Post on 08-Mar-2023
PUBLIC HEALTH IN VIETNAM: ACHIEVEMENTS AND CHALLENGES
Prof. Nguyen Cong Khan
Department of Nutrition and Food Safety - HSPH
Department of Science, Technology and Training - MoH
NATIONAL SCIENTIFIC CONFERENCE ON PUBLIC HEALTH “PUBLIC HEALTH IN VIETNAM: CURRENT SITUATION AND FUTURE PERSPECTIVES”
HDI
Source: UNDP 2014
0.473 0.476
0.563 0.598 0.604 0.611 0.617 0.622 0.629 0.632 0.635 0.638
1985 1990 2000 2005 2006 2007 2008 2009 2010 2011 2012 2013
Human development Index (HDI)
Basis health indicators
Results Target 2015 (MDG & 2011-2015 plan of
the MoH)
Life expectancy, 2013 (1) 75.6 74
IMR 2014, (2) 16.21 14.8
U5MR, 2014 (2) 19.7 19.3
Maternal mortality, 2009 (3) 69 58.3
Under nutrition among children under 5, 2013 (4) 15.3 15
Fully vaccinated children, 2013 (4) 91.4 90
Doctor/ 10000 population, 2013 (4) 7.5 8
Beds/population, 2013 (4) 24.2 23
Commune health station with doctor, 2013 (4) 76.9 80
Health insurance coverage, 2013 (4) 68.5 70
(1) WHO 2014; (2) GSO 2014; (3) GSO, 2009; (4) MoH 2014
Health outcomes
70.2 70.5
70.8 71.2
71.5 71.8
72.1 72.5
72.8 73.1
73.4 73.6
73.9 74.1 74.3 74.5 74.6 74.8 74.9 75.0 75.2 75.3 75.5 75.6
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Life expectancy at birth, total (years)
WHO, 2014
Health outcome
Source: WHO, GSO, UNICEF 2014
37.6 36.4 35.1
33.8 32.5
31.2 30.0 28.7 27.6 26.5 25.5 24.6 23.8 23.0 22.2 21.5 20.8 20.1 19.6 19.2 18.9 18.7 18.6 18.4
16.2
52.6 50.5
48.2 46.0
43.8 41.7
39.7 37.7
36.0 34.3
32.8 31.5
30.3 29.1 28.0 27.1 26.1 25.2 24.5 24.0 23.6 23.4 23.2 23.0
19.7
Mortality rate, infant (per 1,000 live births)
Mortality rate, under-5 (per 1,000 live births)
Health outcomes Malaria cases/ 100,000 population
Source: MoH 2013
728
599
508
446
377
328
233 204
157 119 109
83 70 71 62 49
0
100
200
300
400
500
600
700
800
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2012
Health Facilities
Year 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Hospital 791 821 825 836 833 835 836 842 842 856 878 903 956 974 1002 1030 1040 1042 1069
Polyclinics 1150 1131 1106 1108 1024 936 928 912 930 881 880 847 829 781 682 622 620 631 636
Rehabilitation and Sanatorium
facilities 103 120 121 119 112 92 71 76 77 53 53 51 51 40 43 44 59 59 60
CHS 9670 9935 10014 10078 10109 10271 10385 10396 10448 10516 10613 10672 10851 10917 10979 11028 11047 11049 11055
Health posts in organization 1170 1123 1123 1123 1120 918 891 810 810 789 769 710 710 710 710 710 710 710 710
Others 65 61 59 55 54 50 49 41 38 34 33 30 32 32
TOTAL 12972 13218 13269 1330 13264 13117 13172 13095 13162 13149 13243 13232 13438 13460 13450 13467 13506 13523 13562
MOH, GSO 2014
Health service delivery
MOH, GSO 2014
192.3 196.5 197.9 199.1 195.9 192.0 192.5 192.6 192.9 196.3 197.3 198.4 210.8
219.8 232.9
246.3
266.7 275.1 280.7
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Hospital beds (000)
Health service delivery
Coverage of vaccine UV2+ among pregnant women and child tetanus, 1991-2012
NEPI 2013
