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Viet Nam continues implementing national target programs on healthcare (*)
12/12/2013 21:34' Send Print
Minister of Health, Nguyen Thi Kim Tien. Picture: Viet Nam News Agency/dangcongsan.vn

The effective implementation of National Target Programmes on healthcare has helped prevent and repulse several dangerous illnesses, protect community health and improve physical conditions for people. However, besides achievements there are constraints and weaknesses in the implementation of the programmes. Breakthrough and effective measures should be taken to ensure success.

The Ministry of Health was assigned by the Government to manage 4 out of the 16 National Target Programmes and one component project for the period of 2012 - 2015 including five projects on healthcare, three projects and one component on population and family planning, six projects on food security and four projects on HIV/AIDS prevention.

Some major achievements in implementation of National Target Programmes

Realizing the Millennium Development Goals (MDGs), the health sector has achieved some important and impressive indicators of special concern of all countries in the world. For example, Viet Nam reduced by half the percentage of malnutrition among children under five years of age (light weight) three to four years before the deadline. The percentage of children under one year of age getting measles vaccination increased to 97.1 in 2005 from 55 in 1990 and maintained the percentage of 90 for several years. The percentage of health-care assisted child delivery increased to 97.85 in 2007 from 55 in 2005 and the percentage of 96 was maintained since 2007 until now.

It is remarkable that the number of controlled and monitored pregnancies has increased remarkably from 86.6% in 2006 to 95% in 2010 and pregnant women have accessed to better healthcare. The mortality rate among children under five decreased to 32% in 2011 from 51.2% in 1990. The mortality rate of children under one reduced from 23‰ in 1990 to 12‰ in 2010.

Viet Nam continues maintaining the achievement of eradicating polio and neonatal tetanus. The health sector has rolled out free vaccination of 11 dangerous infectious diseases such as tuberculosis, diphtheria, whooping cough, tetanus, hepatitis B, polio, measles, pneumonia, Hib meningitis, Japanese encephalitis, cholera and typhoid for children and women; recorded and maintain achievements in elimination, eradication, and reduction of morbidity and mortality of diseases in expanded program for immunization. It has also constantly applied progresses of modern medicine to improve the quality of immunization; monitored and basically controlled vaccine-preventable transmittable diseases. The coverage of full immunization of children under one year of age reached 90% percentage at the provincial level.

On malaria prevention, as compared with 2000 when the MDGs were being developed, by 2011 the number of malaria patients was reduced by more than 84% and the mortality was reduced by 90%. The ratio of malaria patients decreased to 0.52 people/1.000 population and mortality of malaria decreased to 0.016 people/100.000 population. So by 2011, Viet Nam made a wonderful achievement of MDGs concerning the number of patients and mortality annually over the past decade.

The model of army-people combination has brought about promising results. The health sector has provided investment for 171 health centers in border and remote regions mostly inhabited by ethnic minorities, coastal areas, islands key areas in terms of national defense and security; trained and supplemented knowledge on obstetrics, pediatrics, and public health for 167 border army physicians and hundreds of demobilized soldiers who become local health workers in especially difficult regions. Annually, the health sector trains thousands of health workers at central level and hundred of thousands of local health workers to make available resources for realizing National Target Programmes.

On HIV/AIDS, the key objective of the National HIV/AIDS Strategy which is to keep the HIV prevalence below 3 percent was achieved. Viet Nam aims to stall and reduce the spread of HIV/AIDS by 2015. In 2010, the HIV cases decreased by 31.5% as compared with 2001. Since 2010, HIV/AIDS patients in need have received medical treatment. In 2012 alone, 60% (72,711 HIV/AIDS patients) received ARV treatment.

Capital construction and equipment provision for HIV/AIDS prevention have been paid much attention to. By the end of 2012, 43 out of 63 HIV/AIDS prevention centers were built or were being built of which 13 centers (30.2%) were completed and 68.3% were provided with essential equipment stipulated by the Ministry of Health. Half of the provincial HIV/AIDS prevention centers have had their own building. The HIV/AIDS prevention workers have been trained and built their capacity. By the end of 2010, there were 14,954 local HIV/AIDS workers, 32.7% of them held university graduate and post-graduate degrees, 66.6% held college and secondary degrees and 0.7% held general education degrees.

