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Implementing some Millennium Development Goals on maternal and child health: Success factors and maintenance solutions
30/10/2014 21:22' Send Print
Minister of Health Nguyen Thi Kim Tien. Source: Vietnam News Agency

Achievements in the implementation of MDG 1 (Reduce under-five child malnutrition), MDG 4 (Reduce child mortality) and MDG 5 (Reduce maternal mortality)

Thanks to relatively complete system of policies and State’s attention and investment, reproductive health service in Viet Nam has recorded good results highly praised by the international community.

On MDG 1

One of the indicators pertaining to MDG 1 on eradication of poverty and hunger is the reduction of under-five child malnutrition rate from 41% in 1990 to 20.5% in 2015. According to annual statistics of the National Institution of Nutrition, under-five child malnutrition rate (weight for age) saw a decline of 7.2% during the period 1990-2000 (from 41% to 33.8%) and 16.3% during the period 2000-2010 (from 33.8% to 17.5%). In 2013, it decreased to 15.3%. With this reduction rate, Viet Nam has fulfilled MDG 1 by now and will surpass the target by 2015.

The most significant improvements in reducing the rate of underweight children under five years of age from 2000 to 2010 were experienced in the South Central of Viet Nam (a 47% reduction), next the Red River Delta (a 46% reduction) and Southwestern region (a 46% reduction). The slowest progress was reported in the Northeastern region (a 37% reduction), Northwestern region (a 35% reduction) and the Central Highlands (a 32% reduction). Viet Nam has achieved the indicator on reduction of prevalence of underweight children under five years of age in MDG 1 on eradication of poverty and hunger. This outcome is a reflection of the Government’s strong commitment and endeavor to not only invest in the program on nutrition but also exert constant efforts in implementing the program nationwide.

However, the under-five child malnutrition rate in some ethnic minority regions tends to stand above 25%. The child malnutrition (wasting form) has not been significantly improved. Nationwide stunting rate remains at 30%. Particularly in poor rural and mountainous areas in Northern region, the Central Highlands and ethnic minority groups, it rises to 40%. Thereby, Viet Nam should continue to make efforts and take actions to equally and sustainably promote nutrition for under-five children.

On MDGs 4 and 5

In addition to a considerable reduction of maternal mortality, rapid and sustained reduction of under-one and under-five child deaths has also been recorded. The under-five mortality rate dropped by half from 58‰ in 1990 to 23.2‰ in 2012. The under-one mortality rate lowered nearly two thirds from 44.4‰ in 1990 to 15.4‰ in 2012. According to assessment of the international community, Viet Nam is likely to achieve MDG 4 on reduction of under-five mortality (to 19.3‰) and under-one mortality (to 14.8‰) in 2015.

These are results of a series of National Target Programs including the Expanded Program on Immunization; Acute Respiratory Infection Prevention; Acute Diarrhea Prevention; Child Malnutrition Prevention; Treatment of common diseases among children; and Reproductive Health. The maternal mortality ratio fell more than three times from 233 per 100,000 live births in 1990 to 69 per 100,000 live births in 2009. As compared with the objective set out by the National Strategy on Reproductive Health in the period of 2001-2010 on maternal mortality ratio of 70 per 100,000 live births in 2010, the health sector completes this indicator one year ahead of schedule. According to the international community’s assessment, Viet Nam is likely to achieve MDG 5 on reduction of materal mortality (to 58.3 per 100,000 live births in 2015) and is one of countries “that makes progress” in implementing MDGs.

However, the under-one mortality greatly varies in different regions and areas. The Central Highlands records the highest under-one mortality rate in the country. This rate in the rural areas doubles that in urban areas. Infant mortality rate is still rather high, approximately 70% of the under-one deaths and 50% of the under-five deaths.

Success factors

First, commitment of the political system.

