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PREMISE ALE PERFORMAEI

RESURSELOR UMANE DIN

ORGANIZAIILE PUBLICE DE

SNTATE DIN ROMNIA

Amalia - Luiza PUPZ(C.MITRULESCU - PIEANU)

Doctorand, Universitatea de Vest, Facultatea deEconomie i de Administrare a Afacerilor din

Timioara

Rezumatul lucrrii

mbuntirea performanelor resurselor umanedin sectorul de sntate este un obiectiv urmrit de toaterile dezvoltate sau n curs de dezvoltare. ns, n lipsa

planificrii resurselor umane i inexistena unei politici deresurse umane clare i transparente, poate aprea o situaiede criza resurselor umane din acest domeniu. Planificarearesurselor umane trebuie s fie o prioritate n ceea ce

privete politicile din sectorul sanitar. n Romnia, lipsaconceptului de planificare i a unei politici n ceea ce

privete resursele umane a condus la contextul actual, cel

al crizei resurselor umane din organizaiile publice desntate.

Rolul pe care resursele umane l joac n oricesistem de sntate este unul incontestabil. Esenial nvederea obinerii performanelor n sntate este calitateamanagementului resurselor umane. Pentru a depi crizaresurselor umane cu care se confruntorganizaiile publicede sntate din Romnia, specialitii n domeniu auformulat cteva recomandri eseniale: elaborarea unei

politici coerente de formare, dezvoltare i alocare aresurselor umane din sntate, creterea numrului

personalului medical i dezvoltarea carierei profesionale ndomeniul medical.

Reforma unui sistem de sntate presupunemodificarea unor aspecte legate de fora de munc,condiiile de munc, gradul de descentralizare amanagementului, competene, sistemul de salarizare i demotivarea personalului.

Cuvinte cheie :performan, resurse umane, planificarearesurselor umane, organizaii publice de sntate

Clasificare JEL: H 12, I 18, I 19.

1. Conceptul de performanLa modul general performana este

definit ca o realizare deosebit ntr-un

PERFORMANCE PREMISES FOR

HUMAN RESOURCES FROM PUBLIC

HEALTH ORGANIZATIONS IN

ROMANIA

Amalia-Luisa PUPZ(C.MITRULESCU-PIEANU)

DOCTORAND PhD CANDIDATE, WestUniversity, Faculty of Economics and

Business Administration from Timisoara

Abstract

Improving the performance of health sectorhuman resources is a goal pursued by all developed ordeveloping countries. However, the lack of humanresources planning and lack of clear and transparenthuman resources policies may lead to a crisis in thisarea. Human resource planning should be a priority interms of health policies. In Romania, the lack of a

planning concept and the lack of a policy on humanresources has led to the actual context, with a humanresources crisis of public health organizations.

The role that human resources play in thehealth care system is indisputable. Essential toachieve quality performance in health care is humanresources management. To overcome the humanresources crisis that public health organizations inRomania is facing , specialists in the field have madeseveral key recommendations: development of acoherent policy formation, development andallocation of human resources in health, increasingthe number of medical staff and opportunities of

professional career development in the medical field.Health system reform involves changing

some aspects of employment, working conditions,degree of decentralization of management, skills,salary system and staff motivation.

Keywords:performance, human resources, humanresources planning, public health system

JEL Classification: H 12, I 18, I 19.

1. The performance conceptIn the general sense, the performance

is defined as a special achievement in acertain domain (dexonline, 2010,

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anumit domeniu.( dexonline, 2010, ). Aa cum afirmVerboncu i Zalman ( 2005, p.6), analizndaceast definiie general a conceptului de

performan, care nu face referire la domeniul

economic, se poate aprecia c performana nupresupune obinerea oricrui rezultat, ci a unuirezultat deosebit. Acest rezultat deosebit poate fi

privit prin prisma a trei dimensiuni:- un rezultat superior rezultatelor obinute

anterior;- un rezultat superior n comparaie cu

realizrile nregistrate de alii;- un rezultat superior obiectivelor stabilite i

asumate.n orice domeniu poate fi ntlnit

noiunea de performan, aceasta putnd fiasociatoricrei activiti desfurate.

O alt definiie legat de performandatde Bourguignon (citat n Dohon i Berland,2007, p.4) se refer la este performant acela

sau aceea ce i atinge obiectivele.n opinia noastr, aceast abordare a

performanei este una cuprinztoare dinperspectiva sferei de aplicare, att aorganizaiilor, ct i a indivizilor.

Stabilirea performanei sectorului publicnu este un lucru uor. Definirea conceptului de

performan n organizaiile publice ntmpinanumite bariere: nelesul pe care l are noiuneade performan, modul n care se realizeaz

performanele i nu n ultimul rnd aspectelelegate de evaluarea acesteia.

n literatura de specialitate opiniile nlegtur cu performana organizaiilor publicesunt numeroase, ns n general se apreciazcperformana reprezint capacitatea/aptitudinea

unei administraii sau instituii publice de a-iprocura resursele ntr-o maniereconomici dea utiliza aceste resurse ntr-o maniereficace nscopul obinerii rezultatului dorit.(OECD -Journal of Budgeting, vol.2/2, pag.45)

Performana unei organizaii publice estestabilit n funcie de modul n care resurseleumane, materiale, informaionale i financiaresunt utilizate pentru a realiza obiectivele propusela nivelul ateptrilor beneficiarilor de servicii.