In the field of food security in the period of 2010 - 2012, the Program on Food Security achieved all its objectives. As far as state management is concerned, since 2011, the Ministry of Health promulgated several circulars regulating implementation of national indicators on food security which has helped build a complete legal framework of food security control from “farm to dining table” in Viet Nam. Information, communication and education has been provided in diversified forms with suitable content and expanded coverage to different targets in the community thus increasing their awareness on food security. Results of a survey in 2012 showed that 76% of producers, 73% of businessmen, 65.8% of food consumers, 94.8% of executives in state agencies and 85.6% of executives of businesses had correct understanding of food security. Attention and investment have been paid to training of cadres in specialized branches. Approximately 1,000 specialized inspectors from the central to grassroots levels were trained.

The network of food security management was basically completed. Divisions of food security and divisions of agricultural, forestry and aquatic product quality control were set up in 63 provinces and centrally-run cities. The intersectoral Steering Committee on Food Security were completed in all provinces, 99.6% of districts and 99.4% of communes.

Inspection and control have been given much attention to by people’s committees at all levels. Ministries, branches and local authorities have closely coordinated in effectively solving problems in food security. Given these efforts, production and food processing establishments have better observed regulations on food security. The number of violations of food security regulations in the period of 2011 - 2013 reduced to 21.1% as compared to 25.7% in 2010.

Food poisoning, particularly in canteens decreased. In the period of 2011-2013, the number of incidents reduced by 10.8%, the number of patients reduced by 10.6% and deaths reduced by 35.2% in 2010. In the first half of 2013, as compared with the same period of 2012, the number of incidents was four cases lower, the number of patients was reduced by 620 people and deaths was also four cases less. Especially, the number of incidents in families, schools, canteens was also lower than that of 2012, which helped reducing cost and yielded positive social significance.

Management, delegation, execution and implementation of health projects of National Target Programmes from the central to local levels have been improved. The Ministry of Health with its leadership role has proved to be the central nerve that regulates activities of the National Target Programmes. National Target Programme Steering Committees, Project Management Boards and other leading organization were set up after careful studies and observation of regulations on management of National Target Programme. Thus positive results have been recorded in prevention and management of epidemics and diseases, contributing to better health care. All provinces achieved 4 criteria on eradication of leprosy. In five consecutive years, there was no new case of leprosy in 50% of districts and towns. Drug-resistant tuberculosis transmission rate was under control. Efforts has been made to increase access to treatment of multi-drug resistant tuberculosis to 55% in 2015 from 25% in 2011; to reduce mortality and morbidity due to dengue fever to below 0.09%; to increase early detection cancer from 5% to 10% and reduce mortality in some type of cancers; to control 60% of pre-diabetes cases and 50% of diabetes Type 2 through screening; to consolidate the treatment network so that by 2015 all provincial hospital have endocrinology faculties; to maintain and strengthen the health preventive network in provinces with suitable number of health worker to support preventive medicine and reduction of morbidity in each family and community.

On coordination of army and people, 70% of island districts received technical and infrastructure support. Healthcare centers in border regions and islands were improved. 70% of standby and mobile health units stand ready to provide health services. In early 2013, 100.000 people in key region of defense, security, mountainous and ethnic minority regions, economically less-developed areas, water territory, islands and disaster-prone areas received health checks-up and medical treatment as planned.

One of the prominent success in coordinating National Target Programmes was professional training from the Central to local areas increased in both quantity and training quality. Training has been organized regularly in all levels. Some provinces set up training centers for health workers and technical workers. Communication and education have been considered as one of the important solutions of National Target Programmes which helps increase awareness and social unanimity. Millions of communication products have been developed and more will be produced year after year. They were in different forms including posters, pamphlets, brochures, radio and television programmes, newspapers and mobilization communication. The success of communication programmes have contributed to raising awareness, changing attitude and behavior of local health workers and people in epidemic and disease prevention, public health improvement and enhancement of social resources.

