• Developing nations can learn a lot from Vietnam in achieving UHC
• It leads in equitable access to health services, affordable medicines and vaccines
Shifting the burden of delivering medical services from higher-level hospitals to primary health care facilities and partnering with the private sector have helped Vietnam become a world leader in achieving universal health coverage.
While virtually every country worldwide has committed to achieving UHC by 2030, as part of the UN Sustainable Development Goals, some countries are progressing much faster than others.
Today, 87.7 per cent of Vietnam’s population (83.6 million people) are covered by health insurance. According to the latest Global Monitoring Report on UHC, published jointly by the World Health Organisation and the World Bank, 97 per cent of Vietnamese children now receive standard immunisations, compared to 95 per cent of children in the United States. Since 1990, the country’s maternal mortality rate has fallen by 75 per cent.
Vietnam has managed to reach such impressive milestones ahead of schedule, despite having an average per capita income of just Sh234,200, as of 2017. The key to its success is not the scale of investment in health care, which amounts to a modest Sh14,200 per person annually (including both public funding and out-of-pocket expenses), but rather how the government uses its resources, including the country’s intellectual capital.
Vietnam’s strategic approach can be seen in its Health ministry’s Direction of Healthcare Activities scheme, which requires health facilities at the central and provincial levels of government administration to help build up the capacity of district and community facilities.
Given a long history of deep disparities in health outcomes between urban and rural areas, Vietnamese still often try to bypass their local health care centres in favour of major hospitals in urban centres. This creates inefficiencies in the health system and increases out-of-pocket costs for patients and their families, without guaranteeing the best care.
So, beyond ensuring that community health facilities can offer affordable, quality care, there is a need to change public perceptions. Families need to trust that they can get a dependable diagnosis of malaria, chronic obstructive pulmonary disease or diabetes locally, as well as necessary medications and other treatments.
To this end, health facilities must strengthen their relationships with local communities, above all by routinely providing a level of service that satisfies patients. Such relationships will help to advance another health-improving, cost-saving imperative: local health workers must be able to educate their communities to maintain health and avoid illness. Success will require good working conditions and access to the ongoing training and management support that are critical to job satisfaction.
Vietnam’s government recognises that, to implement its health care strategy effectively, it needs help. It has established a new Working Group for Primary Healthcare Transformation, led by the Health ministry. The group’s founding partners are the World Economic Forum, Harvard Medical School and Novartis (of which I am chairman of the board).
The working group aims to strengthen existing primary-care demonstration projects in 30 Vietnamese provinces and apply the lessons learned to developing holistic solutions that can be replicated and scaled up. It will also place a high priority on rigorous measurement and evaluation of outputs, from the quality of community-level health services to the cost-effectiveness of primary health care.
Vietnam has significant challenges ahead. It will need to grapple with behavioural and environmental factors underlying poor health and disease, especially high rates of smoking among males, high rates of alcohol consumption and air pollution. The country also has one of the world’s most rapidly ageing populations.
Moreover, important health care reforms must still be undertaken to improve outcomes. For example, the government should create incentives for doctors to be more selective in referring patients to higher-level hospitals and to send more patients to local primary health care centres.
Nonetheless, Vietnam’s progress toward UHC has been remarkable, thanks partly to the government’s embrace of strategic public-private partnerships. For countries that have struggled to move forward, this model – and approaches from other high performers in the race for UHC, such as Indonesia, Rwanda, and Thailand – may be worth embracing.