CAN LC H TNHBO CO TM TTKt qu tham vn ngi dn v Dch v y t, gio dc v hnh chnh cng ti GII THIUThng11nm2008,TrungtmphttrinVNgi nghoCanLc(PPC)vtchcActionAidVitNam (AAV) phi hp cng cc ban ngnh huyn Can Lc ly kin ngi dn v 03 loi dch v cng gm: Y t, Gio dc, v dch v hnh chnh cp x. Qu trnh ly kin c cc c quan a phng v ngi dn ng h v tham gia tch cc. Kt qu nh gi c trnh byviccbnlinquancngcamktcithin dch v. Bo co chnh thc mc hi lng cng nh khuyn ngh ca ngi dn c gi n cc nhm cng ng v cc c quan cung cp dch v. tip tc c thm cc kin ca ngi dn v cc dch v thit yu, trung tm PPC, vi s h tr k thut ca t chc AAV cng cc c quan a phng v ngi dn t chc t nh gi ln 2. y cng l hot ng quan trng thuc khun kh d n Tng cng s tham gia ca ngi dn vo qu trnh ci cch hnh chnh cng Vit Nam do DANIDA ti tr.MC TIUGipngidn,vitcchlngisdngdch v,nhnxtvbytmchilngvccdch v cng ti a phng;Htrcccquanqunlvmtsnvcung ng dch v nhn nhn li cht lng, cch thc cung ng dch v ca mnh t quan im ca ngi dn;Da trn kt qu tham vn v thng qua qu trnh i thoi, chia s thng tin, cc bn s cng a ra giiphpvcamktcithindchvcngc nh gi. Kt qu nh gi cng l c s theo di v i chiu vi cc nh gi sau nyPHNG PHP NGHIN CU p dng phng php Th bo co cng dn Cn b a phng v nhm nghin cu cng thit k bng hi Phng vn theo bng hi cu trc 372 h dn c la chn ngu nhin ti 3 x Thng Lc, ng Lc v M Lc, huyn Can LcDCH V Y TMC TIP CN 67,9% s gia nh c hi s dng dch v trong nm Shccpthbohimkhcao,cbitt l h ngho c cp th khm cha bnh ln n 97,5% Sovihkh,hnghokhmchabnhtrmy t x nhiu hn: 85% h ngho khm trm y t x trong khi t l ca h kh l 69,2%IU KIN VT CHT, TRANG THIT Bnhgicangidnviukincsvtcht trm y t x Nhnchung,iukinvtcht,trangthitbkhm cha bnh trm y t x cn ngho nn. Khong trn 1/3ngidnchorngbungbnh,gingbnh, trang thit b v sinh trm y t x cn thiu v rt thiu. c bit, 68% v 87% ngi dn cho rng iu kinthucmenvtrangthitbkhmchabnh cn thiu v rt thiu.Bng 1: Cc thng tin c bn v mu iu traTiu ch S lngT l (%)S h c tham vn372 -Nhm h H ngho52 13,7H trung bnh 298 80,3H kh22 5,9Gii tnh Nam183 49,2N189 50,8 th 1: Thi gian ch i c phc v nh gi ca ngi dn v iu kin c s vt cht bnh vin/y t cp huyn bnh vin/y t cp huyn, iu kin c s vt cht, trang thit b khm cha bnh c trang b tng i y . Trn 85% ngi dn phn nh iu kin c s vt cht bnh vin l y , ngoi tr iu kin thuc men. Tuy nhin, mt t l cao ngi dn cho rng iu kin csvtcht,trangthitbbnhvin/ytcp huyn tuy y nhng cha tt. V d, c khong t 40% n 57% ngi dn cho rng iu kin thuc men, trang thit b khm cha bnh, v sinh, bung bnh, ging bnh l nhng cha tt.CHT LNG DCH VCht lng dch v c quan tm ch yu n vn qutivchtlngphcv.Dovy,ncnh githeocckhacnhvthigianchi,vicm bo gi gic lm vic ca cn b y t, thi ca cn b y t khi tip xc ngi dn. Thigianchitituynhuynkhlu(47,1% i trn 60 pht), trong khi thi gian ngi dn phi ch i tuyn x l khng