Paper “30 years of vaccination in Vietnam: impact and cost-effectiveness of the national Expanded Programme on Immunization” (Accepted for publication in Vaccine 2014)
“National surveillance data suggests that up to 5.7 million diseases cases and 26,000 deaths may have been prevented by EPI”
Health service delivery
GSO 2013
18.9
34.3 35.2 34.2
40.9 39.2
5.7 7.1 6.3 6.5
8.1 7.3
14.2
30.9 32.6
31.0
37.1 36.0
2002 2004 2006 2008 2010 2012
Utilization rate (%) Utilization of inpatient service (%)
Utilization of outpatient service (%)
Health financing
Source: National Health Account, Vietnam
7.4 7.1
6.5
7.9 7.5
6.6 7.0
6.3 6.0 5.5 5.2
7.5
9.2
8.0 8.5
10.1 10.1 9.5
5.2 5.1 4.9 4.9 4.9 5.3
5.6 5.1 5.2
5.5 5.9
6.5 7.1
6.0 6.5
6.9 6.8 6.9
0
2
4
6
8
10
12
Health expenditure, public (% of government expenditure)
Health expenditure, total (% of GDP)
Health Insurance coverage
Source: National Health Account, Vietnam
5 6 10
12 12 13 13 14 15 17
20.7 22.8
28.8
44.7 43.8 47.1
58.2 59.6
64.3 68 68.5
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Health human resource
Source: Health Statistics Year Book
3.2 3.5 3.6
3.9 4.0
3.6
4.4 4.1 4.2
4.4 4.4 4.4 4.7
5.1 5.4 5.4
5.7 5.9 5.9
6.0 6.2
6.5 6.5 6.6
7.2 7.3 7.3 7.5
0.9 1.0 1.0 1.1 0.9 1.0 0.9 0.8 0.8 0.7 0.7 0.7 0.7 0.8 0.8 0.8 0.8 0.8 0.8
1.3 1.3 1.2 1.2
1.8 1.8 1.9 2.0
1.8
Doctor/10,000 population Pharmacist/10,000 population2
Health human resource
Source: Health Statistics Year Book
4.6 9.4
17.7
23.2
33.9
51.1 56.1
61.5 65.4
69.2 69.4 65.1
67.4 65.9 67.7 70.0 71.9
76.5 76.9
% CHS with doctor
Medical universities/schools
Source: Ministry of Health
0 1 5
2
46
1 1
6 2
68
5 1
10
2 5
1
11
2 6
1
13 16
7
14 16
44
74
0
10
20
30
40
50
60
70
80
Trường đào tạo
YTCC
Trường đại học
Dược
Trường Đại học Y
và Y dược
Trường đào tạo cao
đẳng Y, điều dưỡng
Trường trung học y
dươc
Năm 1985 Năm 1995 Năm 2001 Năm 2005 Năm 2010 Năm 2014
Medical students
Source: Ministry of Health
11,479 8,304
21,950
60,526
Năm 1990 Năm 1995 Năm 2005 Năm 2010
Thành tựu khác của hệ thống y tế
• Preventive medicine: Good controlling of dangerous transmitted
diseases such as SARS, flu A/ H5N1, flu A/H1N1.
• Development of high technologies at a similar level of regional and
international development (interventional treatments, laparoscopic
surgery, organ transplants…).
• Population and Family Planning: Natural population growth of Vietnam
has been reduced and restricted stably
• Pharmaceutical products: In 2012 domestic medicine met 234/314
active elements in the list of essential medicines with all 29 groups
of pharmacological effects as recommended by WHO; 100% of
pharmaceutical production facilities achieved GMP; 100% drug-
testing facility achieved GLP; 39% of drugstores achieved GPP
• Development of traditional medical network from central to
provincial, districts and communes
Conclusion
Thành tựu:
1. Vietnam's health system has made great efforts and achieved many impressive and important accomplishments in protecting and improving the health of people.
