No country can achieve universal health coverage and health-related Sustainable Development Goals without a strong primary health care. And Viet Nam is no exception.
As defined in the Alma Ata Declaration in 1978, primary health care is essential health care that is affordable and accessible to individuals and families throughout the course of their lives. Last year’s 40th anniversary of the Declaration renewed this global commitment for countries to strengthen their primary health care systems. Primary health care is the first point of contact within the health care system for individuals and communities and is critical to ensuring health for all. Global evidence shows that primary health care is the most cost-effective way to deliver health services and the only way to realize equity in health.
Over the past decades, the grassroots health care network in Viet Nam, consisting of district and commune health centers, has been the foundation for delivering timely and affordable primary care to individuals and their families, right in the community where they live. This system, including 11 000 commune health centers, operated based on the well understood wisdom that “prevention is better than cure” and has contributed to containing outbreaks, maintaining and improving health status of Vietnamese people –even during times when the country’s economic conditions were extremely limited. The grassroots health care system therefore has been the pride of the country.
However, together with the country’s rapid social and economic change, Viet Nam now faces new health challenges. Severe climate change, air pollution and environment degradation, smoking and drinking coupled with sedentary life style, lack of physical exercise – all of these are posing risks to health and have become causes of increasing chronic diseases. The health service delivery system has also changed. Lots of investment, as well as patients, are drawn to hospitals, making them overcrowded, while leaving the primary care system under-resourced and under-utilized. In addition, Viet Nam’s rapid population ageing means that increased numbers of older patients will require health care from the hospitals if primary care system cannot accommodate the patients effectively. Thus, health care becomes costly for both families and the economy.
In these new circumstances, Viet Nam will need to reorient its health system to address these challenges and redesign the way in which services are delivered to secure essential public health functions and re-establish a strong primary health care system.
And the Government of Viet Nam recognizes the challenges. The recent Party Resolution 20 reconfirmed its view that “investment in people’s health care and protection is investment in development.” The Resolution also pointed out how Viet Nam would be able to realize universal health coverage (UHC) even with limited resources: by prioritizing the government budget for “prevention, grassroots health care, and hospitals in disadvantaged and remote areas.”
I believe Viet Nam will rise to this challenge, but it will require continued strong government leadership and commitment, as well as multi-sectoral actions. It will also require engagement of each and every one of its citizens to take responsibility for their own health and to lead a healthier lifestyle. With more investment in primary health care and collective actions, we can make UHC a reality in Viet Nam.
Dr Kidong Park, WHO Representative in Viet Nam
Hanoi, 7 April 2019