MINUTES
WORKSHOP TO GET FEEDBACK ON JAHR 2013
Time:
8:30-16:30, 22 May 2013
Location:
Song Hong Hotel, Vinh Yen, Vinh Phuc
Chairman: Dr. Nguyen Hoang Long, PhD. Deputy director of Department of
Planning and Finance, Ministry of Health
Participants:
Vietnamese:
- Ministry of Health units: Department of Planning and Finance, Department of
Health Insurance, Department of Organization and Manpower, Department of
Maternal and Child Health, Legal Department, Vietnam Administration of
Medical Services, Drug Administration of Vietnam, Information technology
Administration, Ministry of Health Cabinet, Health Strategy and Policy
Institute, Hanoi Medical University, Hanoi School of Public Health, VietnamCuba Hospital, Central Endocrinology Hospital.
- Ministries/sectoral agencies: Vietnam Social Security
- Other units: Vietnam Health Economics Association
Development partners: WHO, World Bank, Delegation of the European Union
to Vietnam, United States Embassy, Pathfinder, GIZ, JICA, UNFPA.
Objective of the Workshop:
Discussion and contribution of ideas for the draft sections on “Striving towards
Universal health coverage” of the JAHR 2013.
Detailed contents of the Workshop:
Morning:
1. Dr. Nguyen Hoang Long, PhD, began the workshop and introduced the
agenda. He covered the objective, JAHR development process, structure and
topic of the JAHR report. Part II of the JAHR 2013 report is focused on
universal health coverage. The Workshop on this day aims to gather comments
and feedback to finalize these contents.
2. Dr. Tran Van Tien, PhD, presented some concepts about universal health
coverage and the analytical framework used in the JAHR 2013 report.
3. Dr. Nguyen Khanh Phuong, PhD, presented contents on financial protection
in universal health coverage, including five main issues: reduction of
household out-of-pocket payments; financial protection for the poor and other
vulnerable groups; social health insurance; mobilizing resources for health;
using financial resources effectively, and reforming provider payments.
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4. General discussion of Financial protection in universal health coverage was
led by Dr. Tran Van Tien, PhD along with the other national consultants.
Attendees provided feedback on the draft report, particularly on the priorities
and solutions.
- Kari Hurt, World Bank:
Congratulations to the JAHR team for presenting a clearly designed report
framework. Let me make a few comments:
+ Related to the theoretical framework in relation to the level and scope of
coverage, to some extent it will be necessary to consider what tradeoffs must
be made between the three dimensions of coverage. There is a need to consult
with experience in other countries, to ensure participation of different sectoral
agencies and levels of the health system in the process of developing and
discussing policies. There is a need to see clearly the roles and assignment of
responsibility for all stakeholders.
+ Second point: What is the basis for us to rely on to achieve UHC –
economics, allocation of state budget, human resources? There is a need for
economic analysis to see more clearly what needs to happen and how it should
happen in order to mobilize adequate resources. Increasing the state budget by
0.8% of GDP seems to be not enough, but increasing by 1% of GDP is likely to
be difficult. There will be a need for discussions with other ministries and
sectors in order to increase it to this level. At the same time, it is necessary to
examine what percentage of public spending is reserved for examination and
treatment.
+ Many efforts are needed to achieve universal health coverage. Among the
priority issues there is a need to determine the level of priority, a roadmap, as
well as amount of resources needed for each priority. It is also necessary to see
what are the problems, the challenges that we need to address. When looking at
the list of priorities, if we expand coverage what priorities do we need to
implement, and how can we communicate these priorities. With the near poor
and other vulnerable groups, there is a need for a clear orientation for these
groups.
+ In terms of effectiveness it is important to clarify what is the contents of the
spending, how do the people use the subsidies: drugs, high tech services? There
is a need to use tools like cost effectiveness analysis, health technology
assessment, practice and provider monitor (PPM) and pay attention to tax
policies, incentives for service providers.
- Socorro Escalantes, WHO:
This year’s JAHR has seen major progress in preparation.
