Outlook examines healthcare

The nation's healthcare has seen great improvements in recent years, with expansion of health services to remote areas and reform of the health insurance system.

This month's issue of Outlook examines the successes of healthcare reform across the country. We report on expansion of healthcare services in rural provinces such as Cao Bang, where provincial hospital facilities have improved dramatically. Back in the cities, we find that students have also benefited thanks to the reform of health cover in schools.

We weigh up the pros and cons of private and public health clinics, and report that public hospitals often provide the best value for money.

We also explore the challenges still facing the health sector, meet one of Viet Nam's top surgeons working on fixing cleft palates, and take a special look at the plight of the nation's underpaid and overworked nurses.

Elsewhere in this issue, we tour the ancient city of Hue by cyclo, sample a delicious meal of fried worms, and meet a French martial arts champ who is helping popularise kick-boxing in HCM City.

Readers can also catch up on what's hot in the country's culinary, sports and arts scenes – and check out listings for everything from bars to embassies. Outlook retails for VND15,000 at news-stands, major hotels and restaurants and can be purchased at the head office of the Viet Nam News at 11 Tran Hung Dao Street, Ha Noi, or at our HCM City office at 120 Nguyen Thi Minh Khai Street. — VNS

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Health costs expected to get even higher

Patients, many from rural areas, queue at the Central Endocrinology Hospital in Ha Noi. Increasing medical costs push hundreds of thousands under the poverty line each year, a study by WHO and Ha Noi Medical University reveals. — VNA/VNS Photo Duong Ngoc

HA NOI — About 774,000 households in Viet Nam fall into poverty due to high treatment costs at hospitals regardless of whether they are given financial support, the World Health Organisation revealed at a two-day conference on Tuesday.

Speaking at the conference held by the Ministry of Health, Nguyen Thi Kim Phuong, from the Viet Nam-based WHO, said that the study, under the co-operation of WHO and Ha Noi Medical University, showed that costs were increasing year by year. About 598,000 households fell into poverty after having treatment at hospitals in 2004, 694,000 in 2006 and 774,000 in 2008.

The rate of Vietnamese households who have to spend the steep health costs, more than 40 per cent of their income except for necessities, accounts for 6 per cent or nearly 1.2 million households.

Among them, poor households, households near the poverty line, with chronic patients and with the elderly are the most vulnerable groups, Phuong said.

However, the role of health insurance to protect against huge expenses remains limited.

Figures from the Viet Nam Health Economics Association showed that households' spending for health services made up 52.4 per cent of total social spending in 2008. The spending from the Health Insurance Fund only accounted for 17.6 per cent even though about 44 per cent of the population got health insurance.

The reason, according to PhD Nguyen Van Tien, vice chairman of the National Assembly Social Affairs Committee, is that patients have to pay for health services and drugs at prices as high as those in developed countries.

"The poor have high demand for medical care but low access ability. They receive treatment about 3 times per year on average while other groups receive it 5 times per year. For those who even get financial support from health insurance, hospital fees for each treatment are equivalent to 10 months of expenses, excluding food costs," PhD Ly Ngoc Kinh, former director of the ministry's Medical Treatment Department, said.

Meanwhile, total spending for the health sector was only 6.4 per cent of GDP and the average health cost was VND1.1 million ($60) per year.

Apart from expensive healthcare, patients are suffering from low-quality services, especially in rural areas.

Deputy director of the ministry's Health Insurance Department Nghiem Tran Dung reported that Bach Mai Hospital's experts found out that between 7.1 and 48 per cent out of 416 X-ray films from six hospitals in Thanh Hoa, Phu Yen and Yen Bai provinces were substandard due to improper poses and incorrect techniques.

About 22.6 to 61 per cent of X-ray results failed to match experts' diagnoses, resulting in incorrect diagnoses for patients.

A report from a Ha Noi hospital showed that antibiotics were popular at pharmacies, accounting for nearly 100 per cent of prescriptions in several wards, although half of these drugs were said to be unnecessary.

At the meeting, representatives said that increasing hospital fees would improve service quality. PhD Pham Manh Hung, former vice minister of health, said that the current fees have been applied since 1995 and are no longer suitable due to currency depreciation.

"Patients are still spending a large amount of money for drugs and medical materials during their treatments while accepting low-quality services. The health sector faces a shortage of capital for development and the moral hazard of several health staff," he said.

The ministry submitted proposals to increase hospital fees several times this year. The proposal last July was received with hostility from the public as the new costs were between seven and 10 times the existing ones.

