Vietnam/ Strengthening basic healthcare in rural areas
Since 2020, the Primary Health Care System Investment and Development Project, supported by the World Bank, has improved access to quality services in 13 disadvantaged provinces of Vietnam.
In an interview with a Vietnam News Agency correspondent, Phan Lê Thu Hang, Deputy Director of the Ministry of Health's Department of Planning and Finance and Director of the central-level Project Management Committee, gave an overview of the situation.
Could you tell us about the progress of the Primary Health Care System Investment and Development Project being implemented in 13 provinces?
The project is designed to improve the quality and efficiency of healthcare services in the primary healthcare network of 13 provinces, namely Hà Giang, Bac Kan, Son La, Yên Bai, Hoà Binh (North), Quang Binh, Quang Tri, Quang Ngai, Ninh Thuân (Center), Trà Vinh, Hâu Giang, Bac Liêu and Long An (South).
The project adopts a comprehensive investment strategy: modernization of infrastructures, renewal of medical equipment, training of health personnel, improvement of health education communication activities, new health laws, etc.health education, new primary healthcare legislation and piloting innovative models of primary healthcare service delivery. It is expected to strengthen the capacity of the primary healthcare network, thereby guaranteeing health, increasing life expectancy and improving the quality of life of people living in deprived areas.
In terms of the scale of funding, this is one of the largest investment projects in the healthcare sector, with a budget of around 120 million USD. This reflects the health sector's strategy of prioritizing investment resources to provide essential health services in difficult areas.
This project is considered to be one of the first in the health sector implemented under a new governance model that maximizes local autonomy, in which the provinces act as the main investors for sub-projects implemented in their areas. This governance model promises to have a positive long-term impact on the project management capacity of localities, which were previously heavily dependent on central-level management structures.
What do you see as the first results of the project?
The project was implemented on May 18, 2020, coinciding with the start of the COVID-19 pandemic, which posed significant challenges in the first two years. Despite this, the project benefited from decisive guidance from the Ministry of Health, the efforts of the 13 provincial People's Committees, the commitment of the central project management unit and the provincial project management boards, and the enthusiastic support of donors.
After more than four years of implementation, the project has achieved the expected results. The latest evaluation carried out by the Ministry of Health and the World Bank in May 2024 shows that, despite serious challenges such as COVID-19and changes in the government's Official Development Assistance (ODA) disbursement and project management policies, the project is still considered to meet requirements. The World Bank acknowledges that it is the best evaluated of all the health projects financed by the World Bank in Vietnam.
In terms of investment, 412 construction projects, comprising upgraded or newly-built health posts and medical centers in 109 districts/cities across the project's 13 provinces, have been completed and commissioned, representing over 86% of planned projects. The remaining projects are under construction and are scheduled for completion by November 2024. Most provinces have also signed contracts to supply equipment for local health posts.
How has the project strengthened the capacity of primary healthcare staff?
The capacity-building part of the project, which is supported by a grant from the World Bank and co-financiers, aims to address the lack of capacity among primary healthcare staff. Training provided under the project focuses on improving service delivery and management of priority health problems at the primary level, such ashypertension, diabetes, cervical cancer, maternal and child care, tuberculosis, chronic obstructive pulmonary disease, acupuncture and rehabilitation.
To ensure sustainable capacity building, the project is developing a comprehensive training plan with a two-stage approach: training of provincial trainers and training of primary healthcare staff. This method ensures that, following training, provincial trainers can organize capacity-building sessions for all communal staff in the project's thirteen provinces. The coverage rate of trained communal health staff is high. In addition to training communal staff, the provincial trainers continue to supervise and support them after the end of the project to ensure that capacity is maintained in the long term.
To date, 1,857 provincial trainers and district supervisors have been trained (96% of the total training plan), as have 24,346 communal health workers (85.2% of provincial requirements).
With regard to initiatives aimed at improving the quality of health services at the communal level, the project has designed and piloted a scorecard for health posts, enabling them to assess the quality of their services themselves. so that they can assess the quality of services themselves, enabling them to plan improvements for criteria that are not being met. The World Bank and the Ministry of Health rated this intervention as a strong point.
In terms of coverage, by the end of 2024, the percentage of health posts applying the scorecard should reach 56%, more than double the initial plan.
In terms of policy impact, given the exceptional results achieved in the 13 project provinces, the Ministry of Health has decided to carry out an in-depth evaluation of this initiative to provide a scientific basis for scaling it up.
Considered Vietnam's most successful health project financed by the World Bank, what are the valuable lessons learned from this success that other projects could learn from?
After four years of implementation in an unfavorable context, a number of valuable practical lessons have been learned, not only for the remaining phase of the project, but also for other programs and projects in the healthcare sector.
The success of the project depends on the governance capacity of the participating localities, who act as the main investors for the sub-projects in their areas. More specifically, this involves the leadership and coordination capacity of the provincial People's Committees, the coordination capacity between the relevant provincial departmentss (departments of finance, construction, health, provincial project management boards) and the management capacity of provincial project management boards.
Provinces need to pursue long-term objectives with perseverance, while being flexible in implementing solutions to adapt to changing contexts and environments. Regular and continuous coordination, support, guidance and supervision from the central project management unit and the World Bank for the provinces are crucial, particularly given the relatively limited project management capacities of many provinces.
In particular, the quality control checklist model applied to communal health posts, designed by experts from the central project management unit, and the modelthe management and treatment of non-communicable diseases in communal health posts with technical support from the units were evaluated as strong points of the project.
Source: lecourrier.vn/
