Luận văn thạc sĩ UEB evaluation of allocation and use of health financing in nam dinh province

UPPSALA UNIVERSITÉT& UPPSALA IMU UNIVERSITY OF ECONOMICS & BUSINESS VNU-UEB UIN1VERSITĨT 1AS TER THE SỈS OF MPP M EViUATION OF ALLOCATION ANB SE OF HEALTH FINANCING 11 NAM DINH PROVINCE Aulhor: Su p erviso r: Ninh Thi Hoai Thu Dr Hans Blomkvist l.ocul Supervisor: I)r Nguyên Phu Ha Cíass: MPPM INTAKE ỉ f u ■- Ị iv:-: - • V •: I Hanoi, January - 2015 i Acknovvledgements The thesis has been carried out by thc author NinhThiHoai Thu in the ìmevvork o f the Master’s degree program o f Public Management -U ppsala Jẩversity It is certain that the thesis vvould not be fulfill well without the ỉnhusiastic help o f the Svvedish and Vietnamese instructors and a number o f eders and governmental officials o f institutions related to the research field I am much obliged to Dr Hans Blomkvist - Uppsala University, Svveden vb has offered very clearly oriented guides in the process o f my selecting oúcs and launching research, Dr Nguyen Phu Ha, leading me in the esarch process, giving me more knovvledge and helping me resolve liíìcultiesduring the whole process I sincerely thank the lectures who were enthusiastic to impart useful navledge ot' the public management o f the entire course Thanks for the uport o f the Universitv o f Economics and Business, o f coordinators and Ttgram managers who have created tầvorable conditions for the course I am gratetul to the leaders and experts o f the Department of Planning n Finance - Ministry o f Health, thc leaders o f Health Department of Nam )ih province for their providing materials, answering in interviews and rating íầvorable conditions, which enables me to perlorm the subịect and cess to data sources It is also impossible íor me to tbrget the good feelings and thc support o f 11 c lassmates, friends, colleagues who contributed their ideas, provided 'Ìtirmation to me during my fulfilling the thesis work Y ours faithfully, Abstract Tite Evaluation o f the allocation and use o f health lìnancing in Nam Dinh province l£^e: Pinal assignment tor Mastcr Program in Public Management Auh >r: NinhThiHoai Thu Si|e.-visors: - Dr Hans Blomkvist - Uppsala University, Sweden - Dr Nguyen Phu Ha Dae when the thesis is presented: 2014 - 12 Ain: The study aimed to evaluate the allocation and use o f íinancial rsnrces o f Nam Dinh province, iđentiíy the strengths, weaknesses, 0)p)rlunities and threads o f Nam Dinh province’s health sector in allocation aid Lse addiíional ĩinancial resources, calculate the expected demand o f e;p:nses and income possibilities and then to propose solutions to increase rcvmues to meet spcnding needs and manage hcalth financing in effective lVehod: Analysis o f documents, in-dcpth interviews and SWOT RĩSilt & C onclusions: Health sector oi'N am Dinh province in recent years hismade remarkable achievements in various íìelds o f healthcare for the ptO'le, Nam Dinh has íìnished most important output indicators on or ahead oltie expected plan Plans to develop health sector closely linked with the yta socio-economic development plan from 2011 to 2015 and the p»rí)nnance indicators ot' the national health sector Hovvever, there is no liik between the plan and the annual budget vvith goals, outcome and output ncicators o f the sector, due to the current Capital expenditure and recurrent ooenditure is expected to comply with the norms stipulated in Decision [ 51/2006 / ỌD -TTg o f the Prime Minister, an annual increase o f about 15% til íầils to ensure adequate ílnancial resources required to minimum pcnding demand o f Nam Dinh province’s health Ít inevitably leads to 'ulget deficits, required to cut down on some spending items, resulting in 01-guaranteed operating costs o f local health By necessity of being vãlable with solutions to increase revenue sources, the author has applied VOT analysis for strengths, vveaknesses, opportunities and challenges of Jan Dinh province in the management o f health íìnancing, assessment of lbcation situation, from which calculates the actual spending needs o f the eilth sector and propose measures to raise revenues tor the health sector eie Based on the calculated demand shorttầll, assess the current íinancial ĩs)urces and trend analysis o f tìnancial resources can be offset in time to ían Dinh province, the author makes a number o f recommendations as )lows: Ó' expenditures for investment and development - For the local budget: The Province needs to increase investment Cipitals from the health hudget at least 20% over the previous year, and S)end 30% o f the total expenditures for invcstmcnt and development from tle local budget for health to implement The scheme o f upgrading the dstrict hospitals and the regional general hospital as dìned in Decision N) 47/2008/Ọ D -TTg o f the Prime Minister - The province