi thu thp thng tin, nh gi tnh hnh bit c tnh hnh sc kho,
cc hot ng y t ti mt a phng ang mc no v la chn vn no
cn u tin gii quyt, chng ta cn xc nh mc ch v xy dng cc mc tiu c th
cho cc can thip hay k hoch sao cho ph hp vi ngun lc m ta ang c. C hai l
do quan trng xy dng mc tiu:
1. Chng ta ch c th lp k hoch hnh ng c th v c kh nng thc thi khi chng
ta c mc tiu r rng. iu ny khng ch p dng trong ngnh y t hay trong cc hot
ng y t m cn c th p dng trong mi mt ca cuc sng ca chng ta. V d: nu
nh bn ch ni Ti s i v pha Nam th bn thn bn v cc ng nghip ca bn
s khng th hiu c bn s lm g, v ngi th k ca bn s khng th gip bn
thc hin c chuyn i . Nhng nu bn ni Ti cn phi d mt cuc hp t
xut ti thnh ph H Ch Minh vo chiu ngy mai th thng ip ny s gip cho cc
ng nghip v th k ca bn hiu r nh ca bn v ngay lp tc h s cng vi
bn ln k hoch thc hin c chuyn cng tc , nh mua v my bay, sp xp t
a bn ra sn bay, chun b ni dung cuc hp, lin h vi nhng ngi lin quan
trong thnh ph H Ch Minh, v..v.. Nh vy, mc tiu r rng l ht sc quan trng
cho mt bn k hoch trong bt c tnh hung no.
2. Da trn mc tiu c a ra, th cng vic theo di, gim st, iu chnh vic
thc hin k hoch mi c th thc hin mt cch c hiu qu. c bit, chng ta cn
phi da trn mc tiu th mi thc hin c vic nh gi kt qu sau ny. Khi mt
chng trnh khng nu ln hay khng bit mc tiu th khng th nh gi c kt
qu ca chng. Chng hn, nu mc tiu ca chng trnh y t l tng s dng bm kim
tim sch trong i tng nghin chch ma tu vi cc t l xc nh trong mt khong
thi gian th khi nh gi chng trnh cn o lng mc tng c trong thi gian
xc nh .

44

Nh vy, ta c th a ra khi nim v mc tiu nh sau: Mc tiu l iu m

chng ta phn u t c trong khong thi gian nht nh thng qua nhng hot
ng, vi ngun lc (nhn lc, vt lc, ti lc) cho php.
Trong chng trnh y t, c nhiu hot ng c tin hnh t nm ny qua nm
khc nhng khng thy c ci thin v cc hot ng khng c mc tiu r rng. C
nhiu vn m chng ta khng th nhanh chng gii quyt c v cc vn lin
quan n y t v sc kho cng ng thng do nhiu yu t tc ng v mang tnh a
ngnh. Do vy tin hnh c cc hot ng y t c hiu qu, trc tin chng ta
cn phi xy dng mc tiu r rng, c th lng gi c d dng hn trong vic
nhn c s ng tnh, ng h v phi kt hp ca nhiu ban ngnh c lin quan cho
chng trnh hoc cc hot ng . V sau khi cng vic c thc hin, chng ta
cn phi tin hnh nh gi li xem chng trnh thu c nhng kt qu g, v c t
c mc tiu ra hay khng rt ra bi hc kinh nghim cho nhng ln thc hin
tip theo.
Khng xy dng mc tiu r rng s dn n vic lp k hoch khng tt, khng
thc thi v s gy lng ph cho chng trnh v tc ng xu cho cng ng. Cc cn b
lm vic trong cc chng trnh y t khng th khng bit xy dng mc tiu ng (vit
ng k thut, ng nhu cu, ng ngun lc). Xy dng mc tiu c ng dng v
ht sc quan trng trong khi lp k hoch hng nm, lp k hoch d n, trong gim st,
theo di v nh gi cc hot ng v y t.

2. Cc tiu ch ca mc tiu:
Khi xy dng mc tiu, ta cn nh mc tiu nn ngn gn v r rng. Mc
tiu cn phi tho mn 5 tiu ch sau:
Specific
c th
Measurable
o lng c
Aprorpriate
Ph hp
Relevant
Thit thc
Time bound
Thi gian
C th tm tt nh sau:
Theo ting Vit, ta cn nh cng thc: Mc tiu phi

2 + 3T

SMART
Theo ting Anh, ta cn nh t: Mc tiu cn tho mn ch
- c th: mc tiu a ra phi c th, m t r: Vn l vn g? Xy ra
i tng no? Din ra u?
- o lng: thng thng mc tiu cn phi c th hin bng cc con s c th.
V d nh: t l %, t xut, s lng ..vv
45

- Thch hp: ph hp v c ngha vi chng trnh hoc mc ch chung ca

ca c quan/ t chc.
- Thc thi: mc tiu a ra phi c tnh kh thi, phi c s cn nhc n cc
ngun lc sn c v ngun lc s huy ng c (nhn lc, vt lc, ti lc, thi
gian)
- Thi gian: cn nu r khong thi gian m mc tiu d kin t c.
3. Cc loi mc tiu
Trong cc chng trnh can thip vi quy m ln, din ra trong thi gian di,
ngi ta c th phn bit v xy dng 3 loi mc tiu nh sau:
- Mc tiu qu trnh: l iu m chng ta mong mun t c trong qu trnh
thc hin cng vic c th ti mt thi im c th.
- Mc tiu u ra (hay cn gi l mc tiu can thip): l iu chng ta mong
mun t c ngay khi hon thnh xong ton b hoc mt cu phn ca can
thip hoc mt k hoch y t trong mt khong thi gian nht nh.
- Mc tiu tc ng (hay cn gi l mc tiu lu di): L iu m ta mun t
c hay mun duy tr khi can thip/chng trnh kt thc, nhng mc tiu ny
thng to ra nhng nh hng quan trng v sc kho cng ng v nhng tc
ng tch cc v kinh t, x hi v mi trng.
V d v cc loi mc tiu trong mt chng trnh can thip phng chng suy dinh
dng tr em di 5 tui:
Cc loi mc tiu

V d

Mc tiu tc ng Gim t l tr suy dinh dng di 5 tui ti huyn A t 23%

vo 6/2005 xung cn 10% vo thng 6/2008
Mc tiu u ra
Tng t l cc b m c con di 1 tui thc hnh nui con
bng sa m ng cch ti huyn A t 62% vo 6/2005 ln n
85% vo 6/2007
Mc tiu qu
- Tng t l cc trm trng v cn b chuyn trch v dinh
trnh
dng ca huyn A c tp hun v t vn dinh dng tr
em ln n 100% vo 6/2006
- Tng t l cc b m c con di 1 tui c hng dn
nui con bng sa m ng cch ti huyn A ln n 95%
vo 12/2006
Tuy nhin, cc can thip y t thng a ra hai loi mc tiu nh hng cho ton
b can thip l:
- Mc ch hay cn gi l mc tiu chung
- Mc tiu hay cn gi l mc tiu c th

46

Cng ging nh mc tiu, mc ch l mt ci ch hoc tiu ch m chng ta

hng ti phn u t c. Tuy nhin, mc ch thng cp n cc vn
mt cch bao qut hn, c th l mt nh hng lu di, khng c gii hn v thi
gian ca mt chng trnh hay mt c quan/n v. Do vy, nhiu khi mc ch khng
c xc nh mt cch r rng theo 5 tiu ch m mc tiu cn t c nh nu
trn (xem chi tit trong mc 2).
V d: Mc ch v mc tiu ca Chng trnh khm v iu tr cho cc bnh
nhn HIV/AIDS nh sau:
Mc ch:
- Nng cao cht lng khm v iu tr cho cc bnh nhn nhim HIV/AIDS
Mc tiu:
- Tng t l bnh nhn HIV/AIDS c khm v iu tr bnh y ti tnh
B t 50% vo 7/2005 ln n 80% vo thng 7/2007
- Gim t l ngi n xt nghim HIV/AIDS khng c t vn ti tnh B
xung t 90% vo 7/2005 cn 10% vo thng 12/2006
- Tng t l nhng ngi sng chung vi bnh nhn HIV/AIDS c k nng
chm sc v h tr bnh nhn HIV/AIDS tt ti tnh B t 30% vo 7/2005
ln n 90% vo thng 7/2006.
Mt im cn ht sc lu khi xy dng mc ch v mc tiu cho cc can thip
y t l mi lin quan cht ch gia mc ch v mc tiu ca mt can thip. iu ny c
ngha l cc mc tiu u phi hng n mc ch. Hay ni mt cch khc, cc mc
tiu u gp phn gip cho chng trnh hay c quan/n v t c mc ch ra.
4. Phng php xy dng mc tiu
xy dng c mc tiu ng v m bo c 5 tiu chun nu trn, trc
ht chng ta phi nu c vn mt cch r rng v c th. Cch nu vn nh
sau:
Nu vn phi c cc tiu chun sau:
- Vn g?
- i tng no?
- u?
- Bao nhiu?
- Khi no?
V d: Trong thng 7/2005, t l thng xuyn s dng bao cao su khi quan h
tnh dc trong cc i tng gi mi dm ti qun A, thnh ph H ni l 30%
47

Phn tch vn nu trn:

- Vn g:
thng xuyn s dng bao cao su khi quan h tnh dc
- i tng no: gi mi dm
- u:
qun A, thnh ph H ni
- Bao nhiu:
30%
- Khi no:
thng 7/2005
Nu vn r rng v c th l iu rt quan trng, v nu khng nu vn
c ng v r rng th khng th a ra c mc tiu ng v r rng, iu ny s
dn n cc hot ng trong bn k hoch khng c nh hng.
Sau khi nu c vn r rng, ta cn lu n cc thng tin thu thp c
t bc nh gi tnh hnh tm hiu v cc thng tin lin quan nh:
- Tnh trng hin ti: phm vi, tnh nghim trng ca sc kho
- c tnh ca vn trong tng lai.
- Kh nng ngun lc sn c v s huy ng c trong qu trnh can thip.
iu quan trng l chng ta phi cn bng gia iu m chng ta mong mun
t c vi ngun lc cho php
Cc cu hi c t ra l:
- Hin nay "vn " ang u?
- Sau mt khong thi gian "vn " s t ti u?
- Liu chng ta c ngun lc v nhn lc, vt lc, ti lc v v thi gian
tin hnh cc hot ng nhm t c mc tiu khng?
Nhim v tip theo ca chng ta l xy dng c mc tiu ng v m bo
c 5 tiu chun trn.
V d: Tng t l thng xuyn s dng bao cao su khi quan h tnh dc trong
cc i tng gi mi dm ti qun A, thnh ph H ni t 30% vo 7/2005 ln n
90% vo 7/2006
Phn tch cc tiu chun ca mc tiu trn:
- c th:
+ Vn l vn g: thng xuyn s dng bao cao su khi quan h
tnh dc
+ i tng no: gi mi dm
+ u: ti qun A, thnh ph H ni
+ o lng c: t 30% ln n 90%
48

Thch hp: mc tiu ny ph hp vi chng trnh 100% bao cao su ang

trin khai ti a bn v c ngha trong vic gim ly nhim HIV v cc
bnh ly truyn qua ng tnh dc.
Thc thi: mc tiu ny c tnh kh thi cao, t c s ng tnh ng h,
nht tr cao ca lnh o v cc ban ngnh on th a phng. C i
ng cn b, cng tc vin ca cc bn nh hi ph n, on thnh nin v
y t cng tham gia phi hp thc hin. V ngn sch: c ngun lc v
ti chnh do cc nh ti tr cung cp
Thi gian: 1 nm, t 7/2005 n 7/2006

Nhn xt: Nh vy, mc tiu nu trn l mc tiu c vit ng, r rng v

m bo 5 tiu chun phi c.
Ch : Mt iu rt quan trng l sau khi xy dng mc tiu xong, chng ta nn
kim tra xem mc tiu c t c tiu chun 2 + 3T khng. Nu cha tho mn 5
tiu chun , chng ta cn sa i v iu chnh t c mc tiu m bo 5 tiu
chun trn.

49

LA CHN GII PHP

MC TIU HC TP
Sau khi hc xong bi ny, hc vin c th:
1. Nu cc tiu chun/tnh cht ca gii php
2. Phn tch cc bc trong qu trnh la chn gii php
3. Xy dng c bng la chn gii php gii quyt vn la chn
NI DUNG
1. Tm quan trng ca vic la chn gii php
1.1. Mc tiu ca vic la chn gii php
Gii php l cch lm, hay l ng i nc bc t c mc tiu ra.
t c mc tiu, c th c nhiu gii php m ngi lp k hoch phi xc nh,
ri t s chn ra nhng gii php ti u thc hin.
La chn gii php l mt bc rt quan trng trong qu trnh lp k hoch,
nhm lm gim hoc loi tr cc nguyn nhn gc r c xc nh trong bc phn
tch vn . Tuy nhin y l cng vic khng d dng cht no, nu nh mt nh qun
l khng bit tm v la chn gii php th vic qun l chng trnh khng th t
c nhng kt qu mong mun.
1.2. Tiu chun ca gii php
Mt gii php c coi l ti u khi m bo 5 tiu chun sau:
C kh nng thc hin c: iu ny lin quan n ngun lc (nhn lc,
vt lc, ti lc, kh nng qun l v thi gian)
Phn ny chng ta nn lp bng kim xem xt cc d liu v nhn lc, vt
lc, ti lc v trnh qun l cng nh thi gian c khng chng ta pht hin
cc thiu ht ri tm cch gii quyt hoc phi thay i mc tiu ra. Cc gii php c
kh nng thc thi cng phi ph hp vi cc ng li, chnh sch kinh t, x hi v y
t.
Chp nhn c: tc l khng c nhng tr ngi qu kh nng c th vt
qua ca nhng ngi/c quan thc hin, cng nh ca nhng ngi s dng hay cng
ng.
C hiu lc v hiu qu cao
y l mi lin quan gia u vo trong cc hot ng, cc dch v v vn
c ci thin (u ra), trong , tnh hiu lc ni n kh nng gii quyt (loi b hoc
lm gim) nguyn nhn gc r cn tnh hiu qu ni n mi lin quan gia vic gii
quyt nguyn nhn gc r v chi ph cn b ra.
C th ni cch khc: Cng mt gi tr u t, kt qu cng ln th hiu qu cng
cao.
50

 Thch hp: Mt gii php c coi l "thch hp" khi cc gii php v chuyn
mn, k thut cng nh v t chc c th p dng ph hp vi iu kin, hon cnh
nhng ni m chng trnh hoc k hoch c trin khai.
C kh nng duy tr: C ngha l nu gii php c p dng th khi trin
khai, ni nhn chng trnh c kh nng tip thu v thc hin mt cch c hiu qu,
v gii php ny c th duy tr c cc giai on khc nhau (chng trnh mang tnh
bn vng).
2. Cc bc la chn gii php
Thng thng sau khi phn tch vn v xc nh c cc nguyn nhn gc
r, chng ta s cng nhau tho lun ra cc gii php nhm gii quyt nhng
nguyn nhn gc r ny.
Vic xy dng Bng la chn gii php bao gm by bc phn tch tm ra
phng php thc hin cho gii php mt cch hu hiu nht.
2.1. Tm gii php
- Gii php gip chng ta tr li cu hi: Chng ta phi lm g?
- Nguyn tc: Nguyn nhn gc r no - Gii php
Mi nguyn nhn gc r c th c mt hay nhiu gii php tng ng gii
quyt, song ta ch chn nhng gii php p ng c cc tiu chun nu trn.
V d:
Nguyn nhn gc r
Gii php
1. K nng chuyn mn ca 1. o to k nng chuyn mn cho
cn b y t km.
cn b y t.
2. Cng ng thiu kin thc phng 2. Cung cp kin thc phng bnh
bnh
cho cng ng
3. Thiu thuc
3. Cung cp thuc
2.2. Xc nh phng php thc hin
- Phng php thc hin gip tr li cho cu hi "Chng ta phi lm nh th
no thc hin gii php ?"
- Mi gii php c mt hoc nhiu phng php thc hin tng ng.
V d:
Gii php

Phng php thc hin

1. o to k nng chuyn 1. M lp o to ngn hn ti c quan

mn cho cn b y t
2. Gi i o to
3. o to qua gim st thng xuyn

51

2. Cung cp kin thc phng 1. Truyn thng i chng

bnh
2. T vn trc tip
3. a vo chng trnh ging dy ti trng hc
4. Truyn thng qua t ri, sch mng, tranh nh
3. Cung cp thuc

1. Xin TTYTDP cp thm thuc

2. Dng tin d n Mua thuc
3. Xin UBND cp thm kinh ph mua thuc.

2.3. Chm im hiu qu cho mi phng php thc hin

Cch cho im hiu qu ca phng php thc hin da vo vic nh gi xem
phng php thc hin s lm gim nguyn nhn gc r ti mc no. Phng php
thc hin no c hiu qu cao hn th cho im cao hn.
Mc hiu qu ca phng php thc hin thng c cho im t 1-5:
im 1: khng hiu qu
im 2: hiu qu km
im 3: hiu qu trung bnh
im 4: hiu qu kh
im 5: hiu qu cao
Da vo biu quyt ca cc thnh vin trong t chc chn im hiu qu cho
mi phng php thc hin. C hai cch tnh im ca nhm:
Cch 1: Nhm tho lun v a ra cc l do cho im v thng nht mt im
chung cho c nhm
Cch 2: Tng ngi a ra im v l do cho im ca mnh v sau cng
im ca tt c mi ngi li ri chia trung bnh. Cch ny gip nhanh chng a n
kin thng nht trong ton nhm.
2.4. Chm im kh thi cho mi phng php thc hin
Cch cho im kh thi ca phng php thc hin da vo cc yu t nh thi
gian, chi ph, s chp nhn cng vic cn thit thc hin cc phng php thc hin.
Phng php thc hin no c tnh kh thi cao hn th cho im cao hn.
Mc kh thi v cc bc thc hin ging nh bc chm im hiu qu.
2.5. Tnh tch s im hiu qu vi im kh thi
Kt qu khi nhn im hiu qu vi im kh thi s c s dng lm cn c
la chn ra nhng phng php thc hin m chng ta thy ph hp.
2.6. Chn phng php thc hin
Chn nhng phng php thc hin c s im cao hn im mc do nhm quy
nh. Nu chng trnh c ngun lc th c th t c mc tiu trong mt khong
thi gian ngn hn bng cch trin khai nhiu phng php thc hin cng mt lc, v
52

cc phng php thc hin c trin khai ti nhiu nhm qun th ch khc nhau.
Tuy nhin, nu ngun lc khng di do th tt nht hy nn tp trung trin khai mt
gii php cho tt, hn l phn tn cc ngun lc thc hin nhiu gii php. Trnh t
thc hin phng php c th da vo ct tch s: im cao lm trc, im thp lm
sau
2.7. Phn tch kh khn v thun li ca cc phng php thc hin c la chn
Bc ny nhm mc ch gip cho nhm lm vic lng trc c nhng kh
khn c th xy ra, ng thi cng phn tch c cc im thun li khi tin hnh cc
phng php thc hin. Nhm c th dng phng php ng no ra cc bin
php khc phc nhng kh khn v tn dng nhng thun li . Vic phn tch ny s
gip nhm xy dng c mt bn k hoch hnh ng st vi tnh hnh thc t bng
nhng cng vic, hot ng c th khc phc c nhng kh khn v tn dng
c ti a nhng thun li c sn nhm t c mc tiu ra.
Khi phn tch kh khn-thun li, chng ta cn lu xem xt ti cc yu t sau:
- Con ngi
- Mi trng
- C s vt cht, trang thit b
- Ti chnh
V d v mt phn tch kh khn v thun li
Gii php: o to
Phng php thc hin: M lp tp hun ngn hn ti c quan
Kh khn
Thun li
- Cha c chng trnh tp hun
- C quan c sn c s vt cht
- Chi ph xy dng ti liu tp hun v - Lnh o ng h
mua sm trang thit b ging dy
- C sn ging vin c kinh nghim

Khi xy dng cc gii php, hy thu thp thng tin phn tch mi trng xung
quanh tm hiu xem cc t chc/n v khc c ang lm nhng vic lin quan n
gii php m chng ta nh thc hin hay khng. iu ny s trnh cho t chc thc
hin nhng cng vic trng lp, lng ph ngn sch mt cch khng cn thit.
Ngoi ra, chng ta cng nn xem xt k cc khon ti chnh cho cc hot ng
a ra. V d, khi cn nhc xy dng mt c s y t mi, hy nh rng ngoi chi ph
vn xy dng, chng ta cn phi dnh tin cho hot ng sau ny ca c s. Chng ta
cn phi lp k hoch v ln ngn sch cho chi ph vn cng nh chi ph thng xuyn
cho cc phng php thc hin.

