Download - The process of composing the Strategy

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National Strategy National Strategy For the Protection, Care and Improvement For the Protection, Care and Improvement of People’s Health for the 2011-2020 periodof People’s Health for the 2011-2020 period

and Vision to 2030and Vision to 2030

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The process of composing the Strategy

• Ministry of Health (MOH) established the Steering Committee and Strategy Drafting Committee (April 2010) • The Strategy Drafting Committee make a draft of the Strategy based on:

• Analysis and assessment of the implementation of the Strategy 2001-2010 • The Joint Annual Health Report, and reports from other related departments • Intergration with the 5-year plan in Health sector 2011-2020. Consultancy from • Leaders of MOH• Other relevant departments, administrations, investigation groups (2 rounds) • Experts • Related ministries and departments

• Meeting on Draft 3 (in Vinh Phuc province – 12th April, 2010), chaired by Minister of MOH• Comments from other departments within MOH (Draft 4)• DPF presented the Draft 5 at the meeting on 20th April, 2011 chaird by Mme. Nguyen Thi Kim Tien, Vice minister of MOH • DPF got comments from relevant departments (round 3) and consolidated all comments at the meeting on 20th April, 2011, making Draft 6 • Organized a meeting with 3 provinces and related departments at Do Son on 6-7 th May, 2011, Strategy Drafting Committee meeting on 12th and 18th May, then sent to DPs on 20th May, 2011 • Publish the Strategy on Government’s website (23rd May to 23rd July), received comments from DPs (20th to 28th May)

Structure of the Strategy

PART I: ASSESSMENT OF THE IMPLEMENTION OF STRATEGY IN THE 2001-2010 PERIOD:

(according to WHO’s structure: 6 building block) People’s health status Health service provision

Preventive medicine Examination, treatment and habilitation service provision Family, population planning and reproductive health

Human resources in health Health information system Pharmaceuticals, vaccines and blood Medical equipment and technology Health financing Health system governance

PART 2: NATIONAL STRATEGY FOR THE PERIOD 2011-2015 Forcast of epidemic diseases and health determinants

Forecast of epidemic diseases and disease patterns Forecast of health determinants

Development viewpoint Principles of composing the Strategy (sent to Prime

Minister) Objectives Main targets Solutions Implementation

ASSESSMENT OF THE IMPLEMENTION OF STRATEGY

1. People’s health status until 2010

Achievements:

Average life expectancy: 72.8 years old / Target: 72 years old.

Infant mortality rate: <16.0‰ (Target: 16.0‰ )

Under-five mortality rate: 23,3 %o (Target 25%o)

Maternal mortality 69 per 100 000 live births (2009), Target: 70/ 2010

Under-five child malnutrition rate: 18% (Target: <20%)

Difficulties and Challenges:

There is a considerable disparity in people's health status across regions.

There is a major number of Vietnamese children die every year

Child malnutrition is still higher than that in regional countries. Stunting rate remains serious at 31%.

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2. Health service provision

2.1. Preventive medicine

Achievements A wide network of preventive medicine from the central to village

level; Infrastructure, human resources, budget for the preventive care activities have also been strengthened

Most of targets related to preventive medicine have been achieved.

Difficulties and Challenges Health risk factors are prevalent Understanding and behavior of the people on protection and

promotion of health remains weak Participation of the people, mass and social organizations is

limited Incentive policy for preventive workers is not satisfied. Forecasting capacity is limited.

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2.2. Examination, treatment and habilitation service provision

Achievements

- Health examination and treatment networkk has been expanded and strengthened

- Health service has been improved and Many modern techniques have been applied successfully.

- Many kinds of health service have been applied effectively.

- Number of patient bed per 10 000 inhabitants in 2010 is at 20.5 beds

- Access to health care services of the poor and the government preferential policy beneficiaries has been increased.

Difficulties and Challenges

- Health service provision capacity is still weak.

- Bypassing is relatively prevalent, which leads to overcrowding in high level facilities

- There exists difference in access to quality health care services between income groups and across regions

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- Management of health care quality is facing difficulties and challenges.

- The risk of abusing medical technologies or drugs in some facilities remains high.

- There are many prolems relating to mechanism.