+ In particular, we want to propose interventions for the poor, ethnic minorities
and other vulnerable groups. Data indicate that the poor and vulnerable have
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high health insurance coverage, but their health indicators, use of services and
financial protection remain lower.
+ High direct health spending by the people leads to substantial
impoverishment and this leads to negative impacts on health. There is a need
for greater analysis of out-of-pocket payments and their impacts on people’s
health, especially for vulnerable groups. Why do the poor and ethnic minorities
have to spend so much on transportation?
+ Related to effectiveness of health insurance, there is a need to consider why
these groups choose to bypass lower levels and seek care at higher levels, to
what extent should providers be accountable for this situation. There is a need
to focus on the poor, the vulnerable. How can we improve the effectiveness in
use of resources for health care while at the same time imposing policies to
control costs. In hospitals how are payments made, what kind of cost recovery
are we achieving when for the same drugs, same services, the facilities at
higher levels receive higher payments than at lower levels. The price for the
same drug should be the same across levels of facilities. There is a need for
clear clinical guidelines for treatment.
+ Health spending share of GDP, the total spending and per capita spending are
all higher than many other countries, but the challenge is if we increase
spending even more, what would we spend on, when. would it be an increase in
health care for the people or for purchase of more equipment. 72% of health
insurance reimbursements are for non-essential medicines. There is a need to
control costs of selected medicines. In the future, it will be important to analyze
more deeply what state spending is buying.
- Nguyễn Hoàng Long, PhD:
The section presented by Nguyen Khanh Phuong is a synthesis of 5 different
sections written by different authors, but there is a need for greater linkages
between sections, perhaps with some diagrams to show those linkages and how
they lead to financial protection in universal health care: goals, mechanisms,
impact, challenges. The group writing the sections have many assertions about
reasonable financing, but it is difficult because there is a lack of nationally
representative studies, so on one hand, there is a need to try to find materials to
illustrate the situation, but on the other hand when citing it is necessary to make
clear the sources and scope of the research. The figure for 500 thousand
households, or about 2 million people falling into poverty due to health
spending, does that really reflect the current situation?
In the priorities section, there is a need to examine previous priorities that were
reported in the JAHR on health financing in 2009 (actually the JAHR on
health financing was in 2008) in order to link up and continue discussions from
previous years. Second, for various scenarios of increasing health spending: if
we want to achieve universal health care there is a need to increase health
spending by 0.8 to 1% of GDP, and there is a need to state that with such an
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increase in spending, what benefits will be achieved for health. This is difficult,
but if it can be done it will be more persuasive. Health insurance coverage is
already quite good, but why is financial protection so low? People with health
insurance still face financial difficulties. Indirect costs when poor people seek
medical care account for an additional 50% of total health care costs. There is a
need for analysis and deeper recommendations on financial protection.
- Robert Hynderick, Delegation of the European Union to Vietnam:
Thank you to the group of national experts who continue to prepare reports that
are increasingly complete, well structured, full of information, clear and
concrete.
On behalf of the EC, we consider the JAHR as an important process that has
reflected achievements, priorities and has involved the participation of many
development partners. There has been progress, but there is a need for even
greater depth of analysis on strengths and weaknesses from research studies,
recommendations, in order to better see what needs to be improved, what has
been improved, and where we are now. There is a need to concretize even
further the issues we are facing. We have a list of causes, but no indication of
which cause was more important than another. There is a need to find the main,
leading causes. For example, impoverishment related to health spending, why
do the poor face impoverishment more than the non-poor? Some reasons such
as unavailability of services, or packages of services, cultural issues,…which is
more important? There is a need for ideas about important causes. The poor
are still facing heavier health burdens (30% of the poor face catastrophic
spending) but this gap has not yet been deeply analyzed. What is the reason for
the low effectiveness in use of the health insurance fund, what are solutions for
this problem? Cost-effectiveness has been identified as an important issue, but
the reason for the problem has not yet been deeply analyzed and solutions have
not been found that are tightly linked to these causes. Among solutions
proposed such as provider payments to control costs through capitation, DRG,
these are big issues, and they need to be considered more concretely, along
with a roadmap of each step that needs to be undertaken. One very important
aspect that has been reiterated is that UHC requires comprehensive primary
health care provision. We see that the concepts proposed are not yet consistent,
such as grassroots level (which refers to administrative areas), basic health
services, primary health care and system and network, which seem to be used
more or less interchangeably.
