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The 2015 JAHR was developed in the final year of the five-year planning cycle, which is also the final year for nations to work towards achieving the MDGs, including five groups of goals related to health to which United Nations member countries have committed to achieving by 2015. In addition, the year 2015 is the year in which the new Five-year plan for 2016 – 2020 is being developed, and the JAHR provides substantial analysis for the planning process.
Vietnam Ministry of Health Health Partnership Group JOINT ANNUAL HEALTH REVIEW 2015 Strengthening primary health care at the grassroots towards universal health coverage Medical Publishing House Hanoi, June 2016 Editorial board Assoc Prof Nguyen Thi Kim Tien, PhD - Chief Editor Assoc Prof Pham Le Tuan, PhD Dang Viet Hung, PhD Nguyen Hoang Long, PhD Tran Van Tien, PhD Sarah Bales, MS Coordinators Dang Viet Hung, PhD - Team leader Nguyen Hoang Long, PhD Tran Thi Mai Oanh, PhD Ha Anh Duc, PhD Tran Van Tien, PhD Sarah Bales, MS Tran Khanh Toan, PhD Hoang Kim Ha, MS Duong Duc Thien, MPH Phan Thanh Thuy, MPH Vu Thi Hau, MA Ngo Manh Vu, MS Experts who compiled the report Tran Van Tien, PhD Sarah Bales, MS Assoc Prof Pham Trong Thanh, PhD Tran Thi Mai Oanh, PhD Tran Khanh Toan, PhD Ha Anh Duc, PhD Assoc Prof Nguyen Thanh Huong, PhD Nguyen Khanh Phuong, PhD Do Van Dong, BPharm i Khuong Anh Tuan, PhD Tran Quoc Bao, MPH Nguyen Trong Khoa, MS Dinh Anh Tuan, MS Dinh Thai Ha, MS Pham Xuan Viet, PhD Hoang Thanh Huong, MS Duong Duc Thien, MPH Acknowledgements The Joint Annual Health Review 2015 (JAHR 2015) is the ninth annual report written in collaboration between the Ministry of Health and the Health Partnership Group (HPG) The JAHR report assesses progress in implementing tasks assigned in the five-year health sector plan 2011-2015 and results of implementing the MDGs and five-year plan goals In addition, it provides analysis on the in-depth topic of “Strengthening primary health care in the grassroots healthcare network towards universal health coverage” Implementation of the JAHR 2015 was actively supported by many stakeholders We express our gratitude for all the valuable comments and advice various departments, administrations, institutes, and other units of the Ministry of Health and other ministries and sectors provided during the process of developing this report We are extremely grateful and highly appreciate the technical support and advice of the Health Partnership Group and other organizations and individuals, and the financial support from the World Health Organization (WHO), Global Alliance on Vaccines and Immunizations (GAVI), and European Union (EU) We give special thanks to the domestic and international experts who have directly and actively participated in the analysis of available information and gathered and processed feedback from stakeholders in order to draft the chapters of this report We thank the coordinators of the JAHR, under the leadership of Dang Viet Hung, PhD and deputy director of the Department of Planning and Finance, Nguyen Hoang Long, PhD, the director of the Vietnam Administration of HIV/AIDS Control, with the coordinators, including Tran Thi Mai Oanh, Ha Anh Duc, Tran Van Tien, Sarah Bales, Tran Khanh Toan, Hoang Kim Ha, Duong Duc Thien, Phan Thanh Thuy, Vu Thi Hau and Ngo Manh Vu, who have actively participated in the process of organizing, developing and completing this report Editorial board Financially supported by: WHO Tổ chức Y tế Thế giới ii Contents Acknowledgements .ii Abbreviations and acronyms .vii Introduction PART ONE Implementation of the plan for the protection, care and promotion of the people’s health in the period 2011 – 2015 Chapter I: Socio-economic situation, health status and determinants Socio-economic context Health status and determinants 13 Chapter II: Implementation of the Plan for the protection, care and promotion of the people’s health 2011 – 2015 .38 Health human resources .38 Health Financing 49 Pharmaceuticals, vaccines, biologicals, medical infrastructure and equipment 68 3A Pharmaceuticals, vaccines and biologicals 68 3B Medical infrastructure and equipment 81 Health service delivery 94 4A Preventive medicine and public health 94 4B Medical examination and treatment, traditional medicine and rehabilitation services 109 4C Delivery of population and family planning and reproductive health services 120 Health Information Systems .140 Health system governance 146 PART TWO: Strengthening primary health care at the grassroots towards universal health coverage 157 Introduction 158 Chapter III The grassroots health network and PHC in Vietnam 159 Policy framework to develop PHC in the grassroots health network in Vietnam 159 Grassroots network organization and health service delivery 161 Priorities 169 Chapter IV: Determination of the grassroots health service delivery framework 172 The need for primary-based health service delivery reform to achieve universal health coverage 172 Determination of the grassroots health service delivery framework 173 Basic features of the PHC-based service delivery model 174 Organizational structure of grassroots health