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Một đề tài hay về tiếp cận dịch vụ chăm sóc sức khỏe của người cao tuổi tại Bến Tre. Đề tài fulltext từ đặt vấn đề cho đến kết luậnkiến nghị. Kết quả nghiên cứu cho thấy: After analyzed and discussed, the findings of the study are highlighted as follow: 1. PHC services for older people were inadequacy in terms of both quantity and quality. That might influence the access to health care services by older people; 2. Educational levels and knowledge on health care were associated with the use of general health examination and regular CD followup examination respectively; 3. In terms of income, older people having retirement pension; or getting 3,000,000 VND and over per month; or selfevaluated household income “richest” compared to other households in the same communes had higher percentage of general health examination than those who did not; 4. Older people evaluating that their health status was poor or very poor had higher percentage of general health examination and regular CD followup examination; 5. While health trouble examination was not influenced by selfevaluated health status, it was significantly associated with selfevaluated impact levels of health troubles among older people; 6. There were strong relationships between health insurance status and the use of CD followup examination and regular CD followup examination among older people.
DFC REPORT ACCESS TO PRIMARY HEALTH CARE SERVICES BY OLDER PEOPLE IN RURAL AREAS OF VIETNAM Project Task Award E : WPVNM1207061 : 3.8 : 58363 (AC) : 511-DFC LIST OF CONTENTS LIST OF TABLES .i LIST OF FIGURES ii LIST OF ABBREVIATIONS iii ABSTRACT iv BACKGROUND AND RATIONALE .1 .OBJECTIVES .3 2.1 General objectives .3 2.2 Specific objectives .3 METHODS .3 3.1 .Study setting .3 3.2 Study design .4 3.3 Sampling and sample size .4 3.4 Definition of variables .4 3.5 .Variable measurement and data collection .6 3.6 .Statistical analysis .6 RESULTS .7 4.1 Socio-demographic characteristics of older people .7 4.2 Health status of older people .10 4.3 .Knowledge on health care of older people .13 4.4 Access to PHC services among older people .13 4.4.1 CHSs and PHC services available for older people 13 4.4.2 Health insurance status of older people 17 4.4.3 The utilization of available PHC services by older people 17 4.5 Factors associated with the access to PHC services .19 DISCUSSION .24 5.1 Characteristics of the sample .24 5.2 Factors associated with the access to PHC services .24 5.3 Limitations of the study .26 CONCLUSION AND RECOMMENDATION .28 6.1 Conclusion .28 6.2 Recommendation .29 REFERENCE 30 APPENDIX 33 LIST OF TABLES Table Description of dependent and independent variables Table Percentage distribution of Age, Sex and Education of older people .7 Table Percentage distribution of Ethnicity, Religion, Marital status and Living arrangement of older people Table Percentage distribution of Working status and Income of older people Table Description of chronic disease status among older people .11 Table Description of functional limitations among older people .12 Table Health troubles occurring within the last four weeks of older people 12 Table Knowledge on health care of older people .13 Table Health insurance status of older people 17 Table 10 Utilization of health care services among older people .17 Table 11 Percentage distribution of educational level of older people by the utilization of general health examination 20 Table 12 Percentage distribution of income by the utilization of general health examination 20 Table 13 Percentage distribution of sources of income, amount of income and self-evaluated household income by the utilization of general health examination 21 Table 14 Percentage distribution of knowledge on health care of older people with health troubles by the utilization of regular CD follow-up examination 22 Table 15 Percentage distribution of self-evaluated health status of older people by the utilization of health care services 22 Table 16 Percentage distribution of self-evaluated impact of health troubles among older people by the utilization of health trouble examination .23 Table 17 Percentage distribution of health insurance status of older people by the utilization of CD follow-up examination 23 i LIST OF FIGURES Figure Self-evaluated household income by older people .10 Figure Self-evaluated health status by older people 10 Figure Percentage distribution of health care utilization by types of health facilities .18 Figure Map of Giong Trom district, Ben Tre province, Vietnam .33 ii LIST OF ABBREVIATIONS CD Chronic Disease CHS IFA Commune Health Station International Federation of Aging IHPH MOH PHC UN VEA WHO Institute of Hygiene and Public Health Ministry of Health (Vietnam) Primary Health Care United Nations Vietnam Elderly Association World Health Organization iii ABSTRACT Primary health care (PHC) for older people has contributed to better health and mitigation of chronic disease burdens for older people The study aims to identify whether older people in rural areas of Vietnam are able to effectively access to PHC services and what are the barriers preventing them from access to those services The study was conducted on January, 2013 at Giong Trom district, Ben Tre province A cross-sectional study was applied to collect both quantitative and qualitative data from 520 older people aged 60 or above and four commune health stations (CHSs) The findings show that PHC services for older people were inadequate and very poor That might prevent older people from access to health services Lower educational level and lower self-evaluated health status might be barriers of the access to general health examination The older people getting 3,000,000 VND per month or over and the older people thought that their household income was “richest” accounted the highest percentage of the utilization of general health examination compared to others Health insurance status, knowledge on health care, and self-evaluated health status among older people were also found to be significantly associated with the use of CD follow-up examination, especially with regular CD follow-up examination No characteristics were found to be related to health trouble examination except impact levels of health troubles It might determine the use of that service by older people Some recommendations were given for the improvement of PHC services and for further studies KEY WORDS: access, primary health care, older people, rural areas, Vietnam iv BACKGROUND AND RATIONALE The older population in Vietnam is projected to rapidly increase in the next decades as a result of lower mortality and higher life expectancy The proportion of older people (aged 60 and above) was 7.3 percent in 1990, slightly increased to 8.4 percent in 2010 and will be suddenly reached to 18.3 percent by the year 2030 (UN, 2010) More than two third of the older people are living in rural areas (IFA, 2008) The strong flows of laborers from rural to urban areas have increased