should spend at least 40% o f lottery revenues (expected líttery source for investment, upgrade o f infrastructure, social welfare, sich as education, health, culture and sport is about 50 -70 billion \N D /year) for health, especially for investment and upgrade o f the povincial general hospital, district hospitals and inter-district regional g-neral hospitals, preventive health centers and etc - For Central budget: Although the province regulates the adjustment rate o f the Central budget, because o f the total provincial budget for investment and development in average level (estimated 800-1000 billion VND/year), it cannot spend more for health It requires the Central budget to continue to support the province to upgrade provincial general hospital into regional medical center; upgrade the district health system, especially the district hospitals and district preventive health centers For recurrent expenditure - Ensure that the level o f recurrent expenditure on health per capita prescribed by the Prime Minister, including expenditure increase by 20% because the province has adịustment rate o f t h e budget Annual increase in recurrent expenditure over the previous year is 0% to reduce shortage in recurrent expenditure - Recurrent expenditure íor provincial hospital beds is around 35-45 million VND/year, district hospital beds 30-35 million/year, provincial preventive health centers: 31-35 million VND/staff/year, district preventive Health centers: 28-32 million VND/staff'/year to ensure regular operation o f the unit, so that these units can purchase, repair and maintain assets, equipment and have íìnancial resources for the etTective implementation o f autonomy, selt-responsibility under Decree No 43/2006/ND-CP For the íinancial management * Enhance the role o f the Department o f Health in Consulting the People's Committee to allocation o f local health budget, both regular and investments; the Department o f Health is allowed to manage the general budget; the Department o f ỉỉealth is responsible for: - Guiding the business units under Department o f Construction to estimate budget to report to the Department o f Finance, Department o f Planning and Investment and the People's Committee, People's Council for consideration and decision - Preparing a plan for allocation of the budget for health services in local units, including provincial, district and commune health íầcilities Consult the Department o f Finance, Department o f Planning and Investment to the People's Committee for approval - Delivering estimates, adịusted estimates íor the health units in the province, the preventive medicine centers and district hospitals - With regard to the communal level, based on the annual budget allocation for each district health department, the Department of Finance implements supplementation to the district budget to assign estimates of recurrent expenditure, expenditures for medical staffs in communes, allovvances for medical staffs in villages in the CHS The allocation for each commune is decided by the district People's Committee * Promote the implementation of socialization of iocal health activities such as: Encourage the đeveloprnent o f non-public health facilities; the province needs to take land and allocate land without collection o f land use fees for private hospitals; when planning residential areas and new urban areas and industrial zones, thc province nccds to regulate land arcas for hospital construction Encourage the public medical tầcility to borrovv capitals, implement joint ventures and associate to install machinery and equipment to serve medical examination * Recommend the Provincial People's Committee to base on the actual situation in the locality, the People's Council to issue fee levels o f some basic health services at commune to raise revenues for the operation o f commune health centers such as hcalth Insurance, health care fund for the poor in order to improve the quality and performance of CHS Suggestions for íuture research: The limitations o f the thesis wi 11 be discussed and what can be suggested to study turther in future research proịects Contribution of the thesis: This study providcs directions for changes in the management and use o f íinancial resources o f Nam Dinh province Ít also provides useful recommendations in attracting sources o f revenue to assure tasks for medical expenses o f Nam Dinh province This is a reíerence to the offìcers involved in the reasonable and ìlcient planning and allocation o f íỉnancial resources Table of Contents ACCRONYMS LIST OF TABLES lntroduction 1.1 General introduction 1.2 Obịectives of the study 1.3 Study questions 1.4 Study methods Reference framework 2.1 Strengths 2.2 Weaknesses 2.3 Opportunities 2.4 Threats Study method Data source Secondary data source 4.1.1 Data from reports settlements of