Director of the ministry's Finance and Planning Department Pham Le Tuan suggested the financial adjustment be considered carefully, taking into account benefits of health systems, hospitals and patients.

Health insurance payments should be improved and private hospital incomes must be minimised and there must be satisfactory policies for health workers, Tuan said.

Representatives also suggested implementing health insurance for everyone.

The State and the community should encourage the health sector to improve quality. — VNS

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ASEAN meeting discusses role of traditional medicine

HA NOI — Officials are discussing ways to integrate herbal treatments into national health care at the second ASEAN Traditional Medicine Conference, which opened yesterday in Ha Noi.

The event is organised by the Vietnamese Health Ministry.

Deputy Prime Minister Nguyen Thien Nhan said the Government was determined to promote traditional medicine, which he said was the right direction for health care in ASEAN to move.

"Over 60 years, Viet Nam has been patiently implementing this move, gradually integrating traditional medicine into the health system to protect the nation's inhabitants," Nhan said.

"Developing and applying traditional medicine and herbal cures into health care and protection will be the main focus of ASEAN countries."

Surin Pitsuwan, the ASEAN secretary general, also called for a concerted action by governments, interested parties and health professionals to promote traditional medicine.

In some Asian and African countries, 80 per cent of the population depend on traditional medicine for primary health care. The provision of safe and effective traditional medicine could be a critical tool for increasing overall access to health care, Pitsuwan said.

During the three-day event, delegations will review the results of the first health care conference in Bangkok in 2009. They will also discuss international health issues, such as human resources development in traditional medicine, modernising health care, production and application of herbal medicines.

Since 2007, the Nippon Foundation and the World Health Organisation have been jointly organising a congress on traditional medicine.

In Mongolia, health care medical kits are given to nomadic herders. Visits to medical practitioners fell by 45 per cent as a result of the first aid boxes. Currently, 15,000 Mongolian households use the kits.

The fact demonstrated that the use of traditional medicines could help resolve the problems of cost and access to medical care, delegates heard.

The Ha Noi Joint Declaration will be adopted by delegations at the end of the conference tomorrow.

According to the Health Ministry, Viet Nam has 61 traditional medicine hospitals, while 90 per cent of all modern hospitals have a herbal health care department or unit. Meanwhile, more than 70 per cent of all commune health stations offer traditional medicine. About 30 per cent of all patients examined annually are treated with traditional remedies or a combination of traditional and mainstream health care. — VNS

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Ministry monitors post-flood diseases

HA NOI — Health Minister Nguyen Quoc Trieu has instructed health departments and relevant authorities in central flood-hit areas to carefully watch for and prevent an outbreak of flood-related diseases.

He asked local health departments to focus on post-flood diseases, including dengue fever, acute diarrhoea, and skin diseases to prevent them from spreading.

Trieu instructed local health departments to look into building health clinics on stilts in order to minimise damages from flash floods and heavy downpours.

He highlighted nine health clinics that are currently operated by local army divisions and people and agreed to provide VND300 million (US$15,300) to each so they can upgrade their medical equipment and facilities.

Local authorities proposed the purchase of sterilisation machines for flood-prone areas to facilitate timely distribution of Chloramine B to submerged households to give them access to clean drinking water.

Transportation systems designed specifically for use during the rainy seasons were needed to transfer patients in serious conditions to central hospitals for treatment, he said.

Dengue fever

Preventive medicine centres reported that dengue fever has broken out in many central areas recently.

In Nghe An Province's Dien Chau District, 32 people were reported with the mosquito-borne fever in recent days. The province's Nam Dan, Quynh Luu and Nghi Loc districts also reported several cases.

Nghe An Province's Health Department has asked relevant agencies to help prevent the spread of dengue by spraying chemicals and cleaning up areas where mosquitoes could breed.

Dr Ton That Thanh, head of the Da Nang City Preventive Medicine Centre, said the fever had hit many districts including Hai Chau, Son Tra, Thanh Khe and Lien Chieu, with 3,500 cases reported since the beginning of this month, five times more than the same period last year. One person had died from the fever, he said.

Hospitals and health clinics in the worst-hit districts of Da Nang couldn't find enough beds to cope with the growing number of dengue cases.

The Preventive Medicine Centre in Quang Nam Province said the number of dengue case was increasing to around 1,300 patients. On average, three patients are being forced to share one bed at the provincial general hospital.

