Vietnam
I. Background
The health care delivery system is a pyramid network designed to provide increasingly sophisticated levels of curative care and preventive services at the different administrative levels within a province. In the country there are four administrative levels: national, provincial, district and communal. Vietnam has 53 provinces, 567 districts, 10,024 communes and an estimated 80,000-100,000 villages/hamlets, and has developed 53 provincial general hospitals, 550 district health centers, 930 inter-communal polyclinics and 9,243 Commune Health Centers. There are 600 communes with no structures but with resident health workers. The government has launched a three year program to white out these blank communes.
The preventive structure- The Hygiene and Epidemiology Network-connects the national level to district stations and to the recently established Provincial Maternal and Child Health Centers. There are a large number of vertical national programs whose principal objective is the protection of the health of the population. However, recent reviews of primary health care (PHC) strengthening needs in Vietnam recognized that, although designed for both curative and preventive health care, the planning and delivery of health services in Vietnam is primarily curative oriented.
II. Main Objectives
□Orient health staff and managers to acceleration of process to strengthen primary health care through community mobilization
□Orient People's Committees and managers of non-health sectoral programs to the needs for strengthening PHCs, focusing on preventive health care and community mobilization
□Upgrade existing capacity of community-based mass organizations to deliver education and information on appropriate family health care. This would include such elements as timely care, and linkages between public health systems and the rational use of drugs
□Develop capacity of mass organizations to mobilize families for community-based preventive health care activities, and to increase use of preventive mother-child health services
□Orient participating communities to the Bamako Initiative approach to PHC strengthening; reorient the management and service delivery system to commune-level health services; adjust the terms of reference used by Commune PHC Management Committees
□Strengthen and develop community organizations for community mobilization
□Increase ability of grassroots health workers to diagnose common health conditions and provide adequate treatment
III. Achievements Against Objectives to Date
□Intersectoral meetings took place between all line ministries, branches and organizations to discuss and develop materials for social mobilization in the name of public health care.
□Guidelines were developed for strengthening PHC committees at different levels.
□Project site training materials on community mobilization were developed for PHC Committee members.
□A baseline survey was carried out in selected provinces and districts.
□A manual, Guidelines on Essential Drugs for Treatment of Common Diseases at Community Level, was developed.
□1,576 community health workers participated in 43 training courses on rational drug usage and treatment of common diseases at the community level.
□600 members of PHC committees or community development committees participated in ten training courses on methodologies in intersectoral collaboration.
□The training received by community health volunteers on basic preventive health care and standards of family health, in collaboration with non-related sectors, will be transmitted to families and community interest groups.
IV. Problems and Constraints Experienced During Implementation
□Management capacity of health workers low
□Irregular supervisions of activities
□Poor knowledge and skills of health workers at local/periphery level
□Weak information and financial management
V. Lessons Learned From Project Implementation
□The plan of action must be very clear and as detailed as possible, especially for those activities with intersectoral links. The responsibilities of different line ministries, branches and mass organizations have to be clearly defined.
□Baseline surveys can be carried out in a more cost effective manner by using existing data collection systems at all levels. In-depth interviews should use cluster random sampling in large project areas at the start of simultaneous project implementation.
VI. Issues that Need Discussion and Resolution
□Planning
□Integration of services (i.e. health and nutrition)
□Improvement of service quality
□Supervision and monitoring
□Health inspection
VII. Future Plans
□Baseline surveys to be conducted
□Social mobilization
・ Distribution of social mobilization and family health guidelines for 1994-95 districts
・ Orientation training for non-health members of PHC committees of 1994-95 areas
・ Health education and communication activities in 1994-95 areas
・ Establishment/strengthening of network of volunteer community health workers at the commune level
・ Intersectoral workshops on social mobilization at project areas to be conducted
□Capacity building
・ Reproduction of training material
・ Training in essential drugs for community health workers
・ Increased monitoring and supervision activities, emphasizing service quality and financial record keeping (particularly of revolving drug fund revenues)
・ Training in basic primary health care, planning and management for community health center chiefs
・ Organized districts to be categorized and information/experience exchanges initiated
・ Orientation packages for People's Committees, community interest groups and families to be developed on the Bamako Initiative approach to strengthening public health care, and reviewed by the health sector for coherence
VI. Recommendations
□Basic equipment should be considered an important component for improving the quality of services, and Bamako Initiative projects should hold that as an end objective.
□Domestic and international information and experience exchanges should be considered as a means of training for managerial terms at various levels.