revenue and expenditure 4.1.2 Data from nevvspapers and internet 4.2 Primary data source Researching results 5.1 Assessment of implementation oí the State Budget Law and its implementing guidelines 5.1.1 Mechanisms and tbrms of budget management 5.1.2 Implementation of expenditure norms/ hudget allocation norms 5.1.3 Evaluation ofthe implementation of the Govemment's Decree No 43 32 5.2 Construction of cost estimates and expenditure needs of the health sector in Nam Dinh 5.2.1 Priorities, strategies and activities of local sectors: 5.2.2 Pinancial demand ot Mcdical Service in Nam Dinh province 5.3 Financial resources of the medical Service in Nam Dinh Conclusion, recommendation and contribution of the thesis 6.1 Conclusion and recomendation 6.2 Contribution of the thesis Reíerence Appendix ACCRONYMS BKHĐT Ministry of Planning and Investment BTC Ministry of Pinance BYT Ministry of Health BNV Ministry of Interior BHYT Health Insurance CT MTỌG National Target Program UBND People's Committees HĐND People's Council KCB Healthcare KHHGĐ Pamily planning NS Budget NSNN State budget XDCB Capital construction SYT Health department QĐ Decision NĐ Decree TTLT Joint Circular tr.đ Million Vietnam dong gb Medical bed bc Payroll 43 (1) Expemỉiture fo r Disease Control and Prevention: Includes expenditures oí'regular operations of the preventive medical íầcilities and for disease control and prevention: - Expenditures o f the preventive medical tầcilities such as: Preventive medical centers, centers for HIV/AIDS prevention; centers for reproductive health care; and etc Minimum demand for expenditures o f these units include: expenditures for people, proíèssional activities, procureinent and overhaul and etc - Expenditure íor Disease Control and Prevention: ensure íunds for the initiative in the control and prevention o f diseases in both Central and local levels, including funds to buy drugs, chemicals, and materials for disease control and prevention, funds for training, allovvances íor the disease control in extraordinary cases (2) Expenditures fo r medical care: - Regular expenditures o f hospitals, health centers in district level: Minimum dcmand for expenditures oí' these units include: expenditures tbr people, protessional activities, procurement and overhaul and etc - Expenditures for medical care tor the poor: + Subịects for estimates include: - Poor households as dclìned in Decision No 170/2005/QD- ITg dated Julv 08, 2005 o f the Prime Minister On the basis of the province's poor household rate, 2% per year, expected poor household rate is 10,6% in 2010; 8,6% in 2008; 6,6% in 2009 and 4,6% in poverty reduction rate is expected - Ethnic households (except for households vvith high income) in communes, wards and towns in Region II and III are classiíìed by level of development and recognized under the current decisions of the Minister, the Head of the Committee o f Ethnic Minorities and Mountainous areas (now the Committee o f Ethnic Minorities); + Expenditures: Implementation o f the health insurance policy tor the poor, the rights o f p eop le with health Insurance, in w hich the poor are paid 43 ( Expenditure fo r Disease Con troI and Preventỉon: Includes expenditures o f regular operations of the preventive mcdical íầcilities and for disease control and prevcntion: - Expenditures o f the preventive medical íầcilities such as: Preventive medical centers, centers for HIV/AIDS prevention; centers tor reproductive health care; and etc Minimum demand for expenditures o f these units include: expenditures tor people, professional activities, procurement and overhaul and etc - Expenditure f'or Disease Control and Prevention: ensure funds for the initiative in the control and prevention o f diseases in both Central and local levels, including funds to huy drugs, chemicals, and materials for disease control and prevention, funds íor training, allowances ior the disease control in extraorđinary cases (2) Expendiíures fo r medical care: - Regular expenditures of hospitals, Health centers in district level: Minimum demand lbr expenditures of these units include: expenditures for people, proíessional activities, procurement and overhaul and etc - Expenditures for medical care 1'or the poor: + Subịects for estimates include: - Poor households as deíined in Decision No 170/2005/ỌD-TTg dated July 08, 2005 o f the Prime Minister ()n the basis of the province's poor household rate, 2% per year, expected poor Household ratc is 10,6% in 2010; 8,6% in 2008; 6,6% in 2009 and 4,6% in poverty reduction rate is expected - Ethnic households (except for households with high income) in communes, wards and towns in Region II and 11! are classitìed by level of development and recognized under the current decisions of the Minister, the Head of the Committee o f Ethnic Minorities and Mountainous areas (now the