53

V d: Bng la chn gii php

Mc tiu
Ng.nhn
gc r

Khch hng
khng c
cung cp
thng tin
Nng t l s
dng cc
bin php
trnh thai ca
ph n sau
no ht thai
t 32% ln
70% t thng
1/2005 n
thng 1/2006
ti TT
CSSKSS tnh
KH.

Cn b y t
thiu k nng
t vn

Cng tc
gim st cha
cht ch

Cha c quy
trnh t vn

Gii php

Cung cp
thng tin v
trnh thai cho
tt c KH

o to v k
nng t vn
cho cn b y t

Ch trng
gim st cc t
vn vin

Xy dng quy
trnh t vn

Phng php thc hin

a ni dung v phng trnh thai
trong qu trnh t vn
Truyn thng qua loa pht thanh v
truyn hnh v cc BP trnh thai
Pht cc t ri, sch mng v cc
bin php trnh thai ti PK
Chiu video v trnh thai ti
phng ch

Hiu Kh
qu thi

Tch Thc
s
hin

20

3
4

2
5

6
20

K
C

20

o to tp trung ngn hn

16

o to thng qua gim st thng

xuyn

12

Lp k hoch gim st ph hp

16

Xy dng y cc bng kim,

biu mu gim st
Xy dng ch ti gim st cho c
GSV v t vn vin

20

12

Xy dng QTTV trc, sau no

ht thai da trn QT mu BYT

20

54

VIT K HOCH HNH NG

MC TIU HC TP
Sau khi hc xong bi ny, hc vin c th:
1. Trnh by c phng php vit k hoch hnh ng
2. Vit c mt bn k hoch hnh ng thc hin mt can thip c th
NI DUNG
Xy dng k hoch hnh ng l bc cui cng trong quy trnh lp k hoch
c th ha cc gii php v phng php thc hin la chn nhm t c cc mc
tiu ra. K hoch hnh ng ph hp c li ch:
Gip d dng thc hin cc gii php v phng php thc hin la chn
Gip theo di, gim st, nh gi vic thc hin
Gip iu phi hot ng mt cch hiu qu
Ty tng mc ch v i tng s dng m bn k hoch c cc thng tin v
mc chi tit khc nhau. Nu tuyn trung ng, bn k hoch hnh ng c th
mang tnh khi qut, bao gm cc hot ng ln vi n v thi gian l thng th
tuyn x, bn k hoch cn c th hn vi cc nhim v chi tit c phn cng theo
tun, thm ch theo ngy. Hoc vi cc thnh vin thc hin chng trnh/k hoch th
bn k hoch hnh ng cn chi tit mi thnh vin c th thc hin c th vi nh
ti tr hoc vi cp trn, bn k hoch hnh ng c th t chi tit hn.
1. Phng php vit k hoch hnh ng
Trc khi vit k hoch, chng ta cn kim tra li tt c cc d liu, thng tin,
kt qu phn tch, cc nguyn nhn gc r, cc mc tiu ra, cc gii php v phng
php thc hin la chn vi nhng kh khn, thun li khi thc hin mi phng
php. Chng ta cng cn xem xt li cc ngun lc sn c v huy ng c ca c s,
cc cn b trc tip tham gia v cc c quan, t chc, c nhn h tr Cc bc cn
thc hin khi vit k hoch nh sau:
Lit k cc hot ng/cng vic
Lit k tt c cc hot ng/cng vic cn thc hin: c th l cc gii
php/phng php thc hin nu cc gii php/phng php thc hin ny c
th thc hin. Nu khng, c th chia nh cc phng php thc hin thnh
cc hot ng c th hn nu cn thit. Lu bn phn tch kh khn thun li
trong vic xc nh cc hot ng/cng vic nhm tn dng cc thun li, khc
phc cc kh khn trong thc t thc hin. Trnh khng b st cc hot ng,
nhng cng khng nn qu vn vt.
55

Sp xp cc cng vic/hot ng cn thc hin theo mt trt t hp l, lng ghp

cc hot ng mt cch thch hp. Thng thng, cc hot ng c sp xp
theo th t thi gian, cng vic no cn lm trc th xp trc, hot ng no
cn thc hin sau th b tr sau. Nu c nhiu mc tiu, nhiu gii php/phng
php thc hin th c th sp xp cc hot ng theo tng mc tiu hoc theo
tng gii php.

Xc nh qu thi gian
D kin thi gian bt u tin hnh v thi gian kt thc cho tng hot ng.
n v thi gian c th l ngy, tun, thng hoc nm ty thuc vo thi gian can thip
v mc ch, i tng ca bn k hoch.
Phn b nhn lc v cc ngun lc khc
Tng hot ng, cng vic cn phi c s phn cng r rng: ai l ngi chu
trch nhim thc hin chnh, ngi/c quan phi hp v ngi/c quan gim st hoc
thng qua kt qu. Vic phn cng phi ch t ng ngi, ng vic, huy ng
c tt nht ngun nhn lc v m bo tnh duy tr cachng trnh/d n.
Ngoi nhn lc, chng ta cng cn phi d tr cc ngun lc cn thit khc cho
vic thc hin cng vic nh kinh ph, trang thit b, c s vt cht, v..v.. Chng ta cn
da trn cc ngun lc c sn v c th huy ng c cho ton b hot ng, chng
trnh, tnh cht i hi ca tng hot ng, tng vic m phn b cho thch hp.
Xc nh r a im tin hnh
xc nh r a im tin hnh, chng ta phi tr li cu hi lm u?. C
nhng vic c th thc hin nhiu a im nhng cng c nhng vic ch thc hin
c hiu qu nhng ni nht nh.
D kin kt qu
Mi hot ng cng cn c d kin kt qu, sn phm ca hot ng hoc cng
vic. Cc kt qu ny phi tng xng vi u vo, ph hp vi hot ng v hng
ti mc tiu ra. D kin kt qu cn c th v o lng c c th theo di vic
thc hin, so snh gia kt qu d kin v kt qu thc t nhm rt kinh nghim v c
nhng iu chnh nu cn. Vi cc gii php hoc hot ng, cng vic ln, d kin kt
qu sau khi hon thnh chnh l mc tiu qu trnh ca chng trnh/k hoch.
Trn y l cc ni dung c bn m mt bn k hoch hnh ng thng c.
Tuy nhin, ty theo mc ch v i tng s dng bn k hoch ny m bn k hoch
c th gm cc ni dung khc nhau, mc chi tit khc nhau v theo cc mu khc
nhau. Phn di y s trnh by mt s mu k hoch hnh ng tham kho.
56

2. Mu k hoch hnh ng
Ty theo mc ch v i tng s dng ca bn k hoch m ta c th c cc
mu k hoch hnh ng khc nhau. Sau y l mt vi mu k hoch hnh ng m
ty theo mc tiu v yu cu c th ca mi chng trnh/d n chng ta c th la
chn p dng:
- Mu 1: K hoch hot ng tng th
- Mu 2: K hoch hot ng theo mc tiu/gii php
- Mu 3: K hoch trin khai hot ng theo thng
- Mu 4: K hoch trin khai hot ng theo tun
V d: thng k cc cng trnh v sinh ti thn M l mt trong nhng hot ng
cn thc hin. Hot ng ny cn c th hin c th trong bn k hoch hnh ng
nh sau:
TT

2
3
4
.

Tn hot
ng

Thi gian
Bt
Kt
u
thc

a
im

Thng k 3/1/ 28/2/ Thn

cc cng 2005 2005 M
trnh
v
sinh

Ngi
thc
hin

Y
H

Ngi
phi
hp

Ngi
gim
st

s Y t BS. T
thn
M

..

57

Ngun lc
cn thit

D kin
kt qu

50.000
mua
s
sch biu
mu (xin t
kinh
ph
chng
trnh
VSMT)

Bn
thng k
chnh xc
v
cc
cng trnh
v sinh
ca thn
M

Mu 1: K hoch hot ng tng th

Tn k hoch:
Mc tiu:
1..
2..
3..
Gii php:
1..
2..
3..
S
Tn hot ng
th t

Thi gian
Bt
Kt
u
thc

a im

Ngi, n Ngi, n Ngi gim Ngun lc D kin kt

v
thc v phi hp
st
cn thit
qu
hin

1
2
3
4
.

58

Mu 2: K hoch hot ng theo mc tiu/gii php

Tn k hoch:
Mc tiu:
Gii php 1:
Tn hot ng

Thi gian
T..
n

a im

Ngi chu Ngi phi Ngi gim Ngun lc D kin kt qu

trch nhim hp
st
cn thit

Thi gian
T..
n

a im

Ngi chu Ngi phi Ngi gim Ngun lc D kin kt qu

trch nhim hp
st
cn thit

Hot ng 1
Hot ng 2
.
Gii php 2:
Tn hot ng

Hot ng 1
Hot ng 2
.

59

Mu 3: K hoch trin khai cc hot ng theo thng

Qu I
1
2

Qu II
4
5

Mc tiu 1
Hot ng 1
Hot ng 2
Hot ng 3

Mc tiu 2
Hot ng 1
Hot ng 2
Hot ng 3
.
Mc tiu 3
Hot ng 1
Hot ng 2
Hot ng 3
.

60

Qu III
7
8

Qu IV
10
11

Ghi ch
12

Mu 4: K hoch trin khai cc hot ng theo tun

Thng 1
1
2

Thng 2
5
6

Mc tiu 1
Hot ng 1
Hot ng 2
Hot ng 3

Mc tiu 2
Hot ng 1
Hot ng 2
Hot ng 3
.
Mc tiu 3
Hot ng 1
Hot ng 2
Hot ng 3
.

61

Thng 3
9
10

11

12

Ngi
chu
trch
nhim

n v, Gim
c nhn st
phi
hp

BS. A
.

Y t M
.

Kinh
ph
d
kin

BS. B

TRIN KHAI THC HIN CAN THIP

MC TIU HC TP
Sau khi hc xong bi ny, hc vin c th:
1. Trnh by c li ch ca qun l trin khai chng trnh/d n
2. Phn tch c kh khn 3 chiu trong qun l trin khai chng trnh/d n
3. Trnh by c cc ni dung c bn ca qun l trin khai chng trnh/d n
4. p dng c cc cng c/k thut c bn trong qun l trin khai chng
trnh/d n
NI DUNG
1. Trin khai chng trnh/d n l g?
Sau khi lp c k hoch cho mt chng trnh hay d n y t, chng ta cn
t chc trin khai thc hin k hoch (xem hnh di y). Thc hin k hoch l
qu trnh bin mi k hoch trn giy thnh hin thc, thnh sn phm mong i. Trn
thc t, y l bc kh khn nht trong chu trnh qun l, i hi thi gian cng sc,
tr tu v ngun lc ln nht.

Lp k
hoch

nh gi

Gim st
Theo di

Thc hin

62

Qun l vic trin khai chng trnh/d n l vic p dng kin thc, k nng,
cng c v k thut vo cc hot ng ca chng trnh/d n nhm p ng cc yu
cu ca chng trnh/d n.
Qun l trin khai chng trnh/d n i hi nhng ngi qun l phi hiu r
cc c im ca chng trnh/d n do t chc mnh thc hin. Sau y l nhng c
im, m thng l nhng kh khn m ngi qun l s phi i mt trong sut thi
gian trin khai thc hin:
1. Chung ngun lc vi nhiu chng trnh/d n hay hot ng khc. V d, trung
tm y t huyn ch c mt chic t nhng c s dng cho tt c cc hot
ng ti Trung tm. Hoc cn b chng trnh phng chng AIDS cng kim
nhim lun vic theo di chng trnh phng chng Lao.v.v..
2. Nhm cn b tham gia chng trnh/d n thng n t nhiu phng ban b
phn khc nhau. V d trin khai mt hot ng v o to k nng t vn v
sc khe sinh sn cho cn b y t tuyn x, nhm cn b tham gia ca Trung tm
Y t huyn c th bao gm cn b phng sc khe sinh sn, cn b phng truyn
thng gio dc sc khe, cn b phng k hoch .v.v.
3. Ngi iu phi vic trin khai c th thiu thm quyn chc nng i vi cc
thnh vin nhm do nhiu khi ngi iu phi l mt cn b ca mt phng/ban
nhng cc thnh vin nhm li t cc phng ban khc
Do nhng c im trn, qu trnh thc hin nhiu khi khng din ra nh k
hoch v thng l c nhng thay i trong qu trnh thc hin, c v thi gian, nhn
lc v ti chnh
2. Nhng li ch ca qun l vic trin khai thc hin
Mc d c mt s hn ch nhng nu qun l tt vic thc hin th chng ta s
t c mc tiu ca chng trnh/d n mt cch hiu qu. Ngi ta chng minh
rng qun l vic thc hin s em li nhng li ch sau:
Xc nh r rng cc cng vic v xy dng l trnh c th t c cc yu
cu/kt qu u ra -> Do , tng kh nng thc thi v hiu qu
Ch ng iu chnh trong trng hp thay i v ngun lc, thi gian hay cht
lng
Cho php lng trc cc nguy c v chun b cch thc phng trnh, ng ph
sm.
3. Cc k nng cn thit cho qun l trin khai chng trnh/d n
Qun l trin khai khng ch n gin l vic thc hin cc k thut qun l.
Thc t, ngi qun l chng trnh/d n gii cn c cc k nng a dng. Ba lnh vc
k nng c bn m ngi qun l chng trnh/d n cn c gm:

63

K nng lp k hoch: kh nng lp k hoch s dng cc ngun lc ca

chng trnh/d n bao gm thi gian, cn b, ngn sch, trang thit b ...
K nng chuyn mn: cc k nng chuyn mn ngh nghip c th cn thit
cho tng chng trnh/d n.
K nng con ngi: kh nng qun l v ng vin nhng ngi thc hin
chng trnh/d n; gii quyt cc mu thun v vn gia cc c nhn, v
truyn t thng tin n cc bn lin quan mt cch hiu qu.

4. Kh khn ba chiu trong qun l vic thc hin chng trnh/d n

Kh khn ba chiu l mt thut ng ch ba kha cnh ch yu ph thuc ln nhau
trong vic tc ng ti kt qu ca chng trnh/d n.
Thi gian chng
trnh/d n c thc hin
trong thi gian ngn hay di

Cht lng/phm vi
chng trnh/d n cn p
ng cc yu cu cht lng
v phm vi n mc no

Chi ph - ngun
lc cn c hon
thnh chng
trnh/d n

Nh vy, vai tr ca ngi qun l vic thc hin l qun l thi gian, chi ph v
cht lng/phm vi ca chng trnh/d n - hay k hoch thi gian, ngn sch v cht
lng dch v, sn phm. Ch cn thay i mt trong s cc yu t ny s phi thay i
mt hoc c hai yu t cn li. V d, nu bn c yu cu gim thi gian hoc tng
cc yu cu cht lng/phm vi ca d n, tng chi ph ca d n s tng nhm p ng
yu cu ny
iu chnh cn c
(Mt hoc c hai)
Gim cht lng hay thu
hp phm vi
Gim cht lng hay thu
hp phm vi

Yu cu
Thi gian ngn hn

Chi ph cao hn

Gim chi ph

Thm thi gian

Cht lng cao hn hay

Thm thi gian
m rng phm vi

Chi ph cao hn

64

Cch duy nht nhm thc hin chng trnh/d n c th thay i mt trong
cc bin s thi gian, chi ph hay cht lng/phm vi m khng nh hng n cc yu
t cn li l c sng kin trin khai hiu qu hn trong qu trnh thc hin d n.
Ngi qun l chng trnh/d n nn lm vic vi cc bn lin quan (nh ti
tr, khch hng, chnh quyn, ban ngnh on th) ngay t khi lp k hoch chng
trnh/d n c th qun l kh khn ba chiu ny. Ngi qun l cng cn xc nh
r cch thc o lng nhng thay i ca mt trong ba bin s trn c nhng iu
chnh kp thi v ph hp.

5. Ni dung v cng c/k thut qun l vic trin khai chng trnh/d n
Cc ni dung c bn trong qun l trin khai chng trnh/d n thng bao
gm
Qun l phm vi chng trnh/d n
Qun l thi gian
Qun l nhn lc
Qun l ti chnh
Qun l cht lng
Qun l nguy c
Trao i thng tin
Vi mi ni dung qun l s c cc cng c/k thut gip qun l hiu qu. Tuy
nhin, cc ni dung v cc cng c qun l ny c mi lin quan rt cht ch, khng th
tch ri. Thay i bt k ni dung qun l no cng s nh hng ti cc cu phn
khc, do , ngi qun l lun lun cn xem xt v kim sot vic trin khai chng
trnh/d n mt cch tng th, iu phi cc cu phn qun l mt cch hi ha v linh
hot t c cc yu cu ca chng trnh/d n v p ng c mong i ca
cc bn lin quan.

