Pursuing sustainable healthcare in age of technological revolution

Dr. Kidong Park, representative of the World Health Organization in Vietnam

Vietnam has been making efforts to promote sustainable development in the healthcare sector. What do you think about the results the country has achieved so far?

Vietnam has made significant progress in the health-related Sustainable Development Goals (SDGs). For instance, for maternal health (SDG3.1), the maternal mortality ratio has decreased to 46 per 100,000 live births in 2019 which is already below the 2030 target of 70 per 100,000 live births.

For child health (SDG3.2), the neonatal and under-five mortality rates have decreased to 10.5 and 19.9 per 1,000 live births in 2019, respectively, which are also below the 2030 targets of 12 and 25 per 1,000 live births.

Meanwhile, for reducing the harmful use of alcohol (SDG3.5) and road traffic mortality (target 3.6), we have observed a substantive reduction of drunk driving over the past several years from 45 per cent in 2015 to 27 per cent in 2021, while traffic mortalities dropped from 7,624 deaths in 2019 to 6,700 deaths in 2020.

For universal health coverage (SDG3.8), the social health insurance coverage rate has been increasing steadily from 71 per cent in 2015 to 90 per cent in 2020, effectively removing financial barriers to accessing healthcare services.

What challenges has the COVID-19 pandemic posed to the sustainable development of Vietnam’s healthcare sector?

Despite the impressive progress in health-related SDGs and targets, Vietnam still faces many challenges.

Although Vietnam has made impressive progress in maternal and child health, there remain large disparities between urban and rural/remote areas. The maternal mortality ratios in the mountainous and highland areas are 10-20 times higher than in urban areas while infant mortality rates in rural areas are twice as high as in urban areas, with 16.7 against 8.2 per 1,000 live births.

While Vietnam has demonstrated a capacity to control and respond to communicable diseases (SDG3.3), there are still gaps to achieving the 2030 target of ending the epidemics of AIDS, tuberculosis, malaria, viral hepatitis, and neglected tropical diseases in Vietnam.

The burden of non-communicable diseases (NCDs) continues to increase while the 2030 target is to reduce premature mortality from NCDs by one-third (SDG3.4). Increasing overweight and obesity, especially among school-age children, is another growing concern as the numbers have more than doubled from 8.5 per cent in 2010 to 19.5 per cent in 2020.

In addition, Vietnam will most likely not be able to achieve the tobacco control-related target (SDG3.9) as tobacco smoking among adult males is still very high, with 41.1 per cent in 2021. Furthermore, a growing number of youths are now smoking e-cigarettes, reaching 2.6 per cent in 2019, a number which has likely grown since then.

For universal health coverage, the COVID-19 pandemic has led to disruptions and/or delays in people’s access to essential healthcare services. Reaching the 10 per cent of the population who are not yet covered by social health insurance is another big challenge. At the same time, high out-of-pocket payments for healthcare services are also a growing problem.

In particular, the COVID-19 outbreak exacerbated some of the weaknesses in the grassroots healthcare system. The system needs to be strengthened by improving the management of the district healthcare system as the foundation for primary healthcare, along with reorienting the service delivery system to be people-centred and developing packages of essential public healthcare services. Primary healthcare workers also need to be trained in emerging health issues, such as NCDs and caring for the elderly, and a new provider payment mechanism needs to be put in place for outpatient and community-based care.

What lessons should Vietnam learn from other countries to promote sustainable development in the healthcare sector?

Vietnam needs to prepare itself for population ageing and climate change to ensure sustainable development in the healthcare sector.

The country’s rapidly ageing population requires restructuring its health system to become less dependent on the costly hospital-centric system while promoting and financing primary healthcare.

Vietnam could learn from other countries, some of which have long-term mandatory care programmes or home and community care programmes for the elderly to prevent unnecessary institutional care. Many others are developing age-friendly communities and cities. Healthy ageing in cities includes four main aspects: raising awareness of older people as a resource to society; personal and community empowerment; access to the full range of services; and supportive physical and social environments.

There are also some lessons regarding climate change. Firstly, community involvement, including participatory planning with the involvement of local communities in the planning and decision-making process to enable shared goals, coordinated actions, and further build on knowledge.

Additionally, Vietnam could look into building climate-resilient homes through community-based planning and collaboration, with designs that incorporated disaster-resilient materials and elevated water tanks. The other is protecting people from extreme heat such as having action plans in place to protect vulnerable groups, including training healthcare staff, distributing water, and painting roofs with reflective paint.

In addition, COVID-19 highlighted the need to address health emergencies, such as the importance of high-level commitment and multisectoral coordinated approach, linked to solid technical core capacities such as multisource surveillance supported by laboratory testing and risk assessment, public health measures, care pathway, and vaccination, guided by the Asia-Pacific Strategy for Emerging Diseases and Public Health Emergencies. Timely and strategic communication is also key to successfully controlling any public health event.

Industry 4.0 has a substantial impact on all aspects of the economy and social life. How will Industry 4.0 impact the healthcare sector?

Innovations in the healthcare sector, including digitalisation, can significantly help to improve service delivery and people’s access to healthcare services.

Vietnam is starting to establish electronic health records at the primary care level, and is developing capabilities to produce and use big data through health insurance that should bring the entire healthcare system to new levels of efficiency and improve the quality of healthcare services.

During the COVID-19 outbreak, Vietnam has also made great strides in applying telemedicine in service delivery, including at the primary care level, which helps to maintain essential healthcare services, especially for vulnerable groups, such as the elderly, pregnant women, children, and those with chronic conditions.