Department of Planning and Finance Ministry of Health, March 2016

1. HEALTH CARE PLAN No 139/KH-BYT DATED MARCH 01, 2016ON PEOPLE HEALTH CARE AND PROTECTION 2016-2020 Department of Planning and Finance Ministry of Health, March 2016

2. CONTENT • 5 year Health care Plan review (2011-2015) • Overall review • Detailed review: outcomes and disadvantages • 5 year Plan (2016-2020) • Opportunities and challenges • Targets and key indicators • Budget proposal • Following up and evaluation Theo dõi và đánh giá

3. EVALUATION OF THE IMPLEMENTATION OF THE FIVE-YEAR HEALTH PLAN (2011 – 2015)

4. OVERVIEW Remarkable improvement in People’s Health proved by basic health indicators Average life expectancy increase annually Trend of mother mortality

5. Health status improved Malnutrition Child mortality

6. OVERALL REVIEWS • Achieved and exceeded 16/19 key indicators denoted in 5 year health care plan (3 indicators was not achieved: average life-expectancy, children under 5 year old mortality rate, population growth rate) • Achieved 4/5 indicators and 16/17 indicators in MDGs (nearly achieved the indicator on children under 5 mortality rate within Children mortality reduction) • Accomplished 7 main tasks of the health care sector period 2011-2016: (1) Hospital overload reduction; (2) Financing mechanism reform in public health units; (3) Health insurance coverage implementation; (4) Improvement in grassroot and primary health care; (5) human resource development; (6) Pilot implementation of medical services based on people need; (7) Health education and communication improvement

7. ACHIEVED/EXCEED 16/19 BASIC TARGETS

8. ACHIEVED/EXCEED 16/19 BASIC TARGETS

9. ACHIEVED/EXCEED 16/19 BASIC TARGETS

10. NOTABLE OUTCOMES • Pandemic has been prevented on the spot with wide spread's restrained • Effectively implement strategy to ease hospital overload by mobilizing investment sources, upgrading health care facilities, building more satellite hospitals, technics transfer, health staff rotation (sending officials from upper level to the lower one for capacity building and central overload reduction ) • 76,52% population with health insuranced which exceeded the target elaborated by National Party and National Assembly • health worker’s behavior and attitude reforming towards patients’ satisfaction has been committed and implemented by the whole sector, these activities received positive supports from people. • The World Health Organization (WHO) has recognized Viet Nam's vaccine management system as an internationally standardized one • To develop new high tech especially transplant • To transform health care system from the grassroot to provincial level for better integration and development • MDGs implementations has been highly recognized by international partners

11. DIFFICULTIES AND DISADVANTAGES • Raising demands of people in health care and protection while national budget and resources for this sector stay limited • Lack of focal point and homogeneity in the health care system • There’s a gap in health indicators among regions • Hospital overload at the central level hasn’t been curved properly • There have been limit among prevention – curation - rehabilitation, modern treatment – traditional medicine, • Low proportion of people with national health insurance, high out of pocket hospital fee, limited private sources for health care sector and Incompetence in national health insurance management • Inadequate distribution in health staff, favorable treatment towards health workers hasn’t been implemented • Medicinal material, pharmaceuticals hasn’t been well developed • Health informatics hasn’t met management demands

12. PREVENTIVE MEDICINE • Achievements • Pandemic forecast, surveillance and control improved; Number of dangerous or communicable pandemic under control and prevention • The prevalence and mortality rate decrease year by year • Number of new vaccines included in Expanded Vaccination Programme, the proportion of adequate vaccination go upper 90% • HIV prevalance in community remained under 0,3%; the number of new cases or case transfer to AIDS and mortality rate decreases; the global target on TB, malaria has been reached • Health environment management improved, achieved MDG on the proportion of people access to clean water and sanitation • Thorough inspection on food safety • Health education and communication improved

13. Difficulties, disadvantages • Communicable disease prevalence stay high, pandemic with vaccine control tends to re-emerge • HIV Prevalence keeps high in some Northern mountainous provinces and big cities. Limited number of TB patients follow DOTs treatment. Malaria drug resistance keeps rising, high mortality rate of rabies • NCD cases detected, treated and managed are in small number. Health projects are implemented vertically with numerous focal points, lack of integration, inadequate access to sustainable health services. • There’s large gap on sanitary latrine uses among regions. The capacity of local goverment on waste treatment management, environmental monitoring, pollution control stay limited, health environmental monitoring hasn’t been consolidated. • Food poisoning situation becomes complicated especially number death tolls in within 30 person cases. Intersection cooperation in food safety management keeps limited • The implementation of health education and communication in some localities proved to be inadequate, ineffective or gave no encouragement on emulation activities on hygiene and health care improvement

