Health sector reforms and HRH in the grass-roots network: case study of Vietnam

1
Health sector reforms and HRH in the
grass-roots network case study of Vietnam

• Nguyen Lan Huong. MPH
• Department of Manpower and Organization
• MOH, Vietnam

2
Background

• Grass-root health consists of health facilities
  at district and commune levels (district
  preventive health centers, district hospitals and
  commune health centers). Its most important
  component of the health care system.
• In 1986, Vietnam initiated a reform policy,
  focused on economic reform from planned,
  centralized into a market economy
• In 1989, this policy applied to the health
  sector. Most important was the implementing of
  user fees for health services at central level
  hospitals, and legalization of private practice.
• Since 1990, with the Governments public
  administrative reform, grassroots health network
  has undergone reform process .

3
Public Health system in Vietnam

• In 1998
• 1. Central level

Government
- Hospitals 30 - Institutions 15 - Medical
colleges 14
MOH 16 Departments
Provincial Peoples Committee (Local Gov.)
2. Provincial level
- Hospitals 350 - Provincial Prevention Centers
64 Malaria Centers 28 infection disease
control 22 - Secondary medical schools 53

 
Provincial Health Office 6-8 Departments
3. District level
District Health Centers 667
4. Commune level
Commune Health Centers10, 886
Direct management ( funding, manpower)
Indirect management (Providing guidelines on
professional practice and supervision)
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Public Health system in Vietnam

• In 2004
• 1. Central level

Government
- Hospitals 30 - Institutions 15 - Medical
colleges 14
MOH 16 Departments
Provincial Peoples Committee (Local Gov.)
2. Provincial level
- Hospitals 350 - Provincial Prevention Centers
64 Malaria Centers 28 infection disease
control 22 - Secondary medical schools 53

 
Provincial Health Office 6-8 Departments
District Peoples Committee
3. District level
District Health Office 3-5 staffs
- District Health Hospitals 667 - District
Preventive Centers 667
4. Commune level
Commune Health Centers(CHC)10, 886
Direct management ( funding, manpower)
Indirect management (Providing guidelines on
professional practice and supervision)
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Public Health system in Vietnam
Changes-Setting up District Health
Divisions(DHD) administrative health agencies
-Separating curative and preventive services at
district level. - Moving function on management
CHC to the DHD

• Advantages
• Administrative agencies at district level ,
  responsible for monitoring, supervision and
  evaluation
• Involve local authorities and coordinate others
  sectors in health activities
• Strengthen capacity of preventive services in the
  grass-roots health network

• Disadvantages
• Administrative management skills are poor
• Shortage staffs in DHD
• In remote areas, difficult to follow this model
  because shortage of HRH.
• Coordination between DHD and District Preventive
  Centers in management CHC

6
Health workforce status in Vietnam

• Workforce size is increasing (229, 887 in 2001
  and 259, 583 in 2005). In June 2007, Government
  have issued the staffing norm Number of staffs
  will be increased about 58, 769.
• Distribution 82, 5 at local 12, 20 at
  central level, and
• 5, 25 in other sectors. By geography, health
  staffs concentrate in the better off regions
  (North delta region 18.39 North West 3, 91 ).
  
• Qualification is poor ( 25 had university
  degree including 1.24 Master and 0.44 PhDs65
  had secondary and primary degree).
• Health workforce structure is inappropriate.
  Shortage pharmacists, nurses and midwife
  surplus assistant doctors. (Doctor 18. 98
  assistant doctor 18.82 nurse 19.74
  pharmacist 8.27 midwives 6.94 technician
  3. 77)

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Health workforce production

• 11 medical colleges produce university and
  postgraduate degree.Annually, about 6,200
  graduated including medical doctors, pharmacists,
  nurses, technicians and public health workers.
• 70 training institutions from 64 provinces
  produce secondary and primary degree. About
  18,000 graduated.
• This number is insufficient to meet the demand
  for health system.

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Health workforcein grass-roots health
network

• Preventive service provision
• Shortage of staffs, especially doctorsAveragely,
  21.8 staffs per Preventive center (According to
  Standard at least there are 25-30 staffs).
• Difficult to recruit, especially qualified
  staffs. Almost prefer to stay in the hospitals
• Low qualification 72.65 was secondary degree
  few had been trained preventive medicine.
• Brain drain issues. Qualified doctors move to
  upper level or curative services
• Inappropriate health workforce structure
• District Preventive Centers have been allocated
  new function on reproductive health provision and
  food safety control. It needs more midwives,
  technicians.

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Health workforcein grass-roots health network

• Medical service provision
• Number almost got the standard
• Qualification better than preventive services

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Health workforcein grass-roots health network

• Administrative agency (District Health Division)
• Shortage staffs In some districts, 1-2 staffs
• Poor administrative management skills.
• Incapacities to control/manage commune health
  centers

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Lessons learnt

• Health sector reform impacts HRH and HRH
  influence its implemetation
• Appropriate incentive policy to attract and
  retain health personnel in grass-roots health
  network
• In-service training
• Involve health personnel in design and implement
  reform.

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• Thank you very much