Viet Nam has long been recognized and commended for its strong grassroots health network. The country’s remarkable achievements such as reaching the health-related MDGs (Millennium Development Goals), and the significant increase in average life expectancy over the last 10 years can be attributed to the services provided through this network.
However, Viet Nam is now facing new challenges such as an ageing population, the rise of non-communicable diseases, persistent inequities in health, and changing expectations of the population with regards to the type and quality of services delivered. Forward-looking reform of the grassroots network is critical.
The Politburo’s proposed resolution on enhancing the grassroots health scheme is therefore a timely and important step for sustaining the gains already made and addressing this new set of complex challenges.
The directives and objectives of the Politburo’s resolution are truly commendable and steps towards the right direction. As your development partners, we are committed to supporting the government in moving these forward, and have the following views for your consideration:
- A well-functioning grassroots health system can be a mechanism for equalizing wealth and ensuring that the fruits of Viet Nam’s economic growth trickle down to the people in poor and hard to reach areas. It is an opportunity to uphold Viet Nam’s principle of solidarity and trust in the health system, and for taking forward health’s transformative role in development.
- It is an opportunity to redesign the system to prepare for the future. The system should be able to respond to non-communicable diseases (NCDs) and the needs of an aging population. The NCD services require a much stronger system focusing on prevention. It also requires a network of health care facilities for effective referral and follow-up of individuals for NCD risk management. It must take into consideration the multiple needs of the elderly and the focus should be on the individual as a whole rather than one particular condition.
- The quality of health services lies in competent human resources and good standards of practice. We need a plan and mechanism to place competent, motivated and committed human resources at the grassroots level. Strengthening human resources requires a longer timeframe for scaling up education and continuous training. It also requires provision of the right incentives to motivate health care workers to work at the grassroots level.
- Sustainable financing is key to this reform. It is important to ensure that people can have access to these health services when they need them, and be protected from financial risks.
- Leadership of the provincial governments is important. They should ensure that a minimum package of services which meet quality standards set by the MOH, is provided so that the same services are available nationwide. At the same time, they should also identify their own local solutions to provide services in hard to reach areas.
- Strengthening the grassroots network is also an opportunity to introduce a new planning and monitoring system. The needs of local people and the socio-geographical context that affect their access to health are different. As a result, moving from vertical planning to more effective provincial and district planning is an important direction to increase efficiency and effectiveness. Effective planning and monitoring require quality information so that authorities can make informed decisions.
This is obviously a daunting task which has significant implications for the future of the health of the people and this nation. But the good news is that there have already been many ongoing initiatives by the MOH and development partners, which are addressing some of these issues and providing information for policy options related to the points that I have previously mentioned.
As we speak of this reform, we have been very much encouraged by the successful process in developing the new Viet Nam Health Partnership Document. We think the key for moving forward is: a) a credible technical strategy to address these challenges; b) a reasonable costing of the strategy; and c) a carefully designed implementation plan with critical milestones. We could take on this process with the same level of engagement of all partners to bring their different experiences gained through ongoing initiatives under the MOH leadership.
On behalf of the development partners, I would like to thank the Ministry of Health once again for giving us the opportunity to contribute to this very important reform.
Dr. Takeshi Kasai