ng k khi c 76,2% ch phi ch i di 30 pht. 88,4% ngi dn nh gi gi gic lm vic ca cn b y t m bo. Thi nhn vin tuyn x c nh gi nim n hn cp huyn Mt b phn cn b y t vn cha tn tm vi ngi bnh khi c 20,9% s bnh nhn phn nh khi h c thc mc khng c cn b y t gii thch tho ng thm ch c 4,6% phn nh h hon ton khng c gii thch.CHI PH DCH V Do mt t l ln ngi dn c cp th bo him y tnncmttltngicaongidn(27,4%) khng phi tr tin khi khm cha bnh. Tuy vy, vi nhng ngi phi tr ph, chi ph trung bnh cho ln khm cha bnh gn nht tng i cao(335.000ng).Vimcchiphny,29,9% nhngbnhnhnphitrtinchorngchiph cao v rt cao. Hn na, ngoi chi ph theo ha n, vn c 16,9% s bnh nhn cho bit h phi tr thm cc chi ph ngoi ho n. T l ny thp hn nhiu so vi kt qu nh gi nm 2008 (88%)MC HI LNGXt trn nhiu kha cnh, ngi dn tng i hi lng vi dch v y t c tuyn x v tuyn huyn. Th hin theothangim10,mchilngbnhqunca ngi dn vi dch v ny l 7,1. Ba kha cnh ngi dn hi lng nht (t l hi lng vrt hilng trndi 60%) trmy txl th tc giy t, thi phc v v thi gian ch i c phc v. bnh vin, ba kha cnh ngi dn th 2: T l ngi dn hi lng v rt hi lng vi dch v y thi lng nht l th tc giy t, tnh r rng v chi ph viukintrangthitbkhmchabnh(vitl trn 40%). Kha cnh m ngi dn t hi lng nht trm y t l iu kin trang thit b khm cha bnh, cht lng khm cha bnh v trnh chuyn mn ca i ng cn b y t (vi mc hi lng ca ngi dn thp hn 25%). bnh, vin, ngi dn t hi lng nht vi cc kha cnh chi ph dch v v thi gian ch i (t l ngi dn hi lng trn di 20%).DCH V GIO DCMC TIP CN Tlgianhangcconihc(c3cp)l 65,1%. T l gia nh c con (trong tui) b hc l 9,5%, trong t l h ngho c con b hc (12,5%) cao hn nhiu so vi h kh/giu (4,5%). Cc chnh sch u tin v gio dc tip cn c 18,3% h dn. Trong , a s (67,9%) cc h ngho c hng cc chnh sch u tin v gio dc. Tuynhin,cththyvicxcnhccitng chngccchnhschutinvgiodcc vn khi t l h kh/giu c hng chnh sch l 27,3% cao hn t l chung l 18,3%.CHT LNG DCH V Nhnchung,ngidnchathcsnhgicao cht lng gio dc mc d v trnh chuyn mn, phng php ging dy, v ng x ca gio vin c trn 90% ngi dn nh gi tt. C th thy: 63,8%chobitnhtrngchathngxuyn thngbotnhhnhhctpcaconemchogia nh;28,4%gianhchorngkhilnghctp ca con em h l rt nng.th3:Chiphtrungbnhchomthcsinh/nm (nghn ng)GI CI THIN DCH VBagicithindchvcphnlnngidn a ra l: H tr thm c s vt cht, trang thit b dy v hc (68,3% kin); Tngcngquanhgianhtrngvigianh (52,5%); Gim hoc b cc khon ng gp do nh trng yu cu (51,4% kin). Chtlnggiodcchnhkhachambocho nn c n 92,2% gia nh cho con i hc ph o. Trong s gia nh cho con i hc thm th 97,9% tin rng con khng kin thc nu ch hc chnh kho. Hn na, 74,8% gia nh cho bit nh trng c yu cu hc ph oCHI PH DCH V Chi ph cho gio dc trung bnh trong nm ca cc gia nh kh cao v tng theo cp hc. Bnh qun t 817 nghn ng/HS cp 1 n 1,4 triu ng/HS cp 3 Ngoihcph,ccgianhphingkhnhiucc khon ph khc. Nh vy, cc gnh