Vietnam’s healthcare has made steady progress towards equity, quality, and efficiency - Photo: dangcongsan.vn

The Party identifies investment in the protection of and care for people’s health as an investment in development, bringing common and long-term benefits to the whole society. The protection of and care for people’s health is reflected in the construction of grassroots health care, medical examination and treatment, preventive medicine, medical socialization, health financing reform, and medical staff building. Implementing the Party’s correct policy to protect, care for, and improve people’s health, Vietnam’s healthcare has made steady progress towards equity, quality, and efficiency.

1. The Party’s policy on the protection of and care for people’s health

Medical facilities building

Grassroots health care has an essential role in the Vietnamese health system. Resolution No. 04-NQ/HNTW dated January 14, 1993 of the 4th Plenum of the 7th Party Central Committee “on urgent issues of the cause of people’s health care and protection” introduced a breakthrough point of view “The number of grassroots health workers who are State employees is studied and determined by the Government. Mobile medical teams should be organized to take care of people’s health in highland, mountainous, remote areas and islands”⁽¹⁾.

For the first time in Directive No. 06-CT/TW dated January 22, 2002 “On consolidating and perfecting the grassroots health care network”, the Secretariat stated: “The health care sector has the responsibility to coordinate with related sectors to develop national standards on grassroots health; professional capacity and medical ethics of healthcare workers”⁽²⁾. Establishing national standards on health care is an urgent requirement to ensure that people receive primary health care and access to quality medical services at grassroots levels. Resolution No. 20-NQ/TW dated October 25, 2017 of the 6th Plenum of the 12th Party Central Committee “on the enhancement of citizens’ health protection, improvement, and care in a new situation” raised awareness on grassroots health and determined: “to set up an electronic health book system for each citizen; to update health information and indicators when going for medical examination and treatment”⁽³⁾. The policy of building an electronic health book has demonstrated the Party’s vision of applying digital technology in health in line with the international development so that by 2030, “95% of the population will have their health managed, checked, cared for and protected” as proposed by the 13th National Party Congress⁽⁴⁾.

Facing the complexity of the Covid-19 pandemic, and in order not to be passive before infectious diseases in the community at the same time, the 13th National Party Congress emphasized the need: “to vigorously renew the mechanism and operation mode of the commune, ward, and township health centers to ensure their good performances in the front line in disease prevention and health care of the people in the locality”⁽⁵⁾. The 13th National Party Congress highly appreciated the role of grassroots health care as an effective shield against infectious diseases in general and the Covid-19 pandemic in particular.

Medical examination and treatment

In the early years of the national renewal (doi moi), the Party pointed out the need to “invest in developing two large, highly qualified medical centers in Hanoi and Ho Chi Minh City. When it is possible, centers in the Central region will be developed. There should be a focus on training good staff in specialized medicine and community health”⁽⁶⁾. The 12th National Party Congress stated that it is necessary to unify the technical implementation as standards for hospitals to achieve uniformity in the management and quality control of medical examination and treatment at health clinics. The Fourth Industrial Revolution has had significant impacts on health care, early detection serious diseases; utilizing medical record data, optimizing the medical examination and treatment process, setting up the treatment process; being supported by robots and 3D printing technology in treating patients. Taking advantage of these advances regarding medical development in the coming years, the 13th Party Congress emphasized: “To promote the application of scientific-technical advances, information technology, digital technology in health examination and treatment to introduce electronic health books for the entire population”⁽⁷⁾ and “to develop online medical examination and treatment”⁽⁸⁾ both to perform professional tasks and to support and transfer skills, techniques and improve the qualifications for lower-level staff.

Preventive medicine

The migration resulted from the national renewal process in recent years, and changes in the disease structure pose a need for a more comprehensive orientation on preventive medicine. The Party advocated improving the capacity and operation method of this field to “timely forecast and take preventive measures to minimize the negative health impacts due to lifestyle changes, environmental and working conditions in the process of industrialization and modernization; to improve the capacity to monitor, detect and control epidemics, especially HIV/AIDS and emerging diseases”⁽⁹⁾.