5.1. Qun l phm vi

Bc u tin v quan trng nht trong vic qun l trin khai hiu qu mt
chng trnh /d n l xc nh phm vi chng trnh/d n mt cch r rng. C
th s dng Bn Tho thun hay Bn m t chng trnh/d n trnh by ngn
gn v chnh xc chng ta s thc hin chng trnh/d n g, ti sao lm, kt qu mong
i l g v xc nh phm vi ca chng trnh/d n (iu g thuc phm vi v iu g
vt qu phm vi ca chng trnh/d n).
V d:
Tn hot ng: Kha o to v Qun l cht lng ton din do trung tm o
to vng trin khai cho cc cn b tham gia chng trnh phng chng
HIV/AIDS ti cc tnh.
65

 Ti sao lm: d chng trnh v d n phng chng HIV/AIDS c thit k

chi tit ti cc tnh vi cc hot ng c th nhng cc cn b chng trnh
phng chng HIV/AIDS ti cc tnh cn gp kh khn trong vic ci thin cht
lng cng vic do thiu mt s k nng v k thut qun l cht lng.
Kt qu mong i: sau kho tp hun, c t nht 80% cc hc vin c th p
dng quy trnh qun l cht lng ton din vo mt hot ng phng chng
HIV/AIDS ti a phng.
Phm vi: o to c l thuyt v thc hnh trong thi gian 6 thng, cho cc cn
b tham gia chng trnh phng chng HIV/AIDS ti cc tnh, ch tp trung vo
phng php qun l cht lng ton din trong phng chng HIV/AIDS.
Bn Tho thun hay bn m t chng trnh/d n gip xy dng s cam kt v
hiu bit ca c nhm thc hin v chng trnh/d n. Tt c thnh vin ca nhm nn
c tham gia vo qu trnh vit Tho thun hay M t chng trnh/d n. Cc bn
lin quan cng nn tham gia vo qu trnh ny v ty thuc vai tr khc nhau i vi
chng trnh/d n m mc tham gia c th khc nhau nh ngi c vn, ngi ph
duyt, ngi h tr.
Qun l phm vi d n cn nhm xc nh cc cng vic/nhim v cn cn phi
c hon thnh to ra mt sn phm, dch v hay kt qu vi nhng thuc tnh v
chc nng c th m chng trnh/d n yu cu.
xc nh cc cng vic/nhim v cn thc hin, chng ta c th s dng
Bng phn tch hot ng (PTH). Bng phn tch hot ng cn l mt cng c
thit yu gip nhm lng trc c thi gian, ngun lc v chi ph cn thit hon
tt chng trnh/d n. xy dng c bng phn tch hot ng, nhm cn tho
lun v lin tc tr li cu hi cng vic hay nhim v g s phi thc hin t c
iu trn
V d: phn tch hot ng Cung cp cc kho o to lm sng v ART cho
2.000 cn b y t
Hi Cn phi lm g t c iu ny?
Tr li: Xy dng chng trnh o to.
Hi Cn phi lm g t c iu ny?
Tr li: Xc nh phc iu tr s c dng; K hp ng thit k kho hc;
Xy dng bn hng dn; Xem xt ti liu hin c, v.v.
Tip tc phn tch hot ng cc cp nh hn cho n cp cng
vic/nhim v nh nht tc l cho n khi bn t ti im m cng vic s din ra
trong khong thi gian tng ng vi n v thi gian nh nht m bn mun trong
lch trnh. V d, nu mun ln lch cc hot ng theo ngy, phn tch cc hot ng
thnh cc nhim v hng ngy; nu theo tun, phn tch cc hot ng thnh cc nhim
v hng tun cn hon thnh.
66

Ch :
- Cc cng vic/nhim v i hi thi gian nhng khng i hi cc ngun lc
khc thng b b qun khng a vo bng phn tch hot ng, v d: xin ph
duyt, gi th mi
- Cp chi tit ca bng phn tch hot ng ph thuc vo nhng ngi tham
gia phm vi ca chng trnh/d n, v mc ch ca bng PTH.
- Khng nht thit phi chia nh cc hat ng ca tt c cc nhnh trong bng
PTH cng cp . Trn bt c nhnh no ca biu , khi i n cp
c th v chnh xc theo di v qun l th c th dng vic phn tch ti
im
- Phm vi ca chng trnh/d n cng ln, bng PTH s cng phc tp. Cc
chng trnh/d n nh c th khng i hi phi c bng PTH, nhng vn cn
danh sch cc cng vic/nhim v cn hon thnh.
- Khng nn cc cng vic b ng tc l khng xc nh cng vic di dng
nhng g cn hon thnh. V d, thc hin phn tch l mt cng vic khng
r rng. Tt c cc hot ng, cng vic/nhim v trong bng PTH cn hng
ti mt sn phm hay mt hnh ng c th c im kt thc r rng.
5.2. Qun l thi gian
Qun l thi gian trong trin khai thc hin chng trnh/d n nhm mc ch m
bo tin ca chng trnh/d n. qun l thi gian, ngi qun l cn thc hin
cc nhim v:
Xc nh hot ng
c tnh ngun lc cho hot ng
c tnh thi gian thc hin hot ng
Sp xp cc hot ng
Xy dng k hoch thc hin theo thi gian
Kim sot thi gian
Bng phn tch hot ng gip xc nh cc hot ng cn hon thnh, sau cn c
vo ngun lc (nhn lc, kinh ph, trang thit b, .v.v) dnh cho cc hot ng
c tnh thi gian cn hon thnh. V d hon thnh hot ng lin h vi cc ban
ngnh on th xin kin v s h tr cho vic thnh lp cu lc b ngi nhim
HIV, nu ch c 1 ngi lm s mt 10 ngy nhng nu 3 ngi thc hin th c th ch
cn 3 ngy.
c lng thi gian cn thit hon thnh cc hot ng mt cch chnh
xc c th ngh cc thnh vin ca nhm cng tm hiu v tho lun hay hi kin
ca cc chuyn gia c kinh nghim. Cch chnh xc nht l da trn kinh nghim thc
t thc hin nhim v hay mt nhim v tng t. V d, nu nhm cha bao gi
67

thc hin vic thnh lp cu lc b cc b m nui con di 5 tui, hy hi nhng

ngi c kinh nghim, c th l ng nghip c kinh nghim tnh, huyn khc hay x
khc c tnh thi gian hon tt mi cng vic.
Sau khi phn tch chng trnh/d n hay hot ng ln thnh cc cng
vic/nhim v c th v c tnh thi gian cn thit hon thnh mi cng vic/nhim
v , chng ta c mt m t tng th v cc cng vic phi thc hin c th t
c mc tiu hay yu cu u ra. Tuy nhin hu ht nhng cng vic ny u lin
quan hay ph thuc vo cc cng vic khc, kt qu ca nhim v ny nhiu khi l u
vo thc hin nhim v khc. V d, kha tp hun cha th bt u nu ti liu tp
hun cha chun b xong. Do , vic hon thnh mt cng vic nht nh khng ch
ph thuc vo qu trnh thc hin cng vic m cn ph thuc vo vic thc hin v
hon thnh cc cng vic khc trc . V d, chng ta khng th li xe trc khi tra
kho vo khi ng. tm ra c s ph thuc gia cc cng vic cn thc hin
chng ta s s dng S mng li cng vic m t mi lin quan gia cc cng
vic ny v phn tch tm ra Con ng ch cht c ngha quyt nh ti vic
hon thnh chng trnh/d n.

68

V d: Bng phn tch hot ng ca can thip Tng s ngi nhim HIV trong din qun l c t vn v chm sc ti nh trn a bn qun
A nh sau:
Tng s ngi nhim HIV trong din qun l c t vn v
chm sc ti nh trn a bn qun A

100% cn b y t c k nng t vn v
chm sc ngi nhim HIV/AIDS
vo thng 11/2006

T chc
tp hun

Cc cng vic c th:

Lp k hoch chng trnh tp hun
Xy dng k hoch bi ging
Vit gio trnh tp hun
Chun b bi ging bng powerpoint
Triu tp hc vin

69

Xy dng s mng li cng vic

S mng li cng vic c xy dng da trn mi quan h kt thc--bt
u l mi quan h trong mt cng vic ch c th bt u khi mt hoc nhiu cng
vic khc kt thc. Chng ta phi tr li cu hi nhng cng vic no cn phi c
hon thnh trc khi cng vic ny c th bt u?
V d, trc khi Tin hnh o to th cn phi hon tt vic Xy dng
chng trnh o to m Xy dng chng trnh o to khng th bt u trc
khi hon tt nh gi nhu cu o to.
Chng ta cng cn t hi nhng hot ng no khng b ph thuc vo hot
ng, cng vic khc chng ta c th thc hin cng mt lc?
V d, Sp xp a im tin hnh o to c th c thc hin mt cch c
lp vi vic Xy dng chng trnh o to nhng cn c hon thnh trc khi
lp o to c t chc.
Mt trong nhng im mu cht lp k hoch trin khai cc hot ng hay
chng trnh/d n mt cch hiu qu l tm ra cch thc thc hin cng nhiu hot
ng cng mt lc cng tt nhm hon thnh cc cng vic trong thi gian ngn nht v
i hi ngun lc ti thiu nht.
V d: s mng li cng vic trin khai mt chng trnh o to v qun
l chng trnh y t tuyn huyn

Xy dng
chng trnh
o to

Xy dng ti
liu cho hc
vin/ging vin
T chc o to

La chn hc
vin

nh gi o
to

Gi giy mi
cho hc vin

Ch : i vi mt chng trnh/d n hay hot ng ln c th c nhiu s mng

li cng vic vi trnh t thc hin cc cng vic/nhim v khc nhau. Vic la chn
mt s mng li ph hp c quyt nh bi cc tiu ch u tin ca chng
trnh/d n, v d u tin v thi gian, u tin gim nguy c, ...

Xc nh con ng ch cht
Con ng ch cht trong s mng li cng vic c xc nh l con
ng di nht t im khi u n im kt thc ca mng li. hon thnh cc
cng vic trong con ng ch cht s cn nhiu thi gian nht so vi cc con ng
70

khc. Do , con ng ch cht s quyt nh thi gian ti thiu hon thnh

chng trnh/d n hay hot ng cn hon thnh.
Vic phn tch v xc nh c con ng ch cht v cc cng vic/nhim v
nm trn con ng ch cht l rt quan trng iu phi hot ng ca c chng
trnh/d n. Nu cc cng vic trong con ng ch cht b tr hon th ton b chng
trnh/d n s b chm li. Ngc li, nu cc hot ng ny thc hin ng tin
hoc trc tin s gip cho ton b chng trnh/d n c th m bo hoc y
nhanh tin hon thnh.
Phn tch mng li cng vic v con ng ch cht cng gip tm ra nhng
khu m thi gian cha c kim sot tt. c th l thi gian thc hin b ko di,
tr hon vic bt u, mt nhiu thi gian ch.v.v.. V d c th tin hnh o to th
phi hon tt xy dng ti liu tp hun cho hc vin v cho ging vin. Vic xy dng
ti liu nh vy mt ti hai thng. Trong khi vic la chn hc vin v gi giy mi
cho ti lc n tay hc vin ch mt khong mt thng do nu hai chui cc cng
vic ny c bt u cng lc th sau khi gi giy mi cho hc vin xong phi ch
hon tt xy dng ti liu tp hun khong mt thng na th mi c th tin hnh hot
ng tip theo l t chc o to.
Sau khi tm ra cc im hn ch trong s , ngi qun l c th iu chnh li
th t thc hin cc cng vic hoc iu chnh vic s dng cc ngun lc (nhn lc,
vt lc, thi gian) gim c ti a thi gian ch i hoc chm tr. Nh trong v
d trn, gim bt thi gian ch i, ngi qun l c th sp xp li trnh t thc
hin cng vic v thi gian bt u thc hin, trong hot ng xy dng ti liu tp
hun cn bt u trc c thi gian hon thnh cng lc vi hot ng la chn
v gi giy mi cho hc vin. Ngi qun l cng c th tng cng thm nhn lc
thc hin hot ng xy dng ti liu hot ng ny c th hon thnh sm hn.

71

V d: S mng li hot ng o to cn b y t v t vn v chm sc ngi nhim H

Hp thng nht
khung chng
trnh

Xy dng ti
liu tp hun

Gi cng vn
chiu sinh

Nhn thng tin

phn hi

Lp k hoch
ging dy

Xy dng k
hoch bi ging

Chun b bi ging
trn powerpoint

Chun b tp
hun
Chn hc vin

Gi giy mi
T chc tp
hun

Lp d tr kinh
ph

Thu phng hc

Ph duyt d
tr kinh ph

Tm ng kinh
ph

Mua VPP

Thu ni n ngh
cho hc vin

72

In ti liu

Xy dng k hoch thc hin theo thi gian

Mt trong nhng cng c rt hu ch trong xy dng k hoch thi gian l s
Gantt. Mc ch chnh ca s ny l m t mt cch trc quan thi gian d kin
thc hin cc cng vic ca chng trnh/d n, nu r thi gian bt u v kt thc.
Vic biu din k hoch thi gian bng S Gantt cho php ngi qun l d
n:
Truyn t, chia s thng tin v k hoch chng trnh/d n mt cch d dng
Cp nht tin thc hin chng trnh/d n
Theo di s khc bit gia k hoch v thc t trong qu trnh trin khai kp
thi iu chnh nu cn thit.

73

V d S Gantt K hoch thi gian

Thi gian thc hin (tun)
Cng vic/nhim v

H1. nh gi nhu cu o to
1.1. Thit k cng c nh gi
1.2. Lp k hoch nh gi
1.3. Tin hnh nh gi
1.4. Phn tch kt qu
1.5. Vit bo co nh gi

Ngy
khi
u

Ngy
kt
thc

10

11

12

01/01 21/02

1.6. Hp cng b kt qu nh gi
H 2. Xy dng chng trnh o to 21/02 28/03
2.1. R sot ti liu v xem xt kt qu
nh gi nhu cu o to
2.2. Xy dng chng trnh o to s
b
2.3. Hp vi cc ging vin v chuyn
gia gp v chng trnh o
to
2.4. Chnh sa v hon thin chng
trnh o to
2.5. Xin ph duyt ca lnh o

Thi gian d kin ca hot ng

Thi gian ca tng cng vic

74

Thi gian thc t

5.3. Qun l nhn lc

Qun l nhn lc l mt cu phn qun l rt quan trng trong qun l trin khai
chng trnh/d n, c bit i vi cc chng trnh/d n ln, c nhiu ngi tham
gia, thuc nhiu n v, t chc khc nhau. Qun l nhn lc trong trin khai chng
trnh/d n nhm mc ch lp k hoch v s dng nhn lc thc hin chng trnh/d
n ph hp v hiu qu nht C th s dng S Gantt v Bng phn cng trch
nhim trong qun l nhn lc trong qu trnh trin khai thc hin chng trnh/d n
Cn lu trong qun l nhn lc thc hin, vic phn cng vai tr v trch
nhim thc hin mi cng vic/nhim v l rt quan trng, vic phn cng phi rt c
th: nu r ai l ngi chu trch nhim chnh, ai l ngi phi hp v ai l ngi thng
qua kt qu hay gim st cng vic . Trnh phn cng nhim v cho nhm hay mt
n v chung chung. Nn nu tn c th c nhn chu trch nhim mc d hon thnh
cng vic s c mt nhm ngi tham gia nhng vai tr mi ngi s khc nhau v
ch c mt ngi chu trch nhim chnh, nhng ngi cn li thng ng vai tr h
tr trong qu trnh thc hin. Vic phn cng c th nh vy to ra ng lc cho mi c
nhn m bo cng vic c thc thi. Khi giao trch nhim theo nhm, cc thnh vin
thng cm thy l nhim v chung v trch nhim ca h l khng r rng.
V d, lp danh sch hc vin mt kho o to, cn b A l ngi chu trch
nhim chnh c c danh sch nhng trong qu trnh thc hin s cn s phi
hp ca cn b vn phng B gip lin lc vi a phng v cn c ngi iu
phi chng trnh o to thng qua danh sch trc khi chnh thc s dng.
Mt trong nhng li ch quan trng ca lp k hoch thc hin l gip qun l
tt hn khi lng cng vic ca cc cn b tham gia chng trnh/d n. Song song
vi phn cng cng vic cho cc thnh vin, ngi qun l cng phi phn tch tng
khi lng cng vic m mi c nhn phi thc hin m bo vic phn cng cng
vic l hp l v cc cng vic c th hon thnh ng k hoch. Bng phn cng
trch nhim l mt cng c rt hu ch cn i khi lng cng vic m mi c
nhn phi thc hin.
Trong phn cng cng vic, chng ta cn ht sc lu m bo vic phn cng
l ph hp vi kh nng thc hin thc t v ngi c phn cng c th hon thnh
c. V d, nu mt cn b c phn cng thc hin hai nhim v quan trng cng
din ra mt lc th ngi s khng th hon thnh c hai vic theo ng k hoch.
Trong tnh hung ny, hoc l nn phn cng mt nhim v cho mt ngi khc, hoc
l cn phi thay i s mng li v tnh ton li k hoch.

75

V d: K hoch thc hin can thip v phn cng trch nhim cn b

Tn can thip: Tng s ngi nhim HIV trong din qun l c t vn v chm sc ti nh trn a bn qun A

Cc hot ng/
cng vic

H1. Chun b sinh

hot cu lc b cho
ngi nhim

K hoch thc hin (tun)

Phn cng

Ngy
khi
u

Ngy kt
thc

Chu
trch
nhim
chnh

1/1/06

28/2/06

10

11

12

1.1. Hp phn cng

Mai

1.2. Chun b ti liu

Ngn

1.3. Chun b a im

Nga

1.4. Xy dng ni
dung
1.5. Chun b trang
thit b

Tin
Hoa

1.6. Ln lch hot ng

Linh

76

Tham gia

Linh
Chu
Hoa,
Mai,
Thnh
Mai, Chu,
Ngn, Lin,
Tin
Mai, Linh,
Ngh
Chu,
Thnh,Nga
Hoa,Ngn,
Lin,Ho

Tnh
hnh can
thip
Thng
qua
KQ/gim
st

Tin
Minh
Hoa
Ho
Minh
Thnh

Vo thi
im

V d Bng phn cng trch nhim cn b can thip

Tn can thip: Tng s ngi nhim HIV trong din qun l c t vn v chm sc ti nh trn a bn qun A
Trch nhim c nhn
Cc hot ng/
Cng vic

Ngy
khi
u

H1. Chun b sinh hot

cu lc b cho ngi 01/01
nhim
1.1. Hp phn cng
1.2. Chun b ti liu
1.3. Chun b a im
1.4. Xy dng ni dung
1.5. Chun b trang thit b
1.6. Ln lch hot ng
.