nng ti chnh ca giodccchuynthcphsangcckhon ng gp khc l tin xy dng trng, tin bo v trng, tin in, nc. Thm vo , nhiu chi ph khc ngi dn phi ng thng qua cc loi qu nh qu ph huynh hc sinh, qu khuyn hc, qu lp. Ngoi ra, gianhchoconemihccnphichiphchotin mua ng phc, tin mua sch v, v tin lao ng. Hu nh khng c gia nh no phi bi dng trc tip cho gio vinMC HI LNGSovidchvyt,ngidncmthyhilnghn i vi dch v gio dc. Theo thang im t 1 n 10, ngi dn hi lng cao nht vi bc hc THPT v thp nhtvibchcPTCStngngvimcimtrung bnh l 7,7 v 7,3.Khacnhcngidnnhgicaonhtlquan h gia nh trng v gia nh v ng x ca gio vin (trn 55% ngi dn hi lng v rt hi lng vi cc kha cnh ny). Trong khi , t l ngi dn hi lng vi cc khonnggplthpnht(vitlhilngdi 16%).GI CI THIN DCH VBa gi ci thin dch v c phn ln ngi dn a ra l: H tr thm c s vt cht, trang thit b dy v hc (68,3% kin); Tngcngquanhgianhtrngvigianh (52,5%); Gimhocbcckhonnggpdonhtrng yu cu (51,4% kin). th 4: Mc hi lng ca ngi dn i vi dch v gio dc cc cpDCH V TH TC HNH CHNH CP XMC TIP CN76,5% ngi dn tham gia dch v. S ln s dng trung bnh trong nm ca mt h l hn 3 ln.asngidnbitvchcnngcaphnggiao dchmtca. Thmvo,chc6,2%chobith cmthyengikhinlmccthtchnhchnh x.CHT LNG DCH VNgidnkhngmtnhiuthigiangpc cnbgiiquyt(97%chdi30pht).Hnna, 79,8%chobitthigianlmvictivnphngca cn b l m bo.Phnln(84%)ngidnchilimtlnlgii quyt xong vic. Ch c 16% phi i li nhiu hn mt ln.Ccldochnhdnnphiilinhiulnl khng chun b y cc giy t (43,9%), v khng c lnh o gii quyt cng vic (36,6%).Ngi dn cng nh gi cao nng lc gii quyt cng vic v thi phc v ca cn b ti vn phng mt ca. C 97,3% nh gi nng lc gii quyt cng vic cacnbltyucuvthnhthocngvic. C 98,1% nh gi tt thi ca nhn vin phng giaodchmtca.Nhtl,c89,4%chobitc hng dn y khi c thc mc.CHI PH DCH Vasngidn(84%)chpnhnmcphkhis dngdchvhnhchnhmtca.Thctmcchi ph cng khng cao, bnh qun l l 10.000 ng/ln giao dch.Domcchiphkhnglnchonnngidncng khng nhiu n vic nim yt cc mc ph cng nhviclyphiuthukhitrph.Chc35,5%ly phiu thu khi tr ph v 39,7% bit mc ph phi tr t cn b khi nhn kt qu. th 6: T l ngi dn hi lng v rt hi lng vi dch v hnh chnh mt caGI CI THIN DCH VCcgicithindchvchyutptrungvovic nng cao trnh chuyn mn ca cc b v tng cng c s vt cht trang thit b (c 65% kin ngh). th 5: Thi gian ch i c phc v (DVMC)CC KT LUN CHNHKt qu tham vn ngi dn huyn Can Lc, tnh H Tnh,2010chothyngidnkhhilngvicc dch v c tham vn bao gm gio dc, y t v dch v hnh chnh mt ca. Theo thang im 1-10, mc ngi dn hi lng vi cc dch v nm 2010 dao ng t 7,1 n 8,1. Trong ba loi dch v c nh gi, dch v hnh chnh mt ca cp x c ngi dn xc nhn l c nhng s ci thin r rt nht. iu ny phn no cho thy cc nh qun l, n v cung cp dch v c nlctrongviccithindchvtrongnmvaqua (Xemphlc).Cnthitnntiptccnhngtham vn ngi dn v cc dch v cng cam kt ci thin cc dch v cng cng nh cc chng trnh/d n ti a phng