How to improve the Health System in Viet Nam

Nurse dispensing drugs

Think big - start small

by Maria Dung-Pham

Gam, our admin officer just had a very sweet baby girl. I asked her what the criteria were for her and her husband Son to choose a hospital for delivery. She said, that even if it was not the closest to home, she had chosen a hospital with a good reputation, which was clean and seemed to be well equipped, but most of all where she trusted the midwives and doctors.

Gam and Son are not much different from other young couples in Viet Nam and elsewhere when looking for a suitable place or medical issues including regular consultations, operations or any other form of treatment. They will look for an institution with good service quality, well equipped, professional and trustworthy. On district level these demands are often difficult to meet and many patients tend to choose either the provincial or even the central hospitals.

Looking back on the last 20 years, healthcare in Viet Nam has consistently improved. Each year less children and mothers die, many infectious diseases are decreasing, ante natal screening and vaccination coverage rates are rising and the population is better informed on health issues. In big cities more and more well organised private clinics and specialized institutions open their doors for the richer urban population.

However, the difference in the quality of health services becomes increasingly apparent. District hospitals are not only less equipped but often lack doctors, nurses and midwives. The professional knowledge of their health staff is limited and the management capacity of the hospital directors is insufficient. That is why patients seeking better quality health services and care pass by the district. This leads to overcrowded provincial and central hospitals. The aim of our programme “Strengthening Provincial Health systems” is quite clear: The quality of preventive and curative services and the management capacity of district hospitals needs to be urgently improved. Therefore the project offers financial support, like provision of equipment by KfW as well as technical support by GIZ.

Let me give you practical examples of our work in one programme-supported district hospital: Tay Bac district hospital has 260 beds, treating adults as well as children and newborns. Each month they have about 300 deliveries. As a start we advised them to send a nurse and a doctor as a team to training on newborn emergency care, as health staff did not have the skills to take care of severely ill newborn babies and no special ward for newborns. Whenever there were complications the hospital needed to arrange transfers to provincial hospitals, several hours of car ride away.

Often the babies did not survive the long journey.

After the training Tay Bac hospital established a small emergency unit and is now able to take care of the critical ill babies. Ms Ho Thi Long, the newly trained nurse, now in charge of the new ward, says: “Thanks to our training we were able to treat a premature baby in our district hospital, which had to be in an incubator for more than a week. In just a few days the mother will be able to take her home. This is already the fifth baby that did not need to be transferred”.
Dr. Nguyen Thanh Binh and nurse Pham Thi Minh Huong, a surgical team, were sent to develop skills in endoscopic surgery. This kind of surgery is minimal invasive compared to other methods. The equipment needed for the new method had been provided by KfW. Dr. Binh proudly reports that they have already successfully applied this sophisticated method in over 30 cases.

Some time ago, the same hospital did not even have basic regulations for certain processes including administration and dismissal procedures. The waiting time for patients was long.  After our various trainings on management skills, the hospital director decided to re-organise the numerous processes for the hospital to meet at least the basic quality standards. The whole hospital staff agreed on 50 criteria, which will help them to, step by step, prepare for an accreditation of the hospital on the long run. Together they developed the slogan “San sang, lam duoc”, which means: We are ready! We can do it!

There is a newly emerged tendency among the staff to feel responsible for the quality of their services and the achievement of good results.

Quality-assured health care today not only includes medical services but also comprises supporting services in hospitals such as housekeeping and cleaning services, the provision of sterile supplies and the disposal of generated waste. The prevention of infectious diseases is one of the major challenges for the health system in Viet Nam. However, there is still a lack of knowledge among hospital staff when it comes to behaviour-based problems such as insufficient hand washing and unsafe injection. To increase the know-how our project implemented workshops and organised visits to hospitals with functioning infection control for directors, department nurses and hospital staff. During the course of these workshops and visits the participants shared their experiences and their difficulties to apply their theoretical knowledge in a real life situation.
It was agreed to produce a “Manual on Infection Control in Hospitals” based on the latest Vietnamese guidelines, on all materials prepared and used in the preceding theoretical trainings and health staff’s experiences. The manual would serve as a guide and reference book to bridge the “know-do” gap in infection control. Reviewed by the Ministry of Health it will be published soon and can be used nationwide as a reference book and as a textbook in universities.

To achieve all those results in the provinces, the Health programme will continue to follow our slogan: “Think big, start small, but start now! Contribute to long term change and improvement of the health system in Viet Nam.”

For more information about the GIZ health programme in Vietnam, go to "Strengthening Provincial Health Systems"

See also:

Quality management for hospitals in Viet Nam

Preventing hospital-acquired infections: A major concern for many Vietnamese hospitals

BMZ glossary

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