Ngy
kt
thc
Hoa

Mai

Linh

Chu

P
G

T
P
P
P

Thnh

Ngn

Nga

Ngh

Lin

Tin

Ho

Minh

28/02

T
P

G
P

T
P

G
T

P
P

P
G

P
T

H 2.
T=Trch nhim

P=Phi hp tham gia

G=Thng

77

qua

kt

qu/gim

st

5.4. Qun l ti chnh

Trn thc t, vic c tnh ngun lc ti chnh cn cho chng trnh/d n
c thc hin ngay t giai on xy dng cng hay vn kin chng trnh/d n.
Tuy nhin, qua giai on thm nh, ngn sch c ph duyt c th thay i so vi
d ton xut. Trong khun kh ngn sch chng trnh/d n c ph duyt,
nhm thc hin s tnh ton chi ph cho tng hot ng c th, lp k hoch kim sot
v thc hin kim sot chi ph trong qa trnh trin khai m bo thnh chng
trnh/d n
Cc cu hi quan trng trong d tr ngn sch thc hin chng trnh/d n
iu g cn c thc hin?
Ai nn thc hin iu ny?
H cn ci g thc hin iu ny?
Chi ph h thc hin iu ny l bao nhiu?
Trong qun l thc hin chng trnh/d n, cch xy dng ngn sch hot ng
chnh xc nht l lp ngn sch t di ln. y l cch xy dng ngn sch chi tit
hon thnh tng cng vic ri tng hp li thnh bn d ton tng hp. Cch tnh
ton chi tit nh vy va m bo tnh chnh xc ca bn d ton vi cng vic thc t,
va gip kim sot chi ph ca hot ng trong qu trnh trin khai thc hin.
S d tr ngn sch t di ln:

Phn tch cng vic

Lp ngn sch t di ln

Chng trnh/D n

Hot ng chnh

(3) c lng tng chi ph d n

Hot ng chnh
(2) c lng chi ph mi hot ng
chnh

Cc cng vic cn thc hin

- Cng vic 1 (c lng thi gian)
- Cng vic 2 (c lng thi gian
- Cng vic 3 (c lng thi gian
- .

(1) c lng chi ph mi cng vic

cn thc hin

78

5.5. Qun l cht lng

Qun l cht lng trong qu trnh trin khai thc hin bao gm:
- Xc nh yu cu cht lng: Xc nh cc yu cu, tiu chun cht lng m sn
phm/kt qu u ra ca chng trnh/d n cn p ng. Xy dng k hoch p
ng cc yu cu, tiu chun cht lng ny.
- m bo cht lng trong qu trnh thc hin: p dng cc cng c, h thng
qun l cht lng m bo rng tt c cc quy trnh hot ng u hng ti p
ng cc yu cu/tiu chun cht lng.
- Kim sot cht lng ca sn phm/kt qu u ra ca chng trnh/d n o
lng, gim st cc sn phm/kt qu u ra ca chng trnh/d n xc nh xem
chng c tun theo cc tiu chun cht lng thch hp khng v ra cc bin php
loi tr cc nguyn nhn lm cho kt qu khng c nh mong i.
Ty tng yu cu cht lng cn t c cng nh quy m, phm vi ca
chng trnh/d n m vic qun l cht lng c th n gin hoc phc tp. Trn
thc t c rt nhiu cng c, h thng qun l cht lng khc nhau, v d TQM, ISO, ..
v vic ng dng cng c, h thng no l rt linh hot. Cn lu rng cu phn qun
l cht lng khng phi l mt cu phn ring bit m cn c lng ghp vi cc cu
phn qun l khc.

5.6. Qun l nguy c

Nguy c d n l g?
Nguy c d n l mt s kin hay iu kin khng chc chn. Nu nguy c xy ra s
nh hng tch cc hay tiu cc n mc tiu chng trnh/d n.
- Nguy c l s kin, v d nhng trng hp sau c th xy ra khi trin khai d
n:
Thi gian i cp php ca c quan chc nng lu hn so vi thi gian d
kin trong k hoch;
Vic b tr v phn cng cn b hin ti trong n v cha ph hp vi yu
cu cng vic ca mt s hot ng trong d n;
Cn b tham gia d n chuyn cng tc.
- Nguy c l iu kin, v d nh:
Thiu my tnh ni mng nn vic trao i thng tin rt c th b nh hng
Nhiu d n chng cho nn hot ng d n b ph thuc vo nhng cn b
tham gia kim chc m d n khng chi phi c h, v d kh nng vng
mt trong bui hp hay ti ni cung cp dch v ca d n rt d xy ra nh
trng hp gim st vin d n l cn b ca S Y t hay phi i cng tc,
cn b ca Phng khm ngoi tr (PKNT) bn cng vic ca bnh vin.
- Cc mc tiu hon thnh d n:
79

 Mc tiu thi gian: Phi hon thnh cng vic ng thi hn;
Mc tiu kinh ph: Phi thc hin theo ng k hoch ngn sch;
Mc tiu phm vi v cht lng ca d n: Phi hon thnh cng vic t
kt qu ng nh d kin, m bo s lng v cht lng.
Qua nhng v d trn, chng ta c th thy rng nu mt trong nhng s kin trn
xy ra s nh hng n d n v kinh ph, thi gian..., mt khc, cc yu t v iu
kin lm vic, iu kin t chc khng thun li lm tng thm s nguy c gy bt li
cho d n.
Mc ch ca qun l nguy c trong qu trnh thc hin l phng nga v gim
thiu nh hng ca cc ri ro (tiu cc) v tn dng cc c hi (tch cc) nu xy
ra trong qu trnh trin khai chng trnh/d n

Cc lnh vc nguy c d xut hin

K hoch thc hin
Cc cng vic trn con ng ch cht.
Cc cng vic b ph thuc vo nhiu cng vic khc ( thc hin cng vic
ny cn hon thnh nhiu cng vic trc ).
Cc cng vic m c phn b thi gian qu t hoc qu cht ch.
Cc cng vic khng thc t.
Cc cng vic ph thuc nhiu vo cc yu t bn ngoi. V d, vic ln k
hoch gp mt nh ti tr s ph thuc rt nhiu vo thi gian ca nh ti tr.
Cc mc chnh trong qu trnh thc hin.
Ngun lc
Cc cng vic c phn cng cho nhiu ngi
Cc cng vic s dng cc ngun lc khng sn c hoc c nhng t i, khan
him
Phn cng cho ngi khng trnh
m au, vic thay th cn b, v.v.
Ngn sch
Ngun ngn sch khng chc chn
Thay i trong cc u tin ngn sch
Ngun lc hoc hp ng ti chnh khng chc chn
Phm vi
Khng xc nh r phm vi
Yu cu ca khch hng thay i
80

 S sn c ca cc cng c v k thut
Nhiu sai st khng d kin trc c
Cc yu t khch quan bn ngoi
Nhng thay i v chnh sch
Cc khng hong t nhin hoc do con ngi (v chnh tr, kinh t, hay t
chc...)
Cc bc qun l nguy c
Cch hiu qu nht gii quyt cc nguy c ca chng trnh/d n l phn
tch v xy dng k hoch khng ch v gim tc hi ca cc nguy c ny mt khi
chng xy ra ngay t giai on bt u chng trnh/d n.
1. Xc nh nguy c: Xem xt k hoch d n v xc nh cc nguy c c th tc
ng ti vic thc hin, c th nh sau
iu g c th lm tr hon hay chm tr trong thc hin k hoch?
iu g c th e do cht lng ca sn phm/dch v u ra cui cng
ca chng trnh/d n hay hot ng?
Cc yu t hay s kin no c th lm tng chi ph, vt mc ngn sch
cho php?
iu g c th l nguy c dn ti vic thiu ht nhn lc hay cc ngun
lc khc khi cn thit?
2. Lng ha tc ng ca mi nguy c
Trc khi c th xc nh nguy c u tin qun l, chng ta cn nh gi tc ng ca
tt c cc nguy c xc nh. Nhng lm th no m chng ta c th lng ha nguy
c mt thnh vin quan trng trong nhm d n s ngh sinh? Hoc lm th no c
th so snh nguy c vi nguy c tng gi cc trang thit b quan trng ca d n?
c th so snh c, chng ta s xem xt tng nguy c da trn cc tiu ch: kh nng
xy ra nguy c , mc tc ng ti kt qu d n v kh nng kim sot c nguy
c C th s dng 2 phng php lng ha tc ng nguy c nh sau:
Cch th nht: s dng ma trn theo 2 tiu ch: kh nng xy ra v tc ng v cht
lng, chi ph v thi gian
:Trc tin, hy phn loi kh nng xy ra ca mi nguy c thnh 3 nhm: cao, trung
bnh, thp. Trong , kh nng xy ra cao ngha l c tnh xc sut >70%, trung bnh
l t 30%-70% v thp l di 30%.
- Tng t, phn loi tc ng n d n ca mi nguy c theo 3 kha cnh: chi
ph, thi gian v cht lng d n thnh 3 nhm: cao, trung bnh, thp nh trn.
- Sau , da trn kt qu phn loi trn, s dng bng nh gi tc ng nguy c
di y xc nh xem tng nguy c nm khu vc no: xanh, vng hay
81

trong : xanh l mc nguy c yu, vng l mc nguy c trung bnh v

l mc nguy c cao.
Bng nh gi tc ng nguy c (1)

ng

Tc

Cao v chi
ph, thi gian,
cht lng
Trung bnh v
chi ph, thi
gian, cht
lng
Thp v chi
ph, thi gian,
cht lng

VNG

XANH

VNG

XANH

XANH

VNG

Thp
(xc sut
<30%)

Trung bnh
(xc sut 3070%

Cao
(xc sut
>70%)

Kh nng xay ra

Cch th 2: s dng bng chm im theo 3 tiu ch: kh nng xy ra nguy c ,

mc tc ng ti kt qu d n v kh nng kim sot c nguy c theo
thang im t 1-3 trong 1 l thp nht v 3 l cao nht. Tch s im ca mi
nguy c theo 3 tiu ch ny s gip xc nh c nguy c u tin nguy c c tch
s im cao nht
Bng nh gi tc ng nguy c (2)

STT

M t nguy c

Kh nng Tc
xy ra
ng

Khng
kim
sot
c

Tch s

3. Xc nh u tin nhng nguy c quan trng nht

Cn c vo bng nh gi tc ng nguy c xc nh nguy c no c kh
nng e da d n nhiu nht. Nhng nguy c nm khu vc mu hoc mu vng l
nhng nguy c nn c lp k hoch ng ph. Bn cnh , kh nng kim sot mt
s kin cng nh hng ti vic la chn u tin nguy c. V d, nu c mt s kin
82

hon ton nm ngoi kh nng kim sot ca nhm, nhm s mun a s kin hay
tnh hung vo k hoch ng ph v nhm s khng th c bin php phng nga
no i vi nguy c c.
V d, sau khi thu thp thng tin, tho lun trong nhm d n v tham kho
kin chuyn gia, nhm thc hin d n Chm sc v h tr ngi nhim HIV/AIDS
ti nh ca qun hi Chu TP. nng xc nh c mt s nguy c sau y c th nh
hng ti thnh cng ca d n:
- Ngi nhim khng tham gia sinh hot cu lc b
- Gia nh ngi nhim khng hp tc
- Cn b y t qu bn khng th thc hin c vic chm sc ti gia nh
- Khng kinh ph mua trang thit b v thuc thit yu cung cp cho gia nh v
cn b y t
Nhm lng ha tc ng ca cc nguy c ny v th hin trong bng sau:
Cao
VNG

Trung bnh

ng

Tc

Thp

XANH
Gia nh ngi
nhim khng
hp tc
XANH
Cn b y t qu
bn khng th
thc hin chm
sc ti gia nh
Thp
(<30%)

Ngi nhim
khng tham gia
sinh hot cu
lc b
VNG
Khng kinh
ph mua trang
thit b v
thuc

XANH

VNG

Trung bnh
(30-70%)

Cao
(>70%)

Kh nng xay ra

Kt qu l nhm chn 2 nguy c thuc 2 v vng l 2 nguy c u tin

hng u v xy dng k hoch ng ph cho 2 nguy c ny.
Cng c th s dng phng php chm im xc nh nguy c u tin. V
d, vi 4 nguy c nh lit k trn, nhm s chm im 4 nguy c ny theo 3 tiu
ch trong bng sau:

83

STT

M t nguy c

Ngi nhim khng tham gia

sinh hot cu lc b
Gia nh ngi nhim khng hp
tc
Cn b y t qu bn khng th
thc hin c vic chm sc ti
gia nh
Khng kinh ph mua trang
thit b v thuc thit yu cung
cp cho gia nh v cn b y t

2
3

Kh nng
xy ra

Tc ng

Khng
kim
sot
c
2

Tch s
12

Cn c vo tch s im ca tng nguy c, nhm c th chn nguy c 1&4 l

nhng nguy c u tin hng u ca d n.
4. Xy dng k hoch ng ph nguy c:
Khi xc nh hay chn mt s nguy c u tin, vic cn lm tip theo l phi
tm cch ng ph vi chng m bo s thnh cng ca d n. K hoch ng ph
nguy c thng bao gm:
- K hoch ngn nga nguy c xy ra
- K hoch ng ph khi nguy c xut hin
- Thi im bt u hnh ng ng ph
- Ngi hoc nhm chu trch nhim chnh qun l nguy c
ng ph nguy c u tin, d n cn phi dnh ngun lc cn thit cho s
chun b ch ng ng u vi nguy c. Lp k hoch i ph nguy c d n l
cn thit, nhng c th khng cn lm mt k hoch ring m nn lng ghp vi cc k
hoch ca d n. Da trn phng n thit k vi tng nguy c, nhm cn phn
cng mt ngi chu trch nhim qun l nguy c , cn nhc ngun lc v cc hot
ng qun l nguy c vo trong k hoch ngn sch, k hoch thi gian v k hoch
tng hp ca d n (khi cn).
Bn k hoch qun l nguy c l cng c gip ng ph vi cc nguy c xc
nh u tin. Vi tng nguy c, nhm s ng no c hnh ng phng nga, k
hoch ng ph (nu nguy c xy ra), v xc nh s kin bt u thc hin k hoch
ng ph ny.

84

K hoch qun l nguy c: d n Chm sc v h tr ngi nhim HIV/AIDS ti nh ca qun hi Chu TP. nng
Cc nguy c

Tch s nguy
c/mu sc

Bin php
ng ph

1.Ngi nhim khng tham gia

sinh hot cu lc b

Gim nh

2. Khng kinh ph mua trang

thit b v thuc thit yu cung cp
cho gia nh v cn b y t

Vng

Gim nh

M t bin php

Ngi chu trch

nhim qun l
nguy c
n nh vn ng
Trc bui sinh BS. Lan
hot CLB 3 ngy,
i chiu s lng
ngi nhim ng
k tham gia t hn
s d kin t 10%
tr ln
Huy ng t ngn Bo gi trang thit K ton Hng
sch d n LIFE-GAP b v thuc vt
qu kinh ph cho
php

85

Hnh ng khi

5.7. Trao i thng tin v vic trin khai cc hot ng chng trnh/d n ti cc
bn lin quan
Trao i thng tin (TTT) v vic trin khai cc hot ng ti cc bn lin quan
ng vai tr rt quan trng m bo thnh cng ca mt chng trnh/d n. Cng
vic ny cn c thc hin lin tc trong tt c cc giai on, bt u t lc khi u,
xc nh, lp k hoch, iu hnh, kim sot v kt thc mi hot ng v ton b
chng trnh/d n.
Vi mi hot ng trong chng trnh/d n, ngi qun l cn dnh thi
gian thch hp trao i thng tin nhm t c s tho thun v p ng nhng
mong i t cc bn lin quan. Bn cnh , vic thng xuyn trao i thng tin cn
gip ngi qun l pht hin v gii quyt cc vn khi chng pht sinh.
Chnh v vy, gip cho vic trao i thng tin thc hin chng trnh/d n
c hiu qu, chng ta nn lp k hoch c th cho cng vic ny v coi nh mt
phn ca k hoch d n tng th. ng thi cng cn theo di v xem xt vic trao
i thng tin trong qu trnh trin khai thc t c iu chnh kp thi nu cn.
Nhn chung, c bn cch trao i thng tin chnh nh sau:
Vn bn chnh thc: cng vn, bo co hot ng chng trnh/d n
Vn bn khng chnh thc: cc ghi chp v hot ng d n, th in t
Tuyn b ming chnh thc cc bi trnh by trong cuc hp chnh thc, hi
tho
Tuyn b ming khng chnh thc cc cuc tho lun trc tip, hoc qua in
thoi, cc cuc hp nhm
Tt c cc hnh thc trao i trn u quan trng cp nht v truyn ti ni
dung hot ng ca mt chng trnh/d n n cc bn lin quan. Tuy nhin, vic trao
i bng ming thng xuyn din ra, nhng kh c th lp k hoch hot ng ny.
Khi cung cp thng tin cho cc bn lin quan, ta nn ch n mc chi tit
ca thng tin cn ph hp vi tng i tng:
Cc nh qun l cp cao s khng c nhiu thi gian, do vy, h khng mun
xem/nghe qu chi tit tng hot ng ca chng trnh/d n. V vy, ch nn
thng bo tm tt nhng im quan trng mang tnh tng th cho h tr khi
c yu cu bo co chi tit.
Ngc li, vi cc thnh vin trong nhm thc hin chng trnh/d n th h
quan tm n chi tit hn, c bit xoay quanh hot ng h c phn cng.
Thc t, p ng tt nht yu cu trao i thng tin vi cc bn lin quan,
nhm d n cn phn tch k lng nhu cu thng tin ca tng bn lin quan. V
d:
Nh ti tr quan tm n d n v tin v hiu qu;
Lnh o TTYT d phng cn nhn thng tin v k hoch, tin thc hin
cng vic, v cc bo co;
86

 Phng TCKT cn thng tin tin gii ngn, bo co ti chnh, thanh quyt
ton;
S Y t: thng tin thc hin d n t a bn v t iu phi d n, bo co tin
;
Ngi nhim HIV v ngi trc tip chm sc cn hng dn cch chm sc ti
nh, thng tin v chnh sch v thi quan tm, chm sc ca x hi vi ngi
nhim, thng tin v h tr y t, kinh t ...
K hoch TTT cn c nhng khon mc sau:
Ni dung trao i: nu r thng tin g cn trao i. V du: Bo co tin v
cht lng, Bo co tin tm ng, chi tiu, quyt ton, Nhng vic hon
thnh v cha lm c
i tng trao i: Ngi trong nhm d n, ngi ca TTPC HIV/AIDS, ban
qun l d n, nh ti tr,...
Cch thc TTT (hay phng php chuyn ti thng tin) : Trao i thng tin
vi i tng no th phi bng cch no cho ph hp, v d, thng tin v tin
d n bo co ln TTPC HIV/AIDS thng bng cc bo co chnh thc (vn
bn); chia s tnh hnh hot ng ca tng thnh vin th c th gi th in t
hoc cc bui hp nhm; bi bo v d n, bn tin gi cho tt c cc bn lin
quan th c th a ln trang web, in n phm hay a vo tp ch chuyn ngnh
(nu c). Chia s thng tin cp nht , ang v s thc hin (theo k hoch hot
ng) ca cc thnh vin) th cn phi hp nhm.
Thi gian v tn sut : thi gian TTT c th. Nhiu thng tin v i tng cn
trao i nhiu ln v thng xuyn (tn sut ln). V d hp giao ban nhm d
n trao i cng vic trong nhm c n nh vo chiu th su hng tun,
np bo co cho lnh o th vo ngy 25 hng thng.
Phn cng trch nhim: Ai trong nhm d n hay trong t chc nhn nhim v
thc hin vic trao i thng tin, v d: iu phi d n chu trch nhim bo
co cc thng tin chuyn mn v tin chung v kt qu d n, tr l d n
chu trch nhim chia s thng tin theo di vic thc hin cng vic ca cc cn
b d n; K ton d n chu trch nhim thng bo v tin gii ngn, thi
hn thanh ton ca cc hot ng