the proportion of older people in rural areas and the number of older people living alone or with their old spouse (who are also older) or with their grandchildren Moreover, older people living in rural areas have poorer education level, lifestyles, living conditions (Ninh et al., 2010) and less access to health care (Hoi, Chuc & Lindholm, 2010) compared to those living in urban areas These gaps make older people in rural areas more vulnerable than others Although life expectancy of Vietnamese people has improved, the average healthy life expectancy has been quite low It was only 58 years, ranked 116 among 174 countries in the world (MOH, 2008) This also means that older people are living longer with more illnesses and disability According to the WHO (2012), chronic health conditions are the main challenges for older people In fact, the majority of older people in Vietnam were suffering from chronic illnesses such as hypertension, cardiovascular disease, cataracts, joint and born disorders and chronic lung diseases (Brook, 2008; Hanh et al., 2008) Besides, most of the older people were born, grew up and experienced long colonial and war periods that caused many difficulties and unfavourable healthcare conditions for them In fact, 70 percent of those people “did not have material accumulation” (IFA, 2008, p 2) Therefore, burdens of chronic health illnesses will become heavier and affect not only older people and their families but also the health system and the society as a whole Primary health care (PHC) plays an important role in reducing these burdens PHC is estimated to diminish 70 per cent of global disease burden (WHO, 2008) Being aware of this situation, the Vietnamese government has promulgated the Elderly Law No 16/2009-L-CTN in which PHC has been introduced as one of the crucial terms to improve the health for older people (VEA, 2009) The Law clearly assigned the responsibilities for Commune Health Stations (CHS) in taking PHC for older people through health education and communication, health management profiles, periodic health examination or health examination at home for older people who are unable to go to the stations All these activities are free for older people Moreover, older people also have priorities in receiving cure services available at CHSs in accordance with the Law There have been few studies related on access to PHC services, especially by older people in Vietnam Some studies conducted in general population showed the low percentage of people using PHC services (Thuan, Lofgren, Lindholm & Chuc, 2008; Cư, 2010) This percentage was higher in a recent study (Tam et al., 2010) However, all of the studies found that the main reason preventing people from accessing to PHC was the poor quality of services In the context of the Elderly Law that has been put into force since 2010, we conduct this study to identify whether older people in rural areas of Vietnam are able to effectively access to PHC services and what are the barriers preventing them from accessing to those services The access to PHC services by older people and associated barriers will be measured in three dimensions: availability, affordability and acceptability 2 OBJECTIVES 2.1 General objectives To measure the access to PHC services by older people and associated factors in rural areas of Vietnam 2.2 Specific objectives To describe socio-demographic characteristics, health status and knowledge on health care of older people in rural areas of Vietnam To measure the access to PHC services by older people in rural areas of Vietnam in three dimensions: availability, affordability and acceptability To identify factors associated with the access to PHC services by older people in rural areas of Vietnam METHODS 3.1 Study setting The study was conducted in Giong Trom district of Ben Tre province in 2012 Giong Trom is a rural district, located in Mekong Delta region of Vietnam, 120 km far from Ho Chi Minh city This district covers an area of 311.4 km and divided into Giong Trom town and 21 other communes The total population is around 182,400 The main economic sector in the district is agriculture with the development of fruittrees, sugar-cane, rice, cattle, poultry, and aquaculture The cottage industry professions like locally special cakes, products made of coconut fiber and shell are also developed Giong Trom district has the highest proportion of older people compared to other districts of Ben Tre province The number of people aged 60 and above in the district is 19,075, accounting for over 10 per cent of the total population Most of the older people live with their children or other relations while others live alone, without any pensions, with disability or with poverty The shortage or poor quality of PHC services like periodic health examination, and health education and communication, resulted from CHS surveys, were recognized as the main access barriers to older people The main reasons for that situation were the limitations of human and financial resources, drugs, equipment, and degraded facilities Moreover, lack of awareness about necessary of PHC services for older people of health staff, lack of documents or guidelines for deploying those services were other reasons Actually, when the older people were asked what they expected or recommended to strengthen health care activities for older people in general and improve their health in particular, many people said that they wanted to get periodic health examination at least once per year; some wanted to receive guidelines or consultancy from health staff; some expected to be examined at home, some wanted to receive free examination and drugs and so on About the health care services available at the CHSs including health services for general examination; chronic diseases or health troubles examination Some older people said that they did not use those services or went to other health facilities for examination because they did not believe in health services or drug quality provided by CHSs 4.5.2 Socio-demographic characteristics of older people Age, sex, educational level, living arrangement, and income might influence the access to available PHC services among older people The access to those services was evaluated through the utilization of the following health care services: general health examination, CD follow-up examination, regular CD follow-up examination and health trouble examination Among those socio-demographic characteristics, educational level and income were significantly associated with general health examination and health trouble examination Other socio-demographic characteristics were not significantly related to health care utilization Besides, no significant associations between any sociodemographic characteristics and CD examination were found Table 11 Percentage distribution of educational level of older people by the utilization of general health examination 20 Variables General health examination (N=518) Used Not used Health trouble examination (N=409) Used p