Un aspect important legat deperformana organizaiilor publice este

http://dexonline.ro/>). According toVerboncu and Zalman ( 2005, p.6), byanalyzing this general definition of the

performance concept which is not related tothe economic field, one can consider that

performance does not require obtaining justany result, but only a special result. Thiscertain special result can only be regardedthrough three coordinates:- a result superior to the previously

obtained performances;- a superior result compared to the others

achievements;- a result superior to the settled and

assumed objectives.The notion of performance can be

found in any field, notion which can beassociated to any performed activity.

Another definition concerningperformance, expressed by Bourguignon(cited in Dohon and Berland, 2007, p.4) isreferring to performant is the one whoachieves ones objectives.

In our opinion, this approach toperformance is comprehensive from theperspective of the sphere of application, fromorganizations to individuals.

Settling the performance of the publicsector is not an easy task. Defining theconcept of performance in publicorganizations meets certain barriers: thesignificance which is given to the

performance concept, the way in which theperformances are achieved and last but notleast, the aspects related to this conceptsevaluation.

In specific literature, there are

numerous opinions concerning theperformance of public organizations, but,generally speaking, it is agreed thatperformance represents thecapacity/aptitude of an administration or

public institution to acquire resources in aneconomic manner and to utilize theseresources in an efficient manner in order toobtain the desired result. (OECD - Journalof Budgeting, vol.2/2, pag.45)

The performance of a public

organization is settled according to thecourse in which human, material,

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reprezentat de calitatea personalului, deoareceputem afirma ceficiena serviciilor publice dinadministraia de stat este determinatde calitatea

personalului. Competena profesional icunotinele n domeniul managementului public

sunt decisive n vederea obinerii eficieneisistemului administrativ prin gestionarearesurselor, motivarea angajailor, previzionareaevoluiilor viitoare i controlul proceselor care sedesfoar.

Importana i rolul resurselor umane norganizaie , mai mult dect att, obinerea

performanelor avnd ca piatr de fundamentresursele umane sunt aspecte cunoscute nmediul organizaional.

Vnturile i valurile sunt ntotdeauna

de partea celui mai iscusit navigator.( EdwardGibbon citat n Aubrey, 2007, p.285). Manageriicare neleg comportamentul uman i importanaacestuia n organizaie, cunosc i implementeaz

principii ale managementului performanei vor firecompensai prin performana i profitabilitateaorganizailor pe care le conduc.

2. Importana resurselor umane dinorganizaiile publice de sntate

Articolul trateaz un subiect de

stringent actualitate i nalt importan,datorit faptului c Romnia se afl n plin

proces de integrare n Uniunea European iarsntatea reprezinto prioritate la nivel mondial.Specialitii n domeniu consider c sectorulsntate este unul dintre cele mai complexe idinamice sectoare ale economiei. Acest domeniua suferit numeroase schimbri i n continuare seafl ntr-un proces de dezvoltare i inovare, careacie la o ntreag categorie de fore: modelesociale n schimbare, politicile publice, nouatehnologie, cererea consumatorilor.

Un aspect important este legat de faptulcn prezent calitatea vieii, precum i speranade via au crescut la nivel mondial, datoritdublrii n ultimii 30 de ani a volumuluicheltuielilor pentru sntate n majoritatea rilordezvoltate. n statele dezvoltate din cadrulUniunii Europene cheltuielile cu sntatea atingun nivel important ca i procent din PIB,tendinele fiind de meninere a fondurilor

ridicate alocate acestui sector. UniuneaEuropean a investit i continu s investeasc

informational and financial resources areutilized in order to achieve the proposedobjectives at the level expected by theservice beneficiaries.

An important aspect concerning the

performance of public organizations isrepresented by the quality of the personnel,because we can state that the efficiency ofthe public services from the stateadministration is determined by the qualityof the personnel. Professional competenceand knowledge in the field of publicmanagement are decisive in regard toobtaining the efficiency of the administrativesystem through resource management,employee motivation, forecasting the future

evolutions and control of the ongoingprocesses.

The importance and the role of humanresources in the organization, and, moreimportant, obtaining performances based onhuman resources are known aspects in theorganizational environment.

The winds and waves are always onthe side of the most skilled navigator(Edward Gibbon cited in Aubrey, 2007,

p.285). The managers, who understand thehuman behavior and its importance in theorganization, know and implement principlesof performance management, will berewarded through performance and

profitability of the organizations they direct.

2. The importance of human resourcesfrom public health

Article deals with a highly importantand actual subject, because Romania is in the

process of European integration and health isa global priority. Specialists in the fieldbelieves that the health sector is one of themost complex and dynamic sectors of theeconomy. This area has undergone manychanges and still is in the process ofdevelopment and innovation in response toan entire category of forces: the changingsocial patterns, public policy, newertechnology, consumer demand.

An important aspect is related to the

fact that at present the quality of life and lifeexpectancy has increased worldwide, due to

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n sistemul de sntate, se implic n sprijinireai elaborarea unor politici de sntate la cele mainalte nivele, printr-o analiz exhaustiv asistemelor de sntate din Europa. Factorii carestau la baza analizei sistemelor de sntate sunt

legai de cadru legislativ al rilor, deciziipolitice, tendinele n ceea ce privete reformelesistemului de sntate.