On population and family planning, the implementation of the National Target Programme has brought about great economic and social achievements with high efficiency. In both period of 2006 - 2010 and 2011 - 2013, the population growth rate were lower than planned. The mean population in 2011 was 87.84% million and in 2012 was 88.78 million. It is estimated that it will reach 91.3 million which is lower than planned limit of 93 million. Annual average population growth rate during the period of 2011 - 2013 is 1.05%. It is predicted that the growth rate will stand at 1%.

In 2011, fertility rate was 1.99 births per woman and in 2012 it was 2.05. It is predicted to decrease to 2.02, achieving replacement fertility rate. In 2015, it is estimated that that fertility rate will be 1.9 births per woman as planned.

The crude birth rate reduction during 2011 and 2012 lowered to 0.2‰, with an annual reduction of 0.1‰. It is predicted that by 2015, crude birth rate will be 16.6‰, achieving the annual average birth rate reduction of 0.1‰. The rate of third child birth also declined to 14.7% in 2012 from 15.1% in 2010.

During the period of 2011 - 2013, intervention modules to improve population physical quality have been piloted and multiplied. The number of prenatal screening tests was 1.5% in 2011, 3% in 2012, is estimated to reach 7% in 2013 and 15% in 2015, higher than planned. The number of newborn screening was 6% in 2011, 10% in 2012 and is estimated to reached 18% in 2013 and 25% in 2015, also higher than planned.

The model of “premarital consultation and health checks-up” was rolled out in 2010 in 497 communes and school subsidiaries. It was expanded to 1,464 communes and school subsidiaries in 2012. Also in 2012, 2% of the going-to-be-married couples received premarital consultation and health checks up. It is estimated to increased to 4% in 2013 and 10% in 2015.

Over the past 23 years, Viet Nam has invested heavily on the Programmes on population and family planning which has created direct impacts to the comprehensive development of Viet Nam’s socio-economic situation.

Some constraints and limitations

Though great achievements have been made, National Target Programmes on healthcare have meet with difficulties. Efforts should be made to remove these obstacles, particularly barriers specific to each region, area, and natural, geographical social, economic and cultural conditions. Patients and their families’ complex has also affected National Target Programmes’ medical treatment. Hospitals infrastructure is outdated and insufficient. District hospitals have failed to achieve indicators regulated by the Ministry of Health such as lack of intensive-care units, pharmaceutical, infectious and nutritional faculties. Besides, investment in disease prevention against non-infectious diseases has not been sufficient to prevent consequences of illness.

In the field of HIV/AIDS prevention, foreign aid will be reduced remarkably in the coming time. Though state budget allocation for this effort has been higher, the increase rate is not high. Many localities has not yet taken proactive efforts and invested in HIV/AIDS prevention. Resources for the National Target Programme to maintain communication, intervention to reduce HIV/AIDS affection and expansion of HIV/AIDS treatment will be scarce in the coming period.

It is difficult to achieve some indicators of the National Target Programmes in the period of 2006 - 20110 such as the percentage of food security monitors at provincial and city level who get professional training and improvement; lack of national technical standards and norms on food security which are compatible to international standards; limited resources, slow annual budget allocation, constraints in investment in testing equipment, low testing capacity, restricted avenue and slow participation and investment of social sectors in food security testing.

New problems and challenges have arrived in population work as the birthrate is fluctuating unprecedentedly with a possibility of increasing again. The number of women in child bearing age has continued to rise quickly which is forecasted to reached the highest rate in the period of 2020 - 2025. 29 provinces with a population of 34.4 % of the total population have not yet reached replacement birth rate. If fierce measures are not taken, the birthrate will easily rise up again.