Maternal and child health has always been considered primary priority in people healthcare in Viet Nam. The Vietnamese Government’s high commitment in implementing MDGs is an important factor to achieving maternal and child healthcare. A series of important documents have been promulgated, making positive impacts on mother and child health. In 1989, the Law on Protection of People’s Health was approved, devoting a chapter on mother and child protection. The National Strategy for the protection, care and improvement of people’s health for the 2011-2020 period, the National Strategy on Population and Reproductive Health for the 2011-2020 period; the National Strategy on Nutrition for the 2011-2020 period, the Program of Action on Childcare are among them. The National Assembly set up an exclusive committee in charge of social affairs including maternal and child healthcare.

Second, national economic growth.

After nearly 30 years of renovation, Viet Nam’s economy has relatively rapidly developed and stabilised. During the period 2000-2008, GDP grew continuously at 7.9% annually. Though affected by the global economic crisis since 2008, Viet Nam obtained GDP growth rates of 6.31% in 2008, 5.89% in 2011, 5.03% in 2012 and 5.42% in 2013. Average per capita income reached US$ 1,908 in 2013.

Progress have been made in hunger eradication and poverty reduction. In the 2 years of 2011 and 2012, more than 70,000 billion dong were alloted to poverty reduction. Policy packages on healthcare, education, nutrition, legal services, culture and information, support for vocational training, job creation, and investment in infrastructure have concentrated on supporting poor and disadvantaged groups. The Program 135 has made remarkable achievements in poverty reduction and improvement of poor people’s living standards. The poverty rate in supported areas is reduced by 10%; and poor households’ income in the 2007-2012 period went up by 20%.

Third, intervention of health sector.

Maternal and child health service has been provided through a network from Central to local levels. At the commune level, 99% of communes boast health stations, nearly 94% of health stations have midwives or obstetric and pediatric associate doctors, 66% of health stations have doctors and 84% of villages have health workers. In villages where health stations are inaccessible to people or in ethnic minority regions where child delivery at home is still practiced, the health sector has trained villages’ midwives on maternal and infant healthcare.

Average per capita total expenditure on health increased 4 times from US$ 49 in 1995 to US$ 233 in 2012. Improvements of materal and child health service through upgrading infrastructure of hospitals and consulting rooms, health stations, and training of health workers are important factors contributing to raise maternal and child healthcare.

Expansion of access and improvement of maternal and child healthcare quality in all regions, areas, groups, especially remote, ethnic minority regions and disadvantaged groups are important success factors in reduction of malnutrition and the under-five mortality as well as maternal mortality.

Fourth, postitive support of international organizations and participation of social and media organizations.

The above-mentioned achievements are also attributable to active technical and financial support of the United Nations’agencies, and multilateral and bilateral donors. Though this support is not large as compared to investment, it provides directions, and generates innitiatives and effective interventions in maternal and child healthcare. The participation of non-governmental organizations have also been significant, contributing to implementing and demonstrating effective models of maternal and child healthcate suitable to each locality. Lastly, it is necessary to mention the active role of mass media in transmitting messages on materal and child healthcare to the wider public, mobilizing them to join force with the health sector and society to care for their and their families’ health.

Some constraints

During two thirds of its path to implement MDGs, Viet Nam has gained important achievements and is determined to complete MDGs by 2015. However, beside successes, Viet Nam still faces challenges and difficulties in maternal and child healthcare that need to be addressed. They are:

- Viet Nam has been included in the list of “middle-income country,” thus in the coming years, Viet Nam, which has been coping with, will face a big challege, that is a decline of financial assistance from international organizations and donors.

- State budget allocations have not yet met increased demands of people. Although national target programs have been implemented, they can meet only part of the demands and mainly for essential invesment in mountainous and difficult provinces while in recent years, fundings for national target programs on reproductive health have been cut down.