Conceptul de resurse umane a aprut is-a dezvoltat n anii 80 n Marea Britanie iStatele Unite ale Americii (S. U. A.), oferind onouimagine asupra personalului angajat. Nouaabordare era centrat pe oameni i a pus neviden faptul c personalul angajat reprezintresurse mai importante sau cel puin la fel deimportante ca cele financiare i materiale.

Specialitii n domeniu consider cdintre toate resursele sntii, resursele umanereprezint cel mai important juctor. n acestsector, rolul pe care l are personalul este maiimportant dect in alte sectoare. Aa cum afirmUrsoniu (2000, p.101) managementul resurselorumane are n vedere asigurarea unui efectivsuficient, avnd anumite caliti i o formare

profesional adecvat n vederea utilizriieficace i eficiente a resurselor.

Dup cum am afirmat i mai sus, ndomeniul sntii este incontestabil faptul cresursele umane sunt componente strategice alesistemului sanitar. Esenial pentru obinerea

performanelor n sntate este calitateamanagementului resurselor umane, precum iexercitarea anumitor funcii ale acestuia: analizamuncii, planificarea resurselor umane, formareai dezvoltarea personalului, evaluarea

performanelor personalului, gestionareapersonalului, motivarea personalului. n situaia

Romniei, este cunoscut faptul cmanagementulresurselor umane nu reprezint o prioritate,funciile acestuia nu sunt exercitate n modcorect si coerent, iar unele dintre acestea lipsesccu desvrire. Toate acestea au condus la ocriza .in ceea ce privete resursele umane dinsntate, Romnia aflndu-se pe ultimul loc nUniunea Europeann ceea ce privete numrul

personalului medical raportat la populaie:doctori, stomatologi, asisteni medicali saufarmaciti .

n lipsa interesului i a unor politiciadecvate a resurselor umane n sntate, sistemul

duplication in the last 30 years the volume ofhealth expenditure in most developedcountries. In the developed countries of theEU expenditure on health reached animportant level as a percentage of GDP, the

trend being to maintain this level of fundsallocated to this setor. EU (European Union)has invested and continues to invest in thehealth system, is involved in supporting anddeveloping health policies at the highestlevels through a detailed analysis of healthsystems in Europe. Factors underlying theanalysis of health systems are tied to thecountry legal framework, policy decisions,trends in health system reforms.

The concept of human resources

appeared and developed in the 80s in the UKand USA, providing a new picture of thestaff. The new approach was centered on

people and highlights the fact that staffresources are more important or at least asimportant as financial and material resources.

Specialists in the field believes thatfrom all health resources, human resources isthe most important player. In this sector, therole off staff is more important than in othersectors. As stated by Ursoniu (2000, p.101),human resource management must be able toensure a sufficient staff with certain qualitiesand adequate training for effectively andefficiently use of resources.

As stated above, in the health systemis undeniable that human resources arestrategic components of the system.Essential for obtaining health performance isthe quality of human resources managementand the use of certain functions: job analysis,

human resource planning, training and staffdevelopment, staff performance evaluation,personnel management, staff motivation. InRomania is known that human resourcemanagement is not a priority, its functionsare not exercised fairly and consistently, andsome of them are completely missing. Allthis led to the crisis in health human sector,Romania being the last place in the EU interms of medical personnel reported to the

population: doctors, dentists, nurses or

pharmacists.The lack of interest and appropriate human

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sanitar din Romnia este unul precar, muribund,iar rezultatele se rsfrng asupra sntii

populaiei. Sntatea este un sistem carefuncioneaz pe termen lung. Cunoscnddeficienele cronice ale sistemului de sntate i

dificultatea de a asigura corespunztor acestenevoi trebuie avute n vedere mai multe aspecte.Pentru a discuta de un posibil sistem de

sntate performant n Romnia este nevoie demsuri i reforme n legturcu managementulresurselor umane i problemele ce decurg dinanaliza acestuia.

2.1. Planificarea resurselor umanePlanificarea resurselor umane reprezint

una din funciile de baz ale managementului

resurselor umane.Planificarea este procesul care asigurnumrul de personal necesar i implicitcunotinele tehnice, experien, abiliti icompetene impuse de obinerea performaneistabilitprin strategia organizaiei .

Scopul planificrii resurselor umane estereprezentat de asigurarea resurselor umanenecesare realizrii obiectivelor organizaiei.Astfel, prin procesul de planificare a resurselorumane se asigura identificarea cerinelor de

resurse umane ale organizaiei i elaborareaplanurilor de ndeplinire a solicitrilor.

Procesul de elaborare a obiectivelororganizaiei trebuie s aib n vedere icomponenta resurselor umane, datorit rolului

pe care l joacacestea n procesul de ndeplinirea acestor obiective.

n ceea ce privete necesarul de resurseumane, este important ca acest aspect sfie tratatatt din punct de vedere cantitativ, ct icalitativ. Astfel, este necesar a se rspunde ladou ntrebri: de ci oameni are nevoieorganizaia? i ce fel de oameni are nevoieorganizaia?