87

V d : K HOCH TRAO I THNG TIN

Tn D n: Chm sc, h tr ngi nhim HIV/AIDS ti nh, thnh ph Nng,
2006 2008
T chc thc hin d n: TTPC HIV/AIDS Nng
Thng tin v cc bn lin quan cn TTT
Bn lin quan
Nh ti tr

Ngi lin h
ThS Bi Thanh M,

S Y t

BS. Nguyn Vn N

Lnh o TTPC BS. Phm Th ,

AIDS
Gim c
Phng TCKT
CN Hnh, P trng
phng
Phng Hnh chnh Nguyn vn Minh

a ch
Hi YTCC Vit
Nam, 138 Ging
V, H ni
135 Phan Chu
Trinh, Nng
120 Phan Chu
Trinh, Nng
120 Phan Chu
Trinh, Nng
120 Phan Chu
Trinh, Nng
54 Trn Ph,
Nng
28 Trn Quc
Ton, Nng

Cc TTYT Qun BS H, Khoa AIDS

huyn
Cc ban ngnh Ch Thanh, Trng
on th
ban Ph n qun
Hi Chu
Ngi nhim HIV Anh Xun, i din 97 Bch ng,
Nng
Ngi trc tip B Chinh, i din
118 Nguyn Du,
chm sc
Nng

88

Phone, Fax, E- mail

04-266
btm@......
051-845
051-874
ptdao@yahoo.com
051-873
051-873
051-851
051-832

051-865
051-847

V d: K hoch trao i thng tin

Ni dung

i tng

Tin v cht lng

d n - bo co
chuyn mn
K hoch, hot ng,
tin d n v xy
dng m hnh - bo
co chuyn mn

Nh ti tr

Tin tm ng, chi

tiu, quyt ton

K hoch cung ng
hu cn
ngh cung cp
phng tin, vt t
S ng h ca lnh
o
Hot ng, tin
thc hin v kt qu

Cch thc trao i

thng tin
Gi bo co
Th in t

Thi gian v tn sut

trao i

Ngi chu trch

nhim

Hng qu

Bs. Phng

- Hp giao ban trung

tm
- Np bo co

Hng thng
Hng qu (ngy 15)

Bs. Nam

Phng TCKT

Np bo co

Hng qu

Bs. Phng

Phng HC, TC

- Hp

- Th hai hng tun

- Gi Bo co

- Hng qu

- Cng vn ngh

- Trc khi s dng

phng tin
Hng qu (ngy 15 cui
qu)

Lnh
AIDS

S Y t

TTPC

Np bo co

89

Bs. Phng

Bs. Phng

Ni dung
K hoch thc hin
Kt qu d n/ m
rng phm vi d n
Hng dn cch chm
sc, kin thc chng
k th, ha nhp cng
ng, s quan tm h
tr ca x hi
Hng dn cch chm
sc, s h tr ca d
n

i tng
Cc TTYT Qun
huyn
Cc ban ngnh on
th

Cch thc trao i

thng tin

Thi gian v tn sut

trao i

Ngi chu trch

nhim

th bo bu in

Hng qu (ngy 1 u qu)

Bs. Trinh

Bo co s kt v
tng kt

Hnhg qu
Su thng
Cui nm

Bs. Nam

Sinh hot CLB

Truyn thng

Hng thng (ngy th ba

u thng)

Cc thnh vin trong

nhm

Tp hun

Ba ngy/ nm
Hng thng(ngy th nm
u thng)

Cc thnh vin trong

nhm

Ngi nhim HIV

Ngi trc tip chm

sc ngi nhim HIV

Truyn thng

90

GIM ST H TR TRIN KHAI CAN THIP

MC TIU HC TP
Sau khi hc xong bi ny hc vin c th:
1. Trnh by v phn bit c cc khi nim gim st, kim tra, thanh tra, theo di
v nh gi.
2. Trnh by c cc hnh thc, phng php v nguyn tc gim st
3. Phn tch c cc k nng gim st
4. Trnh by c qui trnh gim st bn ngoi
5. Xy dng c k hoch gim st v bng kim gim st bn ngoi

NI DUNG
Gii thiu:
Trong qu trnh trin khai cc hot ng/chng trnh y t, k nng v tinh thn
ca cc cn b trc tip thc hin cc hot ng trong k hoch ng vai tr ht sc
quan trng to ra cc sn phm hoc cc dch v c cht lng v hiu qu ca cc
chng trnh y t. gip cho cc cn b thc hin tt k hoch ny, cc nh qun l
cn phi thc hin cng tc gim st h tr. Vy gim st h tr l g? Cng tc ny
khc g so vi cc cng tc khc nh: kim tra, thanh tra, theo di v nh gi? Bi vit
ny trc ht s trnh by chi tit cc khi nim lin quan n cng tc gim st h tr
cc hot ng/chng trnh y t, v sau s tp trung vo trnh by quy trnh gim st
bn ngoi, bao gm c vic xy dng k hoch v bng kim gim st.
1. Khi nim gim st h tr
1.1. Khi nim: Gim st h tr l mt chc nng ca qun l trong gim st vin
cn ch trng ti nhu cu v mong mun c h tr ca nhn vin m h gim st.
Khi nim ny c hiu rng hn cc khi nim gim st thng thng khc v ngoi
vic gim st h tr cc hot ng ca cc cn b tuyn di hoc cc cn b bn ngoi
t chc, khi nim gim st h tr cn cp ti vic h tr, gip ca cc nh qun
l i vi nhn vin ca mnh trong khi thc hin cc cng vic c giao. Tc l cc
nh qun l cng chnh l gim st vin i vi cc nhn vin trong c quan/n v m
mnh ang iu hnh. Nh vy, gim st h tr l vic gip (h tr) cc cn b gii
quyt nhng kh khn hoc cc vn m ang gp phi trong qu trnh trin khai
cc hot ng /chng trnh y t nhm gip h thc hin tt hn cng vic ca mnh
v nng cao c hiu qu v cht lng ca chng trnh/hot ng.

91

V d nh, vai tr ca gim st vin ti cc c s cung cp dch v y t l gip cho nhn

vin cung cp dch v c cht lng cao, thn thin vi khch hng nhm tho mn nhu
cu ca khch hng, khuyn khch h quay tr li v gii thiu khch hng khc hoc
nhng ngi c nguy c cao khc n s dng dch v ti c s . Chnh hot ng
gim st ny s gp phn gip cho c s cung cp dch v t c mc tiu ca c s
dch v . Cch tip cn ny nhn mnh vai tr hng dn, cng tham gia gii quyt
vn , thng tin hai chiu gia gim st vin v ngi c gim st.

So snh gia gim st kiu c v gim st h tr

Gim st h tr
Gim st kiu c
Nhn mnh ti vic gip nhn vin Ch l hnh thc kim tra cc hot
gii quyt vn thng qua qu trnh
ng b ngoi, khng thc s gip
nng cao cht lng
nhn vin m h gim st
Ch trng tm ra nhng sai st trong Nhm tm ra v ch trch cc sai st
quy trnh lm vic hn l quy trch
ca c nhn, t quan tm ti quy trnh
nhim cho tng c nhn
lm vic
H tr nhn vin lp k hoch tng Coi trng xem xt nhng vic xy
lai nhm ci thin cht lng cc
ra trong qu kh hn l tp trung xy
hot ng
dng gii php v k hoch tng lai
Lin tc pht trin da trn cc kt K hoch khng u n v lin tc,
qu t c trong giai on trc
khng da trn cc kt qu t c
t ra cc mc tiu nhm ci thin
trc y m k hoch da nhiu vo
cht lng cho cc dch v ngy
cm tnh v mang tnh i ph vi
cng tt hn
hon cnh

1.2. Li ch ca gim st h tr
Mc ch ca gim st h tr l nhm gip cc nhn vin - ngi thc hin
cc hot ng ca chng trnh y t hon thnh ngy mt tt hn cng vic ca h.
Chnh v vy gim st lun ng mt vai tr quan trng trong vic nng cao cht lng
hat ng/chng trnh y t.
Thot u, gim st h tr dng nh i hi nhiu cng sc v thi gian hn
gim st kiu c. Cch gim st ny s mt cng hn trong qu trnh chun b, nhng
sau khi tin hnh th cch ny s mang li nhiu li ch hn v thc s gip cc nhn
vin lm vic hiu qu hn v:
Gim st l mt qu trnh h tr, gip v cm tay ch vic - o to v o to
lin tc, to iu kin thun li trong phm vi c th gip hon thnh tt
nhim v. Hot ng gim st ch yu l nhm vo cn b ang trin khai cng
vic trong nhng iu kin lm vic, mi trng v hon cnh sng, sinh hot c
th. Khi ng dng cc phng php, quy trnh hay cc cng c c gii thiu
trong l thuyt vo cc hon cnh khc nhau, lun cn c iu chnh nht nh
92

cho ph hp vi iu kin thc t. Cc gim st vin phi hiu c tnh hnh,

hon cnh c th th mi gip nhn vin ra v thc hin c cc bin
php c th, thch hp vi hon cnh thc t, c nh vy mi gip h hon thnh
hiu qu cc cng vic.
Nhn vin hc c cch gii quyt vn ca chnh h nn h s t gii
quyt c cc cng vic thng thng hay cc vn n gin, t cn n s
h tr ca gim st vin
Cc nhn vin nhn c h tr v gp trc tip t cc gim st vin, do vy
h c th c sa i sai st ngay trong qu trnh gim st. iu ny rt c li
cho cc hot ng mang tnh k thut.
Gim st vin c uy tn hn v h thc s h tr, gip nhn vin tho g c
nhng kh khn trong cng vic v l ngi to ra nng lc cho nhng ngi
khc.
Qu trnh gim st tp trung tho lun tm ra cc sai st trong qui trnh lm
vic ch khng ch trch cc li lm ca nhn vin, do vy cc nhn vin s ci
m hn trong vic tho lun v ton b qu trnh gim st. Nh , cc nhn
vin lm vic nhit tnh hn v cam kt hn trong cng vic.

1.3. Phn bit gim st h tr v theo di, nh gi, kim tra, thanh tra
Cc hot ng gim st h tr, theo di, kim tra, nh gi, thanh tra c nhiu
im tng ng, tuy nhin bn cht v mc tiu ca ca tng loi hot ng ny li rt
khc nhau. Trn thc t, vic phn bit ny li cng cn thit trnh lm ln khi trin
khai mi hot ng pht huy c ng hiu qu v mc tiu ca chng.

93

Di dy l bng so snh cc khi nim ny:

So
Gim st
Kim tra
Thanh tra Theo di
nh gi
snh
Tng im tng ng: Tt c hot ng trn u nhm mc tiu chung l nng
cao cht lng cng vic thng qua mt qu trnh lin tc thu thp, phn
ng
tch, tng hp v lu tr thng tin t c s nhm gip cho ngi qun l
nm bt c tnh hnh hot ng, iu chnh cng vic cho ph hp vi
tnh hnh thc tin thng xuyn bin ng
l mt qu xem cc hot tm
ra gip ngi xem xt hiu
Khc
trnh h tr, ng
c nhng
qun
l qu, gi tr ca
nhau
gip v ng tin , thiu st v bit c mt
chng
cm tay ch c t k php ch tin v trnh, hay mt
vic, o to hoch ra ca c s iu chnh dch v sau mt
v o to lin trc hay trin khai hot ng thi gian hot
tc ti ch, to khng. Kim hot ng, ca
cc ng nht nh
iu
kin tra cn nhm xc
nh chng
nhm rt ra bi
thun li cho chm im, trch
trnh,
d hc
kinh
cc nhn vin bnh xt thi nhim ca n.
nghim (tht bi
trong phm vi ua theo qui c
nhn
hoc
thnh
c th gip nh.
hay tp th
cng), a ra
hon thnh tt
mt n v.
quyt
nhim v.
nh/chnh sch
cho cc hot
ng hin hnh
v cho cc
chng trnh,
d n tip theo.

94

Theo di:
- Xem xt tin
- iu chnh mc tiu,
hot ng

nh gi:
- Hiu qu, gi tr
- Ra quyt nh

Thu thp, x l thng tin

nhm:
- Lng gi hot ng
- iu chnh cng vic
- Nng cao cht lng
cng vic

Gim st:
- H tr
- o to trc tip
- i tng l con
ngi

Kim tra:
- Tin cng vic
- Ph bnh, phn xt
- iu chnh mc tiu
- i tng l cng vic

Thanh tra:
- Php ch
- Qui nh
- xut x l

2. Cc loi hnh gim st

Trong thc t c nhiu hnh thc gim st, vic p dng hnh thc gim st no
tu thuc vo nhiu yu t nh: bn cht cng vic ang c trin khai ti cc c
s/n v, nng lc ca gim st vin, ngun lc (thi gian, nhn lc, phng tin v
thi gian)..v..v..
Ty theo phng php v mc ch khc nhau, gim st c phn loi theo nhiu cch
khc nhau. y, xin cp n ba cch phn loi nh sau:
2.1. Phn loi theo phng php gim st:
Gim st trc tip: gim st vin gp g trc tip vi nhn vin c gim st
v trao i, tr chuyn, cng vi h pht hin cc vn v gip gii quyt
cc vn .
Gim st gin tip: gim st vin khng gp g vi nhn vin c gim st. H
thng tm hiu vn c s thng qua cc bo, s sch ghi chp do cc nhn
vin gi ln, trao i vi cc nhn vin qua in thoi, th in t, fax.v.v.
Phng php ny thng ch p dng trong nhng trng hp gim st vin do
mt l do no , khng th trc tip n c s gim st. Rt c th, cc gim st
95

vin khng thu thp c cc thng tin st thc t c s do vy hiu qa gim

st gin tip thng rt hn ch.
Gim st lng ghp: Trong khi cc ngun lc thng rt c hn m cng vic
th nhiu, ta nn t chc gim st lng ghp mt cch hp l tng cng hiu
qu ca cng tc gim st v cc hot ng qun l khc, ng thi tit kim thi
gian, ngn sch v cc ngun lc khc. Gim st lng ghp nhm gii quyt cc
vn tn ti trong nhiu hot ng khc nhau trong c quan/t chc. Trn thc
t, cng vic gim st i khi c tin hnh lng ghp vi theo di v nh gi.
Tuy nhin ta khng nn lng ghp gia gim st v thanh tra, kim tra, v khi
tin hnh thanh kim tra, ngi c gim st do s b khin trch v k lut, h
s khng gim nu ra nhng vn v kh khn m h ang thc s gp phi.
H s c gng tm cch che du cc vn ang din ra ti c s, nh vy gim
st vin s khng th thu thp c cc thng tin thc t c nhng h tr
thch hp gii quyt v gip h tho g ccc kh khn ny. im lu trong
khi thc hin gim st lng ghp l cn phi gi c c th ca gim st h
tr l gip nhn vin tm ra vn cn ang vng mc, tng cng k nng cho
h v h tr h gii quyt vn .
2.2. Phn loi theo thi gian
Gim st t xut: Gim st khi c "vn " bt ng xut hin hay khi c thi
gian, hoc lng ghp vi cc hot ng khc. Thng p dng cho gim st trc
tip nhm gip v mt k thut.
Gim st nh k: Gim st theo k hoch gim st t ra. C th p dng
cho c gim st trc tip v gin tip.
2.3. Phn loi theo ngun gim st vin
Gim st bn ngoi: Gim st vin l ngi ngoi, hoc tuyn trn tip xc v
quan st trc tip ngi c gim st thc hin nhim v chuyn mn v tho
lun vi h gii quyt nhng tn ti nu c. Ngi bn ngoi d nhn thy
nhng iu ngi trong cuc khng nhn r.
Gim st ni b (C s t gim st): Thng do ngi qun l gim st nhn
vin ca mnh. Kiu gim st ny c li l gim st vin hiu su tnh hnh thc
t ca c quan mnh, ra gii php thit thc v c th thc hin thng xuyn.
Nh vy, ngi qun l cn gim st h tr cc hot ng m nhn vin ca h
ang thc hin, v vy mt ngi mun tr thnh ngi qun l gii cng nn
rn luyn c y cc k nng ca mt ngi gim st vin. Gim st
theo hnh thc ny mang tnh bn vng, lin tc, hiu qu cao, pht huy c ni
lc, chia x c kinh nghim gia cc cn b trong cng c s, gii quyt kp
thi nhng vn ny sinh trong thc t.

96

3. Nguyn tc gim st
- Gim st l qu trnh thng tin 2 chiu: quan st, lng nghe, giao tip ch ng
v phn hi tch cc vi tinh thn thn i, gip .
- Xc nh c th i tng, ni dung v thi gian cho tng cuc gim st.
- Hiu v p ng c nhu cu ca ngi/n v c gim st.
- Cng tham gia gii quyt vi ngi/n v c gim st.
- Lp k hoch hot ng, gii quyt vn r rng (vn g, ai lm, lm khi
no, khi no hon tt, ni no theo di)
- Dng bng kim ph hp gim st.
4. Cc k nng gim st
4.1. K nng quan st: quan st ni chung trong khi i gim st cn phi thc t, bao
qut, nhng t m (khng b st vn , hin tng) v nh gi theo bng kim. Khi
quan st vic cung cp cc dch v ti cc c s y t, ta nn lu mt s im sau:
- Cn c s ng ca ngi c gim st v khch hng
- Chn v tr quan st thch hp
- Ci m, ng vin, gim mc mt bnh tnh ca ngi c gim st
- Hn ch ni, trao i trong lc quan st ngi c gim st thao tc
- T nh, kn o ghi chp v chm vo bng kim
- Ch phn hi sau khi gim st xong tr trng hp c bit phi can thip
ngay nu thao tc ca ngi c gim st c th gy nguy him cho khch
hng
Quan st l s nhn nhn ch yu bng mt nh gi c ton cnh hoc
tng phn cnh quan v s vic ang din bin ti c s v ngi c gim st. Gim
st vin c th:
- Quan st c s: ton cnh bn ngoi, bn trong, tnh trng v sinh, ni tht cc
khoa phng, t thuc, trang thit b y t cho tng tuyn
- Quan st s sch, bo co thng k, bnh n, biu
- Quan st dch v y t (hot ng ca nhn vin trong lc h ang lm vic)
4.2. K nng giao tip: L s tip xc gia gim st vin v ngi c gim st, hoc
vi khch hng. Cc k nng giao tip thng c s dng nh sau:
- Lng nghe tch cc: l tp trung nghe vi s thng hiu, cm thng v hng th.
Khng lm vic khc khi nghe ni, khng ngt li, khng t v kh chu hay st
rut.
- S dng ngn ng c th: ngn ng c th bao gm t th ca thn th, v tr
ngi, c ch, iu b ca cc b phn c th nh tay, chn, u, nh mt, nt
mtv d: cch ngi, gt u, nhn vo mt ngi ni, phn ng nt mt theo
tnh cm ngi ni. Ngn ng c th biu hin s tn trng, hng th v thng
cm, tuy nhin cn ph thuc vo c im ca mi nn vn ha.
97

Khuyn khch bng li ni v khng bng li ni: l cch dng ngn ng v c

ch, iu b nhm th hin s ch v mong mun ngi ang ni tip tc trnh
by (mt cch thoi mi, khng e ngi). V d: dng cc t ti hiu, ti r
hay ng tc gt u.
Din gii: l s nhc li nhng g ngi ni trnh by nhng theo mt cch
din t khc nhm biu hin s ch v khuyn khch ngi tip tc ni.
Ch nn din gii khi thy ngi ni lng tng, e ngi khng mun ni tip
Lm r: l cch t cu hi nhm hiu r hn ngi c gim st nh ni g.
K nng ny cng tng t nh din gii nhng mc ch l hiu r ngi
ni ch khng phi khuyn khch h tip tc ni.
t cu hi thch hp: l cch dng cc cu hi m nm bt c nhiu
thng tin hn ngi c hi, khuyn khch h tr li mt cch chi tit hn.
Bng cch gim st vin c th hiu r vn hn v h tr h tt hn. Cu
hi m thng c bt u bng cc t hi nh: ai, ci g, u, khi no, ti
sao, nh th no.