The Ministry of Health has provided 200 litres of chemicals and 28 sprayers to the flood-hit provinces. The ministry's Trade Union also provided VND220 million ($11,220) to these provinces. — VNS

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Public, rural hospitals suffer brain drain

A doctor at Ha Noi-based Central Children Hospital examines a patient. — VNS Photo Viet Thanh

HA NOI — A brain-drain of health workers from public to private hospitals and from rural mountain provinces to urban areas is creating a headache for Viet Nam's health system.

The Ministry of Health has released a report saying that although the number of health workers increased throughout Viet Nam year -on-year, it did not keep pace with population increases.

In 2008, Viet Nam had 40.5 health workers per 10,000 people. This was lower than that in 1986 when there were 43.1 health workers per 10,000 people.

The report said 50 per cent of health workers were working in urban areas, but only 27.7 per cent of the nation's population resided there.

Head of Ha Tinh Province's Health Department's Medical Profession office Vo Viet Quang said three doctors with masters degrees in surgery, oriental medicine and dental science left provincial hospitals last year.

Several other provincial doctors also moved to private hospitals in Ha Noi, Vung Tau and HCM City this year.

"They quit State-owned hospitals even though the provincial health department did not agree with their proposals," said Quang.

There are about 640 doctors in Ha Tinh province, about 200 fewer than stipulated by Ministry of Health regulations that each province muat have a ratio of seven doctors to 10,000 people.

Accordingly to this, each district should have at least 30 doctors, but Can Loc District Hospital, for example, has only one doctor who also performs surgery.

The shortage of surgeons led to "some unfortunate mistakes" at the hospital's obstetrics ward. This recently forced the Health Department to bring in obstetricians from a neighbouring hospital in Huong Khe District.

The Health Examination and Treatment Department said at present there were 141,148 health workers throughout Viet Nam specialising in examinations and treatment. However, the actual demand was for 188,182.

Recent surveys have also found that many medical techniques applied in countries around the world for many years were slow to be adopted in Viet Nam.

This was attributed to the shortage of specialists to run modern equipment.

Director of Binh Duong General Hospital Ngo Dung Nghia said there was rising demand for cardio-vascular treatment and advanced endoscopy on the large intestines and stomach, but the hospital did not have enough medical staff to provide these services.

About 50km away from HCM City, the hospital lacks about 80 doctors. Low pay is blamed for the shortage of young doctors.

To solve the shortages, the Ministry of Health has developed an ambitious plan to have 41 health workers, including eight doctors and two pharmacists, per 10,000 people by 2015.

This means more than 282,000 health workers will be needed by then, and Vietnamese universities will have to provide 5,800 doctors and 1,572 pharmacists more annually.

Deputy Health Minister Nguyen Thi Kim Tien said other measures were needed to overcome the shortage.

This included increasing the quota of medical and pharmaceutical students at universities and creating special payment and treatment policies for health workers, especially those working in rural and mountain areas.

Vu Ba Toan, head of the Organisation and Administrative Work Bureau at the Quy Hoa Leprosy and Dermatology Hospital, has suggested raising occupational allowances to health workers - and making it legally binding for staff sent to receive continuing education to return.

He compared the sending of health workers to receive such training as a two-edged knife is most trained staff were willing to compensate training costs to their hospitals and look for higher paid jobs elsewhere. — VNS

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Private clinics treat insured

by Gia Loc

A patient undergoes an ultrasound scan at Phuc Hung private clinic in central Quang Ngai Province. Private clinics and hospitals expect to see more patients because of the better services and facilities on offer. — VNA/VNS Photo Thanh Long

HCM CITY — By 2014, all Vietnamese residents will be covered by national health insurance, and, as a result, competition between public and private facilities will increase, according to an official with the Social Insurance Agency in HCM City.

Bui Minh Dong, deputy head of the agency, said most private health facilities would probably sign contracts with the Social Insurance Agency in coming years because of the increased number of patients covered under national health insurance.

All of the private facilities in HCM City, which currently treat 10 per cent of patients, have already signed contracts with the city's Social Insurance Agency.

These include the hospitals of An Sinh, Hoan My, Trieu An, Phu Tho and My Duc.

The number of private hospitals and health clinics in HCM City this year increased by 10 per cent over last year, and is expected to rise when more people are covered by health insurance.

Dong said that private clinics and hospitals were expected to see more and more patients because of the better service attitude and facilities at these health establishments.

According to Ton That Quynh Trung, chief executive officer of Phuoc An Medical Centre (HEPA), one of the first private hospitals and health clinics in HCM City, the professional conduct and quality of doctors and nurses as well as other staff in private facilities help attract patients, including those that are insured.

