CURRENT SITUATION OF PRIMARY HEALTH

CARE IN VIETNAM:
AN ANALYSIS FROM PUBLIC PERSPECTIVE

Dr. Tran Thi Mai Oanh

Director
Heath Strategy and Policy Institute
 Contents

•Concept of primary health care (PHC)

• Current situation of public using of medical examination and
treatment (E&T) services
• Current situation in management of hypertension and
diabetes
• Conclusion
• Proposal
 Concept of PHC
(According to Declaration of Astana)

• PHC is the provision of necessary

services to meet public needs of
health care, including both health
care for individuals and health
care for the community
• Associated with individual, family
and community responsibilities
• The participation of both the
political system and the whole
society
 Concept of PHC

 Health care services for individuals:

o Prevention: expanded immunization
o Management of risk factors
o Screening for early disease detection and disease management
o Provision of medical E&T services: diagnosis and treatment of
diseases, psychological treatment, rehabilitation

 Heath care services for the community:

o Heath promotion and education, providing knowledge and raising
public awareness about health
o Supporting the public to participate in implementing the program on
prevention and control of communicable and noncommunicable
diseases

4
 Contents

• Concept of primary health care (PHC)

•Current situation of public using of medical
examination and treatment (E&T) services
• Current situation in management of hypertension and
diabetes
• Conclusion
• Proposal
Proportion of medical E&T using health insurance at
commune, district level 2014-2017
and estimates for the first 6 months of 2018:
approximately 70%
2015 2016
Commune Central
Commune Central 22%
26% 3% 3%
Province
Province
28%
27%

District District
43% 48%

2017 First 6 months of 2018

Commune Central
Commune
Central 19% 3%
20%
3%

Province Province
26% 26%

District District
51% 52%

Source: Vietnam Social Insurance

6
 Situation of public using of medical services when having
acute illness
(HSPI. Research on the health situation and the public usage of medical
services in 6 provinces in 2015 – 6,152 households, 25,849 people)
Clinics
2.04
Rate of acute illness: 25,4% Regional polyclinics

18.07
District hospitals
Manner of handling % 25.38
2.14
Provincial hospitals
No treatment 6.7
Central hospitals
Buy medicine for self 41.1
4.48 20.12
treatment Sectoral health care facilities

Outpatient 44.2 3.36

5.72
Private hositals

Private clinics
Inpatient 5.0 18.68

Traditional medicine/Traditional
Others 2.9 doctor/Others

Proportion of outpatient treatment:

Commune health clinics, regional polyclinics, district hospitals: 40.3%;
Private health care facilities: 29.9%
Source: HSPI, 2015. Survey of households in 6 provinces
7
 Reason for using the services at district, commune
level in outpatient treatment
(HSPI. Research on the health situation and the public usage of medical
services in 6 provinces in 2015 – 6,152 households, 25,849 people)

Commune District Provincial Central Private

Percentage % clinics hospitals hospitals hospital HC
Registered facility for PHC 73.8 71.8 65.0 22.5 3.7
Acquaintances of medical
staff 1.9 1.1 2.2 2.4 13.8
Confidence in service
quality 5.5 9.1 21.6 49.8 43.1
Convenient opening time 0.3 0.2 0.1 0.5 15.7
Near your home 15.3 6.8 1.5 2.4 21.4
Recommended by others 0.4 7.8 5.7 13.9 0.2
Level transferring 2.9 3.1 3.8 8.6 2.1

Source: HSPI, 2015. Survey of households in 6 provinces

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 Difficulties in using services at district, commune level of
heath insurance holding patients
(HSPI. Assessment of commune clinics in 3 provinces, 2018 –
Interviewing 533 patients using medical services at commune clinics)

• 24.6% (131/533) health insurance holding patients having out-of-pocket (OOP)

treatment at commune clinics: 120,473 VND on average

Percentage of patients having OOP Items payable when using medical

treatment at commune clinics services at commune clinics

40
35 Travel Cost of
28.5 cost, 1% buying
30 26.9 medicines
25 at the
19.6 clinics,
20
Cost of buying 15%
15 medicines
outside the
10
clinics, 84%
5
0
Ninh Bình Sơn La Hải Phòng
Source: HSPI – WHO, 2018
 Percentage of health insurance holding patients having
to buy additional medicines outside health care facilities
62%
60%

50%

40%

30% 27%
22%
20%
20%
14%

10%

0%
TYT
Clinics BV huyện
District BV tỉnh
Provincial BV TW
Central YTTN
Private
hospitals hospitals hospitals health care

Source: HSPI, 2015. Survey of households in 6 provinces

 Reason why patients have to buy additional medicines
outside health care facilities (district, commune level)

Percentage %

Medicines not covered in the list of health insurance at

district hospitals 49%
Medicines covered in the list of health insurance but
currently out of stock 15%
No confidence in the quality of medicines provided by
health insurance 52%
Requirements by medical staff 17%
Others 21%