The 13th Party Congress emphasized the rearrangement of preventive medicine centers: “To continue to arrange centers and units in charge of preventive medicine at provincial and central levels, forming a system of epidemics control centers which are synchronized at all levels and connected with the world disease control network”⁽¹⁰⁾. Establishing provincial disease control centers and district health centers is a significant policy of the Party to unify and reduce management focal points to minimize the overlapping between projects, programs, and plans and improve the quality of expertise in preventive medicine. Correctly identifying the risk factors of infectious diseases, especially the existence of the Covid-19 epidemic on community life, the Party offered a new perspective on long-term adaptation to the epidemic as a basis to determine the operational direction for preventive medicine: “To improve the quality of forecasting, monitoring, detecting, controlling and preventing major epidemics from occurring; to promptly responding to urgent problems, environmental incidents, ensuring medical security”⁽¹¹⁾. These urgent and timely views have helped Vietnam achieve the dual goals of preventing the Covid-19 pandemic and promoting socio-economic development in 2020 and 2021.

Health financing reform

Since 1989, the Party and State have implemented a policy that allows medical facilities to collect part of hospital fees to support hospital operations, replacing the previous free care policy. In addition, the Party has a policy of including “the cost of protecting the health of workers and public employees in wages... expanding health insurance and accident insurance”⁽¹²⁾, which was the basis for the health insurance introduction in 1992.

Observing medical examination and treatment activities, the Party found that a large part of the State budget allocated to health facilities was spent on salaries for medical staff, including prescribed salaries and allowances, without taking into account work performance, which has not created a motivation to improve work efficiency and has not fully taken into account the elements constituting service prices, making it difficult to reinvest in improving the hospital’s service quality and income of medical staff. Resolution No. 46-NQ/TW dated February 23, 2005 of the Politburo, “On the protection of, care for and improvement of people’s health in the new situation”, provides a breakthrough perspective on health financing reform. “To elaborate and implement an appropriate hospital fee policy based on correct and adequate calculation of direct patient service costs”⁽¹³⁾. The 12th National Party Congress (2016) mentioned that the implementation of the policy on a correct and adequate calculation of medical service prices must have “a roadmap, correct and complete calculation and ensure publicity and transparency; at the same time, provide appropriate support to policy beneficiaries, the poor, and the disadvantaged”(14). The 13th Party Congress emphasized: “To strongly reform health financing”⁽¹⁵⁾. The correct and adequate calculation of the price of medical services was not an increase in costs. The State had previously subsidized it, then included in the price to transfer the part of the State budget allocated to medical facilities to support people participating in health insurance (by 2020, the proportion of people participating in health insurance is 90.7%⁽¹⁶⁾. Poor, near-poor households, children under six years old, ethnic minorities, disabled people, and families under preferential treatment policy are given a free health insurance card or subsidized at least 70% of the health insurance fee.

Medical socialization

Resolution No. 04-NQ/HNTW (1993) laid the foundation for the policy of medical socialization: “To implement the motto ‘The State and the people work together, to diversify forms of health care organization (the State, the collective, the people), in which the State is the key, taking advantage of all available potentials in the country and expanding international cooperation”⁽¹⁷⁾. Implementing the above policy, the National Assembly Standing Committee issued the Ordinance on Private Medical and Pharmaceutical Practice (1993), creating a legal corridor to encourage the development of private medical and pharmaceutical establishments for individuals and organizations at home and abroad.

The Party identifies medical socialization as a development driving force: “To develop medical examination, treatment, and primary health care services of public and private healthcare. To pilot joint ventures between State and foreign medical facilities in both medicine and pharmacy”⁽¹⁸⁾; “The State creates favorable conditions for investment procedures; make incentive policies on taxes, land, to develop non-public medical facilities”⁽¹⁹⁾. This policy of the Party aims to take advantage of the financial, material, and technical strengths of non-state medical facilities to diversify types of medical services to serve the needs of medical examination and treatment of patients. The 13th Party Congress advocated: “To encourage public-private partnership, private investment, providing on-demand medical examination and treatment services”⁽²⁰⁾. At the same time, Congress also emphasized the need to improve the effectiveness of State management over health socialization: “To implement the right direction and effectively socialize in the health sector; to ensure equality between State healthcare and non-state healthcare”⁽²¹⁾.

Healthcare workers building

Regarding the training of healthcare workers, the policy of expanding the scale and diversifying training forms at medical schools is: “To reorganize the network, expand and upgrade the training facilities, meet the demand for health workers in accordance with the sector development planning”⁽²²⁾. In which there is an emphasis on the reform of training programs and contents, proactively approaching advanced medical training programs: “To basically and comprehensively innovate the training of medical staff, meeting the requirements of both medical ethics and expertise in the context of proactive international integration”⁽²³⁾ in order to realize the goal of achieving the ratio of 11 doctors per ten thousand people in the Socio-economic Development Strategy for the period of 2021-2030. In order to overcome the shortage of health workers at the grassroots level, the 13th Party Congress determined that it was necessary to rotate staff, re-plan the health network, and arrange staff at all levels: “To increase the training, retraining, rotation of medical staff and technical transfer to lower levels”⁽²⁴⁾. The remuneration policy is one of the solutions that need to be considered in accordance with the professional characteristics so that medical staff can work and contribute at their best: “To determine the starting salary level following the training period. To have attractive enough policies to encourage qualified people to work at grassroots health care... and in the fields of preventive medicine, forensic medicine, mental health, tuberculosis, leprosy...”⁽²⁵⁾.

