Wisdom for sustainable healthcare

Dr. Kidong Park, World Health Organization representative in Vietnam

What are the key changes you have seen in the local service delivery system over recent years?

Last year, Vietnam lost over 30,000 lives due to the pandemic. The country has tackled its challenges by employing a whole-of-society approach and the healthcare sector has remained at the forefront of the country’s fight against COVID-19.

The sector’s efforts covered case investigation, contact tracing, and isolation carried out by rapid response teams. Over 30 million PCR tests were conducted by the public health laboratory team during the peak of the pandemic peak. Furthermore, case management teams from mobile health stations cared for patients under home isolation and treatment, and ICU teams treated severe cases.

The country has also rapidly increased COVID-19 vaccine coverage. In less than eight months, Vietnam had secured over 170 million vaccine doses through vaccine diplomacy efforts, of which more than 46 million doses were mobilised to the country through the COVAX Facility, while people also contributed over $380 million to the vaccine fund. The healthcare sector has so far administered over 160 million vaccine doses across the country, and over 75 per cent of the population have completed their primary series of vaccination.

Another important achievement of healthcare last year was maintaining social health insurance population coverage, which now covers over 90 per cent of the total population and offers access to essential health services, especially for vulnerable populations. During this time, Vietnam has also made improvements to its service delivery system by applying telemedicine, including at the primary care level. This helps maintain essential health services, especially for vulnerable groups such as older people, pregnant women, children, and those with chronic conditions.

Moving ahead, what should the sector focus on to improve its performance?

During the pandemic peak last August and September, over 220,000 COVID-19 patients were under treatment, mainly in Ho Chi Minh City and neighbouring southern provinces. The health system in the region was seriously overwhelmed and the daily death toll at that time hit over 350.

The country quickly learned lessons from this painful experience and adjusted its patient treatment pathway by introducing the home treatment model and patient referral system. These efforts, combined with high vaccination coverage, enabled the country to cope with the rebounding of cases in November and December. The country had fewer fatal cases over the period.

However, the pandemic is not yet over. Though the majority of Omicron cases are mild, the variant spreads much faster than Delta, can produce a large number of cases in a very short time, and has the potential to overload healthcare system capacity. If this happens, Omicron may claim the lives of those in high-risk groups – the elderly and people with underlying medical conditions.

The country needs to readjust its healthcare pathway to overcome its weakness and improve its overall performance against the next possible COVID-19 wave. Furthermore, Vietnam should continue to regard prevention (including vaccination), diagnosis, and treatment as essential, and remove any potential access barriers such as user fees and voluntary out-of-pocket payment in accessing related services.

Annual budget plans, from local to central levels, should be well prepared to ensure adequate public funds for prevention and surveillance, and the cost of COVID-19 vaccination and treatment, together with other essential health services.

Domestic private and foreign enterprises are eyeing more opportunities in the local healthcare and pharma sectors. What lessons should Vietnam learn from regional countries to tap into the potential?

Both the public and private health sectors should work together to avoid system overload and to save people’s lives. recent resolution from the National Assembly Standing Committee provided a policy framework for private sector participation in treating COVID-19 patients. The resolution indicates that public financing would cover the cost related to diagnosis and treatment, provided by both public and private sectors, thus reducing financial barriers in access to essential services.

In the broad context of sustainable development goals, the private health sector’s role is growing in many countries, including Vietnam. The core of health sector development is to ensure the quality of and equitable access to health services for the whole population, not only during the pandemic but beyond.

Having strong governance, including regulatory mechanisms, in place for both public and private sectors is needed to guide health sector development and, ultimately, protect people’s health. Such mechanisms mean putting necessary tools and standards in place and require both public and private sectors’ adherence to them.

Further, the government should also establish a set of institutionalised policy instruments to manage, monitor, and take appropriate corrective actions when needed, regardless of whether the services are provided by the public or private sector, and coordinate both sides.