4.3. K nng cm tay ch vic:

- Gim st h tr chnh l hnh thc o to ti ch (trc tip).
- K nng ny thng c dng khi i gim st ch yu l hun luyn v k
nng. Cch hun luyn hiu qu nht l cm tay ch vic.
- Cm tay ch vic l cch hun luyn k nng thc hnh bng cch cng lm vic
vi ngi c gim st, ch bo cho h c th tng ng tc (trn ngi bnh
hay trn m hnh), gip h lm ng v tt hn theo qui trnh ca cng vic.
- Cm tay ch vic c th tin hnh trn ngi tht hoc trn phng tin m
phng v trn cc cng c lm vic khc nh bn k hoch can thip
- Ngi hun luyn theo phng php cm tay ch vic khng phi l lm thay
m cn cho ngi c o to lm theo s ch dn tn tnh ca ngi hun
luyn v ch gip lm thay h khi tht cn thit. V d nh khi cn b ca i
sc kho sinh sn ca trung tm y t huyn gim st h tr cho cn b chuyn
trch ca mt trm y t, khi nhn thy cn b tuyn x thc hin khng ng
thao tc t vng cho mt khch hng, th lc gim st vin nn lm thay
trnh xy ra tai bin cho khch hng (ngi bnh)
4.4. K nng phn hi: Phn hi l s phn nh li cho ngi/c s c gim st
nhng nhn xt, nh gi ca gim st vin hoc on gim st. Phn hi phi mang
tnh xy dng, khng nn ph bnh, ch trch.
- Phi chn thi im thch hp nhng cng sm cng tt sau gim st
- Chn a im thch hp
- Phi bo m tnh ring t, b mt
98

Khen ngi nhng g lm tt (c gng tm ra cc u im ca ngi/c s

c gim st khen ngi, ng vin, khuyn khch)
Nhn xt v nhng hn ch phi khch quan, ng mc, khng suy din. Gim
st vin cn t mnh a v ngi c gim st m nhn xt.
iu quan trng l qua tho lun tm ra cch khc phc nhng im yu, hn
ch.

Phn hi cho c nhn:

- Khen ngi trc
- Gi cho ngi c gim st t nh gi, nhn xt cng vic lm (c u v
nhc im)
- Nu cc cu hi gi nu ln sau lm li, anh/ch s lm nh th no?, iu
anh/ch thy kh khn nht l g?
- Tho lun, hng dn li cho ngi c gim st trn hnh v, m hnh cho n
khi h tht s hiu bit v lm c.
- Nhng phn hi cho c nhn khng cn phn hi vi cp trn ca h khi khng
cn thit (v cng ni r cho ngi c gim st bit nh vy)
Trnh t phn hi cho tp th:
- Khen ngi nhng im mnh
- Ln lt a ra nhng im hn ch ca c s nhng cn t nh. Tt nht l t
cu hi cc anh/ch t nhn xt v cng vic ny ti c s ta nh th no?,
cng vic ny theo cc anh/ch c th lm tt hn c khng? cho mi
cn b ti c s t nhn ra vn .
- Bn bc tm ra phng hng gii quyt c th, xy dng k hoch hnh ng
chi tit v c s cam kt ca mi ngi trong khoa phng.
- Thng nht cc vn cn phn hi ln lnh o c quan.
Phn hi cho lnh o n v:
- Nn phn hi ring, ngn gn bo co cng vic v tnh hnh gim st ca on.
- Khng phn hi nhng vn ca c nhn hoc ca khoa phng nu nh khng
cn thit c s can thip ca lnh o.
- Trao i nhng kh khn v tr ngi trong cng tc ca khoa phng cn c s
ch o, tr gip ca ban lnh o.
- Cn c s cam kt c th v k hoch hnh ng ca ban lnh o.
4.5. K nng lm vic nhm: L cch lm vic ca gim st vin vi mt nhm nhn
vin/cn b y t c gim st cng tho lun vi nhau v thc trng ca c s hay mt
vn c pht hin trong qu trnh gim st v cng nhau tm hng gii quyt.
99

Khi lm vic nhm vi nhm ngi c gim st, gim st vin s ng vai
ngi nhm trng iu khin nhm lm vic. Cn lm cho cc thnh vin:
Bit r ni dung ch cn tho lun
Mc tiu cn t c sau khi lm vic nhm: a ra c cc vic phi lm
gii quyt vn c pht hin trong qu trnh gim st ti c s.
Gi , hng dn cho mi ngi u tham gia tho lun: khch l ngi rt r,
tm cch hn ch ngi ni qu nhiu, ni lan man.
Gi mi ngi trong nhm t ni c ra nhng im yu v a ra bin
php sa cha, khng ph phn, ln n, ch trch
Tm tt kin quan trng trong tho lun v ly kin ng thun trong c
nhm.
Bn bc vi nhm lp k hoch hnh ng, sau vi s phn cng c th giao
vic cho tng ngi, thi gian bt u, thi gian hon thnh, ai theo di, kin
ngh vi cp trn h tr cho k hoch c thc hin
5. Phng tin - cng c gim st
Mi hot ng u cn c phng tin, cng c c th. C nhiu loi cng c
khc nhau, tu theo mc tiu ca tng cuc gim st m chun b cng c cho ph hp,
cng c thc hin gim st trong cc chng trnh y t thng l:
Cc vn bn c tnh php quy nh ch trng chnh sch, lut - php lut, Ngh
nh, quy nh... lin quan.
Cc ti liu lin quan.
K hoch hnh ng trin khai chng trnh.
Cc quy trnh k thut: V trng, an ton v mu.
Cc ti liu hun luyn, tuyn truyn lin quan.
Phng tin h tr.
K hoch gim st, lch trnh gim st.
Bng kim gim st ph hp.
Bin bn gim st c (nu ln gim st trc c lm) v mi (bin bn trng
lm ln ny)...
Khng phi ln gim st no cng phi c y cc cng c trn, m chn lc
cng c cho ph hp vi mc ch gim st.
C nhiu loi cng c nhng bng kim l mt cng c quan trng v ph bin
nht dng quan st, nhn xt trong khi thc hin gim st, nht l gim st trc
tip, nh quan st thc hin cc k thut/th thut, quan st mi trng, quan st bui
tuyn truyn gio dc sc khe (GDSK), quan st chm sc, quan st t vn, quan st
nh hng - t im..., cng v vy xy dng bng kim ph kp gim st l mt
trong nhng nng lc ch yu ca gim st vin.
100

6. Bng kim gim st

6.1. Khi nim: l bng ghi danh mc cc ni dung, hot ng cn gim st. Bng kim
gip cho cn b gim st: Khng b st ni dung cn gim st; thc hin theo th t
cc ni dung c chun b trc; gim st ng trng tm, khng thc hin nhng
vic khng cn thit nn tit kim c thi gian; lu tr c nhng ni dung/ch
gim st ln ny, lm c s cho cc ln gim st tip theo; vit bo co sau gim st
c chnh xc.
Bng kim thng c xy dng trc do cc chuyn gia c kinh nghim v k
thut nhng cng c th do cc gim st vin trong on gim st thit lp mi hoc b
sung, sa cha bng kim c sn cho ph hp vi tnh hnh c s c gim st. C
nhiu loi bng kim c dng vi cc mc ch khc nhau, nhng v c bn cu trc
v cch lp bng kim th ging nhau.
6.2. Xy dng bng kim: Khi xy dng cc bng kim cn ch cc im ch yu
sau
6.2.1. Xc nh tn ca bng kim
Tn ca bng kim chnh l tn ni dung, k thut, th thut, nhim v, mi trng,
hot ng...m ta cn quan st.
6.2.2. Phn tch ni dung, k thut, cng vic thnh cc mc, cc hot ng - thao tc
cn quan st
Phn tch, m t ni dung, k thut, th thut thnh cc thao tc phi thc hn. Lc u
cn m t t m, chi tit, thm ch tht chi tit mi thao tc, mi chi tit, mi ni dung
ln nh
Sau khi phn tch lit k cc thao tc, cc ni dung... trc khi a vo bng kim
cn kim tra xem:
+ M t c chung chung qu khng
+ Xem cn st thao tc, ni dung no khng
+ C qu chi tit vn vt khng? C thao tc /vic no khng cn thit phi a vo
bng kim khng?
Nguyn tc chung: Khi a vo bng kim th cc thao tc, cc ni dung khng qu
tm tt, khng st nhng thao tc/nhng ni dung cn thit nhng khng qu vn vt.
6.2.3. Phn chia k thut, th thut thnh cc bc
C nhng ni dung, th thut, k thut n gin, hoc t thao tc c th khng cn
phi chia thnh cc bc. Nhng vi cc ni dung k thut, th thut phc tp hn
hoc nhiu thao tc cn phn thnh cc bc cho d thc hin, d theo di trong quan
st. Cc bc s c xp xp theo trnh t hp l, trong mi bc cc thao tc cng
c t trong th t cht ch theo ng quy trnh.

101

Khng nn chia qu nhiu bc trong mt bng kim v nh vy s tr nn cng

knh, nhng cng khng nn ghp qu nhiu thao tc vo mt bc v kh theo ri v
c th gy nhm ln trnh t gia cc thao tc, kh quan st.
Nhn chung trong mi cng vic, th thut, k thut th cc bc, cc thao tc phi
theo trnh t nghim ngt. Tuy nhin trong mt s th thut trnh t ca mt vi thao
tc lin tip no c th thay i m khng nh hng g. V d: tin hnh th
thut tim tnh mch, nhn vin y t c th gii thch cho bnh nhn trc ri chun b
dng c hoc ngc li; Nhng thao tc bm thuc vo tnh mch ca bnh nhn th ch
c php thc hn sau khi khng nh l chc kim ng vo mch mu.
Vi cc ni dung, th thut ln hoc phc tp c rt nhiu thao tc cng c th s
dng bng kim quan st nhng cn chia thnh cc giai on, mi giai on nn xy
dng thnh mt bng kim ring v nh s theo th t lin tc ca th thut.
6.3. Cu trc bng kim
Bng kim dng quan st thng c khung cu trc nh sau:
Phn u ghi:
- Tn bng kim, i tng quan st, a im quan st, ngi quan st
Phn bng ghi :
- Ct 1: S th t, nh s th t cc bc, th t cc thao tc theo trt t nu.
- Ct 2: Vit tn cc bc, cc thao tc. Vit r, ngn, khng cn gii thch vn
hiu.
- Ct 3: Ghi kt qu quan st. C nhiu cch ghi kt qu quan st, nh:
C / Khng
t / Cha t
Cho im theo cc thang o khc nhau tu trng hp, v d 1, 2, 3, 4 hoc
A, B, C, D
- Ct 4: Ghi ch. C th khng cn ct ny.

102

V d v bng kim
V d 1

BNG KIM QUN ST T VN TRC KHI XT NGHIM HIV

Ngi thc hin:
Ngi quan st:
a im quan st:
Ngy quan st:
C
STT

Ni dung quan st

1
2
3

Cho hi i tng t vn (TTV) khi h n nhn t vn.

Hi l do lm cho TTV n lm xt nghim
Ni cho TTV bit l mi thng tin t vn c gi b mt tuyt
i.
Hi TTV v cc hnh vi nguy c v tnh dc
Hi TTV v hnh vi nguy c trong tim chch
Hi TTV v vic c nhn mu c truyn t nm ... tr li y
khng?
Hi TTV xem h c b bnh ly truyn qua ng tnh dc hay
khng?
Hi v hnh v quan h tnh dc ca ngi bn tnh ca TTV.
Hi v hnh vi tim chch ca ngi bn tnh ca TTV.
Hi v bnh ly truyn qua ng tnh dc ca ngi bn tnh ca
TTV
Hi TTV v kin thc ly truyn HIV
Hi TTV v bin php phng HIV/ AIDS

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Khng
lm

Nhn xt chung:

Ngi quan st/Gim st vin

(k tn)

103

Cha
t

V d 2
BNG KIM VIT MC TIU CAN THIP GII QUYT
MT VN SC KHO
Ngi thc hin:
Gim st vin:
a im quan st:
Ngy quan st:
STT

Ni dung gim st

1
1.1
1.2
1.3
1.4
1.5
2
2.1
2.2
3
3.1
3.2
3.3
3.4
3.5
4
4.1
4.2
4.3
4.4
4.5

Nu vn sc kho
Vn g/cng vic g/hnh vi g?
i tng lin quan n vn /hnh vi
a im xy ra vn
Mc ca vn
Thi gian xy ra vn
Mc tiu
Mc tiu chung
Mc tiu c th
Tiu chun ca mc tiu (cch 1)
C th, c th, ch r i tng/vn
o lng c
Tnh kh thi/t c mc tiu
Thit thc, ph hp
Ch r mc thi gian hon thnh
Tiu chun ca mc tiu (cch 2)
Thc hin mt cng vic c th
Xc nh r i tng c th
Khi lng cng vic s thc hin
a im thc hin cng vic
Thi gian hon thnh cng vic

Khng

Nhn xt chung:

Gim st vin
(k tn)

104

Ghi ch

7. Qui trnh gim st bn ngoi

7.1. Chun b:
- Chn ngi i gim st (gim st vin): nn chn cc gim st vin m bo cc
tiu ch sau :
C k nng thnh tho v chuyn mn trong lnh vc gim st
C kin thc v k nng gim st
Sp xp c thi gian thch hp i gim st
C kh nng lnh o to s tin tng, t chc tt cuc gim st v ra quyt
nh ng sau khi gim st.
- Xy dng k hoch gim st:
Gim st vn g (chn vn u tin)
Mc tiu ca chuyn gim st
Ai i gim st
Ai/n v no c gim st
Cng c gim no s s dng gim st
Thi gian, a im gim st
Ngun lc, phng tin gim st
- Xy dng/chun b cng c gim st
Thu thp v nghin cu cc t liu lin quan n c s c gim st
Cng c gim st (xem mc 6)
- Thng bo v thng nht lch v ni dung gim st cho c s
7.2. Thc hin gim st
Gim st h tr ti cc c s thng c tin hnh theo cc bc sau v c th iu
chnh linh hot da theo tinh hnh thc t:
7.2.1. Gp g ngn vi lnh o hoc ngi qun l ca c s n gim st: Gim st
vin cho hi, ni r mc ch v ni dung, thi gian gim st, d kin thi gian gp li
phn hi
7.2.2. Quan st nhanh c nh gi chung v tnh hnh ti c s
7.2.3. Xem xt k hoch can thip ca c s (nu c)
7.2.4. S dng cc cng c gim st thch hp (v d: bngkim) thu thp cc thng
tin cn thit.
7.2.5. Trao i vi ngi c gim st: nn ch n cc ni dung/cng vic chn
u tin (ni dung nh gim st). Tu tng trng hp, gim st vin c th yu cu
ngi c gim st thc hnh cc ni dung lin quan n ni dung gim st. Trong
trng hp cn thit (cn gim st nhiu kin thc ca nhiu cn b y t) c th pht
105

cc cu hi vit/cc trc nghim khch quan cn b y t tr li. Mc ch ca bc

ny l tip tc pht hin cc thiu ht v kin thc-k nng-thi , tm nguyn nhn
nhm h tr c s gii quyt vn , nng cao cht lng dch v. Thi ca gim st
vin phi ha nh, thn i, n cn, t nh, khch quan
7.2.6. Quan st v hi p v iu kin/c s vt cht/trang thit b: hi, nhn xt v
ch dn v cch b tr phng lm vic, cch to ra khng kh thoi mi, yn tm cho
khch hng; cch ghi chp cc mu s sch, t thuc v danh mc thuc thit yu; danh
mc v cch s dng, bo qun trang thit bCh trng hi v iu kin p dng cc
quy trnh hay cng c mi, nhng kh khn v nguyn vng ca c s.
7.2.7. Hi kin cc bn lin quan: thng tham kho kin ca hai i tng sau:
- Ngi nhn dch v:
Nn hi ngi ang ch nhn dch v, ngi nhn dch v hoc ngi nh
Nn hi ming trc tip, khi cn thit c th pht cu hi vit h tr li v
khng yu cu ghi tn
Khi hi nn p dng cu hi m khch hng c th t do trnh by kin
ca h.
Ni dung hi thu thuc vo ni dung gim st m chun b phng php hoc
cc bng hi cho ph hp trc khi tin hnh gim st. V d khi hi v s hi
lng ca ngi s dng dch v nn dng cch hi gin tip pht hin mc
hi lng ca khch hng nh: thi gian v a im ch i, thi gian v cch
i v, chi ph v ngun sng, cm gic v vic tip xc vi cn b y t, cc bn
khon lo lng ca ngi s dng dch v
- Ngi qun l/ph trch: c th hi trc tip ngi qun l tuyn trn hoc i
din chnh quyn/on th nu h cng tham gia t gim st hoc b tr thi gian
n hi kin h khi cn thit. Nn hi kin nh gi ca h v cc hot ng lin
quan n ni dung gim st, ng thi tham kho s h tr/qun l ca h gip cho
c s c gim st thc hin c nhim v ca mnh.
7.2.8. Phn hi cho c s: y l phn phn hi nhanh bng ming ngay sau khi gim
st. Hp li vi cc cn b qun l hoc lnh o c s, cm n, khen ngi nhng vic
lm tt v ch ra nhng iu cn iu chnh. Cam kt s tip thu nhng kin ngh ca
c s chuyn cho c quan cp trn v tip tc h tr trong thi gian ti. ng thi,
bn bc vi c s v cch gii quyt cc vn c pht hin, lp k hoch gii quyt
cc vn .
Mc ch ca phn hi sau gim st:
- Gip cho ngi c gim st nhn r nhng u im duy tr v pht huy,
nhng nhc im khc phc. y l mc ch c bn ca phn hi sau gim
st.
106