Source: HSPI – WB, 2015. Investigation of medical facilities at

district and commune level - Interview with patients
 Difficulties in using services at district, commune
level of heath insurance holding patients
(HSPI. Assessment of commune clinics in 3 provinces, 2018 –
Interviewing 533 patients using medical services at commune clinics)
Interviewing patients using medical services at
commune clinics
Reasons for unwilling to o Not having confidence in the quality of medical
use medical services at services provided by commune clinics
commune clinics o Lack of medicines and medical equipment
Expectation about the 56.5% patients stating that they will come to commune
quality and availability clinics instead of district hospitals if:
of medical services at o Commune clinics improve the quality of medical
commune clinics services by strengthening the capacity of medical staff
o Commune clinics perform some simple medical tests:
blood sugar level, urine test
o Commune clinics have sufficient medicines of high
quality
o Medicines for hypertension treatment are similar
between commune clinics and district hospitals
o Commune clinics can provide appropriate consultations
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Level of patients’ satisfaction of outpatient services by
types of medical facilities

90%

79% 80% 81%

80%
73%
71%
70%

60%

50%

40%

30%

20%

10%

0%
Trạm y tế
Clinics BV huyện
District BV tỉnh
Provincial BV TW
Central YTTN
Private
hospitals hospitals hospitals health care

Source: HSPI, 2015. Survey of households in 6 provinces

Reason for patients’ dissatisfaction of outpatient services
by types of medical facilities

Chờ
Longđợi lâu
wait Thiếu
Lack thuốc
of Tốn nhiều tiền
Costly Thái độ không tốt
Inappropriate Hiệu quảnot
Effect không như mong đợi
as expected
medicine attitude
100%

14.5 12.5
90%
28.2
3.6
80% 12.5
48.4
52.2
70%

60% 21.1

50%
8.7
40%
29.0 75.0

30% 61.8

20% 43.7

10% 21.7

6.5
0%
Clinics
TYT xã BV huyện
District BV tỉnh
Provincial Central
BV TW Private
YTTN
hospitals hospitals hospitals health care

Source: HSPI, 2015. Survey of households in 6 provinces

 Contents

• Concept of primary health care (PHC)

• Current situation of public using of medical examination and
treatment (E&T) services
•Current situation in management of hypertension
and diabetes
• Conclusion
• Proposal
Medical facilities at which hypertension and diabetes
patents are supervised (STEPs survey) - 50% and 44%
at district, commune level
Private Others Private Others Commune
health care 2% health care 2% clinics
8% 5% 6%

Commune Central
Central clinics hospitals
hospitals 19% 14%
10%

District
clinics/hospitals
38%
District
Provincial
clinics/hospitals Provincial
hospitals
34% hospitals
27%
35%

Hypertension patients Diabetes patients

Source: Ministry of Health, 2015. STEPs survey on the

risk factors of noncommunicable diseases in Vietnam
 Concept of PHC
(According to Declaration of Astana)

• PHC is the provision of necessary

services to meet public needs of
health care, including both health
care for individuals and health care
for the community
•Individual, family and
community responsibilities
• The participation of both the
political system and the whole
society
 Knowledge of hypertensive patients on prevention
and treatment of hypertension
 Self-management of illness and changing behavior
and lifestyle
 50% of people with hypertension know nothing about risk factors
 In the 50% having knowledge about risk factors, only 50% know
that eating salty is a risk of hypertension
 Two thirds of people with hypertension know that medicines must
be take regularly and continuously
 7.5% of people with hypertension do not understand the principle
of using medicines
 36.7% of people with hypertension stated that their illness is not
monitored and treated regularly
 13% of people with hypertension are monitored and treated at
commune clinics
 Only 5.9% people with hypertension performing blood pressure
check at home
Source: HSPI, 2015. Survey of households in 6 provinces
 Prevention and Control of
Noncommunicable (NC) diseases
Health Group with Group with
Group
group controllable uncontrollable
at risk
NC diseases NC diseases

• Implementing • Disease
community- screening • Self- • Coordinating care
based health management between levels
• Early
programs • Managing
intervention, • Continuous
• Health control of risk care complications
promotion and factors Prevention level 3 & Illness Management
education
• Prevention (preventing illness from getting worse,
• Prevention level 2 disability or death)
level 1 (preventing
(preventing diseases from
risk factors occurring)
from realizing)

Role of PHC level in PHC and role of the public

 Perspective on Health care:
Caring for all people, healthy people

Healthy community

Group at risk

Group having health problems

illed and must be

hospitalized

20
 Conclusion
1) Commune clinics and district hospitals/district clinics play an important role in PHC
for the public. However, the public does not have strong confidence in the service
quality of commune clinics.
2) Operations of commune clinics do not satisfy the public health care needs: not
paying adequate attention to the management of non-communicable diseases; not
fully implementing the contents of disease management; shortage of drugs, patients
still have to buy additional drugs outside the health care facilities
3) The public is lacking knowledge of health in general and especially in prevention and
control on noncommunicable diseases  do not know how to prevent disease
themselves and manage their own health  difficulties in changing awareness about
health and changing behavior and lifestyle
4) Private health care (private pharmacies, private practitioners and private health care
facilities) plays an important role in providing medical services for the public
 Proposals
1) Ensuring the availability of health care services and improving the
service quality at PHC level for well-implemented PHC for the public.
2) To build public confidence in commune clinics, commune clinics should
implement active care for the public: performing management of
patients with hypertension and diabetes; actively providing the public
with health knowledge; counseling patients on how to prevent and
detect diseases early...
3) Associating and promoting the role of private health care (private
pharmacies, private practitioners and private health care facilities) in
performing PHC; improving the quality of private health care services.
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