Planificarea resurselor umane vizeazurmtoarele obiective:

- meninerea numrului necesar de personal,cu aptitudinile, cunotinele de specialitatei competenele necesare;

- atragerea persoanelor care deinaptitudinile, cunotinele i competenele

necesare;- analiza resurselor umane din punct de

resources policies in health are responsiblefor the health system in Romania being

poor, dying, and the results have an impacton general health. Health is a system thatworks in long terms. Knowing the chronic

deficiencies of the health system and thedifficulty to ensure these needs, severalaspects should be properly taken intoaccount.

To discuss a possible health system inRomania, performance measures and reformsrelated to human resource management andissues arising from the analysis are needed.

2.1.Human resources planningThe planning of human resources

represents one of the base functions ofhuman resources management.

Planning is the process which insuresthe required personnel count and implicitly,the required technical knowledge,experience, abilities and competencesimposed by the achievement of the settled

performance through the organizationsstrategy.

The purpose of human resourcesplanning is represented by the provision ofhuman resources necessary for theaccomplishment of the organizationsobjectives. Thus, through the process ofhuman resources planning, the identificationof the requests of human resources of theorganization and elaboration of the plans tofulfill the demands are assured.

The elaboration process of theorganizations objectives must consider thehuman resources component as well, because

of the role which they have in the process offulfilling these objectives.Regarding the human resources

effective, it is important that this aspect isregarded from a quantitative angle, as well asa qualitative angle. Thus, it is required toanswer two questions: how many employeesdoes the company need and what kind of

people does the organization require.The planning of human resources

follows these objectives:

- maintaining the required number ofpersonnel, with the required aptitudes,

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vedere al cantitii, cu scopul anticipriiunor probleme ce pot s apar legate desurplusul sau deficitul de personal;

- eficiena utilizrii personalului.n cadrul procesului de planificare

putem vorbi de patru categorii de personal:- personal existent;- personal nou recrutat;- personal potenial;- personal pierdut.

Etapele de planificare a resurselorumane sunt urmtoarele:- formularea obiectivelor procesul de

planificare are la bazobiectivele definite deorganizaie, iar obiectivele ce privescresursele umane au ca i punct de plecare

obiectivele organizaiei;- analiza utilizrii n prezent a resurselor

umane - trebuie s se efectueze o analizcare are n vedere: evaluarea performaneiangajailor, potenialul acestora, salariileangajailor n comparaie cu alte organizaii,timpul de lucru etc.

- analiza mediului extern al organizaiei analiza mediului extern privete analiza

pieei forei de munc, a legislaiei, arecrutrii anumitor categorii de personal etc.

Printre avantajele procesului deplanificare putem enumera:- evitarea excedentului sau deficitului de

personal;- schimbrile ce pot surveni n legtur cu

resursele umane, planificate sauneplanificate, nu mai constituie o problem

pentru organizaiei;- se evit ncrcarea angajailor cu mai multe

sarcini de ndeplinit;

-

se evitsuprapunerea sarcinilor;Procesul de planificare a resurselorumane implici anumite restricii,i anume:- n practic, planificarea resurselor umane s-a

dovedit dificili confuz;- o alta problemntlnitn practiceste cea

a rezistenei la schimbare;- schimbrile ce au loc la nivel economic si

social sunt ample i greu de prevzut cuexactitate;

- implementarea unui plan de planificare aresurselor umane poate presupune costuriprea mari pentru organizaie.

field knowledge and competences;- attracting people who possess the

required aptitudes, knowledge andcompetences;

- analyze human resources from aquantitative angle, in order to anticipateproblems which may occur due to asurplus or deficit of personnel;

- the efficiency of the personnelexploitation;

During the planning process we canconsider the following four personnelcategories:- available personnel;- newly recruited personnel;- personnel with potential;- lost personnel.Steps for planning human resources:

- enunciation of objectives the process ofplanning which is based on objectivesdefined by the organization and theobjectives which concern humanresources are based on the organizationsobjectives;

- analysis of the present exploitation ofhuman resources an analysis must be

performed, concerning the evaluation ofthe performance of employees, their

potential, their salaries compared to otherorganization, working hours etc.

- analysis of the environment external tothe organization the analysis of theexternal environment concerns themarket analysis of the work force, thelegislation, the recruitment of certain

personnel categories etc.

Among the advantages of the processof planning, we may specify:- in practice, the planning of human

resources has proven to be difficult andconfusing;

- another problem found in practice isreluctance to change;

- the changes which occur at the economicand social level are ample and difficult to

predict with accuracy;- implementation of a plan for scheduling

of human resources may implyprohibiting costs for the company.

