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PUBLIC HEALTHCARE SYSTEM ORGANIZATION MODEL IN VIETNAM
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This article discussed Vietnam's ongoing efforts to decentralize the health system and its fitness to respond to global health crises as presented through the Covid-19 pandemic. We used a general review and expert's perspective to explore the topic. We found that the healthcare system in Vietnam continued to decentralize from a pyramid to a wheel m...
Contexts in source publication
Context 1
... pyramid model of organization is best defined as a triangle structure, starting with a single point at the top -the highest level, gradually spreading out towards the basethe lowest level. [3] A pyramid model is used to refer to a hierarchical system of ascending levels (from the base) of organization where each level medically and technically complements the preceding level, and the capacity of the lower level is less than the upper (Figure 1). In this model, interventions implemented at lower levels are designed to target broader segments of society with less intensity of resources and medical technology, which may improve their effectiveness in the context of limited resources available to low-and middle-income countries. ...
Context 2
... effectiveness of public health interventions in a wheel model has been demonstrated in nursing practice, health education, and administration. [5] DECENTRALIZATION FROM PYRAMID MODEL TO WHEEL MODEL IN VIETNAM Figure 1 shows the current public healthcare system organization model in Vietnam. According to this model, ...
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Citations
... The expansion of the physical infrastructure was achieved by adapting military buildings, university facilities, and dormitories to serve as quarantine areas and temporary hospitals 17,24 . ...
Several studies on the fight against COVID-19 have been developed in various countries. However, there are few studies that compare cases corresponding to the first wave of the epidemic in a close period and with different responses and outcomes. Therefore, an integrative review was conducted to analyze the experiences of Italy and Vietnam in dealing with the COVID-19 pandemic during the first wave of the disease, seeking to identify the contributions of the health and surveillance systems as well as the specificities of the measures adopted in each country. Common databases were used and the empirical material related to publications was supplemented with documents from the official websites of both countries. The results of this study show that Vietnam and Italy adopted different strategies to deal with COVID-19, containment and mitigation, respectively, with specific measures that made a difference in the number of cases and deaths in each country.
... A ampliação da infraestrutura física foi realizada por intermédio da adaptação de prédios militares, instalações universitárias e dormitórios para servirem de espaços de quarentena e hospitais temporários 17,24 . ...
Resumo Diversos estudos sobre o enfrentamento da COVID-19 vêm sendo desenvolvidos em vários países. Contudo, são escassos aqueles que comparam casos correspondentes à primeira onda da epidemia em período próximo com respostas e desfechos distintos. Assim, realizou-se uma revisão integrativa para analisar as experiências da Itália e do Vietnã no enfrentamento da pandemia de COVID-19 durante a primeira onda da doença, buscando identificar as contribuições dos sistemas de saúde e de vigilância, bem como as especificidades das medidas adotadas em cada país. Foram utilizadas bases de dados comuns, complementando-se o material empírico referente às publicações com documentos oriundos de sites oficiais dos dois países. Os resultados da presente pesquisa permitem identificar que Vietnã e Itália adotaram estratégias distintas de enfretamento da pandemia, com focos na contenção e mitigação, respectivamente, com medidas específicas que fizeram a diferença no número de casos e óbitos de cada país.
... During the COVID-19 process, it has been observed that countries have different centralization and decentralization practices suitable for their own conditions. It is reported that the simultaneous and complementary coordination of centralization and decentralization in governance in COVID- 19 and similar crises will prevent complexity at management levels and positively affect the effective management of the crisis. ...
It has been reported that the tensions, incoordination and incompatibility between the central and local government, and the disconnection in the institutional capacity in the fight against the COVID-19 epidemic, adversely affected the epidemic management. This study was carried out to evaluate the centralization and decentralization practices in the management of the COVID-19 health crisis in the world within the scope of the literature. With the spread of COVID-19 around the world in 2020, most governments have had to take drastic central measures to reduce the spread of the virus. It was emphasized that the measures taken in most countries in the early stages of the epidemic were not taken in coordination with the local units, causing incompatibilities with the local. As of 2021, due to the different experiences of the local effects of the epidemic during the pandemic process, it has been observed that the measures applied in the countries against the epidemic differ according to the local and regions. Ensuring that coordination and harmony between central government and local government/units are important that is explained by the fact that the local effects of the epidemic are different (infection rate, population density, effectiveness of the measures taken, etc.). During the COVID-19 process, it has been observed that countries have different centralization and decentralization practices suitable for their own conditions. It is reported that the simultaneous and complementary coordination of centralization and decentralization in governance in COVID-19 and similar crises will prevent complexity at management levels and positively affect the effective management of the crisis.
... When 50% of current OPCs are preventive-based health facilities, it would be a challenge for them to be eligible for signing contracts with local HI agencies to provide HI-paid HIV treatment services. To solve this issue, an adaptive model of the healthcare setting is necessary [32,33]. There are two options: 1. Preventive-based health facilities established HIV and AIDS specialized outpatient clinics, which meet the criteria for a curative treatment site, or 2. Moving patients on ART from a preventive-based OPCs into curative-based OPCs to guarantee that PLHIV would be paid by HI for their HIV treatment services. ...
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Background:
Monoclonal antibody (mAb) and Fc-fusion protein (FcP) are highly effective therapeutic biologics. We aimed to analyse consumption and expenditure trends in 14 Asia-Pacific countries/regions (APAC) and three benchmark countries (the UK, Canada, and the US).
Methods:
We analysed 440 mAb and FcP biological products using the IQVIA-MIDAS global sales database. For each year between 2010 and 2020 inclusive, we used standard units (SU) sold per 1000 population and manufacture level price (standardised in 2019 US dollars) to evaluate consumption (accessibility) and expenditure (affordability). Changes of consumption and expenditure were estimated using compound annual growth rate (CAGR). Correlations between consumption, country's economic and health performance indicators were measured using Spearman correlation coefficient.
