care center. There is also a move afoot to reform the education curriculum of Health Care workers nation wide and, more generally to address the nationwide shortage of health care workers. Finally, he observed that the most significant sources of outside funding are UNICEF and INGOs.
Tran Truong Hai, Deputy Director, International Relations Department, Vietnam Ministry of Health
Vietnam’s health care system is organized on four levels: at the central level there are the government departments and ministries, including the International Cooperation Department; at the provincial level there are provincial health services; primary health care is provided at the district level and commune health stations provide local assistance.
The primary objectives of the ministry of health for 1999 and 2000 include reducing morbidity and mortality by improving community health, as well as making primary health care and referrals more accessible to poor people in Vietnam. The third primary objective is to enhance preventative and corrective care management.
To fulfill these objectives, some measures have been identified thus far. Control of epidemics, particularly a nationwide project for the control of dengue, as well as of tuberculosis, and HIV which are on the rise in and out of Vietnam. TB, in particular, was thought to be under control and it is very disturbing to see it on the rise and clearly not controlled. Disease eradication through vaccinations is another measure that has been identified, to decrease new cases of polio and other disease for which vaccines are available. To reduce goiter, a national iodized salt program is in the works.
In addition to disease reduction and eradication, measures will be taken or are being taken to increase available community health stations, as 10% of communes have no stations on priority is to establish stations in those regions. User fees and health insurance will also have to be better addressed in the long run, to efficiently fund the system with special attention paid to making health resources equally available to poor people. Other approaches to improving efficiency within the system include appropriate management to maximize use of doctor’s skills as well as community programs to get doctors in to community health stations.
Some of the major challenges to implementing the above outlined measures are that income is very low in Vietnam, and social divisions
mean that poor people have much less access to services. Lack of technicians and equipment prevents efficient service provision, and the national budget allocation is too low. Presently the government spends 3% of the budget on health care—the health ministry would like at least 5%. The ministry would also like to improve the living conditions of health care workers to attract more providers.
Despite these challenges, the health ministry does enjoy substantial political support from the government of Vietnam, and past experiences have taught them much about what does work well. Also, some indicators are improving in Vietnam—infant mortality and low birth weights are on the decline. Vietnam needs or can best utilize outside NGO support in training providers to treat the severely disabled, nutrition assistance, reproductive health and HIV/AIDS prevention, and health care equipment.
Barbara Lewis, Laos Consortium
The Laos Consortium is engaged primarily in tertiary health care within the hospital system in rural areas of Laos. Ms. Lewis works with the War Victim’s Assistance Project, which works in a single region in Laos, but UXO impacts that health care system nationwide, so their experiences apply to the whole country to some degree. Lack of resources, compounded by the damage caused by bombing have left the health care system without an infrastructure, and the system is further strained by the demands of treating UXO injuries.
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