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trebuie s aib dreptul la ngrijiri i serviciisanitare de calitate i militeaz n vedereaelaborrii unor politici naionale pentru creterea

performanei n sntate.Problemele cu care se confrunt

Romnia n legtur cu resursele umane suntlegate att de calitatea, dar i de cantitateaacestora. Romnia se aflpe ultimul loc n U. E.n ceea ce privete numrul cadrelor medicale:medici, dentiti, farmaciti, asisteni medicaliraportat la numrul de locuitori. ConformRaportului Comisiei Prezideniale pentru analizai elaborarea politicilor publice din Romnia(2008, p. 52) densitatea profesional medicaldin ara noastreste sczutn comparaie cu ceaa Uniunii Europene. n urma analizei densitii

medicilor n rile din regiunea European,Organizaia Mondial a Sntii a clasatRomnia pe locul 31 din totalul de 33 de ari,doar Albania i Bosnia - Heregovina aunregistrat valori mai mici dect ara noastr. icelelalte categorii de personal (dentiti,farmaciti i asisteni medicali) au nregistratvalori ale densitii foarte reduse.

n ceea ce privete gradul de acoperirecu personal medical, Romnia se confruntcu osituaie marcantdatoritinegalitilor regionaleexistente n acoperirea i asigurarea populaieicu personal medical. n urma analizelor recentes-a constatat c exist o penurie de medici nzonele rurale ndeprtate unde condiiile de viai munc sunt dificile. Conform Planuluistrategic al Ministerului Sntii Publice 2008-2010 regiunile cu deficite n rndul

personalului medical sunt Sud i Sud - Est-ul (773, respectiv 665 locuitori/ 1 medic). Regiuneade Nord - Est este cea mai deficitarn legtur

cu numrul medicilor din mediul rural (2778locuitori/ 1 medic). Lipsa resurselor umane nzonele rurale este o problem major.Inexistena unor politici de direcionare iatragere a personalului medical n mediul rural adus la concentrarea acestuia n zonele urbane.Un numr foarte mare de medici specialiti

prefer s lucreze ca i reprezentani la firmelede medicamente, splece n strintate sau alegslucreze n alte domenii dect saleagzonelerurale.

Migrarea forei de munc din sectorulsanitar este o altprovocare, deoarece libertatea

health care services and strives to developnational policies to improve health

performance.The problems Romania is facing in relationto human resources are related both to the

quality but also quantity. Romania is in thelast place in EU in terms of the number ofhealth professionals: doctors, dentists,

pharmacists, nurses reported to the numberof inhabitants. According to the Report of thePresidential Commission for analysing andelaborating public policies in Romania(2008, p. 52) professional density in ourcountry is low compared with EU. Afteranalyzing the density of doctors in thecountries of the European Region, World

Health Organization Romania ranked number31 out of 33 countries, only Albania andBosnia-Herzegovina had lower values thanour country. Also the other categories of

personnel (dentists, pharmacists and nurses)have very low density values.

In terms of coverage by medicalpersonnel, Romania faces a difficult situationdue to marked regional disparities that existin the coverage and in providing the

population with medical personnel. Recentanalysis found that there is a shortage ofdoctors in remote rural areas where livingand working conditions are difficult. In 2005,the number of people who were assesed to adoctor in rural areas was more than six timeshigher than in urban areas. According to the "Strategic Plan of Ministry of Public Health2008 - 2010" , regions with large deficitsamong medical personnel are in South andSouth-East site (773, respectively 665

inhabitants per 1 physician). North-East isthe most deficient in the number of doctorsin rural areas (2778 / 1 physician).Lack of human resources in rural areas is amajor problem. The lack of policy to directand attract medical personnel in rural areashas led to its concentration in urban areas.Many doctors prefer to work as specialistsand representatives for drug companies, orchoose to work abroad , or to work even inother domains in the detriment of choosing a

rural areas.Labour migration in the health sector

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de micare a forei de munc din domeniulsanitar ctigat odat cu intrarea n U. E. acrescut ecartul fa de poziia dificil existentdeja, avnd n vedere situaia n care Romniadeine cu o treime mai puin personal medical la

1000 mie de locuitori fa de media UniuniiEuropene. Romnia nregistreaz n cadrulUniunii Europene cel mai mic numr de doctori,stomatologi, farmaciti sau asisteni medicaliraportai la populaie. ncepnd cu anul 2007,

potrivit statisticilor peste 6000 mii de medici dinsistemul sanitar romnesc au plecat nstrintate. Conform estimrilor PreedinteluiColegiului Medicilor din Romnia, VasileAstarastoae, se ateaptca ncali 10000 mii dedoctori s prseasc ara. Principalele motive

ale plecrii doctorilor n strintate sunt salariileatractive i condiiile de lucru net superioarecelor din ar. Conform recomandrilor O. M. S.dac procentul medicilor unei ri care aleg s

profeseze n strintate depete 2% trebuiedeclarat situaie de urgen, alert roie, itrebuie avute n vedere politici de limitare amigrrilor. n Romnia acest procent este de10%, dar se pare c nu este suficient pentru acontientiza starea acuta sistemului de sntatedin Romnia. ns, se pare ca nici estimrileviitoare nu sunt pozitive, PreedinteleColegiului Medicilor apreciazcn urmtorii 5ani peste 50% din medicii care practic nRomnia vor alege sa plece in strintate.

Cu toate c exist multe semnale dealarmprovenite din direcii diferite, cum ar fi:starea de sntate a populaiei, nevoile serviciilorde sntate, rapoarte cu privire la deficitul

personalului medical din ar, rapoarte cu privirela numrul personalului medical la nivel

internaional, standarde i politici n legturcuimportana sectorului de sntate n asigurareabunstrii sociale, analize comparative ale riinoastre cu alte ri sau regiuni ale lumii, nstoate acestea nu sunt suficiente pentru a aduce n

prim plan analiza resurselor umane din sntate.Romnia a nregistrat cei mai slabi indicatori aistrii de sntate din U. E. iar aceast situaiereflectdeficitul de personal cu care se confruntara noastr.