14. MEDICAL SERVICES, REHAB • Achievement: • Widespread health care system, state-run hospitals have been upgraded, Sea Island Health care has been taken into great consideration • Private health care services keep accelerating with total 171 hospitals (11%) nationwide, more than 30.000 private clinics; 1,1beds/ a thousand people (4,8%) • Solutions provided to ease hospital overload have been effectively/ synchronously implemented. This issue is being gradually tackled. • The development of 60 satellite hospitals in 41 provinces, cities • Training, technic transfer provided to health care units at lower level, working rotation implemented => staff capacity at lower level improved, referral to upper hospital decreased • The model of Family Doctors put into practice since 2013 has received promising results with more 240 family doctor clinics established • Reformation in health service process, hospital evaluation and health worker attitude towards patients • Achievements in applying advance high tech in diagnosis and treatment

15. Difficulties, disadvantages • Disadvantages remained between the combination of prevention, treatment and rehab, traditional medicine and modern one. • Not fully maximize the advantages of traditional medicine, capacity of rehab providers stays low. • The model of the elderly care service has not been implemented widespread • There’s a large gap in health indicator and health service quality among regions • Poor health quality management: No independent evaluation organization, more than 40% Hospital with no management division. • There’s no clinical quality accreditation: examination results have not been recognized among medical units

16. POPULATION, FAMILY PLANNING, MOTHER AND CHILD CARE • Achievement • Population growth kept at 1,05%/year, birth rate replacement is maintained • Quality of population-family planning has been gradually improved, family planning services and contraception methods was brought to 5700 communes with high birth rate and in difficulties • Prenatal and new born screening plan was widened from 11 to 63/63 provinces with increasing screening rate year by year. Prenuptial consultation and health-check up was pushed up. • To effectively provide health education to change people’s attitude in order to reduce gender imbalance. • Numerous official document on reproductive health issued • Monitoring and providing support on reproductive health to staff at lower level • The local and provincial level are covered with reproductive health services

17. Difficulties • High demands of vulnerable group in reproductive health, contraception method, and family planning • High proportion of gender imbalance at birth, the birth rate tends to increase at some localities • For ethnic minority group living in remote area, there’s limited access to qualified medical services pre and during birth • There are some disadvantages in effective birth screening due to high cost birth defect method pre-during and after child birth

18. HEALTH HUMAN RESOURCE AND SCIEN TECHNOLOGY • Achievements • Types of human resources are ascending year by year • Health certificate issued: to 92% health workers at central hospitals, 87% health workers at local level • Professional standards issued: nurse (2012), midwife (2014), practitioner (2015) • Policy issued to tackle manpower shortage in some remote areas: Decision no 319/QD-TTg on human resource development for the following diseases TB, leprosy, mental health, forensic, pathology, pilot project on volunteer doctors • Some provinces provide favorable policies to attract health human resources • Health training system has gradually consolidated and upgraded in terms of facilities, infrastructures • To research and produce 10/11 vaccines for the Expanded Vaccination Programme • To rank among 39 countries worldwide with strengths in vaccine producing. NRA was recognized by WHO • Number of hospitals master multi organ transplant technology, diagnosis technique, vessel intervention, endoscopy and reproduction

19. Difficulties • Quality and quantity of human resources are in misallocation among regions and levels • There’s shortage in human sources for preventive medicine, quality hasn’t met demands • Human resource and facility accreditation hasn’t been implemented effectively • Staff’s management capacity at lower level stay limited • Hospital overload, unfavorable policies put negative impacts on health workers and their manner which resulted in health care system reputation

20. HEALTH INFORMATICS SYSTEM • Achievement • Legal system is synchronously consolidated: The comprehensive development plan for health informatics sys tem period 2014–2020, basic indicator system • Data quality improved by training, tracking and monitoring method • To implement IT application with documents managed by software and internet • To develop e-medical records, e medical services, e insurance card, IT application in training, technique transfer and remote consultation • Difficulties • Out of date Information system on death cases, unsuitable medical record to meet the demand of health check up • Lack of information from private clinics, Hospitals under other Ministries, limited application in date analyses and reports • Statistics record and mining applied but in narrow scale

21. PHARMACEUTICAL, VACCINES, BIOLOGICALS • Achievements • To provide adequate drug for medical services, pandemic and natural disaster purposes • Drug delivery system is set up nationwide, the average density: 1 pharmacy for 2.123 persons • To implement the project on “ Vietnamese using Vietnamese pharmaceuticals”, number of hospitals use 80% of local pharmaceuticals contributing to hospital fee reduction for patients • Pharmaceutical market keeps stable, there’s no ascending pharmaceuticals prices. Pharmaceuticals prices are under controlled. Drug procurement proves its effectiveness contributing to drug price reduction in hospitals • Drug quality is thoroughly managed • Difficulties • Drug produced locally in large amount but low quality and mainly used for normal diseases • Irrational drug uses, selling drug without doctors’ prescription, high percentage of using anti-biotic, raising antimicrobial resistance • Limitation in medicinal material management

