CLOSING REMARKS
By Professor Le Van Truyen, Vice-Minister of Health of Vietnam:
I would like to use this opportunity to thank very much the representatives of the Nippon Foundation and all of our guests and friends coming from the neighboring countries.
I would like to say some words about my thinking about the reasons for the success of the RDF program of Vietnam.
At the beginning , there was some trouble. Now we have an exact definition about what kind of organization is the RDF; we now divide the organization into two kinds: profit organization and non-profit organization. Every sector has its own regulations and mechanisms.
I think that the public sector and public organizations are non-profit, but regarding a profit organization, we have to talk about profit, the margin. In some communes, officials went to the RDF and asked for payment of taxes; because there was talk about profit , they expected tax revenues. Profit-oriented organizations have to pay tax to the community.
I think that RDF is a kind of organization between profit organizations and non-profit organizations. After making that definition, we had to elaborate on the regulations to run this organization, because untill then we didn't have the regulations for this kind of organization. And we had to elaborate on the mechanism to run this very specific kind of organization. The Ministry of Health had to collaborate with government offices, with the Ministry of Finance and the Ministry of Planning and Investment to arrive at an exact definition, and then to elaborate on the regulations and mechanisms for running this type of organization. This is why you can see the minister of finance ordering tax officers to impose 10% taxes on about 3,000 community health centers. We have inter-ministerial circulars about regulations for running the RDF.
For example, in Vietnam, the Ministry of Finance has the obligation to give us instructions concerning profit margins and how we handle the margins; the margin has to be divided among different allocations. And so after two years, we have an on-off [...] to run the RDF safely. If not, there would be so much trouble. I think that this shows the government's commitment to this project. Without this governmental commitment, the RDF would be very difficult to run. I thing that is the main lesson learned by the Ministry of Health for running RDFs and keeping them sustainable.
Thank you very much.
By Reizo Utagawa, Managing Trustee of The Nippon Foundation:
I have learned many things from this conference. I would like to share with you my observations and to say a final few words.
1. Before I say anything else, I want to make clear that I still believe that this has been a graduation exercise. Indeed, my conviction that the various country projects are now “in orbit" was strengthened over these last two days. But I will go into that more deeply later.
2. The supposed "RDF Model" is at first glance deceptively simple. In fact, it is not at all clear even at the theoretical level. Is an RDF supposed to revolve forever? Inevitably, outside factors will make it converge to zero.
3. I think that the concept of revolving drug funds is over-rated. It is dangerous for public health officials and experts to stick to it so closely because it can lead to misunderstanding.
4. RDFs are the center of the Bamako Initiative, which was an experiment in Sub-Saharan Africa. We know that the African RDFs have had, in fact, mixed results. Yes, there have been great successes, but there have also been dramatic failures. We should expect the same range of possibilities here in Asia, and we have to put all outcomes in the proper perspective.
5. During the presentations, every reporter had trouble explaining his or her activities and connecting those activities to revolving drug funds. We cannot think that the revolution of drug funds is the central purpose. We must remember that the purpose is to boost public health care.
6. If an RDF revolves only a few times, that is OKAY, as long as the process of implementation provides an entry point into developing health care systems. In fact, we should stop referrnig to these activities as the "Revolving Drug Fund Project." In would be more appropriate to call it something like the "Structural Impediments in Health Care Initiative."
7. This brings me back to the idea of graduation. The countries here are now clearly asking the right questions regarding the development of public health care. In this sense, they have been successfully "launched."
In conclusion, I would like to emphasize that the Nippon Foundation is fully aware that the professionals in this room and the organizations they represent have made every effort to improve health care in their respective countries. The Foundation has great respect for your complete dedication in spite of the difficulties of your work. For this reason, though the Nippon Foundation cannot influence the paths of launched satellites, we will, with heart, be carefully watching the progress of each.
Thank you.
By Dr. Takusei Umenai, Chairman of the EDP Committee:
We are dealing with drugs. Good medicine is sometimes bitter. Good medicine becomes really good medicine, depending on how it is used. Sometimes it becomes poisonous. We can know this from the comment by the vice-minister of health of Vietnam, Dr. Truyen. Everything is included in his comment; Vietnam is really cautiously prepared to initiate and launch this RDF in this country.
One issue is whether the initiative should center on a profit organization or non-profit. Instead of using organizations, I would use the word business. This concept of business was introduced to public health for first time through RDFs. This is what Dr. Lee mentioned concerning small business or non-profit busniess. A sense of business, this expertise-such a system is quite important now for the future of public health system development.
A second issue, particularly relevant to primary health care so far, is community participation. Yes, there are many ways of approaching community participation, but the most important way now is perhaps the demonstration of business by the community. This is concrete evidence, an example of community participation. This is my perception.
Thirdly, we looked at the sustainability of the system though this experience of running RDFs at the community level. In Vietnam, it terms of finance, in terms of drug management, it became sustainable at the community level. There's evidence for that. But what is the situation at the government level? The government committed itself to getting a loan from the World Bank. This is one example of commitment at the government level. At the beginning, they needed donor support, but after a certain number of years of running pilot projects, the government has now decided to get a loan. This is a very important government commitment and is related to sustainability.
Based on such a core development, we have to look to the new health system. In 1990, when I was at WHO Geneva, the director general of WHO mentioned a new health paradigm, but the idea disappearde after that. Since then I have always continued to think of what the new health paradigm might be. Now I have an idea. This is a key development on which we can look to a new health paradigm. This is my perception and understanding about the development of this program.
My response to Mr. Utagawa's comment is that we can take it positively, neutrally or negatively, depending on ourselves. He is still positive, which is very good and something I am very happy to hear.
Now, as the chairman of technical advisory group to the Nippon Foundation, I am preparing for the next step: how to get a global consensus on a new health paradigm. We have to now prepare to produce the new concept and then take action, like a meeting or whatever, to get a global consensus on a new health paradigm.
In being able to say these thing, I think really this meeting-not only the meeting but also the project-was very successful. Of course there are different levels and kinds of success among the different countries. Still, overall, it was really successful. This is my understanding.
And so, in a positive atmosphere and looknig to a positive future, I close this meeting officially. I extend my sincere appreciation to the participants from many countries, to UNICEF and WHO, to the Ministry of Health of Vietnam, to my colleagues from the university, to the Nippon Foundation, and of course to MSH.
Thank you very much.