2. Performance results

The grassroots health network has been organized nationwide with 947 district health facilities (hospitals, regional polyclinics, maternity wards) and 11,100 commune health stations⁽²⁶⁾. About 90% of commune health stations have doctors working, 99.7% of communes have health stations, and 76% of communes meet the national criteria for commune health⁽²⁷⁾, contributing to improving the quality of health care for the people at the grassroots. During the Covid-19 pandemic, medical centers and health stations of communes, wards and townships have done a good job of receiving and accommodating Covid-19 patients, directing the community Covid team, tracing F0, F1, F2, firmly grasping the locality, controlling population changes to detect and promptly isolate infected patients so as to prevent the disease spreading widely in the community.

Secondly, medical examination and treatment at medical facilities are getting better and better, meeting the people’s health care needs. The number of patients coming to medical facilities for medical examination and treatment has steadily increased over the years. Many central hospitals can perform regional and international techniques. Provincial and district hospitals have gradually mastered high technology, helping to treat some complex cases without transferring patients to upper-level hospitals⁽²⁸⁾.

Thirdly, preventive medicine has made remarkable changes. National target programs on health and disease prevention have been effectively implemented. Implementing Resolution No. 20-NQ/TW, preventive medicine centers were rearranged. In 2020, 2021, the field of preventive medicine has left a clear trace in the prevention and control of the Covid-19 pandemic to protect people’s health and life while successfully realizing the dual goals of the Party and the Government.

Fourthly, the implementation of the policy of reforming health finance in the health sector has transformed significantly. The correct and adequate calculation of health service prices has contributed to implementing the policy of transferring recurrent expenditures from the state budget to health facilities to support people to participate in health insurance to help them pay for their health care services. At the same time, hospitals have financial resources to invest in their facilities and to increase income for medical staff⁽²⁹⁾.

Fifthly, the socialization of health care has focused on hospitals and shifted to preventive health. The public-private partnership model has been expanded. The private healthcare sector thrived, from 102 hospitals (in 2010) to 231 hospitals in 2019 (accounting for 19.3% of the total number of hospitals in the country), significantly contributing to the provision of medical services⁽³⁰⁾.

Sixthly, the training, retraining, and rotation of staff and the State’s encouragement and support policies have contributed to the rapid increase in the quantity and quality of the medical staff. In 2003, there were 241,498⁽³¹⁾ health workers in the health sector, by 2010 there were 344,876⁽³²⁾, by 2018 the number increased to 472,558⁽³³⁾; the number of doctors increased from 25,300 in 1996⁽³⁴⁾ to 96,200 in 2020, reaching the ratio of 8.8 doctors to ten thousand people⁽³⁵⁾.

However, protecting and taking care of people’s health still has some limitations and shortcomings. Specifically: (1) The grassroots health care network is extensive, but its operational efficiency is not high, and it has not responded to the changes in disease patterns. (2) The quality of medical examination and treatment has not yet met the increasing and diverse needs of the people; The problem of people’s skipping lower-level hospitals to be treated at upper-level hospitals which leads to the overcrowding in some central hospitals in big cities has not been entirely resolved. (3) The preventive health system is unstable and inconsistent, affecting the effective use of health resources, and reducing the ability to provide integrated, comprehensive, and continuous services; some infectious diseases have not been completely controlled. (4) There has not been adequate investment in public health development and disease prevention, primary health care and health care in areas of difficulties. (5) State management of medical socialization is still limited. Some people, accordingly, take advantage of the policy of medical socialization to make profit and violate the law. (6) The quantity and quality of health workers are unevenly distributed among regions and levels, between medical examination and treatment and preventive medicine⁽³⁶⁾.

3. Some solutions to improve the effectiveness of the protection of and care for people’s health

Firstly, awareness of the Party committees, authorities, agencies, mass organizations, and the people about the care, protection and improvement of people’s health should be raised.

