Viet Nam seeks to tackle issue of equity in health care for women and children
Hanoi, 11 April, 2008 - Viet Nam is seeking to expand its progress in reducing child and maternal mortality to its poorest women and children by developing innovative ways to address these health inequities.
At a four-day consultation, jointly organized by the Ministry of Health and UNICEF, global and regional experts explored ways to improve both access and the quality of maternal and child health services for the country’s poorest women and children. The outcome, a set of policy recommendations, was presented to the Government of Viet Nam at the conclusion of the meeting in Hanoi.
“The problem of growing inequity is neither a new one, nor one confined to Viet Nam. Every country in this region has its marginalized populations – marginalized either by geography, by gender, by poverty, by ethnicity or by politics. No country is exempt,” acknowledged Anupama Rao Singh, Regional Director for UNICEF East Asia and the Pacific.
“But what makes this time so unique in the history of the region and the world, is that resources, globally and in many of the countries in the region, now exist to eliminate these inequities,” she said in her opening statement.
Research presented at the consultation demonstrated that unless attention was paid to equity in access and progressive policies were specifically targeted to reach the poorest segment of the population, some countries may reach the MDG goals but not actually improve the welfare of their poorest citizens.
In many Asian countries, where public health spending is already low, the middle and upper quintiles of the population often received a much larger share of the public health budget. In many cases, the cost of health care was falling on the shoulders of the poorest, with out of pocket payments for health care leading to catastrophic expenditures that are entrenching many families further into poverty. In Viet Nam, it was estimated that public funding only contributed to a third of all health spending.
While overall progress on child survival in Viet Nam has been impressive with child mortality rates falling from 53 in 1990 to 17 in 2006, the national average masks enormous differences between parts of the country. The mortality rate of children in mountainous and rural areas or of poor families is three to four times higher than that of children in lowland areas or of better-off families. Although child mortality has declined in all income groups, the gap between the richest 20% and the poorest 20% of society is increasing.
While on average the vast majority of women in Viet Nam give birth with skilled assistance (88%), the rate is half (44%) in Northern mountainous areas. An estimated 27% of women in the Central Highlands do not receive obstetric services. Nutrition also remains persistently high, with almost 30 percent of children suffering from stunting.
As presented in a Situation Analysis specially prepared by consultants for the consultation, evidence indicated that health spending was heavily focused on curative treatment, which disproportionately benefit the better off, rather than preventative and primary health care interventions. Looking at trends over the last fifteen years, the study indicated that inequity had actually increased in child malnutrition, child mortality and fertility. It identified factors such as income, location, educational status of the mother and ethnicity in determining health outcomes.
“Over the last decade, the Government of Viet Nam has introduced a number of schemes to increase access to quality health care services and to reduce the financial burden on the poorest people,” said Dr.Nguyen Hoang Long, Vice Director of Department of Planning and Finance, Ministry of Health, “Yet we realize that to ensure equity, we still have work to do. We welcome this opportunity to learn from others and further strengthen our efforts.”
The 60 delegates included renowned public health economists, policy makers from neighboring Mekong countries and representatives from different departments and institutions within the country. They sought to use the evidence presented to identify problems and then based on their experiences develop policy recommendations that can be adopted by the Government.
Some of the challenges identified included financial and economic barriers, such as inadequate government funding, geographical disparities in the supply of health services, which are exacerbated by human resource shortages in remote areas, poor quality of service and growing nutritional inequity between the rich and poor.
These recommendations targeted towards disparity reduction, included:
• To increase the health budget to 10 percent of the government budget by 2010. The “sin tax” on tobacco and alcohol could be increased with revenues dedicated exclusively to health and health promotion.
• To increase and strengthen preventative and health promotion programmes that are often needed most by the poor. To do this, a review of current spending on curative versus public health interventions would be needed that included a plan on how best to reorient spending towards underserved areas where the burden of disease is greatest.
• To decrease geographical disparities in capacity to provide quality service, including more on primary health care infrastructure and it’s functioning in remote and difficult areas. To do this, a number of policies were suggested including to shift from the “one commune, one commune health center” to a more flexible approach which matches the delivery system to the population in the most underserved areas. There was also need to establish the right performance incentives to strengthen outreach services.
• To decrease geographical disparities in human resource distribution, focusing on underserved areas, the central government could develop an overarching human resource management plan, combining financial and professional incentives, indicators to measure performance and a more predictable system to assist in decision making in poorer performing provinces. It was suggested that a national policy on mandatory rural service by medical and nursing graduates could be a mechanism to get health workers to the poorest parts of the country.
• To ensure appropriate level and allocation of funding by provincial government to achieve health equity, it was recommended that central targeted funding to poorly performing provinces by introduction of conditionalites to use to reduce inequities.
• To improve the quality of care and the responsiveness, a series of steps were recommended. These included improving “cultural sensitive services”, by minimizing the communication gap with ethnic groups, devising and declaring a Universal Rights of Patients, and putting in place independent monitoring and performance payment based on level of responsiveness and quality achieved.
• To increase demand for quality public health care, especially amongst the poorest people, it was recommended that conditional cash transfers could be introduced to high risk groups, as well as developing more appropriate and focused communication strategies.
• To provide better financial health protection for the poor, the disadvantaged groups and the near-poor including in the informal sector in order to prevent financial catastrophic health expenditure. To do this the Government should devise an innovative mandatory government full-funded insurance scheme for a limited service package focused on the burden of disease that reaches these groups.
It is hoped that the consultation will be the first of many in the region that seeks to identify practical country specific solutions to address health inequity for women and children.
For more information, please contact:
- Shantha Bloemen, Communication Specialist, UNICEF East Asia and Pacific Regional Office, Tel: +66819060813,Email:firstname.lastname@example.org