He said his medical centre had signed an agreement with the HCM City Social Insurance Agency to accept patients with national health insurance.

Trung pointed out that many hospitals, however, had discriminated against patients who were covered by national health insurance.

The hospitals preferred immediate payments instead of later reimbursements from the national fund, he explained.

"The national insurance fund pays the fees for insured patients and the hospital must wait for these," he said.

Trung said that all hospitals and health clinics should improve quality and invest in new, modern facilities that offer more comfort to patients.

Phuoc An treated 131,000 insured patients for the second quarter, an increase of 20,000 over this year's first quarter.

Trung noted that more private medical facilities like Phuoc An would help reduce the patient overload at public hospitals and health clinics.

"More private hospitals and health clinics are signing contracts with the city social insurance agency so we can meet the demand of residents and treat them more easily and effectively," he added.

Public health facilities have for years held a monopoly in the market.

But new competition between private and public health facilities will help raise healthcare quality, and will add more payments to the general insurance fund, according to Trung.

As fees rise at hospitals in the next few years, the insurance fund is expected to pay a higher proportion of each patient's fee.

When that occurs, the insured patient will likely not have to pay as much at private hospitals as they do now. Private facilities often add fees like bed charges to the patient's bill.

Nearly 4.6 million people of 8 million in HCM City are currently insured. There are 140 public and private hospitals and health clinics. — VNS

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Pharmacies slow to achieve good practice standard

As the year-end deadline for application of Good Pharmacy Practice (GPP) standards nears, only one-fourth of the pharmacies in the city have achieved it.

For the last three years since the Health Ministry issued its decision (No 11/2007/QD-BYT), HCM City has taken several steps to implement it, but so far just 927 of 3,667 medical establishments have succeeded in applying the GPP standards.

The 927 establishments comprise 91 hospitals and 836 residential pharmacies.

"The main reasons for the slow pace is a shortage of professionals in the health sector to guide, train and conduct checks," said Dr Pham Khanh Phong Lan, deputy director of the municipal Health Department.

She told the Sai Gon Giai Phong (Liberated Sai Gon) newspaper that three years was not long enough to make a full assessment, but the application of GPP had started changing the quality of pharmacy system.

"At first, many people doubted the necessity of the GPP, but after three years, there is an important change in awareness. People accept that it is a must for the industry," she said.

In promoting GPP application, the city's health sector focused first on pharmacies in hospitals and enterprises to ensure quality and price of essential medicines.

At present, the department is focusing on firms engaged in wholesale and retail distribution of drugs.

In 2009, there were 752 pharmacies found violating regulations, including 20 that had the GPP certification.

"GPP is the starting point for managing the pharmacy system and regular investigation is the best way to maintain quality," Lan said.

After January 1, 2011, pharmacies that haven't met GPP requirements would be closed or forced to curtail their operations depending on the final decision from the Health Ministry, she said./.

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ADB offers loans for health, irrigation projects

The Asian Development Bank (ADB) will provide loans worth US$160 million and a grant of $11 million to expand Vietnam’s access to quality health services and improve irrigation infrastructure.

Agreements to this effect were signed between ADB and the State Bank of Vietnam in Hanoi on Tuesday.

Of the total, a $60 million loan from ADB and the $11 million non-refundable aid from the government of Australia will finance the Health Human Resources Sector Development Program which deals with obstacles in health service delivery, especially the management of human and financial resources.

The program will upgrade training facilities, provide training for ethnic minority health workers and facilitate the adoption of standard treatment and costing packages for health services provided to the Vietnamese people.

Addressing the ceremony, ADB representative Ayumi Konishi said that Vietnam should accelerate and step up socially inclusive policy reforms to address inequalities and improve delivery of social services as improvements in health status - especially of the poor and ethnic minorities - are critical to achieving the country’s development goals of inclusive development.

Another $100 million loan was for the Strengthening Water Management and Irrigation Systems Rehabilitation Project.

The project will repair the 50-year-old Bac Hung Hai irrigation and drainage system in the northern provinces of Hung Yen, Hai Duong and Hai Phong.

It will also construct a new training centre for the Water Resources University which is expected to be completed in June, 2016 and benefits 14,200 people.

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Party sacks corrupt Phu Yen official

A high-ranking official in the central province of Phu Yen has been expelled from the provincial Party Unit for abuse of power that resulted in losses of VND2.8 billion (US$143,663) to the state budget.

