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Vietnam: Vietnam Health Profile

2015/02/20

Challenges to health system strengthening

Ministry of Health's mission, vision and objectives

The Ministry of Health is the government agency exercising national management in the field of people’s health care, inclunding preventive medicine; consultation and treatment; rehabilitation; traditional medicine; pharmaceuticals, inclunding vaccine production; hazardous effects of cosmetics on human health; food hygiene and safety; medical equipment; health facilities; people and family planning; and health system development and management.

Organization of health services and delivery systems

The health system is a mixed public-private provider system, in which the public system plays a key role in health care, particularly in policy, prevention, research and training. The private sector has grown steadily since the ‘reform’ of the health sector in 1989, but is mainly active in outpatient care; inpatient care is provided essentially through the public sector.

The health care network is organized under national administrative units: central, provincial, district, commune and village levels, with the Ministry of Health at the central level. In the public sector, there are 774 general hospitals, 136 specialized hospitals and 11 576 primary health centres. The establishment of the grassroots health care network (inclunding commune and district levels) as the foundation for health care has yielded a lot of achievements, particularly that of contributing towards attainment of national health care goals for all people. The health stations in communes provide primary health care services, inclunding consultation, outbreak prevention and surveillance, treatment of common diseases, maternal and child health care, family planning, hygiene and health promotion. The total number of private facilities rose from 56 000 in 2001 to 65 000 in 2004. In 2008, there were 83 private hospitals, accounting for 8.64 % of the total number of hospitals nationwide, with 5429 beds, accounting for 3.4% of the total number of hospital beds nationwide.

Health care is further strengthened by implementation of national health programmes to transaction with diseases and health issues that are of significant public health concern. For example, the tuberculosis control programme has made each effort to maintain, over a lot of years, a high implementation rate, with DOTS presently covering 100% of the affected people. WHO has highly commended the programme and has ranked it as being on par with those nations reaching the highest achievements in the world.

The expanded programme on immunization is as well considered a successful child health care programme, with a marked reduction in vaccine-preventable diseases, inclunding the eradication of poliomyelitis and the elimination of neonatal tetanus and leprosy, according to WHO definitions. However, current conditions for vaccine maintenance, vaccination timeliness and safety, inclunding the fact that newly developed vaccines are insufficient to meet request, are part the current challenges to the continued quality of the child immunization programme.

The HIV/AIDS control programme was a priority health programme for the period from 2001 to 2005. Through its implementation, additional than 90% of national officials, members of popular organizations, servicemen and students, additional than 80% of the urban people, and 70% of the rural and mountain-dwelling people gained good knowledge about HIV/AIDS and participated actively in HIV/AIDS intervention activities.
Health policy, planning and regulatory framework

The Government set ambitious goals and targets in the Ten-Year Socio-Economic Development Strategy, the Comprehensive Poverty Reduction and Increase Strategy and the National Strategy for People’s Health Care 2001–2010. These include substantially improving the human development index of the country and providing prevention and treatment services to the whole people.

The Minister of Health again promulgated a five-year plan for health sector, setting the following new targets for 2010:

to increase average life expectancy to 71 years;
to reduce the maternal mortality ratio to below 70 per 100 000 live births;
to reduce the infant mortality rate to below 25 per 1000 live births;
to reduce the under-five mortality rate to below 32 per 1000 live births;
to reduce the % of low-birth-weight infants to below 6%;
to reduce the % of malnourished under-five children to below 20%;
to increase the average height of young people to at least 160 cm;
to increase the ratio of medical doctors to 4.5/10 000 people;
to increase the ratio of college-trained pharmacists to 1/10 000 people.

The National Strategy recognizes the significant role of health and the need to invest in health for accelerated socioeconomic development and to improve the quality of life of each individual. The strategy is based on four principles:

equity and efficiency of the health sector;
the fight against the broad social determinants of bad health;
the integration of traditional and modern medicines; and
an appropriate public-private mix, with the Government in a position to protect the public interest.

The strategy outlines the Government’s major policies and proposals for improving the in general level and distribution of health part all people (ethnic minority groups, women, children, the poor and the elderly). These include:

using the government budget additional entirely and moving to prepayment schemes in the medium term to finance health;;
reviewing and strengthening the organization of the health sector, and consolidating and developing primary health care/community-based services;
strengthening preventive care and health promotion, improving curative care, and putting in place an effective referral system;
developing human resources according to the needs of each level, and improving training;
developing traditional medicines and implementing the national drug policy in order to promote rational and effective use of modern and traditional drugs;
developing new technologies to catch up with other nations in the Region; and
increasing the capacity of planning and management in all areas within the health sector.

As it stands today, the National Strategy provides a broad basis for further planning and can be seen as an orientation document for the development of the health sector. However, it does not provide specific solutions on how to: (1) ensure equal access to health care; (2) improve the performance of the health system and the quality of care; (3) rationalize the prescription and use of drugs and spending on medicines; and (4) respond to new public health problems, inclunding noncommunicable diseases.

