PEDIATRIC HEALTH CARE SYSTEM IN VIETNAM: REALITY AND CHALLENGES

1. PEDIATRIC HEALTH CARE SYSTEM IN VIETNAM:REALITY AND CHALLENGES

2. TABLE OF CONTENTS • Pediatric heath care system in Vietnam • Developmental orientation • Proposals

3. 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

4. VIETNAM’S HEALTH CARE SYSTEM

5. CURRENT RESOURCES IN THE MEDICAL FIELD Medical care providers per 10,000 citizens Number of hospital/clinic beds Physicians Nurses and Midwives

6. PEDIATRIC HOSPITAL NETWORK 3 National hospitals PUBLIC National level Provincial, District, Township & County Levels Town & Commune level PRIVATE Pediatric department in private hospitals Private clinics 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.

7. 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

8. 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)

9. 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

10. CURRENT PEDIATRIC SYSTEM MODEL

11. DISEASE TRENDS • Possibility of disease outbreak during the process of differential diagnosis or treatment: measles • Possibility of new disease outbreak: MERS CoV Communicable diseases Non-Communicable diseases Accident, poisoning & other injuries Source: WHO 2010

12. DISEASE TRENDS (CONT.)

13. 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

14. INFLUENCING FACTORS TO THE PEDIATRIC CARE SYSTEM Administration from Vietnamese government and the Ministry of Health Human resources: - Doctors - Nurses… Hospital’s infrastructure PEDIATRIC FIELD • Available training program for staff • - Research Support from charity and humanity organizations. • Social insurance • Medical budget allotted from the government • Medical equipments • Medications and other pharmacological products People’s knowledge and awareness of medical prevention and treatment for children

15. HOSPITALS WITH EXCEEDING CAPACITY A congested pediatric system • 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 • 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 • Private care: • Private hospitals: target people with higher income • Private clinics: quality of care and patient safety are not yet regulated by any authority

16. 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

17. DEVELOPMENTAL ORIENTATION • Effectiveness • Equity • Quality • Community oriented • Development

18. 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 Warning! Need to concentrate resources to improve hospital quality (Prioritization) • Level 1: • No attempt to improve quality • Regulation violation

19. SOLUTIONS???

20. SUGGESTED FRAMEWORK BY WHO

21. 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

22. 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...

23. TECHNOLOGICAL APPLICATION TO PEDIATRIC CARE • Efficient medical practice • Effective hospital management • Enhancing professional knowledge • High-tech diagnostic and treatment equipments • M-Health, telemedicine

24. CONCLUSION • Current state: DIFFICULT • Challenges: IMMENSE • Demand: numerous, high, expandable, affordable

25. 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

26. Private Health care Public Health care National security

27. THANK YOU!