model 175 Preconditions for the implementation of a PHC-based service delivery model 177 iii PART THREE: Priority issues and recommendations 179 Chapter V: Priority issues and recommendations for the Five-year plan 2016 – 2020 180 Health status and determinants 180 Health human resources 181 Health financing 184 Pharmaceuticals, vaccines, biologicals and blood products 186 Medical infrastructure and equipment 189 Preventive medicine and public health 190 Medical examination and treatment, traditional medicine and rehabilitation services 193 Population, family planning, reproductive health and maternal and child health services 195 Health Information System 200 10 Governance 201 Chapter VI Recommendations for strengthening PHC in the grassroots health network .204 Objectives 204 Recommendations 204 Appendix: Monitoring and evaluation indicators, 2010 – 2015 209 References 219 iv List of Tables Table 1: Regional disparities in some general health indicators, 2014 17 Table 2: Progress towards achieving basic health human resources targets, 2010 – 2014 38 Table 3: Postgraduate students completing their studies, 2010 – 2013 45 Table 4: Results of issuing medical practice certificates and medical facility operating licenses in public facilities, 2014 46 Table 5: Monitoring basic health financing targets and indicators, 2010 – 2014 51 Table 6: Approved and allocated government bond capital for infrastructure investment projects, 2008 – 2014 (billion VND) 56 Table 7: Average cost per outpatient and inpatient visit for the insured, 2010 – 2014 65 Table 8: Trends in number of pharmaceutical establishments by type, 2010 – 2014 70 Table 9: Proportion of drugs sampled that fail to meet quality standards, 2010 – 2013 75 Table 10: Results of quality testing for traditional and herbal medicines, 2010 – 2014 76 Table 11: Number of ADR reports received, 2010 to 2014 78 Table 12: Blood screening results in Vietnam, 2013 79 Table 13: Results of implementing 2015 plan targets and MDGs in the field of preventive medicine and public health, 2011 – 2015 94 Table 14: Morbidity and mortality due to communicable diseases, 2010 – 2015 95 Table 15: Morbidity, mortality and hospitalization due to food poisoning, 2011 – 2014 103 Table 16: Number of public hospitals and hospital beds at the provincial and district levels nationwide, 2012 – 2014 109 Table 17: Number of hospitals, hospital beds and professional services provided, 2010 – 2014 110 Table 18: Diagnosis and treatment guidelines and protocols 116 Table 19: Availability of reproductive health services at the district and commune levels, 2010~2013 123 Table 20: The sex ratio at birth by region, 2010 – 2014 132 Table 21: Results of implementing of objectives, targets of Five-year plan, 2011 – 2015 133 Table 22: Implementation status of maternal and child health targets, 1990 ~ 2015 134 Table 23: Implementation of child nutrition targets, 1990 ~ 2015 135 Table 24: Child mortality rates by region, 2014 137 v List of Figures Figure 1: Average life expectancy, 2010 – 2015 14 Figure 2: Trends of maternal mortality reduction in Vietnam, 1990 – 2015 15 Figure 3: Trends of infant and under-five child mortality in Vietnam, 1990 – 2015 16 Figure 4: Reduction in under-five child malnutrition, 2010 – 2015 16 Figure 5: Regional disparities in basic health indicators, 2014 17 Figure 6: Trends in cause of disease burden measured in DALYs, 1990~2012 19 Figure 7: Structure of disease burden by age group, 2012 19 Figure 8: Structure of cause of death by age group, 2012 20 Figure 9: Change in burden of disease by age group, 2000 to 2012 21 Figure 10: Trends of estimated TB incidence and detection, 1990 – 2014 24 Figure 11: Trends of the HIV/AIDS epidemic, 2000 – 2014 25 Figure 12: Morbidity, admissions and deaths caused by malaria, 2010 – 2014 26 Figure 13: Structure of health financing resources, 2010 and 2012 50 Figure 14: Percentage increase in state budget allocations for health expenditure and overall state budget allocations, 2011 – 2015 53 Figure 15: Uses of state budget funding for health, 2011 – 2015 54 Figure 16: Public financing for the health sector, 2010 – 2015 54 Figure 17: Health insurance population coverage rate, 2010 – 2015 58 Figure 18: Trends in structure of health insurance coverage by entitlement group in the Health Insurance Law, 2009 – 2014 58 Figure 19: Trends in health insurance coverage rate by entitlement group, 2011 – 2014 59 Figure 20: Average number of medical service contacts using the health insurance card by entitlement group, 2014 60 Figure 21: Percentage of households suffering from catastrophic medical expenses and impoverishment due to medical expenses, 2008 – 2014 61 Figure 22: Financial resources of NTPs on health, 2011 – 2015 63 Figure 23: Total fertility rate in Vietnam, 2001 – 2015 129 Figure 24: Total fertility rate by region, 2010 – 2014 130 Figure 25: Trends in sex ratio at birth by region, 2007 – 2014 132 Figure 26: Causes of child death, 2012 .136 vi Abbreviations and acronyms ADB Asian Development Bank ADR Adverse drug reaction AIDS Acquired immuno-deficiency syndrome ART/ARV Anti-retroviral therapy/ Anti-retroviral (drugs) ASEAN Association of