Chia x thng tin, gip cho cc bn lin quan bit r vn c s v tng

cng trch nhim h tr h.
Phn hi nhanh sau gim st chnh l phn hi bng ming ngay sau khi kt thc t
gim st. Khi phn hi bng ming, cn lu nhng iu sau:
- Ni dung phn hi phi bao ph cc mc tiu/ni dung gim st. Cn phn hi
c nhng u im v hn ch ci thin cht lng cng vic, trong ch ra
nguyn nhn v nhng iu khng thun li nh thiu quyt tm, thiu s ng
h, gip ca ng nghip, thiu trang b, phng php lm vic khng ph
hp
- Ch phn hi nhng iu quan st thy, bng cch m t: ti nhn thy, ti
nghe thycch bn lm l ; khng nu ln nhng iu khng quan st,
cc suy din, cc khi qut ho v tm quan trng, tc hi, thc lm vic
- ng c phn hi l v li ch ca ngi nhn phn hi, v cht lng cng vic,
khng v uy tn hay quyn lc ca gim st vin.
- Phn hi ng mc, va d tip thu. Chn a im v thi im thun li
(khng phn hi trc khch hng, mt s iu ch nn ni ring vi ngi cung
cp dch v)
7.3. Cc cng vic sau gim st
Sau gim st c nhiu cng vic quan trng, nu khng thc hin th s khng pht huy
c hiu qu ca t gim st.
- Phn hi bng vn bn sau gim st: Cc cn b gim st cn phi phn hi sm
cho n v c gim st bng vn bn v gi cho cc bn lin quan khc. Mt s
gim st vin sau khi kt thc t gim st khng phn hi kt qu gim st cho
n v c gim st, dn ti t gim st khng em li hiu qu cao.
- Hon thnh bo co gim st: y l vic hon thin phiu gim st v bo co v
t gim st. Phiu gim st phi c lp lm 2 bn, 1 bn lu li c s c gim
st, cn 1 bn lu li ti b phn gim st ca tnh/huyn tham kho cho t
gim st sau. Vit bo co tng hp v cng tc gim st ca c quan: y l chc
trch ca cc tuyn qun l, ch yu ca b phn ch o tuyn. Bo co gim st
phi c gi ti: cc c s c gim st, cc c quan hu quan, cp trn qun l
trc tip c s, cp qun l ngnh
- Lu tr, lu hnh v s dng cc t liu gim st: Nhiu khi t liu gim st
khng c lu tr v khng c chia x s lm cho vic theo di tin thc
hin cng vic b kh khn, hoc khng c c s cho nhng ln gim st sau. C hai
cch lu tr vn bn gim st nh sau:
Gim st vin lp mt H s gim st gm cc phiu v bo co gim st cho
tng c s c gim st v lu li h s . Trong nhng t giam st sau,
gim st vin n gim st c s no th tham kho bo co v nhng ti liu
lin quan n gim st ln trc ca c s . Lu sau khi tham kho xong,
cn tr li li bo co gim st v cc ti liu lin quan vo ng ch.
107

H s gim st cng c th c lu ti c s c gim st v c tp hp

thnh mt quyn s, gi l S gim st. Sau mi t gim st cc gim st
vin u ghi vo y cc nhn xt, kin ngh. Nh vy:
+ Ngi gim st ln sau c th bit c cc vn ca ln gim st trc v
theo di lin tc c kt qu gim st.
+ Ngi c gim st c cn c sa cha/iu chnh cng vic ca h.
Thc hin theo di v h tr sau gim st
Gi bo co gim st cho cc bn lin quan v n c vic h tr hoc p ng
vi cc kin ngh ca c s.
Gi cho c s hoc nhn vin c gim st nhng ti liu, vn bn, vt t cn
thit gip h thc hin cng vic
Khuyn khch t gim st v h tr ln nhau ti c s c gim st
Thng xuyn lin h v nhc nh c s hoc nhn vin c gim st thc hin
nhng khuyn ngh c thng nht trong t gim st
V d: Mu bo co tng hp v hot ng gim st ti nhiu c s
(c p dng khi gim st vin gim st h tr nhiu hn 1 c s)

Tn c quan/n v/a phng:

S ln/t gim st thc hin trong thi gian.thng (t.n)
S c s c gim st:trong tng s c s:
C s ca t gim st (t vn ): nu hon cnh v l do ca t gim st
Cc mc tiu/ni dung u tin c gim st (xp loi theo chng trnh/d n
hoc lnh vc cng tc)
1.
2.
- Tng hp k hoch h tr gii quyt vn :
Tn c s
Vn ni Bin php Ngi thc Thi gian
Kt qu d
cm/nguyn h tr/ch hin v phi
kin
nhn
o
hp
1.
2.
- Nhn xt chung:
- Cc yu cu/kin ngh vi cp trn v cc bn lin quan:
1.
2.
Ngy..thng..nm
Gim st vin (k v ghi r h tn)
108

Kt lun
Gim st h tr ng vai tr rt quan trng trong cng tc qun l cc chng
trnh/hot ng y t. i tng ca gim st h tr l con ngi. Cng vic ny gip
cc nh qun l nh gi c nhn vin ca mnh thc hin cng vic ca h nh th
no. T , c gii php hiu qu gip h lm vic c tt hn. Qun l m khng c
gim st l qun l th lng.
Mun gim st h tr c tt th cc nh qun l phi xy dng c i ng
gim st vin c trnh v chuyn mn cng nh v qun l. ng thi, h cng phi
c nhng k nng tt khi thc hin gim st. Ngoi ra, gim st h tr tt th cc
gim st vin phi lp k hoch tt trc khi i gim st. Mt vic lm khng th thiu
c l sau khi gim st, cc gim st vin cn phi phn hi cho cc i tng c
gim st h c th nhn ra nhng hn ch trong khi thc hin cng vic c th
khc phc. Gim st vin cng cn phn hi, bo co cho cc n v lin quan c quyn
ra quyt nh v ngun lc h tr cc nhn vin thc hin cng vic ngy cng tt
hn.

109

THEO DI V NH GI CAN THIP

MC TIU
Sau khi hc xong bi ny, hc vin c th:
1. Trnh by c khi nim v mi quan h gia theo di v nh gi
2. Xy dng c cc ch s theo di v nh gi
3. Phn tch c cc bc trong qui trnh theo di v nh gi
4. Lp c k hoch theo di v nh gi mt chng trnh y t
NI DUNG
1. Khi nim Theo di v nh gi:
Theo di v nh gi l mt trong nhng thnh t quan trng ca qun l d n nh th
hin trong hnh v quen thuc di y:

Lp k hoch

Gim st
Theo di

nh gi

Thc hin

Chu trnh qun l

1.1. Khi nim:
Theo di l qu trnh thu thp, phn tch v s dng thng tin nhm xc nh
chng trnh/d n/hot ng c c thc hin theo ng k hoch khng, cc hot
ng c t c kt qu nh mong mun khng nhm a ra cc khuyn ngh iu
chnh k hoch hot ng t c mc tiu
nh gi l mt cng c qun l nhm xc nh mt cch h thng v c ch
ch v tnh ph hp (relevance), vic thc hin (performance) v s thnh cng
(success) ca chng trnh/d n. nh gi thng tr li cho cu hi:
Chng trnh c c thit k ph hp (relevance) v ng cch (validity)
khng
Chng trnh c t c hiu qu (effectiveness), hiu sut (efficiency), tc
ng (impact) nh mong mun khng
Chng trnh c kh nng duy tr (sustainability) khng
110

V a ra cc khuyn ngh v bi hc kinh nghim cho vic thit k v trin khai cc

chng trnh/d n (k c chnh sa li chng trnh d n ang trin khai hoc cc
chng trnh d n khc v sau)
C theo di v nh gi u quan trng trong vic qun l, v nh c theo di m m
bo c tin ca chng trnh/d n v nh c nh gi m cc m hnh, bi hc
kinh nghim c rt ra m bo chng trnh/d n c thc hin mt cch hiu
qu, ph hp, duy tr.
1.2. Mi quan h gia theo di v nh gi
Theo di v nh gi khng th thay th c cho nhau. Vic theo di c thc
hin tt, cc s liu c thu thp mt cch y , h thng s gip cho hot ng
nh gi thc hin c mt cch d dng hn.
Theo di xem xt cc qu trnh thc hin chng trnh/k hoch v c nhng
thay i xy ra i vi nhm cng ng ch ca chng trnh/k hoch y t. Cc thng
tin v nhng im mnh v im yu ca cc hot ng ca chng trnh/k hoch y t
thu c thng qua theo di s thc y qu trnh ci thin da trn vic a ra cc
quyt nh qun l ng n v kp thi. Cc nh qun l v nhng ngi thc hin
chng trnh /k hoch ng vai tr chnh trong vic theo di.
nh gi l thc hin vic phn tch su cc hot ng trong k hoch/chng
trnh theo chu k. nh gi da vo cc s liu thu c thng qua cc hot ng theo
di cng nh cc thng tin c c t cc ngun khc (v d, cc nghin cu, cc cuc
phng vn su, tho lun nhm trng tm, iu tra...). Trong nhiu chng trnh, nhm
m bo tnh khch quan trong vic nh gi hiu qu v tc ng cc hot ng ca d
n, cc nh ti tr thng mi cc chuyn gia l nhng ngi khng trc tip tham gia
thc hin cc hot ng lm vic ny mi khi kt thc d n hay bt u xy dng k
hoch cho mt chu k d n mi (external evaluation). Tuy nhin nhiu chng
trnh/d n thc hin nh gi ni b (internal evaluation) v chnh nhng ngi tham
gia thc hin chng trnh/d n mi l nhng ngi hiu r nht v nhng im
mnh, im yu, nhng kh khn trong qu trnh thc hin. Tuy nhin mi cch thc
u c nhng im yu nht inh. V vy, mt s ni cn kt hp c hai cch thc trn,
tc l nhm nh gi bao gm c chuyn gia bn ngoi ln cn b chng trnh/d n,
va m bo kt qu thu c va mang tnh khch quan, nhng va c th c nhn
nhn chnh xc v chng trnh/d n.
Vy theo di v nh gi c g ging nhau v khc nhau? C theo di v nh
gi u l mt cng c qun l. Tuy nhin, theo di l mt hot ng thng xuyn,
nhn vo cc hot ng ang trin khai nhm xc nh tin v kt qu ca qu trnh
thc hin. Cc khuyn ngh ch yu c dng trong ni b. Cn nh gi c thc
hin vi nh k, t hn so vi theo di, nhn vo ton b chng trnh/d n hoc
ang trin khai v a ra nhng khuyn ngh cho c ni b v nhng ngi bn ngoi
111

c quan tm v chin lc, thit k, thc hin chng trnh/d n. Xin xem thm trong
bng di y v s khc bit gia theo di v nh gi.
Theo di
Thng xuyn
Gi ng tin thc hin, phn tch
v lu gi cc thng tin v tin trin
ca chng trnh/k hoch.
Tp trung vo cc u vo, hot ng,
u ra, cc qu trnh thc hin, s ph
hp ca nhng hot ng c th...

Tr li cho cu hi nhng hot ng

no c thc hin v nhng kt
qu no thu c.
Cnh bo cho cc nh qun l v
nhng vn ang xy ra v a ra
cc gii php gii quyt
Do cc nh qun l chng trnh/k
hoch, gim st vin, cc n v/t
chc cng ng c lin quan v cc
nh ti tr t lng gi.

nh gi
Theo chu k (vo cc mc quan trng nh
gia k hoc cui k...)
Phn tch su, so snh nhng kt qu t
c trong thc t vi mc tiu t ra trong
k hoch.
Tp trung vo cc sn phm u ra trong
mi quan h vi u vo; cc kt qu t
c so vi chi ph, cc qu trnh s dng
t c cc kt qu, s ph hp mang
tnh tng th, tc ng v tnh bn vng.
Tr li cho cu hi ti sao thu c nhng
kt qu nh vy v bng cch no. Gp
phn a ra nhng c s l lun v xy
dng m hnh thay i
Cung cp cho cc nh qun l nhng la
chn v chin lc v chnh sch.
Do cc nh qun l chng trnh/k hoch,
gim st vin cc n v/t chc c lin
quan, nh ti tr v/hoc cc nh nh gi
c lp thc hin vic phn tch ni b
v/hoc c lp.

1.3. Lm th no theo di, nh gi c hiu qu

theo di v nh gi c hiu qu, mi mt chng trnh/ d n cn thit lp mt
h thng theo di v nh gi ngay t giai on lp k hoch ca chng trnh/d n
v dnh ngun lc (k c ti chnh) thch ng cho cng tc ny. Theo hng dn ca
b cng c theo di v nh gi mt s t chc quc t nh T chc Y t Th gii
(WHO), Ngn hng Th gii (World Bank), Chng trnh phng chng HIV/AIDS ca
Lin hip quc (UNAIDS), th mt h thng theo di v nh gi nn gm cc thnh t
sau:
n v/ngi chu trch nhim v theo di v nh gi. Nu l chng
trnh/d n ln th c n v, nu chng trnh/d n nh th c ngi chu
trch nhim chnh v nhng cng vic ny. C s phn cng nh vy mi
m bo c cng tc theo di nh gi c thc hin mt cch h thng

112

v bn thn ngi/n v chu trch nhim c th nhn nhn c kt qu ca

hot ng theo thi gian
Mc tiu v k hoch hot ng r rng, v da trn bn mc tiu mi c
th xy dng c cc ch s theo di nh gi ph hp
Cc ch s theo di v nh gi, cc phng php, phng tin thu thp ch
s ph hp.
K hoch theo di v nh gi c th, gm k hoch thu thp thng tin, phn
tch thng tin v s dng kt qu. Bn k hoch ny thng c xy dng
sau khi lp k hoch hot ng, da trn cc ch s theo di nh gi
H thng bo co. Mt s chng trnh/d n thit lp h thng bo co
nhm m bo cc thng tin thu thp c phn tch, trnh by di dng
ph hp vi ngi s dng v m bo cc kt qu theo di v nh gi c
s dng hiu qu

2. Ch s theo di v nh gi
2.1. Khi nim
Ch s l i lng dng o lng v m t mt s vt hay mt hin tng.
Da vo ch s, c th xc nh c s thay i ca mt s vt hin tng. V d, t
l tr suy dinh dng di 5 tui hoc t l cc b m c con di 1 tui thc hnh
nui con bng sa m ng cch.
Mt ch s cn c nh ngha r rng v t s v mu s m bo cc ch
s c th dng so snh c, c bit so snh vi cc ch s cng loi ca a
phng khc. C nhiu ch s m mu s v t s l chun cho c th gii, v d, t l
sinh th, t l cht th, t l cht m, t l cht tr em di 5 tui.
Nhiu khi, nu khng nh ngha r rng v t s v mu s, c th dn n s
sai lch v nhn nh. V d, trong chng trnh k hoch ho gia nh (KHHG), ch
s thc hin c bit n nhiu nht v ph bin nht l T l cp v chng s dng
cc bin php trnh thai (CPR). T s ca ch s ny l s cp v chng m v trong
tui 15-49 p dng cc bin php trnh thai v mu s l tng s cc cp v chng
trong tui trong mt qun th dn c. Kt qu CPR s thay i tu thuc vo mu
s c chn nh cp v chng hay ph n c chng trong tui sinh hay tt c
ph n trong tui sinh . Do vy, khi so snh CPR ti x A vi x B, phi ht sc
ch m bo rng t s v mu s ca ch s ny ti c hai a phng l nh
nhau.
V thut ng cng c nhiu cch din gii v th cn rt ch n nh ngha
ca cc thut ng, chng hn nh: khch hng mi, ngi s dng dch v lin tc,
ngi s dng dch v khng lin tc, cc im cung cp dch v, ni cung cp dch v,
bnh nhn chuyn i, bnh nhn khm li.

113

2.2. Cc loi ch s
C nhiu cch phn loi ch s khc nhau tu theo mc ch s dng ca ngi
s dng v tu theo cch thc xy dng k hoch. V d c ni phn loi da trn
bao ph, tnh duy tr, kh nng tip cn cc dch v ca i tng ch, c ni phn loi
theo s lng v cht lng, c ni phn loi theo u vo, u ra. Nhng cch chung
nht m cc nh qun l thng dng l phn loi da trn mc kt qu t c
ca chng trnh/d n. S phn loi ny da trn l lun ca l thuyt v nhn-qu.
Khi u t ngun lc vo cc chng trnh hot ng (nh nhn lc, thi gian, ti
chnh, trang thit b c s vt cht) th s din ra cc hot ng. Thng ngui ta khng
a ra cc ch s hot ng v coi bn thn cc hot ng l nhng n v c th o
m c khi thc hin theo di, v d, s lp hc c t chc, s bui truyn thng
c t chc, s chin dch truyn thng c tin hnh. Tuy nhin, mt s chng
trnh d n t ra cc ch s ny v gi l ch s qu trnh hay ch s hot ng. V mt
thi gian sau khi nhiu hot ng c thc hin th chng trnh/d n s thu c kt
qu chung ca ton b chng trinh/d n (thng gi l ch s kt qu.) Mt thi
gian di sau khi tin hnh cc hot ng ca chng trnh d n, thm ch sau khi
chng trnh d n kt thc nhiu nm th t c kt qu di hn (thng gi l ch
s tc ng). Vic gi tn v nh ngha cc loi ch s cho n nay vn cha thng
nht trong nhiu ti liu. Trong mn hc ny, ch s c phn loi nh sau:
Cc loi ch s

V d

u vo (input) Ngun S thn bn c cng tc vin dinh dng

lc, nhn lc, kinh ph, S tr di 5 tui b suy dinh dng
trang thit b, thng S t ri tuyn truyn v nui con bng sa m
tin...
....
Hot ng & Kt qu T l cc trm trng v cn b chuyn trch v dinh dng
(mang tnh ngn hn) c th t vn ng v dinh dng tr
(process,
impact, T l cc b m c con di 1 tui ni ng cch nui con
outcome...)
bng sa m
Tc ng (kt qu T l tr em di 5 tui b suy dinh dng
mang tnh di hn)
(impact, outcome ....)
Vi mt chng trnh d n, c th c rt nhiu ch s dng o lng, nhng
cc cn b thit k h thng theo di nh gi cn tm ra c nhng ch s phn nh
chnh xc nht kt qu ca chng trnh/d n. Tuy nhin, trn thc t, thu c cc
ch s chnh xc phi mt nhiu cng sc, thi gian, v nhiu khi rt kh kh thi. V
vy, m bo c mt b ch s theo di nh gi tt (m bo cc c im ca ch
s nh nu trn) mt trong nhng kinh nghim ca cc nh thc hin chng trnh
114

l trong giai on xy dng h thng theo di nh gi, cn c s tham gia ca mi

thnh vin ca chng trnh d n ti cc cp vo vic xc nh cc ch s theo di
nh gi, vi s h tr ca cc chuyn gia ca lnh vc . Bc u, mi thnh vin s
t do lit k cc ch s c th s dng o lng kt qu, sau s tho lun v thng
nht cng nhau, vi mi kt qu mong mun t c th chn cc ch s no.
Danh sch di y gii thiu nhng ch s thng c s dng nh gi
chng trnh k hoch ho gia nh
Ch s u vo (cc ngun lc, cc hot ng):
- Tng kinh ph nhn c t nh ti tr v khch hng.
- Hng ho nhn c (vt t, trang thit b, phng tin trnh thai).
- S nhn vin ca chng trnh c o to v gip v k thut.
- Kinh ph s dng.
- Trang thit b v phng tin trnh thai cp (thng k nhn t s
- Cc khon mc trong k hoch lm vic nh thu nhn vin...

cp).

