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Improving the quality of people’s healthcare
17/12/2010 10:59' Send Print

The right to life and to live in good health is one of the basic, sacred and supreme rights of man. To ensure the exercise of that right, each individual, family, community and State has a role to play with the State bears important responsibility. Each branch also has its own responsibility. The agricultural sector ensures sufficient food supply. The environmental sector ensures healthy living environment. The health sector plays a great role in medical development and public healthcare.

Encouraging results in public healthcare

In its 65-year long history of development and 55 years of implementation of Uncle Ho’s teaching: “Physicians are like benevolent mothers”, the health sector of Vietnam has unceasingly developed and grown stronger. Public healthcare has made great stride and achieved encouraging results. In August 27, 1945, the Ministry of Health of the Provisional Government of the Democratic Republic of Vietnam was established on the basis of the former Indochinese Health Service. The newly independent country faced with difficulties, shortages, poor infrastructure and equipment and lack of medical practitioners. However, the health sector continued to provide healthcare service to the public. During the 9-year resistance war against the French colonialists, the health sector had to serve both the public and the fighting army. It was in this new start, the young health sector made important achievements through producing vaccines against cholera, smallpox, diphtheria and others medicines from local raw material. In 1950, penicillin antibiotic was produced. Difficulties, hardship and dangers could not deter the physicians to hold on to the front to care for sick and injured soldiers, contributing to the triumph of military campaigns with the highest peak being Dien Bien Phu campaign.

After the liberation of the North in 1954, the health sector concentrated on building and developing the healthcare system from the urban to rural areas including preventive medicine and treatment service. In 1961, for the first time, we produced vaccines against polio and smallpox. When the country changed to war time with two tasks of production and fighting, the health services dispatched physicians to grassroots level to provide health care to the people and army of the North and the South. Hundreds of thousands of tons of medicines and medical equipment were transferred to the South. Many physicians, pharmacists, medical graduates and students volunteered to the battlefield to join the fight for the liberation of the South and reunification of the country.

Since the Party initiated the renovation process, the health sector has received close leadership and guidance of the Party and State, the support and cooperation of ministries and branches. The medical practitioners and public servants have persistently striven to improve their services, overcome all difficulties and obstacles and made remarkable achievements. Health indicators have improved, higher than those of many countries which have similar GDP per capita. Vietnam has joined countries having prominent health achievements. Life expectancy is longer. Human Development Indicator has risen sustainably. By now, we have basically eliminated polio, controlled tetanus, measles, whooping cough and smallpox. Maternal and infant motility rates have reduced remarkably. Particularly, in 2009, for the first time the health sector overfulfiled 4 indictors assigned by the National Assembly including lowering birthrate by 0.2%o, and under five malnutrition rate to below 19%, increasing patient beds ratio to 26,85 beds per 10,000 people, fulfilling 9 indicators and overfulfilling another 6 indicators assigned by the Government.

We have successfully implemented the Project under which medical professionals have been rotated from higher level hospitals to lower level clinics to help improve health services, reduce excessive health demands at higher level hospitals, transfer professional skills and train health providers in situ. In 2009, 64 hospitals recorded 1,846 staff rotations assisting 26 specialized health services, transferred 1,023 techniques 80.9% of which have been skillfully used and 16% have been normally used by lower level hospitals. The remaining 3.1% require higher level clinics’ intervention.

The health sector developed a project on upgrading district hospitals, inter-district polyclinics, and invested in construction, improvement and upgrade of tuberculosis, mental health, and cancer hospitals and the children’s faculty of provincial polyclinics in the mountainous and difficult areas from Government bonds. We have upgraded 621 district health centers and 16 provincial polyclinics in difficult areas and some other specialized hospitals, thus we have facilitated access to quality health services for local people.

The prevention of epidemics and diseases was undertaken in time. Drastic measures were taken fight against A (H1N1) flu thus minimizing morbidity and death rates and other impacts caused by the epidemic. Positive changes have been made in Population and Family Planning work. 62 provinces and cities established the Population-Family Planning Services. The population growth rate decreased from 1.31% in 2005 to below 1.2% in 2009 and is expected to fall to 1.14% in 2010. The third-child birth rate fell from 20.8% in 2005 to 16% in 2009. The population quality has been improved in terms of physical fitness, intellectual and mental conditions. The HDI of Vietnam stood at 116 over 177, 8 grades higher than that of 2005.

