2001年-世界发展银行全球_Growing_Healthy___A_Review_of_Vietnams_Health_Sector_218页_17mb

Vietnam Health Sector Review Summary

Core Content

This report, titled Growing Healthy: A Review of Vietnam's Health Sector, published by the World Bank in June 1992, provides a comprehensive analysis of Vietnam's health sector during the early stages of its economic transition from a planned to a market economy. It covers various aspects of health indicators, demand for health services, public and private provision, financing, and human resources, offering insights into the challenges and progress made in the health sector from 1983 to 1998.

Main Views and Key Information

I. Introduction

• Background: Vietnam, despite being one of the poorest countries in Asia, has relatively better health outcomes than expected based on its income level.
• Importance of Health to the Economy: Health is a crucial factor in economic development and human capital formation.
• Scope: The report evaluates the health sector's performance, challenges, and future directions in the context of economic reforms.
• Structure: The report is organized into chapters that cover health indicators, demand for services, public and private provision, financing, and human resources.

II. Status of and Trends in Health Indicators

• Morbidity and Mortality:

  • Infant and Child Mortality: There has been a significant decline in infant and under-five mortality rates from 1983 to 1998.
  • Main Causes: The leading causes of morbidity and mortality include infectious diseases like malaria, respiratory infections, and diarrheal diseases, as well as non-communicable diseases such as tuberculosis.
  • Smoking: Smoking is identified as a major behavioral risk factor, with higher prevalence in urban areas and among higher-income groups.

• Reproductive Health and Fertility Outcomes:

  • Maternal Mortality: The maternal mortality rate has decreased over time, but it remains a concern.
  • Fertility Trends: Total fertility rates have declined, influenced by economic development and education levels.

• Nutritional Outcomes:

  • Child Nutrition: There has been a marked improvement in child nutrition, though disparities persist.
  • Micronutrient Deficiencies: Deficiencies in nutrients like vitamin A and iron are still prevalent in certain regions and income groups.

III. Demand for Health Services

• Utilization Trends:

  • Facility-Based Estimates: Public health facilities have seen varying levels of utilization over time.
  • Survey-Based Estimates: Surveys indicate that health service utilization is influenced by income, education, and regional disparities.
  • Health-Seeking Behavior: People in higher income brackets are more likely to use health services, while the poor face significant financial barriers.
  • Who Uses Public Facilities?: Public health facilities are primarily used by lower-income populations, though access remains uneven.
  • Hospitalization: Hospitalization rates have increased, particularly among the poor, due to rising out-of-pocket expenditures.

• Preventive Health Services:

  • Utilization of preventive services has improved, especially with the expansion of immunization programs.

• Determinants of Utilization:

  • Factors such as income, education, and geographic location significantly influence the use of health services.

• Private Costs of Health Care:

  • Out-of-Pocket Expenditure: There has been a substantial increase in out-of-pocket spending on health services, particularly for drugs.
  • Cost-Effectiveness: The poor bear a disproportionate burden of health costs, which can be a barrier to access.
  • Cost Recovery: The policy of cost recovery has led to increased financial strain on households, especially the poor.

IV. Public Provision of Health Services

• Structure of the Public Health Care System:

  • The system includes commune health centers, district and provincial hospitals, and the national health infrastructure.
  • There is a significant disparity in the number and quality of health facilities across regions.

• Operations of Commune-Level Health Activities:

  • Utilization: Commune health centers are heavily utilized, but their capacity is limited.
  • Staffing and Management: Staffing levels are uneven, and management practices are often inadequate.
  • Primary Health Network: The network has evolved over time, with some improvements in service delivery.

• National Public Health Programs:

  • Malaria Control: A major initiative that has had a positive impact on reducing malaria incidence.
  • Tuberculosis Control: The DOTS (Directly Observed Treatment Short Course) program has been effective in managing TB.
  • Immunization: The Expanded Program of Immunization (EPI) has led to increased immunization coverage.
  • Leprosy Elimination: A focused program that has contributed to the reduction of leprosy cases.

V. Role of Private For-Profit and Nonprofit Providers

• Legal Framework: The legal environment has been liberalized, allowing for private medical practice and drug retailing.

• Private Clinics and Providers:

  • There has been a rapid growth in private health facilities, especially in urban areas.
  • Private providers are often preferred by wealthier individuals due to perceived better quality and service.

• Private Inpatient Services:

  • Private hospitals and clinics have become more common, with some offering services at a higher cost.

• Monitoring and Regulation: The government has struggled to monitor and regulate the private sector effectively.

• Pharmaceuticals and Drugs:

  • The liberalization of the pharmaceutical industry has led to an increase in drug availability but also to issues like antibiotic resistance.
  • Drug vendors and pharmacies play a significant role in the distribution of medicines.

• NGO Involvement:

  • NGOs have played an important role in health services delivery, particularly in underserved areas.
  • Their focus has shifted over time, with an increased emphasis on community-based initiatives and advocacy.

VI. Human Resources in Health

• Supply of Health Workers:
  • There is a shortage of health workers, especially in rural areas.
  • The public sector has been the main provider of health workers, though the private sector is growing.
• Productivity:
  • Productivity of health workers has varied across regions and service levels.
• Salaries:
  • Salaries for public health workers are often irregular and low, affecting service quality and retention.
• Training:
  • Training programs have been implemented to improve the skills of health workers.
  • Traditional medicine training is also emphasized.
• Human Resource Management:
  • There are ongoing efforts to improve the management and efficiency of the health workforce.

VII. Financing of Health Expenditure

• Sources of Financing:
  • Public and private financing sources have evolved, with increasing reliance on private contributions.
• Cost Recovery:
  • The introduction of user fees has led to financial strain on households.
  • There is a discrepancy between official fees and what is actually paid by households.
• Health Insurance:
  • A social health insurance program has been established, covering a significant portion of the population.
  • The program has helped reduce out-of-pocket expenditures and improve access to care.
• Commune Health Center Finance:
  • Commune health centers have faced financial challenges, leading to reduced service quality and availability.

VIII. Public Expenditure on Health

• Overall Health Expenditure:
  • Public spending on health has increased, but remains relatively low compared to other Asian countries.
• Cost-Effectiveness:
  • Public health spending has shown some cost-effectiveness, particularly in maternal and child health programs.
• Composition of Expenditure:
  • Expenditure is distributed across different functions, economic types, and service levels.
• Overseas Development Assistance (ODA):
  • ODA has played a significant role in supporting the health sector, with contributions from various donors.
  • Provincial distribution of ODA is uneven, with some regions receiving more support than others.

IX. Summary of Major Findings

• Past and Present Trends:

  • There has been a notable improvement in health indicators, particularly in infant and child mortality.
  • The transition to a market economy has introduced new challenges and opportunities in the health sector.

• Attaining Health Goals in a Market Economy:

  • The shift to a market economy has led to increased private involvement in health services, but also to greater financial burden on households.

• Major Challenges:

  • Future Health Risks: Continued challenges include the spread of communicable diseases and the impact of smoking.
  • Essential Health Services: Access to essential services remains uneven, particularly in rural and poor areas.
  • Health Care Financing: The reliance on out-of-pocket payments and the impact of user fees on the poor.
  • Sector Capacity: There are concerns about the capacity of the health sector to meet growing demands.

Conclusion

The report highlights the progress made in Vietnam's health sector, particularly in reducing infant and child mortality, and the challenges posed by the transition to a market economy. It emphasizes the need for continued investment in public health services, improved regulation of the private sector, and better financial mechanisms to ensure equitable access to health care.