Ch s hot ng v kt qu (cc dch v, o to, thng tin gio dc truyn thng):

- S khch hng mi s dng cc bin php trnh thai
- S lng ngi cung cp dch v c o to theo tng loi: bc s, y t, iu
dng vin...
- S lng phng khm hoc im phn pht cc bin php trnh thai
- S lng tng loi ti liu gio dc truyn thng
- S lng bui hp vi cng ng v s ngi c tuyn truyn v KHHG
trong cc cuc hp.
- S lng ngi c chuyn n phng khm s dng cc dch v, phn
chia theo tng loi dch v.
- S lng ngi quay tr li phng khm khm li.
- S lng tng loi phng tin trnh thai c phn pht
Ch s hot ng v kt qu (v cht lng chm sc):
- Mc tun theo nhng qui trnh v la chn phng php trnh thai ca
ngi cung cp.
- Mc tun theo cc quy trnh lm sng i vi tng phng php ca
ngi cung cp.
- Cung cp cc bin php phi hp.
- T l khch hng c cc khch hng khc gii thiu (ch s s hi lng ca
khch hng).
- T l thng xuyn s dng bin php KHHG (thay i phng php, gin
khong cch sinh, ngi chuyn i khu vc khc khng tip tc hoc ngng s
dng).
- T l khch hng hi lng vi cc dch v
115

Ch s tc ng v kt qu (u ra ngn hn)
- T l phn trm cc cp v chng trong tui sinh trong khu vc c phc
v.
- Ch s v kin thc thi v thc hnh i vi KHHG.
Ch s tc ng:
- Tng s ngi/cp v chng p dng cc bin php KHHG
- T l sinh th trong khu vc (nu c)
- T l no ht thai trong khu vc
- Tng t sut sinh v t sut sinh c hiu theo tui trong khu vc
- T l t vong tr di 1 tui
- T l t vong m
- T l sinh c nguy c cao (ph n trn 35 tui, nhiu ln c thai...)
2.3. Cch chn cc ch s theo di nh gi mt cch h thng:
Cc ch s tt c cc c im sau y:
C th
o lng c
Phn nh chnh xc kt qu nh o lng
Cn thit
C th dng so snh
Cc ch s c la chn cn phi m bo cc c im ca mt ch s trn
ng thi phi cung cp y thng tin v hot ng/chng trnh ra quyt nh
ng.
Thng mi ch s l c hiu o lng mt kt qu no . Chng hn, t l
tr em suy dinh dng l ch s o lng tnh trng dinh dng tr em. Nhng mt s
ch s c th o c kt qu ca nhiu hot ng. V d, t l s dng bin php trnh
thai, va dng o lng thc hnh ca ngui dn, nhng ng thi cng o lng s
sn c ca dch v cung cp cc bin php trnh thai. V c th vi mi kt qu li cn
nhu ch s kt hp mi c th o lng c chnh xc. V d, o thc hnh ca
cc b m nui con ng cch, c rt nhiu ch s, nh t l b m cho con b ng, t
l b m cho con n sam ng cch, t l tr c theo di cn nng thng xuyn, t
l tr c tim chng y . C ngha l vi mt ch s ln nhiu khi li bao gm
nhiu ch s mc nh hn gp li. V vy, da trn cc c im mt ch s cn
c, cc nh qun l chng trnh d n phi xem xt trong tng hon cnh m chn ra
nhng ch s no m bo tnh chnh xc v mt khoa hc nhng cng kh thi v mt
thc t.
Hin nay, cc t chc k thut trn th gii a ra cc b ch s cho cc chng
trnh/d n v c s dng rng ri trn th gii. V vy, khi xy dng h thng theo
116

di nh gi cho chng trnh/d n, cc nh qun l c th tham kho cc b ch s

ny, c bit l nhng chng trnh/d n thc hin nhiu vng min khc nhau c
th dng b ch s so snh gia cc vng min.
3. Theo di
Cc nguyn tc c bn thc hin theo di tt l:
Thng xuyn theo di vic thc hin k hoch c ph chun tr li
cho cc cu hi Hot ng no tt, theo ng k hoch? Hot ng no
khng? trong mi lin h vi tin trnh hng ti vic t c cc kt qu
mong i ra trong k hoch. Kt qu theo di cn phi lu gi di
dng cc bo co, a ra cc khuyn ngh v tip tc theo di cc quyt nh
v hnh ng sau .
Theo di c hiu qu i hi cc nh qun l chng trnh/k hoch y t phi
lm vic thng xuyn vi c s, m bo c nhng ti liu thng xuyn
phn nh cc kt qu cng nh kh khn khi chng bt u ny sinh m
khng ch n khi li hu qu nghim trng cho tin thc hin chng
trnh/k hoch.
Theo di c hiu qu l lng gi mt cch khch quan vic thc hin v tin
ca chng trnh/k hoch da trn nhng tiu chun v ch s r rng
c ra trong k hoch hoc theo cc qui nh chuyn mn k thut. V
d, theo di cht lng k hoch chm sc sc khe sinh sn ca mt c
s y t tuyn huyn hoc tuyn tnh, ngi theo di phi la chn mt s tiu
chun c bn c quy nh trong chun quc gia nh: (1) Mc sn
sng ca cc k hoch ti c s y t; (2) Phng nga nhim khun ti c s y
t; (3) Hot ng t vn ti c s y t;... theo di cht lng cc k hoch
y t cn phi da trn cc bng quy nh ca B Y t.
Theo di c hiu qu cn phi a ra c nhng bi hc kinh nghim gip
iu chnh kp thi v ph hp cc k hoch hot ng.
c th tin hnh theo di c hiu qu cn phi c k hoch theo di ph hp v
cc kt qu ca theo di c s dng lm c s cho nh gi. Lp k hoch theo di
cn c tin hnh theo cc bc sau:
La chn ch s
Xc nh thng tin cn thu thp
Xc nh tn sut thu thp
Xc nh ngun thu thp
Xc nh phng php thu thp ph hp
Xc nh cng c thu thp thng tin
Xc nh cch thc phn tch x l thng tin
Xc nh ngi thu thp v x l thng tin
Xc nh cch thc s dng v cng bkt qu
117

La chn ch s l bc khi u quan trng nht ca cc bc tip theo, v

c trnh by trn.
Xc nh thng tin cn thu thp
Da trn nh ngha ch s m xc nh cc thng tin, d liu cn thu thp. V d
o c t l suy dinh dng ca tr em di 5 tui th cn s lng tr di 5 tui
b suy dinh dng v s lng tr em di 5 tui cng ng .
Xc nh tn sut thu thp ch s
Thng tin tnh ton cho cc cn thu thp thng xuyn, khi din ra hot ng.
V d s ph n i khm ph khoa nh k theo chin dch c thu thp trong nhng
ngy chin dch, s tr s sinh nh cn c ghi li vo thi im m tr sinh ra, s
lng khch hng n khm bnh ti mt c s y t c ghi chp tng hp hng ngy.
Nhng thu thp cc ch s th c th theo cc khong thi gian khc nhau. C ch s
ch cn thu thp 1 nm mt ln, v d s tr s sinh nh cn, s ca t vong m, c ch
s c thu thp hng thng nh t l suy dinh dung ca tr em di 2 tui, nhng c
nhng ch s cn thu thp 6 thng 1 ln nh t l suy dinh dng ca tr em t 2 n 5
tui. Tu theo mc ch theo di, xc sut xy ra ca s vt hin tng v mc qun
l m nhng cn b thc hin chng trnh d n quyt nh tn sut thu thp v tng
hp cc s liu o lng cc ch s. V d, cng t l tr em di 5 tui n khm ti
trm y t v cc bnh thng thng, trm y t c th thu thp ch s hng thng, nhng
S y t ch cn s liu ca 6 thng 1 ln hoc B Y t ch cn s liu mt nm mt ln.
Thng thng, cc ch s u ra s c thu thp thng xuyn hn so vi cc
ch s hiu qu v ch s tc ng.
Xc nh ngun thu thp thng tin
C th thu thp thng tin o lng ch s t nhiu ngun khc nhau, cn tn dng
tt c nhng ngun s liu sn c t cc chng trnh, h thng s liu. V d, vi t l
tr em di 1 tui c tim chng y , ta c th thu c thng tin t vic xem
phiu tim chng ca tr, c th hi b m v nhng ln a con i tim chng, c th
xem s tim chng gi ti trm y t. Tu theo ngun lc, s cn thit v mc chnh
xc ca thng tin, tin cy ca ngun thng tin m ngi qun l c th xc nh
ngun thu thp thng tin ph hp. C th kt hp thu thp thng tin t nhiu ngun
khc nhau. Thng thng, vi theo di thng xuyn ngi ta chn ngun thng tin d
tip cn, d thu thp, nhng thu thp thng tin cn s chnh xc cao, thng dng
cho nh gi, ngi ta thng ly thng tin t cc cuc iu tra c bn, phng vn trc
tip i tng.
Xc nh phng php v phng tin thu thp thng tin
Vi mi thng tin cn thu thp phc v o lng cc ch s, c th thu thp
bng nhiu phng php khc nhau v s dng cc cng c khc nhau. V o
118

lng s hi lng ca khch hng i vi c s dch v, ngi ta c th thu thp t

phng vn trc tip khch hng (thng l phng vn khi khch hng ri c s) bng
phiu phng vn, t xem xt phiu gp ca khch hng i vi c s, t xem s liu
t l khch hng c ca c s dch v, hoc quan st thi ca khch hng. Ngui
qun l cng ty theo mc chnh xc yu cu v ngun lc m chn phng php
thu thp s liu thng tin ph hp. Phng tin thu thp thng tin cn thit k ph hp
thu thp c chnh xc cc thng tin. Nhiu chng trnh d n gp kh khn
khi cc biu mu s sch thu thp thng tin khng nht qun vi thng tin cn thu
thp, dn n kh khn khi thu thp hoc thm ch, thng tin b sai lch hoc thiu ht.
Xin xem chi tit trong bi Thu thp v s dng thng tin phn tch tnh hnh hin
ti.
Xc nh ngi thu thp, phn tch s liu
Ngi thu thp thng tin thng l nhng ngi trc tip tham gia hot ng,
chng trnh cc cp khc nhau, v chnh h mi l nhng ngi s s dng s liu
a ra cc quyt nh cho vic ci thin chng trnh.
S dng kt qu
iu ny rt quan trng v nhiu ni, cc thng tin ch c thu thp v gi ln
cp trn hoc ch thu thp m khng c phn tch v s dng mt cch hiu qu. Cc
cn b qun l cn lu im ny v s dng kt qu phc v cho cng tc qun l l
mt trong nhng mc tiu ca theo di, nh gi. Trc mt, nhn vo kt qu, bn thn
nhng ngi tham gia hot ng c th rt kinh nghim, iu chnh cng vic c
thc hin tt hn. Sau , nhng kinh nghim c th c s dng iu chnh cng
vic a bn khc, hoc cho ton b cc hot ng nu iu lin quan n ton
b chng trnh.
4. nh gi
4.1. Phn loi nh gi
Mt s chng trnh phn loi nh gi da vo cc thi im nh sau:
a) nh gi tin thc hin: l nh gi c tin hnh trong qu trnh thc hin
hot ng/ chng trnh y t (sau mt qu, 6 thng, 9 thng...) nhm xem xt vic
trin khai k hoch c ng mc tiu khng gip vic gim st, iu hnh k
hoch ng hng, ng tin . y cng c coi l hot ng theo di.
b) nh gi kt thc: L nh gi kt qu cui cng ca hot ng/ chng trnh y
t hoc k hoch (k hoch nm hoc k hoch di hn), thng c thc hin khi
mt chng trnh hoc mt d n kt thc, dng so snh vi mc tiu ban u
c ra.
c) nh gi tc ng: L nh gi v tnh duy tr ca chng trnh/d n v cc tc
ng lu di v sc kho cng ng, kinh t v x hi, hoc cc tc ng ca n i
vi vic hoch nh chnh sch hoc pht trin chin lc cho mt ngnh, mt c
119

quan n v Loi nh gi ny thng c tin hnh sau khi chng trnh/d n

kt thc nhiu nm.
C nh gi tin trnh, kt thc v tc ng u cn c nh gi ban u. l
vic thu thp cc s liu cn thit xy dng mc tiu ca k hoch/ chng trnh y
t. Nhng thng tin thu oc ban u l c s cho t chc trin khai k hoch v sau
ny s c dng so snh, i chiu vi kt qu t c cui chu k hot ng
hoc khi kt thc chng trnh. Nu khng c nh gi ban u th nh gi kt thc v
tc ng s gp nhiu kh khn v khng c nhiu chng c, d liu so snh s khc
bit.
Mt s chng trnh chia nh gi lm hai loi l nh gi qu trnh v nh gi
tc ng:
- nh gi qu trnh: c thit k nhm xc nh chng trnh c thc hin
ng theo cc chin lc/gii php thc hin khng, cc chin lc a ra c
ph hp hay khng, k hoch c theo ng tin hay khng.
- nh gi tc ng: c thit k nhm cung cp nhng thng tin v kt qu
cc mc khc nhau ca chng trnh thc hin. Thng c s so snh
xem xt s thay i c din ra nh mong mun khng v ti sao.
4.2. Cc bc nh gi chng trnh/hot ng y t
Thc hin mt nh gi chng trnh/d n y t l s dng nghin cu trong
cng tc qun l, v vy tin trnh v cch thc tin hnh tng t nh thc hin mt
nghin cu.
Cch n gin nht l chia mt nh gi lm ba giai on nh sau:
Giai on 1. Xc nh cu hi nh gi
- Bc 1. Xc nh gi thuyt v mc tiu ca chng trnh.
- Bc 2. Din dch gi thuyt v mc tiu ca chng trnh sang cu hi nh gi
- Bc 3. La chn cu hi nh gi
Giai on 2. Tr li cu hi nh gi
- Bc 1. Thit k nh gi. Da trn cu hi nh gi m la chn thit k
nghin cu ph hp.
- Bc 2. Lp k hoch v tin hnh nh gi, bao gm c la chn i tng,
phng php thu thp thng tin, phng tin thu thp, phn tch s liu
Giai on 3. S dng cu tr li vo qu trnh qun l
- Bc 1. Vit bo co v a ra cc khuyn ngh
- Bc 2. Lp k hoch thng bo kt qu
- Bc 3. S dng kt qu

120

Ni dung ca bo co nh gi
Sau khi phn tch xong cc s liu nh tnh v nh lng, cc cn b nh gi
cn phi vit bo co cc kt qu thu c. Ni dung ca mt bo co nh gi cn vit
ph thuc vo nhng ai s c bo co ny, h quan tm n phn no nht, v cui
cng ph thuc vo h mun g.
Cc nh ti tr, cc nh qun l chng trnh can thip u mun mt bo co
y . Tuy nhin i vi nhng ngi khc, mt bo co y li khng cn thit
i vi h. Cc nhn vin chng trnh, khch hng, cc nh chnh sch v cng ng
khng cn mt bo co qu nhiu thng tin, m h cn mt bo co ngn gn, r rng,
d hiu.
Ni chung, mt bo co nh gi cn phi tr li cc cu hi nh gi. Bo co
nh gi khc vi cc bo co nghin cu khc. Trong bo co nh gi th cc kt qu
c trnh by trc tin. Tu theo ln ca chng trnh/hot ng v tu theo yu
cu ca ngi c bo co chnh m cc ni dung, hnh thc v di ngn ca bo
co c khc nhau. Nhn chung, mt bo co nh gi y bao gm cc mc sau :
Cc ni dung trong mt bo co nh gi
I. Tm tt kt qu nghin cu nh gi
A. Nu cc cu hi nh gi
B. Trnh by tm tt chng trnh can thip
C. Cc kt qu chnh thu c
1. Tm tt cc kt qu
2. Bn lun
3. Cc khuyn ngh i vi tng i tng c th (cc nh qun l chng
trnh, cc nh ra chnh sch...)
II. Vn chng trnh can thip gii quyt
A. Phm vi ca vn , mc nghim trng ca vn , xu hng ca vn
B. Nhng gii php gii quyt vn
III. Ni dung ca chng trnh
A. Mc tiu chung v mc tiu c th
B. Cc hot ng
1. K hoch hnh ng c xy dng trc khi trin khai chng trnh
2. Cc hot ng thc t c trin khai
M t s khc nhau gia cc hot ng thc t so vi k hoch
C. Tng quan v chng trnh
1. M t nh ti tr cho chng trnh
2. i tng can thip ca chng trnh
3. L do thc hin chng trnh
4. Kinh ph thc hin chng trnh
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D. Cc i tng hng li
1. S lng v c im cc i tng hng li
2. M t l do h l i tng hng li
E. M t c cu t chc nhn s ca chng trnh
IV. Ni dung nh gi
A. M t cc cu hi nh gi, mc tiu nh gi
B. Thit k nghin cu nh gi
1. Phng php nghin cu
2. Thi gian nghin cu
3. K thut v cng c thu thp s liu
4. Phng php phn tch s liu
C. Kt qu nh gi
1. Cc kt qu thu c
2. Cc hn ch ca kt qu
3. Kt lun
4. Bn lun: so snh kt qu vi nhng nh gi tng t khc, xut nghin
cu nh gi tip theo
D. Khuyn ngh
V. Phn khc
A.Ti liu tham kho
B. Ph lc: bng, biu , cng c thu thp s liu...
Tm li, theo di v nh gi l hai thnh t quan trng trong qun l chng
trnh d n hot ng, cn c lp k hoch ngay t giai on u tin. gp phn
vo s thnh cng ca chng trnh, hot ng, vic theo di v nh gi cn nhn
c ngun lc thch ng c v nhn lc, thi gian v ti chnh, trang thit b.

122

TI LIU THAM KHO

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123

16. Qu dn s Lin hp quc (1993). nh gi chuyn cht lng cc dch v

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