Many new health institutions have been set up which include the Medical University of Vinh, the Medical Secondary School of Bac Can (built on the basis of the former Health Training Center of Bac Can) and the Dang Van Ngu Medical School (built on the basis of the former Secondary Classes of the National Institute of Malariology, Entomology and Parasitology). Another 5 Medical Colleges were established on the basis of the former Medical Secondary Schools of Dien Bien, Son La, Hung Yen, Ninh Binh and Lam Dong provinces. The National Institute for Food Control of the North, the Centers of Food Control of the Central and the South were also set up.

We have also completed the clinical experiment of the vaccine against avian influenza A (H5N1). We also produced the vaccine against A(H1N1) flu in laboratory and will produce the vaccine en mass in the coming years. We have been able to stabilize medicine prices which stand at 7 in the scale of essential consumer goods. Proportion of locally-produced medicine increased nearly 10% as compared with that of last year, ensuring adequate medicine supply. The medicine quality meets international criteria and GMP of the World Health Organization.

High technologies have been applied to healthcare. Coordination and cooperation with different branches and levels have been stepped up to meet diversified and complex demands for healthcare. All activities in health provision from hygiene, disease prevention, diagnose, treatment to social mobilization for epidemic prevention and control to regulation of healthcare demands at higher level hospitals, school healthcare, population-reproductive health could not be successful without concern and guidance of Party organizations and administrations. In general, achievements in the health sector were attributable to contribution of branches and levels, particularly the close guidance of Party organizations and administrations throughout the country.

In the past years, the health sector also received effective assistance of the United Nation, governments of other countries, financial organizations, non-governmental organizations, and international scientists and consultants. Thanks to the support, we have caught up with international medical advances on epidemic prevention and control, health check-up and treatment, scientific research and staff training. Vietnam’s bilateral and multilateral international relations in healthcare with other countries and international organizations have developed and contributed to the cause of public healthcare.

New opportunities and challenges for the health services

The world economy has shown signs of recovery though not stable. In many countries, employment rate is still high. Inflation is a potential threat. While globalization, and exchange are expanded, trade protection also increases hence fiercer “trade war” and international competition.

Our country’s GDP this year suppassed that of 2009. The year 2010 opened up potential growth. It is also the year when the 5 year-plan (2006-2010) and the 10th tenure of the Party end. Vietnam has celebrated the 1000th anniversary of Thang Long-Hanoi capital and other red letter days. Party organizations at all levels have organized Party congresses in anticipation of the 11th Party National Congress. However, the country is facing many obstacles and challenges. Import surplus and overspent budget have not yet shown signs of improvement. Inflation is looming large. Climate change impacts seem to come earlier and more atrocious. The country was subjected to severe drought, repeated bushfire, and extended salinity. Storms and flood frequented the Central of Vietnam. All these require great efforts of the health services.

We have made notable successes in birth rate reduction. However, this result is not sustainable. Many localities and villages are reported to have high birth rate. Son preference is still a pressure in many families. Safe contraception have not yet been properly supplied in some places some time. The population size has been doubled as compared with that of the years when the country was reunified in 1996. Though Vietnam ranks 13 in population in the world, its population density doubles that of Asian countries and China.

Healthcare demands have increased. According to WHO, with 1% increase in GDP, healthcare demand grows by 1.5%. Vietnam’s GDP in 2010 is expected to reach 7%, and healthcare demand will increase to 10%. This brings about opportunities and great challenges.

If we consider patients as “clients/God” of the health services, we are facing great opportunities and challenges.

Great changes have been noticed in disease patterns. Percentage of communicable diseases (signs of less developed country) in 1976 accounted for 55.5% of the total diseases. It dropped to 25.2% in 2008. In a reverse trend, non-communicable diseases (signs of developed countries) which, in 1976 were 42.7% increased to 63.1% in 2008. At the same time, the percentage of toxication and injury also increased 6 folds (from 1.8% to 11.7%).

Though increased investment on medical technical infrastructure has been made recently, health services is still lower than that of regional countries. Hospital campus is small and equipment newly procured and constructions newly built are not compatible.

At present the number of medical assistant doctors and doctors through out the country rises to 150,000 from 300 in 1954 in the north. Among them 56,200 are doctors. The ratio of doctors for 10,000 people is 6.52. They are precious human resources who have played up to their role in all heath institutions through out the country. Nevertheless, there is a high shortage of high quality physicians for rural and border areas and islands as compared with some other countries. (According to UNDP 2000-2004 statistics, the ratio of doctor per 10,000 population of the Federation of Russia was 42.5, of Italy was 42, of France was 33.7, of the US was 25.6, the UK 23, of Canada was 21.4, of Japan was 19.8, of South Korea was 15.7, of Singapore was 14, of China was 10.6.