- Lương Chí Thành, PhD- Deputy director of the Health Information
Technology Administration:
I agree with Dr. Long’s comment on the data used that are not consistent, and
the lack of nationally representative research. For example, health spending
share of GDP, if we calculated it at 95 USD/person x 90 million people and
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divide by GDP that is approximately 210 billion USD, which would only be
about 4% of GDP. The terminology used is not consistent, for example on page
49, it indicates that out-of-pocket spending is private spending, but in a lower
section it indicates that OOP is approximately 92% of private spending. Some
of the priority issues seem to be more assertions than a real assessment. There
is a need for research programs to fill in gaps in scientific evidence.
- Nguyễn Thị Khánh Phương, PhD
A quick calculation shows that health spending/GDP is approximately 6.1%
(95 USD/1540 USD).
- Assoc. Professor Hoàng Văn Minh
The OOP data is taken from the Household Living Standards Survey. The
reasons for OOP are taken from discussions, not from surveys on causes.
VHLSS data in ethnic minority regions is inadequate for separate analysis and
assessment. Catastrophic spending rates in Vietnam are high because
internationally indirect costs are often excluded (e.g. transportation costs).
- Ton van der Velden, Pathfinder:
Most of the analysis is based on major surveys like the VLSS, but there is a
need for more concrete research. The national experts face difficulties in
finding data to write the repot. We can propose recommendations in the JHAR
for research programs in order to have more data to meet requirements for
research on health financing.
- BS Le Thi Thanh Huyen, UNFPA:
There is a need to reconsider the different sections so the report can be more
comprehensive in proposing solutions that when implemented may lead to
major changes. With UHC there is a need to focus on equity in health care
services. The MOH has already made an assessment and proposed solutions on
equity. There is a need for information on why and how one can propose
appropriate solutions. There is a need for more roles and coordination with
other sectors, for example on financial assistance for transportation, yet there is
a lack of participation of the transportation sector making it hard to implement.
There is a need or more analysis on the role of health care providers,
particularly we do not yet see the role of the private sector, in fact there are
somewhat negative comments on the role of private health insurance. There is a
need for clear division in the health system regarding which areas should allow
the private sector to reduce the burden on the state, and in which areas the
public sector should ensure coverage. For the elderly, there is a need for deeper
analysis of what kind of support they need, what contents, which groups,
especially the elderly in rural areas. In the recommendations there is a lack of
contents to ensure financing for operating health services such as human
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resources, health information, monitoring and supervision. There is a need for
financial assurance to run the health system, instead of using the term financial
protection.
- Hoàng Thị Phượng, HSPI:
+ One of the objectives is to increase coverage, especially of the vulnerable,
and we have paid attention to ensuring breadth of coverage, with less attention
paid on increasing depth of coverage. In rural areas, people mainly access
grassroots health services, with low service quality, leading to low use of
health insurance fund and surpluses, while in urban areas there are always deep
deficits.
+ Financial protection: A research study on amounts paid by households at
health facilities indicated that out-of-pocket payments remain high, especially
at central level facilities, of which only about 30% of out-of-pocket payments
are co-payments and the rest are paid directly by the patient. One of the reasons
for this is the implementation of social mobilization and financial autonomy.
Therefore, how can we reduce out-of-pocket payments? There is an inherent
conflict between financial autonomy and increasing revenues with the need to
reduce out-of-pocket spending. Is there any solution that can separate
increasing revenues of health workers from increasing facility revenues?
+ In the contents of the repot there is a need for more data to support the
assertions about abuse of health services.
- Nguyễn Hồng Sơn, Vụ TCCB:
+ The general structure: There are many different health financing sources, the
report is mixing up the different sources. Perhaps the authors should analyze
each source to identify deficits in different sources in order to propose
appropriate solutions for each source.
