Suchergebnisse

Background: To assess the reproductive, maternal, newborn and child health (RMNCH) service coverage in Vietnam with trends in 2000-2014, projections and probability of achieving targets in 2030 at national and sub-national levels; and to analyze the socioeconomic, regional and urban-rural inequalities in RMNCH service indicators. Methods: We used national population-based datasets of 44,624 households in Vietnam from 2000 to 2014. We applied Bayesian regression models to estimate the trends in and projections of RMNCH indicators and the probabilities of achieving the 2030 targets. Using the relative index, slope index, and concentration index of inequality, we examined the patterns and trends in RMNCH coverage inequality. Findings: We projected that 9 out of 17 health service indicators (53%) would likely achieve the 2030 targets at the national level, including at least one and four ANC visits, BCG immunization, access to improved water and adequate sanitation, institutional delivery, skilled birth attendance, care-seeking for pneumonia, and ARI treatment. We observed very low coverages and zero chance of achieving the 2030 targets at national and sub-national levels in early initiation and exclusive breastfeeding, family planning needs satisfied, and oral rehydration therapy. The most deprived households living in rural areas and the Northwest, Northeast, North Central, Central Highlands, and Mekong River Delta regions would not reach the 80% immunization coverage of DPT3, Polio3, Measles and full immunization. We found socioeconomic, regional, and urban-rural inequalities in all RMNCH indicators in 2014 and no change in inequalities over 15 years in the lowest-coverage indicators. Interpretation: Vietnam has made substantial progress toward UHC. By improving the government's health system reform efforts, re-allocating resources focusing on people in the most impoverished rural regions, and restructuring and enhancing current health programs, Vietnam can achieve the UHC targets and other health-related SDGs.

BACKGROUND: To assess the reproductive, maternal, newborn and child health (RMNCH) service coverage in Vietnam with trends in 2000−2014, projections and probability of achieving targets in 2030 at national and sub-national levels; and to analyze the socioeconomic, regional and urban-rural inequalities in RMNCH service indicators. METHODS: We used national population-based datasets of 44,624 households in Vietnam from 2000 to 2014. We applied Bayesian regression models to estimate the trends in and projections of RMNCH indicators and the probabilities of achieving the 2030 targets. Using the relative index, slope index, and concentration index of inequality, we examined the patterns and trends in RMNCH coverage inequality. FINDINGS: We projected that 9 out of 17 health service indicators (53%) would likely achieve the 2030 targets at the national level, including at least one and four ANC visits, BCG immunization, access to improved water and adequate sanitation, institutional delivery, skilled birth attendance, care-seeking for pneumonia, and ARI treatment. We observed very low coverages and zero chance of achieving the 2030 targets at national and sub-national levels in early initiation and exclusive breastfeeding, family planning needs satisfied, and oral rehydration therapy. The most deprived households living in rural areas and the Northwest, Northeast, North Central, Central Highlands, and Mekong River Delta regions would not reach the 80% immunization coverage of DPT3, Polio3, Measles and full immunization. We found socioeconomic, regional, and urban-rural inequalities in all RMNCH indicators in 2014 and no change in inequalities over 15 years in the lowest-coverage indicators. INTERPRETATION: Vietnam has made substantial progress toward UHC. By improving the government's health system reform efforts, re-allocating resources focusing on people in the most impoverished rural regions, and restructuring and enhancing current health programs, Vietnam can achieve the UHC targets and other health-related SDGs. ...

This article discussed Vietnam's ongoing efforts to decentralize the health system and its fitness to respond to global health crises as presented through the Covid-19 pandemic. We used a general review and expert's perspective to explore the topic. We found that the healthcare system in Vietnam continued to decentralize from a pyramid to a wheel model. This system shifts away from a stratified technical hierarchy of higher- and lower-level health units (pyramid model) to a system in which quality healthcare is equally expected among all health units (wheel model). This decentralization has delivered more quality healthcare facilities, greater freedom for patients to choose services at any level, a more competitive environment among hospitals to improve quality, and reductions in excess capacity burden at higher levels. It has also enabled the transformation from a patient-based traditional healthcare model into a patient-centered care system. However, this decentralization takes time and requires long-term political, financial commitment, and a working partnership among key stakeholders. This perspective provides Vietnam's experience of the decentralization of the healthcare system that may be consider as a useful example for other countries to strategically think of and to shape their future system within their own socio-political context.

Background: Stakeholder engagement is crucial for conducting high-quality implementation research as well as for the incorporation and adoption of health interventions and policies in the community.Objectives: This study sought to build a mutually rewarding collaboration between stakeholders in Vietnam and investigators in the United States.Methods: A collaboration was established between investigators from several institutions in Vietnam and the University of Massachusetts Medical School that was built on mutual trust, cross-cultural learning, and shared experiences. This collaborative arrangement has led to sustainable stakeholder engagement in Vietnam. We formed a multidisciplinary transnational research team and maintained regular contact both online and in person. We also conducted a needs assessment study, in which several focus group discussions and in-depth interviews of stakeholders in Vietnam were carried out.Results: The formal collaboration between investigators in Vietnam and the University of Massachusetts Medical School began in 2011 and has strengthened over time. The U.S. team provided expertise in study and intervention design, data collection and analysis, and trial implementation, whereas the team in Vietnam brought a deep understanding of local health care delivery systems and expertise in the delivery of health care interventions at the grassroots level. Our initial partnership has now grown to include committed individuals at the government, academic, and community levels including the Vietnam Ministry of Health, key governmental and nongovernmental research institutions and agencies, medical and public health universities, and communities in rural settings. The needs assessment study found that there are important gaps in the delivery of hypertension management practices in many rural communities in Vietnam and that stakeholders are fully engaged in our ongoing, community-based, hypertension-control project.Conclusions: Multiple layers of stakeholders and communities in Vietnam are fully engaged with, and have contributed significantly to, our ongoing hypertension control research project in Northern Vietnam.HighlightsThe formal collaboration between investigators in Vietnam and the UMMS began in 2011 and has strengthened over time.The U.S. team provided expertise in study and intervention design, data collection and analysis, and trial implementation, whereas the team in Vietnam brought a deep understanding of local health care delivery systems and expertise in the delivery of health care interventions at the grassroots level.Our initial partnership has now grown to include committed individuals at the government, academic, and community levels including the Vietnam Ministry of Health, key governmental and nongovernmental research institutions and agencies, medical and public health universities, and communities in rural settings.The needs assessment study found that there are important gaps in the delivery of HTN management practices in many rural communities in Vietnam and that stakeholders are fully engaged in our ongoing, community-based, HTN-control project.