22. MEDICAL EQUIPMENT AND INFRASTRUCTURE • Achievements: • Accomplished 610/766 hospitals under provincial level, 05 central hospitals are under construction, satellite hospital net work are developed • To gradually apply IT in issuing certificate for imported medical equipment and infrastructure • The whole system on health facilities producing, purchasing, import-export is widened • Great effort made to medical equipment maintenance improvement • medical equipment accreditation network developed • Difficulties: • Limitation in implementing infrastructure investment policies at local level • Limitation in medical technology evaluation, cost-effectiveness in investment and its uses • Quality control management has not been implemented in every health care units. No accreditation center built in 3 regions. • Number of medical equipment manufactured locally get lower than targets proposed. Only simple equipment produced

23. HEALTH FIANCING • ACHIEVEMENTS: • Total national budget for health care sector: 357.971 bn (7,52% total expenditure). The growth rate expenditure for the health care sector is higher than that of national budget. • The proportion of aid maintained at 2% , although it tends to be cut • To boost up socialization in health care sector, model of loan , joint venture , cooperation and investment to build hospitals is piloted successfully • VINACOS was established in 2013, Medical services fund has maintained its supports to the poor nationwide • Innovation in working, financing mechanism for state run units, amendment of hospital fee schedule, autonomy and PPP improvement. Gradually and strictly follow roadmap of hospital fee • Start to do research on payments method innovation:, fee for service, capitation, DRG, medical service package • National health insurance coverage is at 76,5%, Government issued roadmap for the implementation to the year 2020

24. HEALTH FIANCING • Difficulties • Investment to health care sector in general, to the preventive medicine in specific . Many localities haven’t achieved 30% as denoted in Resolution No 18. Financing mechanism focus on effectiveness, preventive medicine quality and public health. • Finance reimbursement is not as effective as proposed • Health insurance faces up with challenges especially its coverage to the rest of population (approximately 23%) who don’t have insurance. • The proportion of out of pocket fee keep high (45%) • Private source pooling for health care sector stay limited • Socialization, joint venture prove its positive sides however there’s still abuse in technique application and other experiments • Hospital fee can not cover all expenditures of health care units • Unsuitable charges, cost for preventive medicine, food safety and accreditation. • Some localities show no concern to Medial services Fund for the poor

25. HEALTH CARE ADMINISTRATION • Achievements: • To issue Law, bylaw, strategy, policy • To improvepolicy dialogue, multisectoral information exchange • To set up 2 training agencies in the north and the south, organize training courses on health management and budget proposal • To consolidatehealth system from local to central level • Health inspection improveditslegacy and network • Difficulties • Uneffectivepolicy, lack of plan and resources to implementstrategy • Healthcare net work has not met the demands of new situation, l • Shortage of quality and quantityin Inspection net work • Uneffectivehealth administration reformation

26. ORIENTATION FOR THE NEXT 5 YEAR 2016-2020

27. OPPORTUNITIES • Guidline, policy of Central Party and National Assembly proves to be significant in healthcare sector, investment to health care means the direct investment for sustainability • Law system of the health care is gradually improved • Economy escalates within stable society with rural development • Globalization and strong international integration provide more choices for better health service and education • Advanced transportation and communication creates favourable condition for people increase their access to medical services • Rising awareness of people, local government and intersectional cooperation in the health service improvement .

28. CHALLENGES • Socio economic factors: • A large gap among incomes, high proportion of poor household, backward practices • Descending investment for health care sector • Unfavorable policy towards health workers • Demography: large population scale, population aging, gender imbalance, free migration • Environment: climate change, pollution, food safety are not well managed • Behavior , lifestyle : smoking, alcohol abuse, drugs, prostitution, imbalance diet, lack of exercise

29. TARGET To reduce mortality rate due to pandemic contributing to lifespan and basic health indicator improvement. To promote the capacity and effectiveness of the health system , putting a solid foundation for a health system with equitability, efficiency , quality and sustainability to meet the needs of people in the context of industrialization and modernization .

