It is my great pleasure to join you in this important meeting on launching the implementation model to Strengthening Health Care Capacity at Grassroots Level in 26 Commune Health Stations.
Dear Minister
Let me congratulate your successful launching and allow me to add some message on behalf of WHO.
First, it is all about Universal Health Coverage
Last week, global health leaders gathered in Tokyo to examine global progress towards our shared commitment of ensuring all people have access to quality health services where and when they need them, without suffering financial hardship. That is, our shared commitment to the goal of Universal health coverage. Alongside other health leaders, Minister Tien renewed her – and Viet Nam’s – commitment to this goal.
Grassroots health system is the vehicle through which Viet Nam will be able to achieve UHC. And the way that you reform and redesign this system will determine how effectively and how quickly you reach this goal.
We are encouraged that UHC has been prioritized at the highest levels of government, with the 12th Central Committee of the Community Party recently approving Resolution 20. This resolution firmly reorients the health system towards prevention of ill health and provision of care close to the community.
The plan that Minister Tien has just presented, will help to equip your grassroots network so it can better perform its promotive, preventive and management functions closer to the community. It shows that your commitment to UHC is already being concretely implemented.
A stronger grassroots network is therefore the right thing for the people and also for the health sector. WHO is fully committed to supporting your efforts in this area. Second, it is all about People-centered integrate care and the prevention and management of non-communicable disease
Last week, WHO in the Western Pacific also issued the first monitoring report of countries progress toward UHC. Overall finding was that countries in the Western Pacific Region are on track for some targets, but overall progress is too slow to hit global targets by 2030. All countries will face important challenges to reach the SDG targets for NCDs. Viet Nam will also face similar challenges.
What we have observed is that the grassroots network delivers mainly acute, episodic care, addressing the conditions at hand without a broader perspective into the patient’s life and without proper skills to manage NCDs. In hard-to-reach areas, where peoples’ needs are often greatest, CHSs are overstaffed but these health workers are under-resourced and under-empowered. District Health Centers and Commune Health Stations are competing each other to get more share of limited financial resources available.
To meet the health needs of the population, we must train and empower health workers to no longer treat diseases in isolation. When a mother comes into a commune health station for family planning, she should have her blood pressure measured; the doctor should ask her whether she has been screened for cervical cancer, whether her children have been immunized or whether she may be cooking indoors on an open fire, the probable cause of her and her children to have frequent respiratory infections. Seeing a patient as a mother, daughter, carer and member of a community is the essence of primary health care that puts the person at the center, and requires a fundamental shift in a health care professional’s thinking and ways of working.
If implemented correctly, the grassroots health reforms will minimize direct and indirect costs for both families and the overall health system, by helping to prevent and identify diseases and health risks at an early stage, and by managing non-communicable conditions as close to the community as possible. Equipping CHSs to manage chronic conditions is critical from the perspective of the patient and for ensuring cost-effectiveness.
Dear Colleagues,
Our third message is that the key to success is having empowered district health system manger and health workforce.
We believe that the District Health Centre Director should be empowered to create change around the grassroots health care network and to facilitate transformation of the relationship between commune health station and district health center and to facilitate the delivery of an expanded scope of services at the CHS level.
DHC directors could form a key cadre of change agents. If empowered, these are people who can generate change in mindset and ways of working. These DHC directors would see the entire health workforce in their district as their resources, and agents for change.
They could create “PHC teams” of district and commune, and find ways to make sure the best and most appropriate health workers are where they are needed most. For example, the most remote CHSs might need more experienced staff but no body want to go there. In that situation, the empowered DHC could sort out this issue by rotating staff among communes.
At the same time, you should retrain existing health workforce in grass root health facilities for them to have sufficient skills to screen, early detect and manage NCDs. The family medicine approach will be a solution.
Fourth, another key to success is enabling environment.
Building the trust of the community in grassroots level is something that will also need to be tackled simultaneously. Supply side changes alone won’t be sufficient to increase access to/utilization of grassroots level services.
Efforts would be needed to better engage the community in thinking about how the grassroots health care facilities – particularly commune health stations – can do better at understanding and responding to their needs.
Finally, the efforts set out in this pilot plan, must be carefully considered within the broader context of the overall health service delivery system, and recognizing the increasingly important role of the private sector in delivering primary health care – as well as the role of the MoH as regulator of the whole health sector.
WHO remains committed to supporting the Ministry in its efforts to strengthen the grassroots health system toward achieving universal health coverage.
Thank you.
Dr Kidong Park