History 

Vietnam is a lower-middle-income country that has achieved impressive gains in economic growth and poverty reduction in the past 20 years, claiming one of Asia’s fastest-growing economic growth rates in recent years.  Broader socioeconomic development and in-country efforts to accelerate progress toward universal health coverage (UHC) have led to increased investments in the health sector and improvements in health outcomes across the country.1234 With these economic gains, Vietnam has shifted from an agricultural to an industrial and service economy. Like many lower-middle-income countries undergoing industrialization and urbanization, Vietnam faces the challenges of the dual burden of both communicable and non-communicable disease, a large aging population, and poor access to care in disadvantaged rural and remote areas.12

Prior to reforms, primary health care professionals in Vietnam were often ill-equipped to provide high-quality care that was accessible, acceptable, and available to the population. This led to high rates of out-of-pocket spending, low satisfaction with PHC and district hospital services, and high utilization of specialty and hospital-based care.2  This situation was the result of many interrelated factors, including: 

What is high-quality PHC?

Five core principles underpin high-quality primary health care - first contact accessibility, coordination, continuity, comprehensiveness, and person-centeredness. A health workforce with the competencies to deliver on the core principles of high-quality primary health care is essential for the delivery of services that are trusted, valued, and effective. Recognizing this, HPET made building an integrated, comprehensive PHC service delivery model the core of its efforts. 

  • Limited governmental ability to fund and regulate the composition and distribution of the health workforce leading to an imbalance in the distribution of health workforce across regions, with the most disadvantaged regions facing a severe shortage of qualified health professionals15
  • Further challenges to equitable distribution and retention arising from low production capacity, restricted capacity for employment of graduates in remote areas, and low pay in the public sector5
  • Inefficient management of patient care by the health workforce, in part due to a medical education system that  focused primarily on hospital-based care, with little emphasis on fostering the development of the skills and competencies needed to deliver high-quality PHC at the front lines of care (commune health stations and health centers)2367
  • Deficient facility infrastructure at commune health stations, which contribute to poor perception of the quality of services by patients2

Working toward an integrated, person-centered PHC workforce model

To address these challenges, Vietnam increased investments in the health sector to implement a series of PHC-oriented workforce reforms that aimed to improve the quality of education and training for the health workforce and strengthen PHC capacity across 15 of the poorest provinces. (3,8) In particular, in 2013 the Ministry of Health partnered with the World Bank and the European Union to implement a sustainable and effective human resource for health development strategy - the Health Professionals Education and Training for Health Systems Reform Project (HPET). 2367

To improve the quality of health professionals’ education the project has focused on making targeted improvements in the quality of health professional’s education through mechanisms related to quality assurance and supportive supervision. This has involved the creation of a quality assurance task force responsible for the establishment of standards for health professionals’ education, peer review assessments for professional education programs, and a standardized examination system for medical nursing students. To better align the competencies of existing health workers with local community needs, HPET supports a combination of short and long-term modular training programs and on the job training for diverse PHC teams, spanning physicians, nurses, midwives, village health workers, assistant pharmacists, and laboratory technicians. The training programs focus on ensuring that the workforce has the appropriate competencies in the core principles of high-quality PHC and family medicine 2367 To support the sustainability and accessibility of these training programs at the community level, they are designed to be built into existing education, training, and management structures and continue beyond the HPET project period as a part of continuing professional development programs. Finally, to ensure that the PHC workforce has the resources needed to deliver appropriate care, HPET financed the purchasing of modernized equipment for select beneficiary provinces. 2367

Progress and next steps

As of 2017, HPET had built and updated six training programs for PHC teams based on the core principles of PHC and by the end of 2018, approximately 9,000 local health professionals had enrolled in long- or short-term training courses, including 7,800 commune health station staff.3 To support the scale of a PHC service delivery model beyond the beneficiary provinces, HPET has worked with the Ministry of Health to develop its existing commune health station service delivery model in 26 communes through guidance on appropriate training, resources, and the facilitation of various conferences, workshops, and study tours in line with the core principles of PHC and family medicine.3 Additionally, HPET has helped to boost awareness and support for PHC through various public outreach and awareness campaigns.3 Collectively, these efforts have helped to accelerate progress toward a stronger, grassroots workforce trained in the core competencies of PHC and raise public awareness and understanding of the importance of a quality grassroots health system.39 To support broader improvements workforce education and practice and PHC capacity at the local level, the Ministry is considering expanding HPET training to other provinces in Vietnam.3 In the meantime, HPET plans to update its education and training model this year to include teaching curriculum and on-the-job training on non-communicable diseases. It will also conduct post-training assessments of PHC teams in collaboration with the Health Strategy and Policy Strategy Institute in Hanoi and improve workers’ skills in the use of information technology to better manage patient care.3  Updates on and results of this assessment can be found here.

 

References:

  1. WHO WPRO. Human Resources for Health Country Profile: Vietnam. World Health Organization; 2016.
  2. The World Bank. Health Professionals Education and Training for Health System Reforms (P131825) - Project Appraisal Document. The World Bank - East Asia and Pacific Region; 2014 Jul.
  3. Minh HB. Vietnam accelerates universal healthcare drive with EU, WB funding [Internet]. The Voice of Vietnam: Society. 2019 [cited 2019 Jul 29]. Available from: https://english.vov.vn/society/vietnam-accelerates-universal-healthcare-drive-with-eu-wb-funding-393239.vov 
  4. Hoang CK, Hill P, Nguyen HT. Universal health insurance coverage in vietnam: A stakeholder analysis from policy proposal (1989) to implementation (2014). J Public Health Manag Pract. 2018;24 Suppl 2 Supplement, Public Health in Vietnam:S52–9.
  5. Nguyen MP, Mirzoev T, Le TM. Contribution of health workforce to health outcomes: empirical evidence from Vietnam. Hum Resour Health. 2016 Nov 16;14(1):68.
  6. Nguyệt CM. A new approach to improve primary health care at the grass roots level - European External Action Service [Internet]. European External Action Service. 2017 [cited 2019 Jul 30]. Available from: https://eeas.europa.eu/delegations/vietnam_en/26396/A%20new%20approach%20to%20improve%20primary%20health%20care%20at%20the%20grass%20roots%20level
  7. Vietnam Ministry of Health - HPET. Ministry of Health: Health Professionals Education and Training for Health System Reforms Project (HPET) [Internet]. Ministry of Health: Health Professionals Education and Training for Health System Reforms Project (HPET). 2015 [cited 2019 Jul 30]. Available from: http://www.hpet.vn/Index.aspx?LangId=2 
  8. The World Bank. Laughter is The Best Medicine: How Theater Helps Bridge the Gap Between a Vietnamese Commune and Their Health Clinic [Internet]. The World Bank. 2018 [cited 2019 Aug 15]. Available from: https://www.worldbank.org/en/news/feature/2018/11/05/laughter-is-the-best-medicine 
  9. The Government Public Relations Department, Thailand. Foreign-funded project benefits thousands of health workers [Internet]. The Government Public Relations Department, Thailand. [cited 2019 Aug 15]. Available from: https://thailand.prd.go.th/1700/ewt/thailand/ewt_news.php?nid=7724&filename=index