2.3. Family, population planning and reproductive health

Achievements

- Vietnam has achieved the replacement fertility rate and maintained this population growth rate over many years

- The health examination and treatment network is strengthened and developed


- Pre-marital health check-up, ante-natal screening and neonatal screening services are not expanded

- The service quality remains poor, especially in remote, isolated areas and ethnic minorities

- Imbalance in sex ratio at birth gets more serious

- The risk of high fertility rate may occurs in some locals.

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3. Human resources in health

Achievements

- The number of health human resource has increased over years. Vietnam ranks in the top rows among countries for high health workforce ratio to 10,000 inhabitants

- Quality of health workforce has been improved, many medical categories have been formulated


- There exists imbalance structure and distribution of health workforce.

- Qualifications of teachers, methods and teaching facilities are inadequate and poor, and very field practice is applied

- Quality control system for training seems inadequate and ineffective

- Health workforce management is ineffective. Planning for training and use of health workforce is facing huge difficulties

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4. Health information system

Achievements Health information work has shown considerable improvements and

many legal policies in health information have been Many channels of information collection are explored There are diverse information sources

Difficulties and Challenges Information is not up-to-date Quality of information is limited There is no policy, orientation and health information system

development plan available. Information of some areas is not available Many information sources do not have dissemination mechanism, so it

is not easy to access Limited knowledge in data analysis, assessment and forecast

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5. Pharmaceuticals, medical equipment and civil work

5.1. Pharmaceuticals, vaccines and blood

Achievements

- Ensure sufficient provision of quality drugs

- Regulations on drug quality is reviewed and revised to gradually integrate into regional and global standards

- Many conventional drugs are used and proved to be very effective.


- Imported drugs are prevalent.

- Vietnam had to import 90% of active substances to produce local drugs - The administration and control of drug prices in Vietnam market remains a

big challenge

- Purchase of drugs for self-medication is very common as regulation for drug sale over prescription is not strictly followed.

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5. Pharmaceuticals, medical equipment and civil work

5.2. Medical equipment and technology

Achievements Considerable investment in and upgrading of medical equipment has been

made in recent years (from such sources as Government budget, ODA, and others)

Modern equipment is available Develop and issue 135 sector standards and 35 Vietnam standards for

medical device. The system of production, business and import-export of medical equipment

has been expanded

Difficulties and Challenges High risk of abusing investment leads to limited efficiency Standardized audit, warranty and preventive and corrective maintenance is

almost neglected by health facilities Lack of comprehensive investment

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6. Health financing

Achievements

- Total spending in state budget for health increases rapidly

- The state budget is used to support health insurance for the poor and for children under 6 years old.

- The proportion of public share out of total expenditure on health increases obviously

- People are given the right to make their own decisions

- Health insurance coverage, especially Health insurance for the poor in community has come into practice.


- The state budget spending for health care remains insufficient.

- Imbalance of budget allocation between prevention and cure.

- There is no effective measures to control health care costs

- Payment mechanism is still limited

- The application of co-payment mechanism in health insurance for the poor decreases accessibility to health care services

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7. Health system governance

Achievements

- Many health policies have been timely revised and supplemented.

- The organizational structure of health delivery system has been completed and stabilized

- Health inspection system has been strengthened


- Many health policies are delayed for reform

- Policy implementation is not appropriate

- The development, issuance of technical standards to manage health care quality is not fully implemented

- Organization of local health system is not appropriate

- In health insurance, lack of a full-time unit responsible for the state management of health insurance at provincial and a lack of professionalism of health insurance implementing agencies.

- Health inspection, check-up and fail to meet up requirements for state management of health

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No Targets 2001 Performance

2010 Target

(Decision No.35/TTg)

2010 Performance

1 Life expectancy 68 71 73

2 Reductions in fertility rate (p1000)

0,2 0,2

3 MMR/100.000 95 70 68

4 Under 1 MR 35 < 25 < 16

5 Under 5 MR 42 32 25/2009

6 LBW <2,500g (%) 7,1 6,0 5,1

Health performance based on Health indicators (according to Decision No.35/2001/QD-TTg)


2010 Target


2010 Performance

7 Under 5 malnutrition (%) 31,9 <20 18

8 Fully vaccinated 97

(6 vaccines)

> 95 > 95

(7 vaccines)

