Vietnam

1. Vietnam

2. Contents • Human Resources • Strategy 2011-2016 • Projects presentation • Suggestion for the 5 years plan

3. The whole team

4. Strategy FromMedical CaretoInsertion

5. SPINAL UNIT PROJECT 1/ 2003 First spinal unit opening in HCMC 2/ 2007 Decentralization to 3 southern provinces 3/ 2008 Opening a National Reference Spinal Unit in Hanoi 4/ 2010 Decentralization in 6 northern provinces

6. Equity Fundin Da Nang, Phu Yen and Nha Trang Access to rehabilitation services Capacity building Data Collection Advocacy

7. CONGENITAL DIFFERENCESin Hue province Prevention Early detection Early intervention Integration

8. In the aftermath of TYPHOON KETSANAin Da Nang province Spinal unit rehabilitation Health & emergency support to 100 spinal cord injured patients 22 houses accessibilty adjustment

9. KHANH HOA WELCOME to LIFE PROJECT Identification & prevention of risky pregnancies Improvement of delivery conditions Early detection & Care of Baby Disabilities Mutual Risk insurance for pregnant women Rehabilitation of Children with Disabilities

10. ROAD SAFETY PROJECTin rural area: Dong Nai Education & Sensitization Engineering & Enforcement Victims assistance Safe roads for Persons with Disabilities

11. Perspectives and Suggestion for the 5 years plan

12. Birth defects:Public Health Threat (1) • In the world (MOD, 2006) • Estimated 8 million children are born annually with birth defects • 95% of them in low and middle income countries • At least 3 million people die every year as a consequence of birth defects • Birth defects have a large contribution to infant and childhood mortality, especially in countries with IMR <20 per 1,000 live births • In Viet Nam: • The number of children born with birth defects annually is around 87,000 (MOD, 2006). • In Newborn Intensive Care Unit in No1 Children Hospital: birth defects account for 14,7% of the deaths, and account for 42% of hospital admissions • In 2009, there are 6.1 millions population (7,8%) with disability aged 5 and over in entire country (VN Population and Housing Census, 2009)

13. Birth defects:Public Health Threat (2) • Example of Neural Tube Defects in Vietnam: • Collection of NTDs data from major urban hospital in Ha Noi and HCMC • 12% of all birth defects were from Neural Tube Defects. • 50% of children born with NTDs die in infancy • National projections using NTD rates: indicate that from 2009-2015 about 42,000 Vietnamese children will be likely born with NTDs, resulting in about 21,000 deaths. • The survivors will require corrective surgery, rehabilitation, lifelong care and social welfare (Nationa Institute of Nutrition, 2008)

14. Birth defects: Hidden Conditions? • Birth defects are largely unrecognised as being a significant public health problem because: • First, there is unawareness on the toll of birth defects and associated disabilities because of lack of reliable data • Second, there is misunderstood belief that effective care and prevention of birth defects requires cost and high-tech interventions • Third, a misperception exists in the belief that programs for care and prevention of birth defects will draw funding away from other high priority interventions in maternal and child health

15. Birth defects are preventable or treatable • Up to 70% of birth defects are preventable or treatable, mostly through the use of simple interventions (WHO 2006) • Better care and management can reduce the number of deaths and impact of disability on people's lives • Power of prevention: • Family planning combined with encouragement to complete reproduction before age 35 can contribute to a 50% reduction of Down syndrome (WHO, 2000) • Rubella immunization to prevent Congenital Rubella Syndrome: each CRS case prevented saved their health care system an estimated $37,000 in English-speaking Caribbean (MOD, 2006) • Folic acid supplementation (before conception) can reduce to 70% of neural tube defects (MOD, 2006)

16. Suggestion: Framework for Action on Birth defects (1) • Basic practical measures can help to reduce the incidence of birth defects • Promotion of using folic acid: health education, food fortification program • Immunization program for women of childbearing age to protect against infections such as rubella • Training programs: training health workers to recognize and understand the causes of common birth defects can lead to prompt diagnosis and treatment

17. Suggestion: Framework for Action on Birth defects (2) • Health education program: better control of maternal infections, chronic diseases before conception • Preconception care: reducing the risk of birth defects • Newborn screening before and after birth: early detection and treatment • Service development program: providing coordinated services for basic treatment, rehabilitation, palliative care, surgical services for birth defects • Creation of community support network

18. Suggestion for planning and further inclusion into Health planning • Prevention and care of birth defects should be high on the agenda to improve people's health in the next five years 2010-2015 • IMR in Vietnam below 20 > public health cooncern should include the prevention of birth defects (WHO, 1999) • Care and prevention of birth defects help to reduce infant and childhood mortality - achievement of MDGs 4 (MOD, 2006) • Prevention and care of birth defects is feasible and cost-effective in the mid and long term • Implementation of WHO's resolution on birth defects (May, 2010)

19. Conclusion 1. The multi partner mechanisms to be overseen by the government need to address the different dimensions of any given health problem. Ex: for Disability(accounting for 7.8% of population aged over 5 according the 2009 Vietnamese Population and Housing survey )interventions and analysis of this health issue should not only be focused on defining and treating impairment as such, but should also take into account the preventive , predictive outcomes of disability to better formulate the long term needs of this group in the social and economic field. Cooperation with other relevant ministries and development partners, outside the Health Sector ,( Ministry of Transport , MoEd , MOLISA ,.. and departments is required to achieve this .

20. Referring to formulation of special decrees, laws and ordinances for disability, diseases, and medical conditions in Vietnam, the Adoption of the Disability Act and adherence to International treaties on Disabilities, World Health Assembly resolutions on disability prevention and birth Defects and the Millennium Development Goals ( MDG) , Worldwide injury prevention campaigns ( traffic , Labor , occupational ,..) should find their clear expression in the National Health strategy also. It is essential that the Health Strategy plays a key role in implementing these commitments be it in political commitment, national policy and international legislation ( by further using Vietnam as an example for other countries ) .

21. 3. Financing health care and ensuring that the beneficiaries of insurance systems ( long term disabilities ) get the best possible outcome for their health is an essential key to maintain trust between health providers and donors. 4. There should be a clear participation from civil society ( disability organizations,.. ) allowed in monitoring on how health expenditures are used with an objective of quality control and outcome focus towards the beneficiary ( versus on the financial health of the institution providing the care ). Next to enhancing the quality of care , decentralization of care should always be accompanied by equity of care for all .

22. Thanks for your attention, Hen Gap Lai