On August 24, Nguyen Kim Phuc, 53, was also dismissed from the post of director of Phu Yen's Department of Natural Resources and Environment.

According to inspectors, while he was at the helm of a VND13 billion ($667,693) environmental protection project funded by Sweden, Phuc misappropriated its funds and violated economic and financial regulations, including renting out land assigned for the Bai Mon-Mui Dien eco-tourism area.

Tran Thi Na, Phuc’s subordinate, was also expelled from the party unit for the same violations.

The Phu Yen Party Unit’s standing committee has ordered related agencies to hand over the case to police for criminal investigations.

The project was part of the SEMLA program – a Swedish initiative to support environmental and natural resources programs in six provinces between 2004 and 2009.

In another corruption scandal, Ho Chi Minh City authorities have criticized Nguyen Van Chau, director of the city’s Department of Health, and Pham Khanh Phong Lan, his subordinate, for shortcomings in managing the granting of Good Pharmacy Practice (GPP) certificates.

GPP comprises baseline standards issued by the International Pharmaceutical Federation (IPF) in 1993. It was revised in 1997 and has been endorsed by the World Health Organization.

Vietnam’s Ministry of Health in November 2007 issued a decision asking all drugstores to meet GPP standards, including having a minimum area of at least 10 square meters, by this year-end. Stores that fail to comply will have their licenses revoked.

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Sun Wah vows $1m for education, health

HA NOI — The Hong Kong – based Sun Wah Group has pledged sponsorship worth US$1 million for education, health and art projects in Viet Nam.

An agreement signed between representatives of the diversified conglomerate and the Health Ministry in Ha Noi yesterday will have $700,000 go to health projects – the focus will be public health – and the remaining $300,000 to education and art projects.

The sponsor wants the money used to enhance the knowledge of foreign languages among teachers, especially those living in remote and rural Viet Nam.

It will also provide scholarships for Vietnamese students to study in China, provide money to build remote schools and organise training courses for teachers and students at schools for the disabled.

Sun Wah Fund president Jonathan Choi said it was the second time the conglomerate had provided $1 million to sponsor projects in Viet Nam and he was pleased with the practical results.

The previous sponsorship had focused on education and the arts.

Sun Wah had decided to add health projects to its list despite its previous inexperience in this field because the conglomerate was celebrating the 40th anniversary of its arrival in Viet Nam.

Sun Wah also planned to organise an exhibition at the Viet Nam Museum of Fine Arts for Thang Long – Ha Noi's 1,000th birthday in December and another in the HCM City Museum of Fine Arts.

Sun Wah Group focuses on seafood and foodstuff, real estate, financial services, infrastructure, technology and the media.

It has enterprises in Viet Nam, Myanmar, Cambodia, Singapore, Canada, Europe, USA and Australia. — VNS

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Cattle from Thailand bypass border quarantine checks

QUANG BINH — Thousands of buffaloes and cows have been imported from Thailand without going through quarantine procedures, a media report said.

The regulation on a 15-day quarantine period was not being imposed at the Cha Lo Border Gate in central Quang Binh Province's Minh Hoa District, a report in the Nong thon Ngay Nay (Countryside Today) newspaper said.

The official excuse was the long distance between the Animal Health Department and the segregation areas made the cost and transportation of food for the stock expensive.

Quarantine certificates were being issue within as few as 1-7 days, the report said.

Importing livestock can be lucrative. One buffalo or cow can be bought for VND10 million ($523) in Thailand and sold for VND15-20 million ($785-1,046) in Viet Nam.

As many 10,000 buffaloes and cows crossed the border in the first seven months of the year.

Under regulations, livestock must go through seven stages of a 15-day quarantine period, supervised by Cha Lo Border Gate's Customs, Animal Health Agencies No 3 and the provincial Animal Health Department.

After 15 days, if segregated buffaloes and cows show no signs of disease, the owners receive quarantine certificates and the stock can be sold on the domestic market, the regulations state.

Violators are liable to a fine of VND15-20 million (US$785-1,046).

However, the rules were being ignored by agencies, the report said.

Provincial Animal Health Department head Pham Hong Son said "We just issue quarantine certificates for companies after the Animal Health Agency No 3 finish all quarantine procedures for animals and send files to us."

If animals had diseases, responsibilities belonged with the agency, Son said.

Besides, he said, the department and agency faced many difficulties in quarantining animals. Transporting feed for animals for 15 days was expensive, he said.

"We have submitted a proposal to building one concentrated segregated station in the Khe Ve area in Minh Hoa District," he said. — VNS

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