Healthcare models for sustainability era

Dr. Angela Pratt, Representative in Vietnam World Health Organization

The country’s strong recovery from the recent pandemic continued, and many lessons were identified that need to be applied to strengthen the system. These include ensuring reliable systems for timely procurement, a robust and sustainable surveillance system for respiratory pathogens, and maintaining strong communication and engagement with communities and fighting misinformation.

In addition to that, several important policies and laws were strengthened as critical foundations for reforming and advancing progress in the system.

Importantly, there was also progress in a range of key disease control priority areas, including reductions in the rate of HIV transmission and progress towards malaria elimination.

The government also adopted further initiatives to improve prevention and management of non-communicable diseases (NCDs), maternal and child health, and the health of older people.

Vietnam strengthened commitments to mitigate climate risks and build resilience. It joined the international Alliance for Transformative Action on Climate and Health, and the Ministry of Health (MoH) helped organise an important health event with the WHO and UN Development Programme at COP 28. These activities will all contribute to achieving the government’s ambitious commitment of achieving net-zero carbon emissions by 2050, under the Prime Minister’s leadership.

In 2023, Vietnam faced a very challenging situation in the supply of vaccines for routine immunisation, with stockouts across the country for many months as a result of complex procurement rules and regulations.

The WHO was happy to contribute donations of some vaccines in 2023, along with our colleagues at UNICEF. I understand that orders for domestically produced vaccines have been finalised and supplies are starting to flow again to health clinics around the country – and we greatly appreciate MoH Minister Dao Hong Lan’s efforts and leadership to resolve the bottlenecks.

However, there is still a long way to go to restore immunisation coverage to pre-pandemic levels, plug significant immunity gaps, and ensure that Vietnam’s children are protected from vaccine-preventable disease. We welcome the government’s direction to prioritise immunisation activities in 2024 to help achieve this.

Regarding NCDs, this is driven largely by a set of preventable risk factors including high smoking rates, excessive alcohol consumption, unhealthy diets, and insufficient physical activity. All are an increasing challenge for the health system in Vietnam, as is the case in countries all over the world.

The WHO, along with other partners, is supporting the MoH and the government of Vietnam on a range of initiatives to tackle this growing burden on the health system and the economy, as well as on communities and families.

A particularly high priority is increasing tobacco taxes to reduce the affordability of related products in Vietnam, especially for young people. In addition, there is advocacy for increased tax on alcohol and the introduction of excise tax on sugar sweetened beverages, supporting implementation of existing drink-driving bans, strengthening other aspects of road safety, and strengthening grassroots healthcare to enhance detection and treatment of NCDs.

We will also work with the MoH to jointly conduct communication and education campaigns to raise awareness and encourage better lifestyle choices to help Vietnamese people live healthier and longer lives.

Stakeholders, including donors, international non-governmental organisations, civil society organisations, and multilateral agencies, have made a significant contribution to helping advance Vietnam’s health system and in responding to a broad range of health challenges.

Vietnam has a very dynamic health sector, strongly supported by many national and international partners, and under the leadership of the MoH, stakeholders and partners continue to work together well to support the strengthening of the health sector in Vietnam.

In the broader context of health sector development, the private health sector’s role in healthcare is growing in many countries, including in Vietnam. However, health services are unique, especially with regards to everyone’s right to access essential healthcare with financial protection.

Therefore, it is critical that public-private partnerships are well regulated and do not replace publicly funded health service delivery, and instead provides a means of expanding healthcare options and access in areas where the private sector has a comparative advantage.

This requires having strong governance, including regulatory mechanisms, in place for both public and private sectors to guide health sector development and ultimately to protect people’s health. Such mechanisms aim to put the necessary tools, norms, and standards in place and require both public and private sector adherence to them.

In addition, equity must be maintained to avoid the creation of a two-tier system where only the wealthy can afford the best treatment and care. At the heart of universal health coverage is the need to ensure the quality of, and equitable access to, health services for all people.

Vietnam’s health system is at a critical juncture; a rapidly ageing population, a shifting disease burden, including the rising tide of NCDs, as well as a fast-developing economy, all of which are creating increased demand for high-quality health services. Climate change is also having a growing impact on the country’s health services, and infectious diseases such as HIV, hepatitis, TB, and malaria, still afflict some groups in the population.

For these reasons, in 2024 and beyond, the WHO and the MoH will work together on five key areas. These include building a stronger legal system towards the goal of advancing universal health coverage; creating a stronger more integrated primary healthcare system; strengthening national capacities in health emergency preparedness, readiness response, and recovery; reducing risk factors for NCDs and injuries; and building a health sector that is more climate-change resilient and environmentally sustainable.

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