Justificación

This section is going to start with what aspects of health care in Vietnam are good and then deal with deficiencies, especially outside the major cities.

Vietnam, the easternmost country on the Indochina Peninsula, has made great progress in health care since 1990s, and is currently working to develop a universal health care system, which will cover all residents and provide them with basic health care. Since its origins, the Communist Party of Vietnam has professed a commitment to providing fair access to health care services, even during periods of war and extreme poverty.1

The overall quality of health care in Vietnam is regarded as good as reflected by Health Partnership Group. In 2011 the average life expectancy of Vietnamese reached 73 years and the child mortality rate has shown a declining trend over time. The national rate fell from 15.8 per 1,000 live births in 2010 to 15.5 in 2011.2 Vietnam continues to make progress towards achieving the health Millennium Development Goals (MDGs) of the United Nations, such as prevention and control HIV/AIDS, malaria and other diseases; reduction by 50% in the proportion of people without regular access to basic hygiene and safe water.3 In 2005, Vietnam’s Ministry of Health launched a palliative care initiative that uses the World Health Organization public health strategy for national palliative care programme development. With international financial and technical support, the initiative has made significant early progress. A rapid situation analysis in 2005 led to national Guidelines on Palliative Care in 2006, radically improved opioid prescribing regulations in 2008, the training of more than 400 physicians in palliative care by early 2010 using three curricula written especially for Vietnam and the initiation of palliative care services in some hospitals and in the community.4 Although Vietnam’s economy is in the midst of a global financial crisis and economic recession, the Government has managed to maintain an increasing investment in health care

1 _{Cf. Jonathan D. London, “Vietnam’s Mass Education and Health Systems: A Regimes Perspective,” American} Asian Review 21, no. 2 (Summer 2003): 125.

2

Cf. Health Partnership Group, Joint Annual Health Review 2012: Improving Quality of Medical Services

(Hanoi: Vietnam Ministry of Health, 2012): 13.

3 _{Health Partnership Group, Joint Annual Health Review 2012, 26.}

4 _{Eric L. Krakauer, Nguyen Thi Phuong Cham and Luong Ngoc Khue, “Vietnam’s Palliative Care Initiative:}

Successes and Challenges in the First Five Years,” Journal of Pain and Symptom Management 40, no. 1 (July 2010): 27.

sector to improve the people’s health. The state budget share of GDP spent on health in 2007 was 2.36%, declining to 2.30% in 2008, then back up to 2.77% in 2009 and 3.09% in 2010.5 Along with these impressive achievements there are numerous difficulties and challenges in health care services in Vietnam. Commercialization of health care services in public hospitals since the late 1980s has brought about a lot of changes to Vietnam’s health care system. The health sector began charging fees and privatized drug sales and thereby a large part of the fiscal burden of healthcare was shifted from the state onto individuals. The benefits of commercialization of health care have not been shared equally. The main beneficiaries of commercialization continue to be affluent social groups, while most of the people may be at high risk of falling into poverty when encountering major medical expenses. Moreover, in reality the poor and the exempted groups still find services unavailable without an informal fee, known as ‘under table’ or ‘envelope’ payments, to doctors, nurses, midwives and other healthcare staffs.

Another challenge in health care services is that urbanization and industrialization are happening quickly, thus creating huge pressure on big cities. Overcrowding in Vietnamese hospitals is a significant issue with it not being uncommon in some state-run hospitals for two or three patients to literally share one bed. The reason is most of the best health workers have incentives to move from rural or poor urban areas to major cities, such as Hanoi and Ho Chi Minh City (formerly known as Saigon). Health care facilities in these capital areas are better equipped and have more modern equipment to provide good health treatments that health centers in other provinces do not have. This disparity has caused many health care problems especially for the poor and the ethnic minorities who mostly live in isolated and remote areas. In addition, the Vietnam demographic is that of a populous country entering an ageing stage very fast. The Population Census in 2009 indicated that Vietnam’s population would continue to rise, on average, about 900 thousand people per year. Furthermore, the population age structure has changed dramatically with the population in the age group of 60 years and older increasing from 8.0% in 1999 to 9.4% in 2010. A high proportion of the elderly population will necessitate rising needs for health care services in the immediate future.6 For example, while communicable diseases have seen a declining trend, non-communicable diseases continue to increase in prevalence. This study finds that more often people at the age of 60 or

5 _{The data source used is Vietnam Ministry of Health, National Health Accounts Implemented in Vietnam for} 1998-2010 (Hanoi: WHO, 2011).

older are suffering cardiovascular diseases, diabetes, cancer and chronic lung diseases. This will heavily influence the demand for geriatric health services, palliative and end-of-life care. Besides those difficulties, there remain other issues such as, low salaries for health care professionals, insufficient government subsidies, outdated medical equipment. All of them make the health care system of Vietnam largely underdeveloped and both the quantity and quality of hospitals, clinics and medical workers have not kept pace with Vietnamese society’s expectations.