+ Some concepts and data need to be more precise. For example, the proportion
of total health spending on health is reported at 31.32% (p. 85), while in
another section it is indicated to be approximately 27% (p. 87), or total health
spending in some section is reported to be increasing while in another section it
is reported to be decreasing. There is also a need to be more consistent in how
health spending is compared to GDP or to state budget health spending.
(Phuong explained that these are two separate indicators, but perhaps it needs
to be more clear in the text).
- PGS. Phạm Trọng Thanh:
In the priorities for health insurance, there is the issue of high health insurance
coverage (67%), but the share of total health spending from health insurance is
only 18%. There is a need to supplement explanations for this.
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- TS. Nguyễn Hoàng Long:
There is a need for more time to reread more carefully the report so participants
can contribute more ideas through e-mail. In OOP, 40% is related to selfmedication, 30% is payment for private services, 30% is payment for public
health care services. Therefore there is a need for recommendations on
solutions for each of these problems. Health insurance for the poor and ethnic
minorities has been slow, actually this is only the case for the near poor.
Assertions about low effectiveness of using health insurance among the poor
needs to be reassessed, with clear indicators to support such an assertion.
- PGS Nguyễn Duy Luật, Hanoi Medical University:
The JAHR is very important but has not yet been widely disseminated. There is
a need for more copies for use in training and research establishments. The
report this year focuses on an important topic, and needs to be tightly linked
with the primary health care strategy of Alma Ata 1978 on health care for all
by 2000. There is also the need to assess achievements of implementing
primary health care and any remaining problems. Some comments need to be
made clearer, for example “quality services”. Regarding assurance of
financing, this is mainly related to medical examination and treatment, but
inadequate attention has been paid to financing of prevention and promotion.
- Nguyễn Hoàng Long explained further about the channels through which the
JAHR has been disseminated including CD, printed version and through the
Webpage jahr.org.vn
- Dương Huy Lương, PhD - Vietnam Administration of Medical Services
Some recommendations and solutions are only listed under short-term solutions
or long-term solutions, which may make the readers misunderstand that there
are only short or long term solutions. Some solutions are still quite general, for
example “there is a need to research…” or some solutions such as the need to
increase the number and quality of services at the grassroots facilities close to
the people, strengthen IEC, reform policies, which are only orientations.
Section 5.1. on implementing generic drug policy along with some solutions
includes some very concrete solutions, but also some that are still not concrete.
There is a need for stability in the way priorities are determined, and how
solutions are proposed in the JAHR. There should be a standardized format for
recommendations and solutions. Solutions for sections 6.2 and 6.3 are not
clearly solutions.
- United States Embassy representative:
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In the public private partnership, United States partners would like to have
research on this issue, and they have much experience and innovations in this
area, and the ability to strengthen investments in this area. There is a need to
expand and strengthen the capacity to cooperate through inviting foreign
companies, particularly US companies to participate. There is a need for further
in-depth analysis on benefits of public private partnerships. There should be an
expansion of dialogue, and transparent information on this issue.
- Đàm Viết Cương, PhD – Former Director of HSPI
There is a need for greater understanding of the health system, not only the
system of providing health services, but also the roles of other sectors.
Changes in the health system must go hand in hand with changes in the socioeconomy. Therefore investment in the current cumbersome health system that
exists at present, how can one ensure effectiveness and efficiency? Seems like
we are abusing the terms system and network?.
Afternoon
5. Trần Thị Mai Oanh on behalf of the group of national experts writing the
sections of the Chapter, has summarized Chapter 3 on health service coverage,
including the following contents:
Concepts on health service coverage;
Organization of the health service provider network (4 priority issues: limited
capacity, lack of integration, irrational method for budgeting and disbursing
funds, limited effectiveness of implementing policies and lack of mutual
support);
Preventive service coverage (5 priorities: some infectious diseases and NCDs
have not yet been managed; prevention and primary health care do not yet
ensure continuity and comprehensiveness and integration; preventive medicine
services do not yet ensure depth of coverage; lack of human resources; limited
intersectoral participation);
Medical and rehabilitation services coverage with priorities identified as:
continued overcrowding while lower level facilities have limited capacity;
limited quality of medical services; overuse of services; lack of human
resources; weak management of private health sector; limited capacity of the
rehabilitation and traditional medicine system.
