Legacies of primary health care in an age of health sector reform: Vietnam's commune clinics in transition

Abstract

Developing countries that were early, enthusiastic adopters of Primary Health Care often developed an extensive -but eventually dilapidated and under-utilized -network of public clinics at the grassroots. As paradigms and investment patterns of health sector reform have shifted, the question of what role these public clinics can meaningfully play, and how best to revitalize them, has become important in a number of countries. This paper evaluates the strategy taken by, and outcomes of, a major attempt in Vietnam to revitalize the grassroots infrastructure of primary health care against the backdrop of the country's economic transition. The project's substantial supply-side investments in infrastructure led to marginal increases in utilization and the quality of preventive health services provided by the centers. But because the project failed to take adequate stock of broader, public sector-wide trends and reforms over the transition, the investments had little impact on the incentives, accountability patterns and capacities of clinic staff and the local authorities. Such institutional factors are heavily implicated, in Vietnam as elsewhere, in the substantial and often increasing disparities in service access and quality that continue to afflict transitional health sectors.

Quality of reproductive health services at commune health stations in Viet Nam: implications for national reproductive health care strategy

“…They were recruited from the community to avoid any possible courtesy bias arising from their relationship with CHS service providers. 11,25 Key topics covered in both interviews and focus group discussions with providers were their perceptions of service quality (e.g. the physical environment of the CHS clinic, its facilities and equipment and level of staff expertise) as compared to alternative providers, and difficulties faced by the CHS in provision of reproductive health care.…”

“…10 AD Ngo, PS Hill / Reproductive Health Matters 2011;19(37): [52][53][54][55][56][57][58][59][60][61] In addition, analysis of national statistics showed substantial differentials in utilisation of CHSs, a significant problem for the primary health care network. 11 The proportion of CHSs that meet national standards is low in many provinces. 12 …”

An approach to health system strengthening in the Union of Myanmar

“…An important characteristic of HSS strategies in many of these countries (including Myanmar) is the challenge of strengthening systems to address regional or "within country" inequalities in health care access. Studies across in Asia in locations such as China [32], Vietnam [33] and Indonesia [34] all articulate this policy and organizational challenge in relation to the impact of economic or geographic constraints on service accessibility.…”

Health system strengthening in Cambodia—A case study of health policy response to social transition

“…Those 'caught out' by this delayed technical response include millions of poor households in the Asian region in countries such as China, Vietnam [61] Mongolia [62] Myanmar, Cambodia and Laos, who are financing over 70% of their own health care from extremely low income bases [63]. In these circumstances, the challenge for decision makers is to reduce the lag time between social transition and health policy response and implementation, thereby minimizing the harm of transition on the health and well being of their populations.…”