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The views expressed in this presentation are the views of the author and do not necessarily reflect the

views or policies of the Asian


Development Bank Institute (ADBI), the Asian Development Bank (ADB), its Board of Directors, or the governments they represent. ADBI
does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequences of their use. Terminology
used may not necessarily be consistent with ADB official terms.

TRENDS IN HEALTH POLICIES IN VIETNAM


TO PROMOTE WOMEN'S SEXUAL AND REPRODUCTIVE HEALTH

NGUYEN LAN HUONG.MPH


Ministry of Health Vietnam
CONTENTS

1 Health care system in Vietnam

Women’s sexual and Reproductive Health


2
in Vietnam

3 Current status: Achievements and challenges

4 Health policies
Health care system in Vietnam
Health service delivery system Other:
- Military
• Ministry of Health - Public security
- Transportation
• Central general and specialized hospitals
- Construction
• Institutes
-…
Central • Medical and pharmaceutical Unit

• Dept of Health
• Provincial general and specialized hospitals
• CDC ( Preventive , Family planning, reproductive
63 provinces health, Food safety,...)
Private
• Medical colleges/Secondary medical schools sector:
-183 hospitals
- 8.627 beds
• Division of Health - >30.000
General
• Health center
clinics,
• Hospital, population-family planning specialized
710 districts center clinics

11,743 commune, • Commune Health Station


wards, towns • Village Health Care worker
MOTHER –CHILD SYSTEM - ORGANIZATION CHART
MINISTRY OF HEALTH (MOH)
Mother Child Health Department National obstetric hospital

PROVINCIAL DEPARTMENT OF HEALTH (63)


General Hospital (Obstetric Dept)
Reproductive health Center
Specialized Hospital (Obstetric , Pedi, OB-Pedi. )

DISTRICT HEALTH CENTER (710)


District hospital (Ob Dept, Pedi Ward.) Reproductive health Ward

COMMUNE HEALTH STATIONS (11.743)


General Doctors, Assistant doctors, midwives, nurses

VILLAGES (>110.000)
VHWs (Village health workers)/VBAs (Village birth attendants)
Mother-child health care service

Central level Provincial District level Commune Village


level
3 National OB Dept or OB Ward in ≈94% ≈1700 very
Hospitals OB hospital in each district coverage of remoted
each province hospital secondary villages have
to perform Emergency midwives, or Village birth
almost all cars available assistant attendants
technical in most district doctors
advanced OB hopitals (perform
midwifery
techniques)
≈50% of all
births
delivered at
CHSs
Women’s sexual and Reproductive Health
in Vietnam
1. Current status
 Reproductive health is one of a cause of death and illness for women.
 Poor women are facing unintended pregnancies, maternal deaths and
postpartum complications, sexually transmitted diseases (HIV), gender
violence and other sexual and reproductive issues.
2. Achievements
• Vietnam is one of three countries have achieved MDG5 in terms of a
reduction of three-thirds of maternal deaths.
• Expanded coverage of sexual and reproductive health care services
(including integrated services in family planning)
• Improved quality of service including safe motherhood and neonatal
care
• The mother-child health care service system from central to grass-root
level.
• Improved training for health workers.
Maternal mortality rate

The MMR in Viet


Nam had substantially
165 dropped by more than
two thirds, from 233
per 100,000 in 1990
to 60 per 100,000 in
98
2014.
69
63 58 58.3

2000-2001 2007-2008 2009 2013-2014 2015 2015(MDG)

Sources:
• 1990: WHO estimate
• 2000-2001: Survey on maternal mortality - MOH
• 2006-2007: Survey on maternal & neonatal mortality - MOH
• 2009: Census – GSO
• 2013-2014: Survey on maternal & neonatal mortality in 7 northern mountain provinces
• 2015: Survey on maternal death and death of children under 1 year old in Viet nam 2014
Proportion of births attended by trained health personnel

98.5
98.1
98.3
97.94
98
97.9
97.5
97.09
97
96.66
96.5

96

95.5
2010 2011 2012 2013 2014 2015

Viet Nam has improved maternal healthcare services and ensuring better
access to adequate healthcare
Percentage of delivery received antenatal care
92 90.8 90.6
90
90
88 86.68
86
84
82
80 79 79.23
78
76
74
72
2010 2011 2012 2013 2014 2015

The maternal healthcare services has improved, especially antenatal


care at all levels across the country
3.Challenges

 MMR reduced but tends to slow down


 Disparities remain in access to reproductive health services between
regions;
 Young women still face obstacles in accessing full information and services
about reproductive health and sexual health
 The issues of reproductive health and sexuality still exist many challenges
for traditional SRH issues such as maternal mortality, neonatal mortality,
sexually transmitted diseases and HIV / AIDS and emerging topics such as
genital cancer, gender and gender equality
 Capacity of MCH system:
- Lack of obstetric personnel at all levels, particularly at district hospital.
>60% doctors working at OB ward are GP
- Overloaded work
- Personnel competencies
Percentage of delivery received antenatal care by region
120

100 96.9
90.8 90.9 91.5 92.3
88.1
79.4
80

60

40

20

0
Whole Red river Northern Central Central South east Mekong river
country delta midlands and coastal areas highlands delta
mountain
areas
Source: Health spastic year book 2015. MOH

Disparities remain in access to reproductive health services between regions


Proportion of births attended by trained health personnel by region

102
100 99.9 99.9
100 99.2
98.1
98
96
93.8
94
92 91.1
90
88
86

Source: Health spastic year book 2015. MOH


Health policies for women’s sexual and
Reproductive Health
Current policies

The Law on the health in 1989: Chapter VIII on MCH and family planning.
Contraceptives are free. Abortion is legal.

Health Insurance Act 2008 and amended in 2014:


- Medical services: Cover 95% for the poor and 80% for near poor
- >70% coverage in 2016

Amended Labour Law (5/2013): 6 months for maternal leave.

National Strategies on Population and Reproductive Health (2001-2010, 2011-2020)

National Action Plan on Maternal and Newborn care


Trend health policies
to promote Woman's sexual and Reproductive Health
Solution Activities
Improve quality of health care for • Expanding health care facilities
women • Improve capacity of health staffs
• Training more obstetricians & midwive for
rural and remote areas
• Improve quality of Essential Obstetric care
Improve the knowledge of woman • Training for women especially young women
about sexual and Reproductive about about sexual and Reproductive health
health
Reduce disparity among regions • Improve capacity for Village Birth Attendants
• Allowances for Village Birth Attendants

Remove Social and Cultural • Work closely with communities to improve


Constraints acceptability of modern maternal health services
• Outreach activities
• Train and use Village Birth Attendants in ethnic
minority community
THANK YOU VERY MUCH

No Woman Should Die Giving Life