Formarea i dezvoltarea personalului

sunt activiti de nvare i acumulare de noicunotine, abiliti i atitudini necesare

is another challenge, because the labormovement the healthcare gained with theentry in the EU has worsen the alreadyexisting difficult position, given the situationin which Romania has in terms of medical

staff one third less of EU average reportedto 1000 inhabitats, registering in the EUcountries the lowest number of doctors,dentists, pharmacists or nurses reported to

population . Begining 2007, according tostatistics 6000 doctors have gone to workabroad. Estimates of the President of theCollege of Physicians of Romania, VasileAstarastoase, says that 10,000 doctors areexpected to leave the country. The mainreasons for the departure of doctors are

atractive salaries and working conditionssuperior to those of the country. Accordingto WHO recommendations , if the percentageof doctors choosing to practice in a countryabroad is bigger than 2% , then an emergencysituation must be diagnosed, red alert, and

policies of stopping the migration must beconsidered. In Romania this percentage is10%, but it seems that it is not acute enoughto realize the state of the health system inRomania. But it seems that the futureestimates are not so good- the Chairman ofCollege of Physicians estimates that in thenext five years more than 50% of physicianswho practice in Romania will choose to goabroad.

Although there are many warningsignals from different directions, such as

population health, health services needs,reports on the shortage of medical staff inthe country, reports on the number of

medical staff at international level, standardsand policies on the importance of healthsector in providing social welfare,comparative analysis between our countryand other countries or regions, all of theseare not sufficient to bring attention toanalysis of human resources in the healthsystem. Romania had the worst healthindicators in the EU and this reflects the lackof personnel our country is facing.

Training and staff development are

learning and accumulation activities of newknowledge, skills and attitudes necessary for

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indivizilor n vederea ndeplinirii obiectivelorstabilite. Fora de munc din sectorul sanitarnecesit un proces de formare continuu dinurmtoarele motive: formarea personaluluimedical este un proces de lungdurat, resursele

umane trebuie sa fie n permanenla curent cunoutile din domeniul sntii. Pentru arspunde nevoilor de sntate ale populaiei estenevoie ca personalul medical sa fie supus unui

proces de formare.Un alt aspect important legat de

performana resurselor umane este legat demotivare. Motivarea personalului se realizeaz

prin: salarii, condiii de lucru bune, promovareprofesional, faciliti oferite de organizaie cares le ofere confortul necesar, oportunitatea

socializrii, recunoaterea public a valoriimuncii prestate etc. Satisfacia are la bazi alifactori aa cum afirm Abrudan ( 2010, p.51):satisfacia se obine atunci cnd exist unechilibru ntre ceea ce aduce salariatulorganizaiei ( diplome, competene, experien)i ceea ce i oferorganizaia (salariu, varietatea

postului, nivelul de complexitate). Salariulreprezint factorul decisiv n alegerea

personalului medical de a pleca n strintate.Salariul mediu al unui medic este de 500-600 deeuro pe luniar un medic rezident ctigntre170 i 340 de euro pe lun. n strintatediscutm de salarii ce pornesc de la 2000-3000de euro pe lunpentru medici rezideni i salariide peste 5000 de euro pentru medicii specialiti.Condiiile de lucru n spitale nu sunt uoare,lipsa materialelor, deficitul tehnologic, ustensilei aparatura veche ngreuneazmunca medicilor.Acetia lucreaz n medie de 5-6 ori mai multcantitativ i mai dificil dect media european.

Cu toate cRomnia se confruntcu o crizdepersonal n domeniul medical, se scot foartepuine posturi la concurs n cazul n care avemnevoie de personal. Chiar dacavem un numrredus de medici, Romnia specializeaz unnumr mic din totalul numrului de studeniabsolveni ai facultilor de medicin (48% dinnumrul absolvenilor ).

Resursele umane din sntate nu se potdezvolta ntr-un cadru unde nu existpoliticicoerente cu privire la acestea i la sistemul

sanitar i nu s-a publicat nici un document depolitica resurselor umane n sntate.

individuals to meet the desiredobjectives.Workers in the health sectorrequires a process of continuous training forthe following reasons: training health

professionals is a long process, human

resources must be continually updated withnews in the field. To meet the public healthneeds , the medical personnel need toundergo a training process.

Another important aspect of humanresources is linked to motivation. Staffmotivation is achieved through: wages, betterworking conditions, promotion, facilitiesoffered by the organization to providecomfort, socialization opportunity, publicrecognition of the value of work done .

Satisfaction is based on other factors asstated by Abrudan (2010, p.51): satisfactionis achieved when there is a balance betweenwhat the employee brings in organization(qualifications, skills, experience) and whathe is offered from the organization (salary,

job variety the level of complexity). Wagesare the decisive factor for medical staff to goabroad. The average salary of a doctor is500-600 euros per month and a residentdoctor earns between 170 and 340 euros permonth. Foreign wages in many countriesrange from 2000-3000 euros per month forresident physicians and over 5000 euros forspecialist doctors.Working conditions inhospitals are not easy, lack of materials, thedeficit of technology, tools and equipmenthampers medical work. They work anaverage of 5-6 times more quantitative andmore difficult than the European average.Although Romania is facing a shortage of

medical personnel, very few new jobs areoffered when we need them. Even if we havea small number of doctors, Romania isspecializing a small number of total numberof graduates of medical students (48% ofgraduates).