Essential medicines (access to drugs in some regions, and for some groups is
limited; use of drugs does not ensure safety or rationality).
6. Discussion on contents about service coverage
- Socorro Escalantes, WHO:
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The issue of inadequate capacity is often mentioned, but there is a need for
further clarity on which specific capacities are missing, particularly which
capacities are weak at the grassroots level. When we talk about capacity we
also need to speak of indicators to evaluate and serve as a basis for developing
capacity. We also need to assess infrastructure at health facilities, we can only
ensure health service provision when equipment and infrastructure are
adequate. At the same time, we need to clarify which services should be
provided at the grassroots level. These services need to be clarified in order to
control for effectiveness. We need to point out clearly what aspects could
influence on a large scale in the locality.
Related to use of traditional medicine, it seems that we have some ambitious
strategies, but to achieve these goals we need to assess whether this will be
effective or not, are these drugs effective or not, or are they potentially
hazardous. Which type, which methods should be used. Currently there is a
lack of a basis for identifying priorities.
Management agencies need to work together to find a way to collaborate in
managing medical examination and treatment, discuss at a fundamental level
the issuing of the essential medicines list and list of drugs covered by health
insurance, which drugs are needed and should be used in which way. The
health insurance agency also needs to consider specific drugs, vitamins and
whether or not they are essential drugs that should be covered by health
insurance or not.
The problem of drug prices is a problem in many countries. It is very difficult
to control drug prices. It is necessary to assess which drugs need prices
controlled: set the prices, impose taxes, determine prices through competitive
tenders? When policy makers propose approaches it is necessary to understand
which points are the most important to consider, and on that basis to make
appropriate recommendations.
- TS Lê Phong, Central Endocrinology Hospital
Report is named JAHR 2013, but it is mainly a review of the year 2012 or is it
an orientation for 2013, if so then it is a bit late.
Currently we have a double burden of disease, so what is the situation for
funding treatment of NCDs? What kind of health system is appropriate. We
need to make appropriate policies for both prevention and treatment. We often
say top priority for preventive medicine, but allocate only 1800 billion VND
for preventive medicine, but an unknown amount for curative care. Investment
in goiter control is only 5 cents and brought huge benefits. Investments in EPI
led to clear reductions in diseases that could be prevented by vaccines,
indicating effectiveness of investment for preventive medicine, so how much
should preventive medicine be allocated out of the total budget? National
Target Program budgets remain too low.
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There is a need to determine intervention solutions based on cost-effectiveness.
With diseases like diabetes, for example, it is difficult to diagnose, especially in
pre-diabetic stage. At the same time the prevalence is rising rapidly in Asian
countries (including India, China). We need to clarify the role of authorities at
all levels and the community in prevention and control of NCDs. We want to
have the participation of commune health stations, but it requires human
resources and equipment, so there is a need to assess the best model of care
provision to ensure cost-effectiveness.
- TS Nguyễn Quỳnh Hoa, Vietnam-Cuba hospital:
The problem of drugs was mentioned in both service coverage and health
financing, in priority problems and solutions they are related and complement
each other. The problem of too high drug costs must be linked with rational and
safe use of drugs, otherwise it won’t be effective. The solution of central
competitive tendering following Circular 101 has indicated it can reduce drug
prices substantially , but still faces many problems, and it is unclear whether
this solution can be used in the short term. Setting one uniform price will be
very difficult. There is a need for greater attention to be placed on safe and
rational use of drugs, does the central level abuse prescription of drugs more
than lower levels? The application of the new drug tendering procedures with
cheaper drugs has led some doctors to write prescriptions for patients to buy
drugs outside the facility, which has implications for safe and rational use of
drugs.
- PGS Nguyễn Duy Luật, Hanoi Medical University:
There is a need to further clarify and ensure consistency in the use of the terms
basic health services and primary health care. What is the difference?