9 % of commune have physician 56,3 80 80

10 % Communes with midwives or Ob/Ped. Ass. Doctors

88,1 > 95 95

11 % Village have health worker 77,4 85 90

12 Doctor/10,000 pop. 4 4,5 7


2010 Target


2010 Performance

13 Pharmacist/10,000 pop. 0,38 1 1,2

14 No. of Government beds/10,000 > 20,5 20,5

In which: Beds not included in the public sector

2,0 0,76

15 No of communes meet the national standards

0 80 80

* Eradication of Poliomyelitis Eradicated Eradicated Eradicated

* Eradication of Tetanus Eradicated Eradicated Eradicated

* Eradication of Leprosy Eradicated Eradicated Eradicated

Causes

1. The implementation of party and government policies of staff, sectors and organizations at central and some provinces/cities is slow, the instructions for implementation are not specific enough

2. Awareness of the health sector performance is unclear and inconsistent. The viewpoint that investing in health is the investment for development is not strictly followed and done

3. Failure to translate the stewardship into specific policies as indicated on the resolution 46/TW "Health care work is a special occupation, and health workers should be recruited, trained, used with special treatment".

4. Health system organization and structure is inconsistent, unstable and unsuitable, especially the grassroots level

5. Social mobilization for health has been promoted, but it has not met the demand for protection, care and improvement of people's health

6. Information, education and communication for behaviour change has been innovated but sill below requirement

Forecast

Forecast of epidemic diseases and disease patterns Forecast of health determinants:

Social-economic factors( living standard, life-style, evils…) Population-related factors Industrialization and urbanization Climate change Environmental health Lifestyle-related factors .

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Content of Draft Strategy

Development viewpoint: 1. Health is the most precious treasure of mankind and entire

society; Health care service is a special societal service and health examination and treatment is a not-for-profit activity. Investing in health is the investment for development, which reflects the humanitarian nature of the society.

2. Reform and improvement of a health care system toward Equity-Efficienct-Devellopment, securing social security. All people, especially the poor, ethnic minorities, children under-six, target policy groups, people living in underpriviliged, remote, isolated areas and vulnerable groups are entitled to accessing basic and quality health care services.

3. The cause of protection, care and improvement of people's health is the duty of everybody, every family and community; it is also the responsibility of Ministries, sectors, party committees, authoritiesm fatherland fronts, mass organization and civil society, where the health sector play a key role in technical and clinical care.

4. The state holds a decisive role macro management, orienting the development for the protection, care and improvement of people's health through a statutory and policy system; the state governs, allocates resources and manages service price and quality. Promotion of social mobilization for health, development of non-public sector, strengthening public-private partnership to mobilize resources for health accompanied by rapid increase in the state budget for health. Giving priority to preventive medicine, basic care and primary health care. Combine modern and traditional medicine, civil and military medicine and strengthen collaboration in health work with other sectors. Accelerate the process of modernization in health, development of basic and specialty medicines.


5. Complete the socialist-oriented market economy in health care activities, reforming operation mechanism and health financing in public institutions and accompanied by rationalizing the roadmap toward universal health insurance.

6. Control population size and improve quality of population to assure sustainable socio-economic and environment development.


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GOAL:

To ensure all people get primary health care services, expanding access to and use of quality health care services. People live in a safe community that promotes their physical and spiritual development. To reduce morbidity, enhance well-being, increase life expectancy and improve quality of the population

1. Reduce morbidity, mortality and disability; contain infectious diseases, keep common diseases and emerging diseases under control. Maintain achievements in polio eradication, eradicate neonatal tetanus, measles, and expanding use of vaccines to prevent other diseases. Limit and gradually control risk factors of non-communicable diseases, school health problems, environment, lifestyle and behavior-induced diseases, food safety and hygiene, nutrition. Promote comprehensive health care activities with a focus on positive and proactive prevention and, screening for early detection and prompt treatment of diseases

2. To improve quality of health examination and treatment services, and rehabilitation at all levels; reduce hospital overcrowding in high level facilities. Accelerate the development of specialty medicine and basic medicine, expanding curative care services for the grassroots level. To strengthen combined traditional and modern medicine, preventive and curative care. To promote private sector, or non-public sector, and public-private partnership

Specific objectives

Specific objectives

3. To improve quality of the population, maintain fertility rate at appropriate low level, meeting the needs for family planning of the people, increasing access to quality reproductive health care services, control sex ratio at birth; strengthen integration of population elements to policy-making and socio-economic development at various levels and sectors.