Findings:
Between 2010 and 2020, CAGRs of consumption in each region ranged from 7% to 34% and the CAGRs of expenditure ranged from 9% to 31%. The median consumption of biologics was extremely low in lower-middle-income economies (0·29 SU/1000 population) compared with upper-middle-income economies (1·20), high-income economies (40·94) and benchmark countries (109·55), although the median CAGRs of biologics consumption in lower-middle-income economies (31%) was greater than upper-middle-income (14%), high-income economies (13%) and benchmark countries (9%). Consumption was correlated with GDP per capita [Spearman's rank correlation coefficient (r) = 0·75, p < 0·001], health expenditure as a percentage of total (r = 0·83, p < 0·001) and medical doctors' density (r = 0·85, p < 0·001).
Interpretation:
There have been significant increases in mAb and FcP biologics consumption and expenditure, however accessibility of biological medicines remains unequal and is largely correlated with country's income level.
Funding:
This research was funded by NHMRC Project Grant GNT1157506 and GNT1196900; Enhanced Start-up Fund for new academic staff and Internal Research Fund, Department of Medicine, LKS Faculty of Medicine, University of Hong Kong.
... With the establishment of the CDC model, lower-level hospitals were merged into CDC to provide both prevention and treatment (including HIV/AIDS prevention activities, treatment and care services). In contrast, higher-level hospitals are allowed to be separate from CDC. 5 Moreover, it has also faced several obstacles in shifting the finance of HIV/AIDS services from external funds to the social health insurance (SHI) fund and the local government budget. 4 Notably, when the HIV/AIDS epidemic is still highly concentrated among KPs in Vietnam, 2 it requires substantial effort to include KP towards the universal health coverage goals. ...
The COVID-19 pandemic has aggravated the obstacles for HIV/AIDS programs in limited-resource countries like Vietnam to achieve the HIV/AIDS-related Sustainable Development target. The paper aims to evaluate the impact of the COVID-19 pandemic on the provision of HIV/AIDS services-a pathway to achieving universal health coverage for key populations (KPs). Employing mix-methods, we conducted a desk study, one focus group discussion, and ten in-depth interviews with participants from the Ministry of Health, Provincial Centres for Disease Control, and HIV/AIDS-related facilities. The results showed the reduced coverage of KPs with access to prevention (i.e., harm-reduction services, counselling), testing, and treatment services (i.e., antiretroviral therapy, isoniazid preventive therapy). It also showed the reduced coverage of quality essential services, mainly in skipping consultation and testing, delaying un-emergency services, and redirecting KPs to non-HIV-specialised facilities. There was a gap in providing support for mental health, violence/abuse, and reproductive health. Financial risk protection for KPs was reduced due to uncertain local budget allocation; decreasing their ability to pay for HIV/AIDS-related services and social health insurance premiums; and increased out-of-pocket payments to comply with the COVID-19 control measures. This paper provides recommendations for strategic planning to ensure universal health coverage for KPs in the post COVID-19 era, especially for limited-resource countries like Vietnam.
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We translated the Effort-Reward imbalance questionnaire, an instrument for measuring work stress, into the Vietnamese language and investigated its psychometric properties among nurses in Vietnam. In a hospital-based cross-sectional study design, we sampled and interviewed 207 nurses working full-time (response rate 83%). We evaluated the internal consistency using standardized Cronbach's alpha coefficients and structural validity using confirmatory factor analysis. Discriminative validity was assessed by comparing the measured scores between age groups, gender, education levels, income groups, and job positions. In addition, we confirmed the criterion validity by investigating its association with self-reported health using simple and multiple logistic regression models. Most of the participants were female (73.3%), young (average 28.5 years old), and had education levels of college or higher (53.5%). We observed sufficient internal consistency in effort, reward, and over-commitment scales (Cronbach's alpha 0.80, 0.76, and 0.68, respectively). Confirmatory factor analysis of the three-factor hierarchical model showed an acceptable fit and fair construct validity with most moderate or stronger (>0.3) factor loading coefficients. Poor self-rated health was more likely in respondents in both Effort-Reward ratio's middle tertile (adjusted Odd-Ratio=2.80, p-value=0.031) and highest tertile (adjusted Odd-Ratio=2.64, p-value=0.05), adjusting for age, gender, and education levels. The Effort-reward imbalance scale has adequate reliability and validity for assessing work stress among nurses in Vietnam. Its significant association with poor self-rated health warrants further investigation. The validated instrument can help measure the effort-reward imbalance to manage better work-related emotional strains and mental health issues among nurses and ensure human resources' stability in healthcare in Vietnam.
As of 2020, the cumulative number of COVID-19 cases recorded in Vietnam was less than 1500, proving the success of COVID-19 control in Vietnam [1]. Vietnam has been recognized as one of the few countries that successfully controlled COVID-19 in 2020 [2]. Several recent articles have summarised a set of lessons learned, the so-called "Zero-new-case-ap-proach". These included (i) a rapid and coordinated public health response with a decentralized health care system [3]; (ii) massive quarantine and targeted lockdown; (iii) third-degree contact tracing; (iv) centralized patient management; (v) early school closures and robust border controls; (vi) mask policies and 5K message (5K refers to use face masks in public places, disinfect regularly, keep distance, stop gathering, and make health declaration); and (vii) innovative mass testing strategies in the resource-constraint system (sample pooling strategy of PCR test with 2-7 swaps) [4], These "Zero-new-case-approach" strategies all focused on the non-pharmaceutical aspect of disease control. They aimed to maintain zero community transmission by establishing a comprehensive public surveillance system and enacted drastic measures with the support of the police and military forces.