Another new problem in population control, sex ratio at birth has increased suddenly (sex ratio at birth is the number of baby boys per 100 baby girls). This ratio fluctuates between 103 - 106. In the pervious three censuses, the ratio increased from 105 in 1979 to 106 in 1989 and 107 in 1999. However, from 2006, the ratio has rocketing rapidly and continuously from 110 in 2006 to 111 in 2007 and 112 in 2008. International experts observed that that ratio is also increasing in countries of similar culture (son preference) like Viet Nam, however there hasn’t had any country with such high rate. If no positive measure will be taken, sex imbalance will leave behind bad implications and affect social order and security.

Population aging is also a matter of concern. In other countries, population aging happened after several decades, but in Viet Nam within three years from 2005 - 2008, the populations structure transited from a young population to that of aging population. Thus Viet Nam has not yet well prepared to adapt to the population aging, especially social security for the elderly.

The quality of population is low. The percentage of children with hereditary inborn deformities accounts for 3% and will continue to rise due to harmful living conditions and environment and toxic residue from the wars and backward lifestyle, customs and traditions. If no preventive and early treatment measures will be taken, some of these diseases will highly increase and cause heavy consequences to families and society. Other countries have conducted prenatal and newborn screening to improve quality of races since 50 years ago. But it has just started five years ago in Viet Nam.

Some solutions to step up National Target Programmes’ effective implementation

In face of limitations, difficulties and challenges mentioned above, to step up the implementation of the Millennium Development Goals Programmes, as far as state management is concerned, the health sector identified that in the coming period, the leadership role of the Ministry of Health, the Management Board of Programmes at central and local levels will be strengthened. Delegation of management, clear responsibility of each participating and coordinating individual and unit in the programmes from central to local levels will be identified. The National Target Programmes will be further provided with equipment, medicine and human resources. Local assistant doctors will be further trained to improve their professional capacity. Exemplary and good models will be commended and multiplied. Exchange of visits and experience among national models and with regional and international organizations will be expanded. Besides, state budget for National Target Programmes on healthcare will be larger. The model of public-private hospital will be further studied for expansion. Franchising of health services will be piloted. The model of treatment of outpatients under the guidance and direct consultation of grassroots health workers will be expanded. Studies of international experience in treatment of multiple medicine resistant patients will be conducted.

In addition, information, communication and education among community will be promoted with diversified and multimedia platforms. The healthcare service together with the educational sector will gradually integrate disease prevention and healthcare in all level of education for all targets. Communication will be extended through the internet by establishing the National Target Programme websites. Communication content will be renovated for continuous and sustainable provision of information to community.

Concretely, on HIV/AIDS prevention, by June 30, 2013, the number of living HIV/AIDS patients is 214.795 and 65,401 died of AIDS. HIV prevalence is in 100% of provinces, 98% of districts and 78% of communes and words. Thus in the coming time, Viet Nam should continue to increase investment to HIV/AIDS prevention. Viet Nam should further integrate HIV/AIDS into socio-economic development plans of localities. Local budget investment should be higher to provide allowances to specialized health workers and collaborators for their participation in HIV/AIDS prevention.

On food security, the health sector will coordinate with the media to continue provide information and knowledge about food security to people, increase state budget expenditure to the programme. Besides, we will improve quality and effectiveness of inspection and control while imposing strict penalties on violations of food security regulations, especially in district and commune levels and publish these cases to the public through the media. We will able provide people with sufficient information on food security to avoid misunderstanding and inconveniece to socio-economic activities and businesses given Viet Nam’s deep international integration.

On the National Target Programme on Population and Family Planning, the health sector will continue raising awareness of local Party Committees, authorities and the whole political system and people to avoid negligence and misunderstanding that population and family planning are not longer the goals of local Party Committees, authorities but the health sector.

Given high political will, efforts of the health sector, and coordination of all levels and branches, the National Target Programmes on healthcare have had a firm ground to fulfill their goals stipulated by the resolution of the 11th Party Congress./.

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(*) Published on the Communist Review, Issue No 852 (October 2013)

Nguyen Thi Kim TienMember of the Central Committee, Minister of Health