Socialisation in health provision is an important orientation. We are very glad that the Party, Parliament and Government have created conditions for diversification of health provision. In terms of macro management, beside the State administrative system, there are dozens of specialized medical, pharmaceutical and medical equipment organizations. In practice, apart from the public health system, hundreds of hospital, more than 30,000 health stations and 100,000 pharmaceutical stores were set up. Some big hospitals have already combined new operation mechanisms of State and private investment to expand medical facilities. Many pharmaceutical and medical equipment companies were equitised. All these achievements have brought about new zeal, initially breaking away with monopoly, and the ask and give mechanisms and creating a healthy competition. However, the results achieved still fell short of expectation and a lot more needs to be done.

The medical management capacity in both state and direct grassroots levels is still low. Though the renovation process has undergone a quarter of a century, we are still slow in improvement of health management. State management has been focused mainly on public health care and state-run medical institutions. In many places, egoism, and locally-minded thinking remain an obstacle to healthcare development.

Fundamental measures

In order to successfully fulfill targets stipulated in the Resolutions of the 10th Party Congress and objectives of the healthcare strategy of the 2011-2020 period, we should focus on comprehensively and effectively the following solutions:

First, capitalizing and bringing into play the comparative advantage of the golden population structure which is estimated to last for 20 years from 2005 to 2025 with high percentage of population at working age and low dependant ratio. Efforts should be concentrated to improve population quality, to quickly reach stable golden stage, to provide quality reproductive healthcare for mothers and children, to ensure basic rights of children and to create a healthy environment for children particularly children in remote, isolated and disadvantaged areas to physically and mentally develop. Special attention must be given to protect and care for children in especially difficult situations, and to prevent and reduce risks facing children. National strategy on gender equality and woman empowerment must be developed and implemented to ensure women’s participation in learning and improving their capacity to meet work demands.

Second, increase of State investment is coupled with social involvement in health care. Professional ethics must be upheld and negative practices in health checks-up and treatment should be done away with. Patients with health insurance have favorable access to health services. Every citizen, in demands of or able to pay, are provided with high quality health services. Legal framework on food safety and hygiene are to be completed. Food inspection and control should be scaled up. Violations of food safety and hygiene must be strictly punished.

Third, it is important to develop a roadmap to implement the orientation stipulated in the Resolution No 05-CP dated 18 April, 2005 of the Government which is reiterated in the Decree No 38-CT/TW dated 7 September 2009 of the Party Secretariat that says: “to transfer state budget which used to be allocated to healthcare entities directly to health insurance beneficiaries through health insurance policies.” Patients are now treated as “clients or god”. Health providers are encouraged and honored for their civilized and careful behaviors towards patients. Vietnam’s health achievements must be popularized among the population to reduce dependence on foreign health services which can be offered by national health institutions.

Fourth, together with building and developing public health services, it is necessary to promote non-public health sector (private, non-profit and humanitarian health services). Harmonization and complementary mechanisms, cooperation and healthy competition and development are to be strengthened. Patients can have access to more choices of health services.

Fifth, management renovation must be perceived as a breakthrough and driver of development. Administration reform must be accelerated. State management over the health services is identified as management of public, non-public, state and non-state health services. Attention must be given to uplift weak links in the healthcare chain, to create equilibrium for fair play of all health providers and to encourage equal competition and interaction. Public healthcare institute management should be reformed to ensure their self-reliance and self-responsibility. It is necessary to strengthen research institutes, to provide guidance to management of both public and non-public lower health services and to harmoniously generate their synergy to achieve higher effectiveness.

Sixth, grassroots health network must be strengthened. Capacity building for Commune Health Stations is necessary. Construction of district hospitals and improvement of provincial and central hospitals are to be completed. Some health check-up and treatment institutions of regional level will be built. Different economic sectors are encouraged to set up high quality specialized medical establishments to help relieve higher level hospitals from overload. Public health establishments operate on the basis of self-reliant and transparent to provide equal, effective and quality health services.

Seventh, health insurance policies should be renovated and completed to ensure people’s access. Healthcare must be provided to entitled and poor people, children and the elderly.

One of our goals is by 2020 all communes and wards have doctors. Preventive medicine is to be strengthened to prevent big epidemics. Measures must be taken to control and prevent HIV spread. Child malnutrition rate must be reduced. The quality of food safety and hygiene must be enhanced. We must also develop pharmaceutical and medical equipment industries as well as traditional and modern medicine./.

Nguyen Quoc Trieu