Health Equity in Vietnam


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Time: 2009-2010

Funding organization: The Rockefeller Foundation


The evidence from routine data relating to health indicators suggests that the Vietnamese health care system is making rapid and laudable progress. Yet a closer examination would reveal a widening gap in the distribution of gains in health outcomes across regions and income groups. The grassroot care, historically the backbone of the health system, is in disarray, having suffered heavily from government expenditure cuts. Health policy has shifted its focus from grassroot to a complex network of health care providers, ranging from public hospitals to private practitioners. But the scale and heterogeneity of this network and the overall decentralization of government decisions to local levels make the governance and management of the system increasingly challenging. Although government continues to subsidize the poor, reflecting its socialist orientation, the increased reliance on market mechanisms has led to a neglect of social mandates and growing health costs. The dilemma for the government is that it has to rely on market mechanisms to mobilize resources for the increasingly costly system, but the market mechanisms are not ideal in maintaining equity. Meanwhile, state subsidization has not resulted in lower out-of-pocket expenditure (accounting at present for over 70% of total household spending on health), leading to further medical disadvantage and entrenching poverty. Increasingly, the insurance market 'segments out' higher income groups into a separate health care system distanced from the public system. The private system siphons resources from the public sector, weakening social commitment to cross-subsidization, risk sharing and equitable health care. Greater market-driven care also results in associated problem of ‘over-servicing’, bias towards biomedical interventions at the expense of public health approaches, provider competition, and deteriorating trust between patients and providers.

These unresolved problems have remained in the health system for decades due to, in the main, the absence of evidence-based policy development, effective health stewardship, including reliable quality-control mechanism and monitoring, responsive partnership between the public and private sectors of health care, as well as the grassroot feedback which is  critical in advocating and promoting health equity on behalf of the poor and the vulnerable population.

Project programs


Situation analysis of health equity challenges in Vietnam

The analysis will highlight some fundamental areas of health inequity in Vietnam. The report should be state-of-the-art surveys of existing scientific evidence of health equity in Vietnam, and also include secondary data analyses. The report should consist of the major section: i) health equity in international perspective; ii) addressing health equity in Vietnam: a historical perspective; iii) Emerging issues and challenges; iv) Non-state actors: Efforts and challenges; and v) Conclusions and recommendations.


Advocacy and public discussion on health equity

ISDS together with the center for Creative Initiatives in Health and Population (CCIHP) will collaborate with the Committe for Social Affairs of the National Assembly to advocacte for health equity.

Collaboration will also be with the Vietnam National Television (VTV) to have programs on health equity which should include expert interviews and/or round-table discussions. In addition, we will work with newspapers to have artcles on key issues of health equity posted.