30. SPECIFIC TARGETS • Universal health coverage; all people can access to fundamental qualified health services. To ensure no pandemic spread, gradually control harmful factor to people health, environment, food safety, behavior and lifestyle • To promote quality, effectiveness of medical service provider, • To ensure the coordination, connection, combination among levels, prevention, curation and rehab, primary health care • Hospital overload reduction at central level, to maximize the roles of specialized medical center. Technique and professional skill transfer to service providing network. To modernize traditional medicine and combine traditional medicine with modern one. • To remain low birth rate, to control increasing speed of SBR, malfunction and congenital diseases contributing better population quality, To meet the demand of family planning and to increase the access to qualified reproductive health care

31. SPECIFIC TARGETS • To maintain balance in human resource allocation among regions, different level, human resource training and using • To increase the percentage of state expenditure to health care sector, to improve the effectiveness in budget allocation. To develop medical facilities – infrastructure, medical services in the remote areas especially those are in needs • To provide adequate/qualified drugs, vaccine, biological, blood products, medical equipment at reasonable price to meet people’s demands of safe, effective preventive/curative medicine services • To improve management capacity and policy implementation, administration reform to meet the demand of the system in a new context. To consolidate local health system. To plan the whole system focusing on one focal points in order to the effectiveness of investment

32. MAIN INDICATORS • 59 targets, including: • National Assembly, PM assign 02 target • (1) number of beds/10.000 persons; (2) proportion of people with health insurance • 16 indicators in 5 year socio economic development plan • To add more indicators to general overview on health care activities, NCD management, UHC, SDGs, targeted program

33. 16 KEY INDICATORS

34. 16 KEY INDICATORS

35. 9 KEY TASK • Hospital overload reduction, medical services – rehab improvement • Local health network development focusing on preventive medicine • Mother and child care, population and planning promotion • Human resource, science technology improvement • Following code of conduct, ethics standard improved • Financing mechanism reform, UHC • To re-organize management model of food safety, pharmaceuticals, vaccines, biological, medical equipment • To consolidate health system form central to local level, to improve state management and international cooperation • To develop informatics system and health communication/education

36. BUDGET PROPOSAL • For the sector: 742.320 bn, equivalent to 8,4% total national budget • For development: 176.148 bn to accomplish health system as in plan 2015 toward 2035 approved by PM • Recurrent expenditure: • Budget proposal (from national budget): 550.314 bn VND; in which 153.968 bn VND used for insurance support • Expenditures proposal (from insurance revenues and other sources) 625.641 bn VND • Objectives: Take preventive medicine into great consideration, insurance support for the poor, people with average income Focusing on TB, leprosy, mental health, hospitals in remote areas

37. PRIORITIES FOR BUDGET ALLOCATION • Investment expenditure • Complete transitional projects for usage. • Invest in preventive medicine according to the health system development planning to 2025, with vision to 2035, including building Centre for Disease Control (CDC) at provincial level and regional testing centers. • Invest in grass-root health care (commune health stations, general clinics and district hospitals which have not been invested for period 2008-2016). • Invest in hospitals without income such as leprosy, mental health, forensic examination systems; regional mental health & forensic examination institutes and centers, etc. • Government bonds planned to invest in central hospitals and provincial hospitals which have not been invested during the past time. • Invest in new infrastructures such as: Orthopedic institute in the south, Endocrinal hospital in the south, Medical-biological research institute, etc • Prioritize counterpart capitals for ODA and PPP projects

38. PRIORITIES FOR BUDGET ALLOCATION • Frequent expenditure • Prioritize preventive medicine and grass-root health care • Purchase and support in purchasing health insurance for beneficiaries of social affairs, pro-poor households, low middle-income people • Prioritize TB hospitals, leprosy hospitals, mental health hospitals, hospitals in mountainous and disadvantaged areas.

39. MONITORING, EVALUATING • Annually, National Assembly implement oversight activities on targets assigned to the MOH • The MOH is responsible for the evaluation on its operation and map out the orientation for the next year • Health Dept is in charge of monitoring, evaluating plan implemented at provincial level • Target announcement and information collected has to follow PM regulation on national statistical indicators. The indicators under the control of the MOH has to be collected via health information portal combined with other trusted sources

40. IMPLEMENTATION • The MOH is directly responsible to the Government on plan and tasks implementation • Health Dept at central cities, provinces or health care units under other sector develop and implement Annual Plan and report results to authorized agency • Other Ministries, Vietnamese Fatherland Front, other relevant social organization cooperate with the MOH to monitor, and implement assigned plan • MPI, MOF pull all sources to submit to the Government and propose budget allocation to health care sector based on Resolution No 18 of National Assembly • Provincial People’s Committees give direction to relevant Depts in developing and implementing assigned tasks • Depts, Administration, Ministerial Office, Inspectorate and Units under MOH is responsible for annual action plan that goes in line with main tasks denoted in 5 Year Plan. • The Dept of Financing and Planning (MOH) is the focal point agency to help Minister monitor and evaluate health care plan

41. Thank you!