Southeast Asian Nations BCC Behavior change communication CHS Commune health station COPD Chronic Obstructive Pulmonary Disease DALY Disability adjusted life years EC European Commission EENC Early essential newborn care ENT Ears, nose, throat EPI Expanded program on immunizations GDP Gross Domestic Product GDP Good distribution practice GLP Good laboratory practice GMP Good manufacturing practice GPP Good pharmaceutical practice GSP Good storage practice HBV, HCV Hepatitis B virus, Hepatitis C virus HCMC Ho Chi Minh City HIS Health information system HIV Human immuno-deficiency virus HSPI Health Strategy and Policy Institute HTA Health technology assessment ICD-10 International Classification of disease IEC Information, education, communication IHR International health regulations IMR Infant mortality rate IT Information technology JAHR Joint Annual Health Review MDG Millennium Development Goals MMR Maternal Mortality Ratio MOH Ministry of Health MRI Magnetic resonance imaging NCD Non-communicable disease NGO Non-government organization NRA National Regulatory Authority NTP National target program ODA Overseas development assistance PIC/s Pharmaceutical Inspection Convention and Pharmaceutical Inspection Cooperation Scheme vii PPP Public private partnership SDG Sustainable Development Goals STI Sexually transmitted infection TB Tuberculosis TFR Total fertility rate U5MR Under mortality rate UNFPA United Nations Population Fund USD United States dollar VND Vietnamese dong VSS Vietnam Social Security WHO World Health Organization viii Joint Annual Health Review 2015 Introduction Purpose of the JAHR report As agreed upon by the Health Partnership Group (HPG) since 2007, the Joint Annual Health Review (JAHR) has the overall objective of assessing the current situation and determining priorities of the health sector in order to support annual planning of the Ministry of Health, and at the same time to serve as the basis for choosing focal issues for cooperation and dialogue between the Vietnamese health sector and international partners Specific goals of the JAHR include the following: (i) an update on the health sector situation, including an overview of new policies and an assessment of progress in implementation of tasks and achievement of health sector targets laid out in the health sector plans, and progress in implementing health MDGs in Vietnam and (ii) in-depth analysis and evaluation of one aspect of the health system, or one important topic that is the focus of policy-maker attention Contents and structure of JAHR 2015 Depending on the situation each year, the contents and structure of the JAHR report are varied to satisfy the goals and concrete requirements of health sector planning and selection of focal areas for cooperation and dialogue between the Vietnamese health sector and international development partners In 2007, the first JAHR report was compiled, providing a comprehensive update of the major building blocks of the Vietnamese health system, including the following topics: (i) health status and determinants; (ii) organization and management of the health system; (iii) human resources for health; (iv) health financing; and v) health service provision The 2008 and 2009 JAHR reports, in addition to the health system update section, covered the specific topics of Health financing and Human resources for Health, respectively The 2010 JAHR report was developed during the final year of implementing the fiveyear health sector plan for the period 2006 – 2010, and the focus was placed on a comprehensive update of health system building blocks, in order to support development of the five-year health sector plan for 2011 – 2015 The 2011 JAHR was developed in the first year of implementing the five-year plan for the period 2011-2015, and had the task of providing an update on the new orientation that was determined in the Eleventh National Party Congress, and in the five-year socio-economic development plan, in order to promote implementation of the socio-economic plan and support development of the 2012 annual health sector plan The 2012, 2013 and 2014 JAHRs were developed in the second to fourth years of the five-year planning cycle, with the task of supporting development of the annual health sector plans, through updates on new policies, assessment of progress in implementing tasks in each of the six building blocks of the health system In addition, these reports provided in-depth analysis in different areas including Medical service quality, Universal health coverage and non-communicable diseases (NCD) ... Strengthening primary health care at the Grassroots towards Universal Health Coverage for the future PART ONE: Implementation of the plan for the protection, care and promotion of the people’s health. .. analysis of the topic ? ?Strengthening primary health care at the grassroots towards universal health coverage? ?? with the following contents: Chapter III: The grassroots health network and PHC in... 204 Joint Annual Health Review 2015 ■■ Develop and promulgate policies and plans on the strengthening of the grassroots health network: MOH will submit the Master Plan for Strengthening the grassroots