The health sector needs to be well acknowledged that it provides services and performs a humanitarian act for the life and well-being of each individual, for the happiness of each family and of the whole society. Protecting, caring for and promoting health is not just the responsibility of the health sector itself, but of the entire political system and the people. Therefore, it is necessary to continue to raise to people and organizations’ awareness and launch the publicity of health work through various forms of communication.

Secondly, thoroughly grasp and well implement the Resolution of the 13th National Party Congress on the protection of, care for and improvement of people’s health.

When applying the Party’s viewpoints in formulating guidelines, plans, and projects on people’s health care work, party committees at all levels, authorities, and the health sector need to start from practical conditions to develop short, medium, and long-term goals. In leadership work, all levels of committees and the health sector must consider the issues that need to be prioritized and deal with those that need a long-term strategy to avoid subjective and hasty actions.

Thirdly, the efficiency of State management over health should be improved.

The efficiency of management should be improved to establish an appropriate mechanism and create an effective operating environment for medical entities, and at the same time, regulate and strictly handle violations of the law in the field of health care. Governments at all levels should strengthen their guiding role in planning, managing and regulating programs and projects in each phase in accordance with local development requirements.

Fourthly, all areas in people’s health care work should be implemented synchronously and effectively.

The grassroots health system should be invested in and built in a streamlined and efficient way, ensuring uniform and consistent direction in terms of medical expertise and professionalism and appropriate support policies to devote wholeheartedly to their work.

Hospitals should be developed towards universalization, specialization and international integration; the working attitude, customer service and communication skills of medical staff should be improved.

The motto that prevention is better than cure should be well implemented; health finance should be continuously reformed; the local budget on preventive medicine should be increased following Resolution No. 20-NQ/TW (2017) of the Party. Health care targets should be included in the annual socio-economic development program.

The staff training, retraining, and fostering should be expanded to overcome the shortage in quantity and quality of health workers; this should be attached with reforms in remuneration policies for health workers. Individuals and organizations should be encouraged to participate in supervision and criticism in the development of guidelines and mechanisms on medical socialization; the work of medical socialization in preventive medicine and grassroots health care construction should be promoted.

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Endnotes:

(1), (6), (17) CPV: Complete Party Documents, Vol.52, National Political Publishing House, Hanoi, 2007, pp.525, 523, 523.

(2) CPV: Complete Party Documents, Vol.61, Truth National Political Publishing House, Hanoi, 2016, p.76.

(3), (23), (25) CPV: Documents of the Sixth Plenum of the 12th Party Central Committee, National Political Publishing House, Hanoi, 2017, pp.143, 147-148, 148.

(4), (5), (7), (8), (10), (11), (15), (20), (21) CPV: Documents of the 13th National Party Congress, Vol.1 , Truth National Political Publishing House, Hanoi, 2021, pp.266, 268, 267, 151, 267, 268, 137, 267, 151.

(9), (13), (19), (22) CPV: Complete Party Documents, Vol.64, National Political Publishing House, Hanoi, 2016, pp.140, 142, 145, 143-144.

(12), (18) CPV: Document of the National Congresses in the reform era (6th, 7th, 8th, 9th, 10th and 11th National Congresses), National Political Publishing House, Hanoi, 2013, pp.267, 419.

(14) CPV: Documents of the 12th National Party Congress, National Political Publishing House, Hanoi, 2016, pp.302-303.

(16), (24) CPV: Documents of the 13th National Party Congress, Vol.2, National Political Publishing House, Hanoi, 2021, pp.48, 137.

(26) Ministry of Health: Health Statistical Yearbook, Medical Publishing House, Hanoi, 2020, p.52.

(27), (28), (29), (30), (36) Ministry of Health: Report No. 1611/BC-BYT dated December 31, 2019, Summary of health work in 2019 and tasks and key solutions in 2020, Hanoi, 2019, pp.4, 5, 12, 16, 17.

(31) Ministry of Health: General report on overview of the health sector in 2009 - JAHR 2009, Hanoi, 2009, p.49.

(32) Ministry of Health: Health Statistical Yearbook 2010, Medical Publishing House, Hanoi, 2011, p.51.

(33) Ministry of Health: Medical Statistical Yearbook.

(34) Ministry of Health: General report on overview of the health sector in 2007 - JAHR 2008, Hanoi, 2008, p.36.

(35) General Statistics Office of Vietnam: Statistical Yearbook 2020, Statistical Publishing House, Hanoi, 2021, p.836.

MA. DO THI NHUONG

University of Medicine and Pharmacy, Thai Nguyen University