- Though maternal and child mortality has dropped, the reduction rate has been slowed down in recent years and there remains relatively wide gaps among regions and areas (in mountainous areas, these indicators triple those in plain areas). Infant mortality is relatively high, accounting for 70% of the under-one dealths and 50% of the under-five dealths. Despite obvious improvements in child malnutrition (weight for age), stunting rate is still relatively high, accounting for almost 30% of the under-five childen.

- There are limitations in access and quality of prenatal, natal and postnatal maternal healthcare. It is rather common that in some mountainous and ethnic minority areas, there is no midwive.

- Though the network of reproductive health service provision has been established and strengthened, constraints remains. Infrastructure and equipment for obstetric and paeditric departments in district hospitals are poor, falling short of demands for emergency and treatment of pregnant women, children and infants. Due to funding contraints, health workers in obstetric, infant and paediatric faculties have rarely received training and updated knowledge, leading to limited skills, particularly in saving of mothers and newborns.

- The reporting and information system has also been poor and restricted, some collected data are inaccurate, failing to capture materal and child mortality, especially there is no data on infant mortality. It also fails to ensure timeliness and serve policy making and development of intervention plans.

Promote achievements and overcome contraints and difficulties

First, strengthen and complete the network of reproductive health/maternal and child healthcare from central to local levels. Build capacity, sufficiently recruit health workers for obstetric and pediatric faculties of provincial and district polyclinics and provide necessary equipment for obstetric and newborn emergency and first aid. Assist all district hospitals to be able to access to provincial hospitals within a period of more than 60 minutes for caesarean section and blood transfusion. Form and operate separate newborn health section at district hospitals.

Second, human resource development. Strengthen training of doctors specializing in obstetric and paediatric, attach importance to preliminary training of specialised doctors for the two specialities which are in short supply of human resources even in provincial hospitals. Train health workers directly working in obstetrics into “skillful midwives.” Following is one of important warnings of the World Health Organization (WHO) “ensure each birth is attended by skillful attendants to limit and handle on time obstetric complications and safe delivery.”

Third, ensure incentive policies and mechanisms to attract health professionals, expecially qualified ones to mountainous and remote areas. Promulgate regulations on social obligations of doctors to work in remote areas, implement special policies to assist village midwives of ethnic minorities as well as village health workers.

Fourth, increase investment, ensure finance and logistics. Provide necessary state budget allocation for reproductive health/maternal and child healthcare. The National Assembly and Government invest more on reproductive health through National Target Program with a minimum of 100 billion dong per year and gradual increase in the following years to better meet increasingly diversified demands for reproductive health of people, especially of mothers and children (since 2008, the national target program on reproductive health received an average investment of 35 billion dong per year. In 2014, the investment is cut down to 20 billion dong).

Fifth, strengthen information-communication-education on health to raise awareness, change attitude and behaviour of people, particularly people in mountainous and remote areas on prenatal care, risks of irregular prenatal checkups and birth outside health centres or self-delivery, and birth not attended by trained health professionals as well as short birth intervals, higher number of birth and birth at young ages (under 20 years of age) or birth at older ages (above 35 years old).

Sixth, scale up effective models such as “community-based referral” (1); “Continuous maternal and infant healthcare from community, family to health center”; step up “assessment of maternal mortality” to draw professional experience to review, assess in detail the process of diagnosis, monitoring, first aid to pregnant women and identify causes and impacts to the deaths. This activity will help physicians draw lessons to enhance treatment quality and first aid to avert similar complication cases.

Seven, intensify monitoring and professional support from higher to lower levels; well implement the Program to rotate health professionals from higher to lower levels (Program 1816), the Program on satellite hospitals; heighten efficiency and effectiveness of inspection and control of the implementation of the Law on Medical Checkup and Treatment; regulations of hospitals, technical procedures and techncial and professional guidances of Ministry of Health towards public and private health institutions.

Caption: (1) When there is an emergency case but commune or village clinics do not have ambulance, the community is mobilized to transport the patient to referral hospital by people’s available transport means

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