Service coverage means “meeting the true needs of the people” which is very
difficult to ensure because the needs are subjective. The concept of “adequate
quality” also requires clarification of what adequate means. In medical
examination and treatment, besides human resources and medicines, there is a
need for medical equipment but this has not yet been adequately covered in the
report.
- Hoàng Văn Minh, Hanoi Medical University
In the criteria for determining a basic service package cost-effectiveness,
disease burden, and available resources were mentioned. This is primarily
health economics criteria. Another angle should be mentioned- Equity. There is
also the need to mention the health economics skills available in Vietnam, are
they adequate for meeting the need for cost-effectiveness and disease burden
analysis? If not, then perhaps we need to mention the need for additional
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training in health economics, for example improving capacity for implementing
cost-effective assessments of services.
- Lê Thị Thanh Huyền, UNFPA:
It seems like we are missing a health systems perspective, and we are focusing
too much on health services delivery. We should make the assessment from the
perspective of: access, coverage, financial protection. Perhaps we could
reorganize the report in the following way in order to analyze and identify
problems and propose solutions:
 Have people got access to comprehensive health services yet? Which
groups have not yet got access, and why?
 Analyze the second perspective: Current ability of the health system to
ensure health service coverage? There is a need to distinguish the 2
concepts of health care and health services. In the repot there is not yet
mention of counseling, which is currently very weak part of the health
system in Vietnam. Currently what needs have we met, where are there
gaps, at which levels of the system, and in which fields, so we can make
appropriate recommendations.
 Health financial protection for different group.
Besides these issues, we should also have recommendations specific to
different levels of the health system, by target groups, while at the same time
making general recommendations on health system reforms.
- Dương Tuấn Đức, Vietnam Social Security:
For one problem, but from many different perspectives there are many different
solutions. For example for issues related to copayments and Decision 14 for
low income people. There is a need to reconsider to ensure consistency. For
OOP, there are cases where the people choose to pay out-of-pocket to get a
higher level service, but should this be called OOP? On the other hand control
over service prices is not effective, financial autonomy has led to many
problems in over use of medical equipment in public hospitals but by setting
their own prices rather than following official prices.
Use of medical services by the poor varies substantially across regions. In
HCMC they may come 30 times per year. Costs of drugs change depending on
whether new government set service prices are used. When the new service
prices are applied drug share of costs will fall. The problem of competitive
bidding for drugs has many irrationalities: Instead of choosing an appropriate
drug package, drugs are chosen because of lowest prices, leading to patients
instead of taking just one pill, have to take a handful. Because service prices
were too low, drugs accounted for a high share (60%).
Some policy recommendations need to be considered for feasibility because
some issues are outside of the authority of the MOH, for example revisions to
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the Law on Pharmaceuticals, the Law on Health Insurance, but it is very
difficult to change the State budget law and funding allocations for health
insurance. Indicators assessing capacity of preventive medicine indicate that
5/6 are not met, while the remaining indicator is doubtful.
Then there is the problem of overcrowding even in lower levels, that is the
overcrowding in recording registers (83 different books) because there is not
one focal point, leading to fragmentation of resources; severe separation
between prevention and curative care.
Traditional medicine, a majority of which has unclear source, has high prices,
so is it really any better than western medicine? Basic service package remains
fuzzy, how could this be put into the law on health insurance? There is a need
to choose and consider tradeoffs between services, while considering adding
services, should also consider dropping some services.
- TS Lương Chí Thành, Health information technology administration:
There is a need for consistency between problems and solutions. For example
many problems related to information, yet there are no solutions. Problems
mentioned in Section 3.2 proposes solutions that are basically the same as in
the existing project to reduce overcrowding.
- Kari Hurt, WB:
We need to be very clear on the needs of the people, what services do they
need, to what extent are we meeting their needs, and what financial resources
are there to provide those services.
It is also important to mention problems such as spread of disease in the
community, problems of the elderly, whenever there are changes we need to be
able to respond, make adjustments. Provision of services also requires
adjustments to be more flexible. Currently we cannot meet the demand for
inpatient care, so how will we be able to meet the demand when needs
increase? What additional support is needed for comprehensive care, special
care? There is a need to ensure financing for services when needs increase.
