Strengthening provincial health systems

Project description

Title: Strengthening provincial health systems
Commissioned by: German Federal Ministry for Economic Cooperation and Development (BMZ)
Country: Socialist Republic of Viet Nam
Lead executing agency: Ministry of Health
Overall term: 2009 to 2017

Context

In the course of the economic boom in Viet Nam, the health sector has made impressive progress. However, there are still considerable differences between the regions of the country. The good national averages obscure deficits in the rural regions, where it remains difficult to gain access to needs-driven, evidence-based health services of reliable quality, especially for disadvantaged sections of the population such as ethnic minorities, women and children.

In addition, demographic developments and changing lifestyles are placing an extra burden on the health system. Accidents, chronic illnesses and cardio-vascular diseases are some of the most frequent causes of death today. Medical facilities in rural areas cannot adequately screen for diseases such as cancer and vaccinate for Hepatitis B and there is an increasing need for modern diagnostic tools and treatments in general. This in turn poses enormous challenges for hospitals at provincial and district level in particular.

Objective

In five selected provinces, the poor and disadvantaged have better access to decentralised, needs-oriented and quality-assured health services.

Approach

Since 2009, in cooperation with KfW Development Bank, GIZ has been supporting the implementation of Viet Nam's strategy to improve access to high-quality health services. The programme operates at several levels. It provides advisory services to provincial and district health authorities and 29 hospitals in needs-based, cost-effective planning and modern management methods. Targeted in-service training measures in selected preventive and curative services, such as prevention of cervical cancer and care of new-borns, and the introduction of integrated quality management mechanisms, all strengthen the capacities of health care personnel and improve the services provided by the health facilities.

Support for the development of a pilot telemedicine network in cooperation with KfW Development Bank represents a further contribution to improving services in remote areas. Experience at provincial level is fed into the policy dialogue at national level to drive the development of national guidelines and standards.

Results

In a total of 14 hospitals, strategic five-year plans have been developed, most of which have already been authorised by the political authorities and given a budget. They form the basis for the annual needs-based operational planning. The introduction of electronic hospital management information systems has already harmonised the working processes in 13 hospitals, while the processes for creating standardised reports have also been improved. Hospital staff are receiving tailored advice and training in the continued efficient application of these systems in modern hospital management. A course in hospital management has been accredited by the Ministry of Health and can now be offered in over 1,000 hospitals nationwide. The delegated cooperation agreement concluded with the EU in 2014 has also helped bring these results to fruition.

In the 29 supported hospitals, over 2,000 doctors, nurses, midwives and pharmacists have so far been trained in the care of new-borns, emergency care, intensive medical care, X-ray and ultrasound diagnostics, rational drug treatment and comprehensive care. These training programmes have in turn inspired a range of initiatives to improve quality, for example by helping to improve hygiene in the institutions, decrease hospital infections, reduce the use of antibiotics and lower infant mortality.

A guideline on hygiene in operating theatres, which was developed by the project, is now a national standard. 250,000 examinations have already been carried out in the supported provinces as part of the intervention to prevent cervical cancer. As a result, 1,171 women received early treatment, which stopped the cancer from developing.