2. Most of the millennium goals have been achieved or will be achieved in 2015
3. Vietnam’s health indicators are at a level similar to or better than the countries with similar levels of economic development
Epidemiological transition (hospital cases)
59.2
37.6
24.9 19.8
39
50
62.4
71.6
1.8
12.4 12.7 8.6
0
10
20
30
40
50
60
70
80
1986 1996 2006 2010
Communicable diseases Non-Communicable diseases Injuries, poisoning
Food safety Food poisoning in 2015
• 179 food poisoning cases
– 5552 patients contracted
– 5147 patients hospitalized
– 23 dead.
• Food poisoning tends to be complicated such as FP in collective kitchens at industrial zones, FP due to poison mushroom or natural toxins
Number of facilities violated food safety rules: 78.413
Behavioral risk factors (%)
27.4
37
54.9
69.6
1.7 5.6
Smoking Alcohol use (in the last 30 days)
Overall Men Women
Source: Ministry of Health
Ageing problems
7.2 8.1 8.7
11.8
21.4
1989 1999 2009 2019 2039
% aged 60+
Source: General Statistics Office
Measles outbreak
Source: Ministry of Health
6584
11235
14431
18817
11942
6720 8160
528
19287
7554
4180 10
3 1 0 0 0 0
136
0
20
40
60
80
100
120
140
160
0
5000
10000
15000
20000
25000
sè m¾c tö vong
Dengue fever and weather in Hanoi
20
40
60
80
10
0
0
10
02
00
30
04
00
50
0
01 Jan 0701 Apr 0701 Jul 0701 Oct 0701 Jan 08thang
case rainfall
temp humid
20
40
60
80
0
20
04
00
60
08
00
10
00
01 Jan 0801 Apr 0801 Jul 0801 Oct 0801 Jan 09thang
case rainfall
temp humid
20
40
60
80
0
10
00
20
00
30
00
40
00
01 Jan 0901 Apr 0901 Jul 0901 Oct 0901 Jan 10thang
case rainfall
temp humid
20
40
60
80
10
0
0
20
04
00
60
08
00
01 Jan 1001 Apr 1001 Jul 1001 Oct 1001 Jan 11thang
case rainfall
temp humid
20
40
60
80
10
0
0
10
02
00
30
04
00
01 Jan 0501 Apr 0501 Jul 0501 Oct 0501 Jan 06thang
case rainfall
temp humid
20
40
60
80
10
0
0
20
04
00
60
08
00
01 Jan 0601 Apr 0601 Jul 0601 Oct 0601 Jan 07thang
case rainfall
temp humid
2005 2006
2007 2008 2009 2010
Antibiotic treatment and antibiotic resistance
Research by TDH in 2009-2010 in 19 hospitals in Hanoi, HCMC and Haiphong
74%67%
84%
26%33%
16%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Total E.coli or Klebsiella Acinetobacter or Pseudomonas
Appropriate Inappropriate
Inappropriate antibiotic use was 74% and appropriate use was 26%
(Similar to research result of Kollef et al 1998 (73.3%))
IMR
JHAR, 2014
16.0 16.0 15.9 16.0 15.8 15.5
10.0 9.8 9.5 9.4 9.2 8.5
-
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
2006 2007 2008 2009 2010 2011
Pe
r 1
00
0 li
ve b
irth
s
Rural Urban
IMR 2011
MICS 2011
23
17
12
23
11
10
30
No education
Primary
Secondary and higher
20% poorest
20% richest
Kinh
Ethnic minorities
(per 1000 live births)
Malnutrition
MICS 2011
6
13.9
22.4
13.2
9.5
20.6
3.1
10
22
Urban
Rural
No education
Primary
Secondary…
20% poorest
20% richest
Kinh
Ethnic…
Malnutrition among under 5 children (%)
Health care utilization
MICS 2011
81.6
50.5
5.6
44
69.3
27.2
88.7
67
59.6
Urban
Rural
No education
Primary
Secondary and…
20% poorest
20% richest
Kinh
Ethnic minorities
Pregnant women had >=4 antenatal examinations (%)
Health care utilization (% used in the last 12 months)
VLSS 2002-2012
16.5
32.4 33.8 34.2 37.5 36.6
22
36.7 36.3 35.4
45.5 42.2
2002 2004 2006 2008 2010 2012
20% poorest 20% richest
Một số vấn đề khác • Quản trị hệ thống y tế còn nhiều bất cập: phối hợp
liên ngành; y tế dự phòng và điều trị; Đầu tư cho y tế dự phòng, hệ thống y tế…
• Bao phủ bảo hiểm ở nhóm lao động phi chính thức còn thấp, thanh toán “Theo phí dịch vụ” vẫn là chủ đạo; Chi cho thuốc chiếm tỷ trọng lớn.