thng qua vi phng php ny.Bo co cng cho thy mt s kha cnh vn cha p ng c mong i ca ngi dn, i hi cc nh qun l, cung cp dch v cn tip tc ci thin dch v theo trchnhimcamnh.Mtsccvnchnhc ngi dn nu ra bao gm:DCH V Y Tiukintrangthitbkhmchabnh,thucmen cnthiuthnvchtlngkhngcaocbitl tuynx. Trnhcacnbytcbittuynx cn hn ch.tuynhuynvncnhintngquti,thhin thigianchitituynhuynkhlu(47,1%i trn 60 pht),Mtbphncnbytvnchatntmvingi bnh khi khong ngi dn phn nh h khng c cnbytgiithchthongthmchkhngc gii thch khi h c thc mc.Nhng ngi s dng th khm cha bnh min ph v thBHYTthnunhngbtcptrongvnthtc giy t v cht lng khm cha bnh. Trong khi , vi nhngngikhngcthkhmchabnhminph hoc BHYT, chi ph phi tr l kh cao vi mc bnh qun l 335.000 ng/ ln khm cha bnh. Ngoi ra, ngoi chiph theo ha n, vn c mt t l ng k (16,9%) s bnh nhn phn nh phi tr thm chi ph ngoi ho n.Nhvy,ngidnangtiptcphilachn gia cht lng dch v v vn chi ph ngay c khi c th khm cha bnh, th bo him.DCH V GIO DCTlgianhccontrongtuibhcvncn tngicao,gn10%,trongchyurivocc h ngho.iu kin trng lp, trang thit b dy v hc cha m bo. C n 2/3 kin ca ngi dn ngh cn u tthmcsvtcht,trangthitbdyvhccho nh trng. Cht lng gio dc chnh kha cha m bo cho nn c n 92,2% gia nh cho con i hc ph o.Chi ph cho gio dc trung bnh trong nm ca cc gia nhkhcaovtngtheocphc.Bnhqunt817 nghn ng/HS cp 1 n 1,4 triu ng/HS cp 3. iu nyldo,ngoihcphccgianhphingkh nhiucckhonphkhc.Nhvy,ccgnhnngti chnh ca gio dc c chuyn t hc ph sang cc khon ng gp khc l tin xy dng trng, tin bo v trng, tin in, nc, cc loi qu nh qu ph huynhhcsinh,qukhuynhc,qulp.ythcs l mt ro cn i vi cc gia nh c iu kin kinh t kh khn.DCH V MT CA CP XNhnchung,dchvmtcacscithinrrt trong nm va qua. Ngi dn hi lng vi hu ht cc khacnh,ngoitrvncsvtcht,trangthit b vn cn thiu thn cha p ng c nhu cu ca ngi dn.PH LCMc hi lng v dch v y t, 2008 2010 (%)Mc hi lng v dch v gio dc, 2008 2010 (%)Mc hi lng v dch v hnh chnh cp x, 2008 2010 (%)2008 2010Y t (x & huyn) Trm y t x Bnh vinYu cu v th tc, giy t 39.1 71.4 53.5Thi gian ch i khm, cha bnh 34 58.5 20.6iu kin trang, thit b khm cha bnh 24.7 13.2 40Cht lng khm, cha bnh 25 25.4 33.5Thi phc v30.1 61.2 35.7Trnh chuyn mn ca y, bc s 22.1 25 34.8Chi ph khm, cha bnh 29.2 26.9 18.8Tnh r rng v cc chi ph 35.9 52.7 41.6im - 7.1 7.12008 2010(3 cp) Cp 1 Cp 2 Cp 3Mi quan h gia nh trng v ph huynh 39.8 70.5 64.1 70.6Chng trnh, ni dung hc tp 31.4 43.4 42.5 51.0Phng php ging dy v hc tp 35.5 61.0 44.1 54.9ng x ca gio vin vi hc sinh 38.4 70.5 59.8 55.9C s vt cht, trang thit b dy v hc 28.6 55.2 45.7 45.1Cc khon ng gp29.6 15.2 15.7 12.7im - 7.6 7.3 7.72008 2010Yu cu v th tc, giy t 40.4 77.2Thi gian ch i c gii quyt 38.7 70.0Mc ng hn 42.2 63.6C s vt cht, trang thit b 26.2 38.0Chuyn mn ca nhn vin 28.1 51.1Thi phc v 35 73.4Chi ph cho dch v 32.6 41.3im 7.88