Some recent policies have begun to address these issues. In October 2002, the Prime Minister signed Decree 139 to establish the Health Care Fund for the Poor, which aims to provide free health Insurance for 14.6 million people. As of December 2008, 15.8 million people had received health care through this financing mechanism.

Health care financing

Since 2000, the National has continued building and adjusting health financing policies with better concern for equity, efficiency and development than in the completed. The broad orientation of health financing was decided upon in the 1990s through development of a health insurance scheme, the partial user fee policy and the Government resolution on “social mobilization” in the areas of education, health and culture. These orientations have created a health financing system that combines partially subsidized national health services with health services that collect user fees from patients. Nevertheless, the partial user fees created some contradictions and have led to inequalities.

Therefore, the Government had to pay attention to financial assistance for certain social groups, particularly for the poor. Health financing underwent further major changes in the 1990s as the National began to strongly promote decentralization of public finance, which had major implications for the health sector.

Total health spending in 2008 was 7.3% of GDP, with government spending accounting for only 38.5% of total health spending. Most health finance is used for curative and preventive care (93%-98%): curative care accounts for 75.2%, preventive care for 23.6%, and there is some spending on scientific research and training (less than 2%). By 2008, within the sphere of the government system, the number of enrolees in public health insurance was over 37.7 million, accounting for 43.76% of the people, inclunding compulsory insurance, voluntary insurance and insurance for the poor.

Human resources for health

Currently, the number of health workers per bed in general for the whole country is 1.4 (inclunding arrangement workers). The number of medical doctors on average for the whole country is about 2.6 per 10 beds, while the number of nurses is about 3.0 per 10 beds. The number of doctors per 1000 people is 0.65, the number of nurses is 0.78, and the number of pharmacists is 0.12 (not inclunding the private sector).

According to data from the Ministry of Health, of all health workers at the provincial level in the whole country, 81.8% are working in curative care, 13.0% in preventive medicine and those in management account for 4.0%.

The number of health staff in public facilities has increased over the completed five years, from 241 498 in 2003 to 299 100 in 2008. Total staff at the central, provincial, district and communal levels includes: 56 258 medical doctors (inclunding PhD and master degree), 10 524 pharmacists, 67 081 nurses and 22 943 midwives.

Partnerships

The external relations line of the Party and the National is one of multilateralism, diversification and expansion of health cooperation with international NGOs and foreign partners to gain financial, technical and technological support. In implementation of this, international cooperation in health has created positive changes in terms of both quantity and quality. Since the 1990s, the number of donors/partners in health has increased considerably. However, aid for health still accounts for just 3% of total health spending and between 8% and 10% of government spending. As Viet Nam reaches middle-gain-country status, the number of health partners is expected to decline; indeed, some partners with a world mandate to focus on the poorest nations have by presently announced their intention to leave the country. Nevertheless, aid to the health sector has been significant in certain areas, particularly HIV/AIDS and communicable disease control. ODA funds have come in diverse forms and have included grant aid from governments, international organizations, intergovernmental organizations and NGOs, and soft loans from international monetary institutions. While Viet Nam has a substantial general budget support programme, coordinated by the World Bank, there are no examples of budget or programmatic support in the health sector, where assistance remains heavily project-based (98% of health projects funded by a single donor).

Challenges to health system strengthening

Despite the significant achievements recorded in health care, the country is still beset with a lot of problems. The Party Politburo’s Resolution No. 46 - NQ/TW on Health Care, Protection and Development for People in the new situation points out irrationalities of the health sector as follows:

The health system is slow to renew and has not adapted itself to the development of a socialist-oriented market economy and changes in disease patterns.
The quality of health services has not met the increasingly diversified needs of the people.
The health care conditions for the poor and those in remote areas and areas inhabited by ethnic groups remain very difficult.
Pharmaceutical production and supply capacity remains weak; the price of pharmaceuticals remains high in comparison with people’s incomes.
The organization and operation of preventive medicine remain insufficient. A portion of the people lacks awareness about self-protection, self-care and health promotion. Environmental health and food safety have not been put under tight control.

Therefore, Viet Nam still faces a number of key challenges, such as:

achieving adequate recognition that improved health outcomes are central to poverty reduction and economic increase and that health improvements require an intersectoral approach to address broad health determinants;
developing a clear consensus part policy-makers on the road to developing an efficient equity-oriented health sector;
achieving better coordination part ministries and across departments in the Ministry of Health and part partners;
strengthening pro-poor health policies to meet the needs of the disadvantaged and ethnic minorities, particularly addressing the problems of financial access and the lack of responsiveness of health services to the needs of the poor;
strengthening the public health schedule to address the incomplete schedule of infectious diseases and the problems brought about by urbanization, changing lifestyles and an ageing people;
strengthening capacities at district and provincial levels to prioritize and implement successful interventions within an increasingly decentralized health system; and
improving the enforcement of regulations and speeding up the implementation of public government reform.

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