Health human resources often cannot develop if a coherent policy framework islacking and the health care system did not

publish any document on human resourcespolicy.

2.3.Romanian health care system

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2.3. Strategii ale sistemului de sntate dinRomnia cu privire la resursele umane

Pe site-ul Ministerului Sntii (2010, ,http://www.ms.ro/ ) se specific prin Planul

strategic al Ministerului Sntii Publice 2008-2010 obiective generale i specifice referitoarela resursele umane din sntate.Obiective generale:- Dezvoltarea, modernizarea infrastructurii

furnizorilor de servicii medicale i dotareaacestora cu aparatur/echipamente medicalei mijloace de transport specifice.Obiectivele specifice aferente obiectivuluigeneral enumerat:

construirea a 28 spitale noi (8 spitale

regionale de urgen i 20 judeene deurgen);reabilitarea a 15 spitale judeene deurgen;dotarea cu aparatur/echipamentemedicale;dotarea cu mijloace de transport specifice;

- Dezvoltarea resurselor umane nconcordan cu nevoile populaiei.Obiectivele specifice aferenteobiectivului general enumerat:

identificarea unor faciliti pentru atragereapersonalului medical n zonele izolate,defavorizate economic, precum i nspecialiti deficitare;identificarea unor modaliti flexibile defurnizare de servicii medicale n zoneleizolate i n cele defavorizate economic;dezvoltarea i extinderea reelei de asistenmedicalcomunitarintegrat.

Aa cum reiese din Planul strategic al

Ministerului Sntii Publice 2008- 2010,publicat pe site-ul Ministerului Sntii (2010,http://www.ms.ro/) rezultate ateptate sunturmtoarele:

- creterea eficienei actului medical;- creterea calitii actului medical;- creterea satisfaciei pacienilor;- creterea satisfaciei personalului

medical;- mbuntirea indicatorilor de activitate

ai spitalelor.

Obiectivele stabilite i rezultateleateptate formulate de ctre Ministerul Sntii

strategies regarding human resourcesOn the site of Ministry of Health

(2010, www.ms.ro) it is specified by the"Strategic Plan of the Ministry of PublicHealth from 2008 to 2010" the general and

specific objectives pursued in health humanresources.General objectives:- Developing, upgrading health care

providers and providing them with medicalequipment and specific means oftransportation. Specific objectives related tothe overall objective listed:

construction of 28 new hospitals (8regional hospitals and 20 county emergencyhospitals);

rehabilitation of 15 countyemergency hospitals;

the aquisition of medicalequipment;

aquisition of specific means oftransportation;

- Human resource development inline with population needs. Specificobjectives related to the overall objectivelisted:

Identification of facilities to attractmedical staff in remote, economicallydisadvantaged, and in specialties with highdeficiencies on medical staff;

identify ways to provide flexible carein remote and economically disadvantagedareas;

develop and expand integratedcommunity healthcare network.

As is apparent from the "Ministry ofPublic Health Policy Plan 2008 - 2010"

published on the website of the Ministry ofHealth (2010, www.ms.ro), the followingresults are expected:- Increasing the efficiency of medical care;- Improve the quality of medical care;- Increased patient satisfaction ;- Increase medical staff satisfaction;- the improvement of hospital activity

indicators.Objectives and expected results

formulated by the Ministry of Health through

the Strategic Plan 2008-2010 have no realbasis, because the problems that Romania is

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prin intermediul planului strategic 2008-2010 nuau o bazreal, datoritfaptului cprobleme cucare se confruntRomnia i care ar trebui sfieo prioritate pentru autoriti nu sunt cuprinse naceste obiective. n timp ce mai toate spitalele

din ar nregistreaz deficite ale personaluluimedical, se nchid secii pentru ca nu mai avemmedici care s lucreze n ele, avem chiar ispitale care sunt pe punctul de a se nchide, nusunt bani pentru medicamente i materialesanitar , Ministerul Sntii i propune sareabiliteze spitalele i chiar sa construiascaltelenoi. Atragerea personalului medical n zoneledefavorizate ar trebui s reprezinte un obiectivulterior politicii de meninere a personaluluimedical n ar, deoarece necesitatea unui numr

mai mare de cadre medicale exist chiar i nspitalele din cele mai mari orae din ari chiardin Bucureti.

3. ConcluziiPotrivit Bncii Mondiale i evalurilor

Comisiei Europene, Romnia se confrunt ncontinuare cu probleme legate de srcia

prezent n anumite zone ale rii i n rndulunor grupuri ale populaiei, precum i cudificulti ce privesc sistemul de sntate,

nregistrnd cei mai sczui indicatori ai strii desntate din U. E.

