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PEDIATRIC HEALTH CARE SYSTEM
IN VIETNAM:
REALITY AND CHALLENGES
TABLE OF CONTENTS
 Pediatric heath care system in Vietnam
 Developmental orientation
 Proposals
INTRODUCTION
 Vietnamese health care system in general and
Vietnamese pediatric care system in particular are in
the process of reforming and developing. It focuses
on:
 Effectiveness
 Equity
 Quality
VIETNAM’S HEALTH CARE
SYSTEM
CURRENT RESOURCES IN THE
MEDICAL FIELD
Medical care providers per 10,000 citizens
Number of
hospital/clinic
beds
Physicians
Nurses and Midwives
PEDIATRIC HOSPITAL
NETWORK
PUBLIC
National level
Provincial, District,
Township & County
Levels
Town &
Commune
level
3
PRIVATE
Nationa
l
hospit
als
12 pediatric hospitals
11 obstetric and pediatric
hospital
84,2% general hospitals
at provincial level offer
pediatric care
General doctors provides pediatric care.
645 county hospitals
and 48 general hospitals
No pediatricians
10,748 local health centers.
Pediatric
department in
private hospitals
Private clinics
TRENDS OF POPULATION PROPORTION
(1989-2050)
Red line: Proportion of children under the age of 15
Blue line: Proportion of adults over the age of 65
Nguồn: Tổng cục thống kê (GSO), UN
CONNECTION BETWEEN
POPULATION AND PEDIATRIC CARE
(Nguồn: Dân số và cơ cấu dân số Việt Nam vào năm 2014 - 2019, Tổng cục dân số và kế hoạch hóa gia đình VÀ Báo cáo tổng quan ngành Y tế năm 2013, Bộ Y tế)
HUMAN RESOURCES IN
PEDIATRIC BRANCH
 Huge shortage of medical staff
- 0.6 pediatrician/10,000 children under the age of 16( ≈ 1.800
peditricians)
- Pediatrician/Medical doctors: 3% Doctors/Patient beds: 0,2%
- Discontinuation of pediatric training since 1998
 Uneven distribution of human resources
 Quality of training program
CURRENT PEDIATRIC SYSTEM
MODEL
DISEASE TRENDS
• Possibility of
disease outbreak
during the process
Communicable
diseases
of differential
diagnosis or
NonCommunicable
diseases
treatment: measles
Accident, poisoning &
other injuries
• Possibility of
new disease
outbreak: MERS
CoV
Source: WHO 2010
DISEASE TRENDS (CONT.)
ENVIRONMENTAL EFFECTS ON
CHILDREN’S HEALTH
Air pollution
Water pollution
Food safety
Smoke
Unknown factors
Other factors
Industrial pollution
Weather and climate
Waste management
Arthritis and respiratory diseases
Environment safety
School
INFLUENCING FACTORS TO
THE PEDIATRIC CARE SYSTEM
Human resources:
- Doctors
- Nurses…
-Available training
program for staff
-- Research
- Social insurance
-Medical budget allotted
from the government
Administration from
Vietnamese government
and the Ministry of
Health
Hospital’s infrastructure
PEDIATRIC FIELD
People’s knowledge and
awareness of medical
prevention and
treatment for children
Support from charity and
humanity organizations.
- Medical equipments
- Medications and other
pharmacological products
HOSPITALS WITH EXCEEDING
CAPACITY
A congested pediatric system
National level:
-
Filled to capacity, not enough
staff
-
Shortage of hospital beds
(requires 110-130%)
-
Great pressure on
physicians, nurses and other
staff
-
Challenge in staff
management and overall
operation
Local level :
-
Preference in transferring
complicated cases to
national levels
-
Limitation in specialty
training results in distrust
and noncompliance in care
-
Outdated infrastructure
and medical supplies
-
Abandonment of advanced
medical equipments
-
Low wage fails to motivate
medical staffs at work
Private care:
-
Private hospitals: target
people with higher income
-
Private clinics: quality of
care and patient safety are
not yet regulated by any
authority
SUMMARY OF THE CURRENT
STATE OF VIETNAMESE HEALTH
CARE SYSTEM
 Sparse network of pediatric care is unable to fully support local health providers or provide
adequate care for children nationwide
 Overloading and Uneven distribution of resources between lower levels and regions
(geographic and/or socio-economic)
 Infrastructure update fails to match up with the socio-economic development
 Missing latest evaluation and statistics on child health’s need
 Healthcare policies, systematical management, and investment still face many challenges
 Ineffective campaign for communication and public health.
 Modest wage and employment benefit package for workers in public hospitals
 Lack of strategies and policies to retain highly skilled employees
 Under pressure from the community because of many limitations in the field
DEVELOPMENTAL
ORIENTATION
Effectiveness
 Equity
Quality
 Community oriented
 Development
DIAGRAM FOR QUALITY
IMPROVEMENT
Improvement scale for Vietnamese
hospital quality
Long-termed
goals
Level 5:
- Excellent outcome
- “Gold en” quality
- Reach international standard
Level 4:
- Strictly abide to rules and regulations
- Output assessment
- Achieve some positive results
Acceptable
Standard
Level 3:
- Sufficient performing regulations
- Establish and complete structure organization
- Activities deployment
Level 2:
- Follow quality assurance guideline
- Implement some activities to improve quality
- Deliver some input factors
Level 1:
- No attempt to improve quality
- Regulation violation
Warning!
Need to concentrate
resources to improve
hospital quality
(Prioritization)
SOLUTIONS???
Medical
Treatment
Manage
ment
Prevention
SUGGESTED FRAMEWORK
BY WHO
PEDIATRIC STAFF TRAINING
 Pediatric Branch provide training for pediatric system
 Providing adequate pediatric health workers supply for pediatric hospitals
according to population size, geographical and economic features
(pediatrician/doctor: 30%, nurse/doctor: 2)
 Training programs:
– Formal training programs: First-degree and second-degree specialist
program, resident doctors training, and post-graduates training program.
– Continuous training: specialty training program, module training session,
and technology transfer training program,
– Training program via workshop, seminar, conference
– Cooperative training programs with other medical centers and universities
national and international
EXPANDING PEDIATRIC CARE
NET WORK
 Narrowing the disparity in health among regions


Broadening pediatric health network in remote areas and for minority groups....

Appointing doctors to work in underserved areas

Targeted ratio of 1 doctor per 1000 children for primary care
Reducing mortality rate in children under 5 years old

Reproductive care program and obstetric hospitals

Pediatric emergency, safety in patient transferring

Enhancing and improving neonatal and pediatric departments at provincial and
district levels
 Redeveloping/accelerating the development of community pediatric
program

IMCI, GOBIFFF, APLS, Newborn care, nutrion...
TECHNOLOGICAL
APPLICATION TO PEDIATRIC
CARE
 Efficient medical practice
 Effective hospital management
 Enhancing professional knowledge
 High-tech diagnostic and treatment equipments
 M-Health, telemedicine
CONCLUSION
 Current state: DIFFICULT
 Challenges: IMMENSE
 Demand: numerous, high, expandable, affordable
SUGGESTIONS FOR URGENT ACTION
 Reopening pediatric specialist training program, opening pediatric
nursing program: Pediatric Association, universities/colleges…
 Ensuring consistency for all training programs (CME) within different
organizations, national hospitals as well as medical school
 Bring back pediatric care programs for the communities with the
collaboration from all hospitals
 Formalize all clinical guidelines and other medical training materials
for all organizations, hospitals (including private entities), schools,
etc.
 An excellent system requires: connection, two-way communication
Private
Health
care
Public
Health
care
National
security