4. To promote development of human resource for health both quantity and quality, develop health workforce with high skills; strengthen health workforce to work in rural, mountainous, remote and isolated areas, and some specialties (para-clinical, preventive medicine, pediatric care and health communication and counseling…). Assure balance between training and use of human resource

Specific objectives

5. To reform operational mechanism, health financing, increase public investment in health, promote universal health insurance, adjust and effectively use financial resources.

6. To ensure sufficient drug supplies, vaccines, biomedical products and medical equipment with quality and reasonable price in response to the need for disease prevention, and treatment; manage and use of drugs and equipment in a rational, safe and effective way.

7. To improve capacity for management, complete the legislation system, health policy, promote administrative reform and develop health information

No Input indicators In 2010

In 2015

In 2020

1 Number of doctor/10,000 inhabitants 7.0 8.0 9.0

2 Number of pharmacist/10,000 inhabitants 1.2 1.8 2.2

3 Villages with active VHW (%) 85 90 >90

4 Commune with doctor (%) 70 80 90

5 Commune with midwife or assistant doctor in obstetric and pediatric care (%)

> 95 > 95 >95

6 Number of doctor/10,000 inhabitants 20.5 23.0 25.0

In which: Non-public beds 0.76 1.5 2.0

No Implementation indicators In 2010 In 2015 In 20207 Fully vaccinated infants (%) >95

(7 VX)

>90

(8 VX)

>90

(10 VX)

8 % of commune achieving new national benchmark for commune health

80

(2001-2010)

60

(2011-2020)

80

(2011-2020)

9 Health insurance coverage (%) 60 70 > 80

10 Proportion of health examination and treatment by combined traditional and modern medicine

14 20 25

11 Proportion of solid medical waste treated

75 85 90

No Output Indicators Year

2010

Year 2015

Year 2020

12 Life expectancy at birth (years) 73.0 74.0 75.0

13 MMR (p100,000 live births) 68.0 58.3 52.0

14 IMR (p1,000 live births) <16 14.0 11.0

15 U-5MR (p1,000 live births) 25 19.3 16.0

16 Size of population (million inhabitants) 86.9 93.0 98.0

17 Population growth rate reduction %o 0.20 0.20 0.20

18 Population growth rate (%) 1.03 1.00 1.00

19 Sex ratio at birth (boys/100 girls) 111 113 115

20 Under-five child malnutrition rate (weight for age) (%)

18.0 15.0 12.0

21 HIV AIDS prevalence in the community <0.3 <0.3 <0.3

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Main Solutions:

1. Strengthening the organizational apparatus

2. Promoting preventive medicine and HIV/AIDS control, food safety and hygiene, health promotion

3. Health examination and treatment and rehabilitation

4. Population-family planning and reproductive health care

5. Human resource development

6. Science-technology development

7. Financing and investment

8. Pharmaceuticals, medical equipment and infrastructure

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Main Solutions:

9. Health Information

10. Information- education and communication

11. Strengthening the state management in health

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ORGANIZATIONS OF IMPLEMENTATION

1. The Ministry of Health

2. The Ministry of Planning and Investment, Ministry of Finance

3. The Ministry of Home Affairs

4. The Ministry of Labor

5. The Ministry of Education and Training

6. Vietnam Social Securities

7. The Ministry of Natural Resources and Environment

8. The Ministry of Transportation

9. The Ministry of Agriculture and Rural Development

10. Relevant Ministries,

Issues need to be discussed:

1. What kinds of activities need to be maintained and developed.

- Network/ Organization- Activities- Programs and projects- Issues need to be renovated

2. Operating & finance (including value of the health’s services) Health Insurance Communication of sexual health education.

3. The issues need to be focused to develop

- Quality of service

- Staff capacity (manage, major)

- Applying IT staff

(6 building block, activities need to be maintained, innovated, to be created breakout)

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The draft strategy (Version 6) was updated, prepared & added more than 50 times (10 times

for each versions) by ideas of departments in MOH and specialists of Ministries, Departments.

Thanks for your attention!