Este nevoie de o perioadlungde timpcoroborat cu desfurarea unor reformeeconomice i financiare n vederea mbuntirii

performanei sistemului de sntate i deprotecie social din Romnia. n Romniaultimilor 30 de ani, veniturile i cheltuielile cusntatea au crescut, ns sistemul sanitar esteunul deficitar, senzaia de lipsuri continu s

persiste i s se accentueze. Managementulresurselor umane este unul deficitar, ncomparaie cu rile europene nivelul asigurrii

populaiei din Romnia cu personal medical esteinferior. n cazul unor politici neadecvatenumrul personalului medical va continua sfien scdere. Medicii din Romnia, att cei cuexperien ct si cei tineri, chiar i studenii seorienteaz din ce in ce mai mult spre a-idesfura profesia n strintate. Ecartul existentcu privire la resursele umane ntre zonele urbane

i zonele rurale este unul ngrijortor. Lipsa unorpolitici de reorientare demografica medicilor a

facing and that should be a priority for theauthorities are not included in these targets.While almost all hospitals in the countryhave shortages of medical staff, wholesections are closing because they do not have

doctors to work in them, we even havehospitals that are on the verge of closing,there are no money for medicines andmedical materials , the Ministry of Healthaims to rehabilitate hospitals and even buildnew ones. Attracting medical staff indisadvantaged areas should be a goal afterthe one of maintaining the health care

personnel in the country, because the need ofhuman resources in hospitals in the largestcities in this country and in Bucharest is still

present.

3. ConclusionsAccording to the World Bank and the

European Commission evaluations, Romaniais still confronted with problems of poverty

present in certain areas of the country andamong certain population groups, anddifficulties relating to the health system,registering the lowest index of health in EU

population.It takes a long time in conjunction

with the pursuit of economic and financialreforms to improve the performance of healthsystem and social protection in Romania. InRomania over the last 30 years, income andhealth expences have increased, but healthcare is lacking, the sense of deprivationcontinue to exist and to grow. Humanresources management is weak and incomparison with European countries the

population in Romania has fewer medicalstaff. In case of inadequate policies thenumber of medical personnel will continue to

be diminishing. Doctors in Romania, both theexperienced ones and the young ones, evenstudents are increasingly moving towardsexerciting their profession abroad. Thespread of the existing human resources

between urban and rural areas is worrisome.The lack of policies for demographic medicalreorientation has led physicians to focus

human resources in urban areas afectinghealth and life quality of population from

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condus la concentrarea resurselor umane nzonele urbane afectnd calitatea serviciilorsanitare i a vieii populaiei din zonele rurale.

Conform Raportului ComisiePrezideniale pentru analiza i elaborarea

politicilor din domeniul sntii publice dinRomnia ( 2008, p. 57 ) au fost formulateurmtoarele recomandri cu privire la direcia pecare ar trebui sa o urmeze politica de resurseumane din sntate: elaborarea unei politicicoerente de formare, dezvoltare i alocare aresurselor umane din sntate, cretereanumrului personalului medical i dezvoltareacarierei profesionale n domeniul medical.

Planificarea resurselor umane trebuie sfie o prioritate n ceea ce privete politicile din

sectorul sanitar. Necesitatea planificriiresurselor umane este vital datorit faptului cun sistem de sntate care nu prevede efectuareaunor analize referitoare la numrul medicilorexisteni i numrul medicilor necesari, nevoiade medici specialiti ntr-un anumit domeniu nfuncie de sntatea populaiei, orientareamedicilor ctre specialiti care s rspundnevoilor cetenilor, este un sistem frviitor.

Atta timp ct resursele umane dinsntate nu ocup locul cuvenit, condiiile ncare i desfoar activitatea suntnesatisfctoare, motivarea i recompensareaacestora nu reprezint obiective politice, neconfruntm cu un sistem care nu se axeaz penevoile reale ale populaiei.

MulumiriAcest articol a fost elaborat ca parte a

proiectuluiPOSDRU/88/1.5./S/55287 Doctorat n

economie la standardele Europeicunoaterii (DOESEC), proiect cofinanat dinFondul Social European prin ProgramulOperaional Sectorial Dezvoltarea ResurselorUmane 2007-2013 i coordonat de Academia deStudii Economice din Bucureti n parteneriat cuUniversitatea de Vest din Timioara.

Bibliografie

1. Abrudan D. 2010, Performana norganizaii din perspectiva resurselorumane, Solness, Timioara;

rural areas.According to the Presidential

Commission Report regarding analysis andelaboration of public health policies inRomania (2008, p. 57), the following

recommendations were formulated regardingthe direction of policy of human resources inhealth should follow: a development of acoherent policy training, development andallocation of human resources in health,increasing medical staff number andoportunities of career development inhealthcare.

Human resource planning should be apriority in terms of health policies. The needfor human resource planning is vital because

a health system which does not providesanalysis on the number of existing andrequired number of doctors, specialistsneeded in a given area depending on the

population health, orientation to specialtiesneeded by the citizens, is a system with nofuture.

As long as health human resources arenot properly placed, the conditions of workare unsatisfactory, motivation and reward isnot a political objective,we are facing with asystem that doest focus on the needs of the

population.

AcknowledgementsThis article is a result of the project

POSDRU/88/1.5./S/55287 DoctoralProgramme in Economics at EuropeanKnowledge Standards (DOESEC)". This

project is co-funded by the European SocialFund through The Sectorial Operational

Programme for Human ResourcesDevelopment 2007-2013, coordinated by TheBucharest Academy of Economic Studies in

partnership with West University ofTimisoara.

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