• Chất lượng và phân bố nhân lực y tế: bất cập.
• Hệ thống thông tin y tế thiếu đồng bộ
• Nhận thức về xã hội hoá y tế (XHH) chưa thống nhất
• Lạm dụng dịch vụ và kỹ thuật y tế
Other issues • Limitation in governance of health system. Lack of inter-
sectoral collaboration in diseases prevention. Cooperation between prevention and treatment is still not good. Investment for prevention and related networks still remain limited.
• Health insurance coverage within informal sector keep at low level. “Fee for service” keep the role as the main payment method. Expenses for drug still account as high proportion in total health expenses.
• Quality and distribution of human resources for health: inappropriate
• Health system information: inconsistent
• Awareness of socialization in health is not unitized
• Overuse of medical and technical services
Conclusion • Key challenges:
1. Health: an increase of NCDs and its risk factor, aging trend, new emerging diseases or relapse, climate change related health issues
2. Health system: Health system have not yet been prepared well to respond issues mentioned above. While central hospitals always suffer from overloading, health facilities at lower level have not yet been invested appropriate. Impacts of health policy in financial protection are still limited, especially health insurance. Payment methods still remain inappropriate.
3. Inequity in health and healthcare: Among different population groups, the poor, people with low level of education and minority people.
Health system: priorities for research and change
• Health system organization and governance: combine prevention and treatment.
• Universal health coverage together with health equity.
• Invest for preventive medecines, implement PRIMARY HEALTH CARE elements in new context.
• Equip health system with new capabilities to respond to new health problems and to the changes in climate, population and socio-economic status.
• Develop a sycronizied health informatics system.
• Planning and projection capacities.
HIV, TB, malaria
Other infectious
Mat//peri/nutritional
CVD
Cancers
Other NCD
Road traffic accidents
Other unintentional
Intentional injuries
0
5
10
15
20
25
30
2004 2015 2030 2004 2015 2030 2004 2015 2030
Dea
ths
(mill
ion
s)
High-income countries
Middle-income countries
Low-income countries
Mortality: global projection, 2004-2030
Effective multi-disciplinary collaboration
• In policy making.
• In planning and projection
• Disease control
• Response to climate change
• Food safety control
• Appropriate nutrition: in treatment and prevention
• Deal with new public health issue (such as antibiotic resistance, etc.).
Innovation in HRH training
• Capacity-based training
• Training
• Need-based training
• Redistribution of HRH: policies and attraction.
• Training for health system reform: Public health, Family health care.
• Health management
Science based Problem based Systems based
Scientific
curriculum
University based
Problem based learning
Academic
centers
Competency driven:
local-global
Health
education
systems
Inst
ruct
ion
al
Inst
itu
tio
nal
1900 2000+
Three generations of reforms
Inter- and Trans-Professional Education
Higher income countries Lower income countries
Inter-
Professional
Education Inter- & Trans-
Professional
Education
Program innovation
Enrolment source
Multidisciplinary and cross-sectoral
approach
Capacity-based and job-
descrition-based
approaches
Public health training
SYSTEM INNOVATION
Completing health policy system and health law
• Laws (such as revision of health examination and treatment law, etc.).
• Develop professional standards and norms in health sector.
• Innovation of payment methods, improve financial protection for vulnerable groups.
• Socialization in the direction of openness, transparency and quality of health services.