Since late 2022, a WHO-supported primary health care pilot project has brought care closer to people in need in Ho Chi Minh City, Viet Nam; with benefits for patients, families and the health care system.
On an intensely hot day in early 2024, Doan Thi Hien, 77, walked into Nhi Binh commune health station in Ho Chi Minh City.
After being diagnosed with hypertension 19 years ago, Ms Hien has had to rely on family members willing to spend a whole day to take her to the district health center for consultations and to pick up her medicines. Since late 2022, however, a pilot project supported by the World Health Organization (WHO) is bringing essential health care closer to Ms Hien and the many millions of people in Viet Nam with noncommunicable diseases (NCDs)./countries/viet-nam/ms-hien--77-year-old-in-nhi-binh-commune--ho-chi-minh-city.png?sfvrsn=1e7f2122_7)
Ms Hien, 77 years old, living in Nhi Binh commune, Ho Chi Minh City Credit: © WHO Viet Nam
Around the world, NCDs, including heart disease, stroke, cancer, diabetes and chronic lung disease, kill 41 million people each year, equivalent to almost three out of every four deaths globally. In Viet Nam, NCDs are responsible for 80% of deaths. The country has made great improvements in mother and child health and reducing infectious diseases like malaria and tuberculosis, but NCDs remain a significant health challenge, with many people living with undiagnosed conditions. Approximately, 70-80% of people with hypertension or diabetes are not being treated.
Rates of NCDs have been rising dramatically in Viet Nam over the past few years, making this problem an even more pressing one to address. Between 2015 and 2021, the prevalence of hypertension among adults in Viet Nam rose from about 1 in every 5 people to more than 1 in 4 people. In the same period, the prevalence of diabetes increased from 1 in every 24 people to 1 in 14 people.
Early detection and timely treatment is the key to successfully managing NCDs. However, many people living with NCDs may not be showing any symptoms until the disease has substantially progressed. One way to help address this challenge, is proactive community-based testing and long term treatment.
Since 2016 WHO has been working with the Ministry of Health to ensure more people can receive the treatment they need. Under this approach, commune health stations are managing up to 80% of people with mild or moderate NCDs, with nationally standardized protocols and tools that most commune health stations can now use.
Health care workers at these health stations receive training, using WHO-supported training packages and tools including a simple protocol for hypertension and diabetes management, and an online NCD reporting system for tracking progress.
Integrating NCD management into primary health care boosts NCD prevention, reduces the cost of treatment and minimizes complications such as heart attacks, strokes, amputations and blindness. By making better use of health system resources, the integrated approach is helping people to be healthier and safer.
WHO has been collaborating with the Ministry of Health, Institutes of Hygiene and Epidemiology and public health institutes to support 52 of the country’s 63 cities and provinces to adopt these protocols and tools.
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Mr Hong Pho Man, 62 years old, getting his blood pressure checked at Ward 5 health station, District 3, Ho Chi Minh City Credit: © WHO Viet Nam
In Ho Chi Minh City, Viet Nam’s largest city, with more than 9 million inhabitants, WHO has been supporting 10 out of 22 district health centers and 43 out of 310 commune health stations, as part of the pilot project to integrate NCD care into primary health care since late 2022. Now in 2024, Ho Chi Minh City will begin to roll out the model to the remaining commune and district health care facilities.
For nearly two decades after her hypertension diagnosis, Ms Hien has needed to ask her son or daughter-in-law for help travelling more than 10km to the Hoc Mon district health center. But now, the WHO-supported model has brought health care closer to Ms Hien who, for the first time, can get a health check-up and pick up her medicines in her neighborhood, at the Nhi Binh commune health station.
“At times, a trip to the district health center would take me almost a day just to get checkup, consultation, and medicines…. [but now] it only takes a short while here and the station is just half a kilometer away from my home.”
“Due to my age, being able to get my medicines and health checkup here [at the commune health station] is greatly appreciated,” said Ms Hien./countries/viet-nam/ms-hien-talking-to-dr-truong.png?sfvrsn=b5cdff11_3)
Ms
Hien talking to WHO technical officer Dr Lai Duc Truong Credit: © WHO Viet Nam
Ms Hien also prefers having consultations at her commune health station as the doctor has more time to give her information and answer questions about her condition. This might not always be possible at busy district health centers or hospitals.
“Following my doctor’s advice, I enjoy a low sodium diet,” shared Ms Hien, “My blood pressure is stable. I can still walk and bike.”
Dr Pham Van Nghia at Nhi Binh commune health station said having strong primary care near where people live enabled health care workers to give advice on lifestyle factors such as smoking, exercise, alcohol and diet that can prevent, delay or help manage NCDs.
“Commune health stations serve as the closest bridge between community members and the health system. We know our patients very well, not only their health conditions but also on a personal level. We know their families and understand exactly what triggers each patient’s condition, such as their drinking, smoking or sleeping habits.”
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Dr Pham Van Nghia at Nhi Binh commune health
station Credit: © WHO Viet Nam
Between February 2023 and January 2024, the number of hypertension patients visiting commune health stations nearly doubled, and the number of diabetes patients increased nearly 4 times.
With focus on better grassroots care, 20% more patients had controlled blood pressure, and 56% more patients had controlled blood glucose. There has also been improvement in essential medicine supply, with more commune health stations having enough supply of the three types of hypertension and two types of diabetic medicines.
WHO Representative in Viet Nam Dr Angela Pratt, “Viet Nam’s health system is at a critical juncture: a rapidly ageing population, a shifting disease burden – including the rising tide of NCDs – as well as a fast-developing economy – are all creating increased demand for high quality health services.”
“It is important to create a stronger and more integrated primary health care system to help meet essential health needs for all. We are very proud to collaborate with the Ministry of Health, local health authorities and health partners, with the support of Resolve to Save Lives, to strengthen hypertension and diabetes management in primary health care, so that people can be screened and treated for their conditions in a timely way.”
With success in Ho Chi Minh City, future plans for the initiative include expanding the model to all commune health stations across the country and integrating care for other chronic conditions such as depression, HIV/AIDS, chronic obstructive respiratory disease and asthma. This expansion will make a significant difference in bringing care closer to home and improving the quality of life for millions of people across the country.