Cost-effectiveness assessments are needed, but not only to estimate
effectiveness, we also need to consider the costs. For tertiary hospitals, how
should we distribute them geographically, what roles should relevant
stakeholders have. We also need to analyze the role of counseling.
- TS Dương Huy Lương, Vietnam Administration of Medical Services
There are too many solutions and recommendations, they should be
consolidated as they are now too broad. There are many recommended
solutions that require substantial amount of time and effort such as developing
a set of criteria. Should use a consistent terminology either dam bao or bao
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dam. Should avoid the term “generic”. Some solutions are too general like
“review”, but it should be more concrete. Solutions on Family doctor in the
short-run includes trying a pilot for family doctor, while in the long-term there
is already the idea of scaling up without knowing results of the pilot.
- Socorro Escalantes, WHO:
In ensuring continuity of service provision we have spoken about monitoring
indicators for the JAHR in 2010, including also MDGs and ability to reach
MDGs. We have laid out indicators that need to be achieved, but there is also a
need to pay attention to regional factors and factors related to specific target
groups. We also need to assess different needs of different groups. We also
need to ensure that JAHR reports from the past include follow up and are
consistent with the current JAHR report.
- Lê Thị Thanh Huyền, UNFPA
There should be some summaries at the end of each section so readers can
more easily follow. There is a need to address the issue of equity. This is quite
clear in the report on MDGs. Should supplement MICS 2010-2011 as a data
source. Should include unmet need for family planning services. We can
provide this information. From now to 2020 tens of millions of people will
enter reproductive ages, the report should discuss the issue of young people and
their unmet needs.
- TS Đàm Viết Cương, Former direct of HSPI
The health system not only has shortcomings, lacks integration, but is
irrational: it is heavily administrative and not based on needs. The basic service
package was developed based on needs. There are 2 types of grassroots health
services: fixed location dependent on CHS and doctor and those that don’t
require a doctor provided through mobile outreach services. There is a need for
this distinction to be made in the report.
- Robert Hynderick, EC:
There is a need for a more integrated approach: to ensure UHC there is a need
for adequate health workers, with clear job descriptions, appropriate
assignment of technical services at different types of facilities, coordination
and supporting financial mechanisms.
- Nguyễn Hoàng Long:
When writing each chapter, there is a need to link between sections and to link
with the general framework. At the beginning of the chapter, there should be a
diagram illustrating the connections between the different parts of the chapter.
The overall structure is one of concepts and policy orientations, followed by
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descriptions of the network of service providers as currently organized, then on
that basis, you should cover 3 service areas: preventive medicine, treatment and
essential medicines.
- Đỗ Hồng Anh, General Office of Population and Family planning
The issues of population and family planning addressed in the report are
relatively simple, and sex ratio at birth is not really a priority problem related to
UHC. Instead, in relation to service provision, other problems need more
attention such as STIs, family planning services, in order to propose more
appropriate solutions. Some solutions are only to improve conditions, but
won’t contribute substantially to UHC without other solutions.
- TS. Trần Văn Tiến:
In the essential medicines section: the price of drugs in the section on
achievements indicates that price increases are slower than general price
increases, while in the part on difficulties and challenges, it indicates that drug
prices have not been controlled effectively. While this may seem to be a
contradiction, it actually makes sense. It is necessary to make clearer because
what has not yet been controlled is the initial drug price. By controlling drug
margins above the initial price it is inadequate to control the initial drug prices
set by companies.
- Nguyễn Hoàng Long, on behalf of the organizers and coordinators, I wish to
thank all participants who have spent their time focused on contributing ideas
to the workshop. If you have any further comments please send them by e-mail
in the next week. The coordinators will reserve one day to sit with the authors
to review how to complete the report. After revisions we will send it out to you
again for another round of comments. We are trying to speed up the translation
into English. We will soon organize a workshop to discuss part I of the report
focused on updating progress of the health system towards 5-year plan
implementation.
The discussion ended at 16:30 the same day.
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