Vietnam health system and health

infrastructure: achievements,
challenges and orientation

Pham Le Tuan, Deputy Ministry of Health, Vietnam

Contents
Overview of Vietnam health system
Achievements
Shortcomings and challenges
Key missions
Health infrastructure
Brief information
Geneal indicators:
Area: 332.000 km2 (65th)
Population: 90 mil (13th)
GDP per capital: $2,000 (133rd)
Health indicators: Better
LEB: 73 than other
countries
IMR: 15.3/1.000
with
U5MR: 23.2/1.000 similar
MMR: 69/100.000 imcome
% health budget in GDP: 3%
% health spending in total gov
expenditure: 11%
 The health system hierarchy

MOH Other
National general and specialist ministries
hospitals health facilities:
Research institutes - Military
National Medical universities - Police
- Transport
level - Construction
-
Pop: 1-2 million (average)
Provincial Health Departments
63 provinces Provincial hospitals
Private sector:
Preventive health center,
183 hospitals
reproductive health centers etc.
>8,000 beds (0.9
Medical colleges
per 100.000
habitants)
Pop: 100,000-200,000 (aver) >35,000 clinics
Primary health

708 districts Health Offices

District hospitals/centers...

Pop: 5,000-10,000 (aver)

11,162 communes Commune Health Centers
Village Health Workers
 Public-private mix of providers - Vietnam
5

Outpatient care Inpatient care

60% 4%
40% private 96% private
public public
 Health financing in Vietnam
100%

Significant public 80%

spending (51%) and 60%
reducing out-of-pocket 40%
payments (49%) 20%
0%
2005 2006 2007 2008 2009 2010 2011 2012 2013
Public vs private health spending
HI was introduced in 80

1993 and the HI Law 70

63,9
67
68,9 70
60 60
came out in 2008, 50 46,1
56,6

Revised HI law 40 42 41

introduced in 2015: 30
20
Compulsory HI 10
Household-based 0
enrollment
Health insurance coverage
Key achievements
The health system from the national level down to
grassroots level has been strengthened.
The population-based health system and preventive
system have widely developed.
Primary health care, preventive care with communicable
diseases control have been accelerated.
Every citizen has access to quality essential health services.
The hospital network has been upgraded over time:
Quality of medical services quality has been increasingly
improved,
A large variety of hi-tech services have been extensively
introduced.
 Health Financing
Increase state budget for health (10%)
Strive to achieve universal insurance: 71.6% covered by HI

Implement health policy for vulnerable groups, the poor, n

Implement social mobilization, PPP etc. to mobilize more

resources for health
Hospital autonomy policies is stimulated to increase
efficiency, effectiveness
Health investment:
Infastructure for health .
Challenges
Increasing public needs for medical care and change of disease pattern:
Growing non-communicable diseases, injuries,
Infectious diseases continues to put pressure on health system
Large gap in the health status between regions and areas of the country
and different populations
Health service provision:
Unbalanced between levels of care: primary health care vs secondary and
tetiary care
Overloading hospitals for higher level hospitals
Health financing:
How to increase the efficiency and effectiveness of resources (medical
equipment, drugs, finance etc..): budget allocation, HTA, payment method
Health insurance coverage remains at slow pace.
Health resources deficiency both in quantity and quality, and irrational
allocation of resources among different areas and service categories
 Double burden of diseases: requirement for
health system reform

Source: Calculated using data from the Global Burden of Disease Study 2010. Global Burden of Disease Study 2010 (GBD 2010) Results by
Cause 19902010 Vietnam Country Level. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2013 .
Ageing in Vietnam: big challenges for health system

Silver Tsunami
No Time to Lose

Based on
Toomas Palu,
World Bank
(2015)
Key missions
1. Strengthen grassroots health, reform primary health care:
Physical facilities, equipment,
Human resources: family medicine orientation
Service provision: management-based NCDs, expansion of
medical services
Referral mechanism

Pyramid-shaped Wheel-shaped organization

organization (Soft referral)
Key missions
2. To implement short-term and longer-term solutions to
reduce overloading in hospitals.
Expand and build new hospitals in some overcrowding
areas (oncology, cardiology, trauma, obstetrics, pediatrics
etc)
Develop satellite hospitals to transfer clinical techniques to
lower levels)
Reform PHC health, strengthen grassroots health
3. Reform health financing
Increase public spending for health

Renovate budget allocation towards performance and

output- based approach
Renovate payment methods (DRG, capitation)

Expand financial support for vulnerable groups (the poor,

ethnics)
4. Improving health workforce quality
Meeting basic needs over time for health human resources
at various levels (CHCs to be manned by doctors)
Making human resources distribution increasingly
equitable and rational among different regions and areas
Design and health in Vietnam

The health infrastructure does not meet the needs of health:

Number of hospital beds per 10,000 people is 23.5
Distribution of hospital beds is unbalanced between the regions
Hospital overcrowding happens in selected central hospitals and
specialties (cardiology, oncology, trauma, obstetrical) ... is very high
while number of beds are low
Technical infrastructure of health facilities have been improved,
but still not guaranteed technical standards with regards to:
Customized to general hospital, specialize hospital and clinics
Environmental sanitation, medical waste disposal etc
Patients need, especially disabled, elderly
Medical workers' working and relaxed space
Vietnam does not have competent and architectures and experts
to design health facilities
 Vietnam has large needs for building and
upgrading hospitals/facilities at different levels:
Totalestimated investment budget in 2016-2020
period: $US 7.5 billion
Central level
# of health facilities to be upgraded: 60
# of health facilities to be newly bult: 8
Local level (mainly to be upgraded):
Provincial facilities: 200
District facilities: 700
Commune health stations: 2.000
 Expectation
Mobilize expetises of global experts to
support the vision of an affordable
healthcare system for Vietnam
Better understanding of stakeholders (local
and health authorities, architects and
designer, facilities managers) with regards
to design and health, salutogenic approach
Explore and apply salutogenic concept in
design of urban/rural infrastructure,
appropriate hospital and health facilities
model;
Support the training of
designers/architectures with indepth
knowledge on design and health
International symposium on Design and Health
in Vietnam 2016

Ministry of Health of Vietnam is working with

the Academy to organize the International
symposium on Design and Health in Vietnam
next year.
The goal of this symposium and workshop is to
provide a forum for the latest knowledge and
information on health infrastructure from
around the world to enable benchmarking and
the development of tools for the planning and
evaluation of healthcare facilities in Vietnam.
Design & Health Vietnam 2016 will explore
global salutogenic perspectives on the
planning, procurement, finance, design,
construction and operation of health facilities
within the local context of infrastructure
development in the region.
Ha Long Bay-Natural Wonder of the world
Nha Trang-Khanh Hoa sea city in the Central
Phu Quoc- island in the south
Welcome to Vietnam!