Committee o f Ethnic Minorities); + Expenditures: Implementation o f the health Insurance policy for the poor, the rights of people with health insurance, in which the poor are paid 44 high technology services On the other hand, in the future, district hospitals, provincial hospitals and commune Health stations will be upgraded to increase the ability to provide medical services to the poor and the poor will enịoy more medicaỉ services with better quality Costs for these services are increasing so that it is necessary to adịust spending levels to purchase health Insurance accordingly 2010 estimated spending levels under the Prime Minister's decision is 80,000 VND/person which demands tor a spending level o f 220,000 VND/person With this plan, the health insurance fund for the poor is 15,592 million VND in 2014, 26,019 million VND in 2015, 27,121 million VND in 2016, 28,137 million VND in 2017 - Support fo r low-income peopỉe to purchase health Insurance: The scheme o f socialization of Health activities has been approved hy the Prime Minister and the Decree No 63/2005/ND-CP stipulates support for low-income people to purchase Health Insurance The State supports 30% o f the level o f support for the poor every year With this plan, support for the iow income people to purchase the health Insurance is 1,760 million VND in 2014, 5,499 million VND in 2015, 9,238 million VND in 2016, 14,517 million VNI) in 2017 (3) Expenditures fo r other Health activities, including: + Activities o f the Council of Medical Examination + Activities o f Provincial Board o f Health Protection + Healthy Cultural Villages + Prevention o f Injuries and accidents + Health activities at schools + Plan for the National Nutrition + Reciprocal Capital o f the loan and aid in rccurrcnt expcnditures 45 + Expenditures 1'or prọịects of national target programs beyond additional Central budget to secure íunding for the implementation of the objectives oflocal health care + Safety in blood transfusion + Prevention o f non-communicable diseases (cardiovascular, neurological diseases, diabetes ) + Implementation of reproductive health strategy + Implementation o f the project of Controlling microbial contamination and chemical residues in food (4) Expenditures fo r heaỉth care in communes and viỉỉages: - Expenditures for health care in communes include expenditures for medical staffs in communes, allovvances tor medical staffs in villages and recurrent expenditures for communal health care + Expenditures for salaries and contributions are based on the number o f commưnal medical staff and: * Salary regime for communal medical staiT, * Contributions, * Preíerential allovvances of the sector (Circular No 02/TTLT-BTC-BYT-BNV) * Allowanccs prescribed in Circular No 09/2003/TT-BYT-BTC-BNV dated September 29, 2003 on guiding the implementation of Decision No 155/2003/ỌD-TTg dated July 30, 2003 of the Prime Minister + Regular expenditures for communal health care: Base on actual activities, the demands and capabilities o f thc local budget to estimate under the provisions o f Circular No 119/2002/TTLT-BTC-BYT dated December 27, 2002 on guiding revenues and expenditures and recurrent expenditures o f CHSs Minimum expenditures should be 10 million VND/station/year (excluding salaries, allovvances and contributions of the communal health staffs, tunding for health carc for the poor in the communes) for payment of electricity, water, telephone, stationery, maintenance of assets and etc 46 + Allowanees tor medical staffs in villages: Based on the number of staíTs and the provincial People's Committee regulations, minimum expenditure is 40,000 VND/person/month under Notiíication No 176/'TB-VPCP dated October 14, 1998 o f the Government OHìce b) On the basis of the health targets to be achieved, the íinancial demand of the medical Service in Nam Dinh is expccted as follows: Table 11: Expected íinancial demand of the medical Service in Nam Dinh Unit: Million VND No Expenditures I Expenditures for investment and development II Regular expenditures: In which: Regular expenditurcs oíthe S tate budget ibr medical íầcilities108.318 120,497 132,847 3 1508.993 Expenditures for National Target Program Expenditures tbr medical examination tor the people under the social policies Expenditures from other revenues Total amount Source: The author calculation and evaluation 47 Based on these assumptions, the íìnancial revenues for the Health sector in Nam Dinh are summarized in the following table: Table 12: Expected íìnancial capacity and shortage of revenues of the health sector in Nam Dinh Expectation Revenues Total 2014 2015 2016 2017 amount State budget for expenditure for investment Total amount - Local budget - Central budget - ODA State budget for regular expenditure Total amount - Local budget - Central budget 134,064 161,632 182,446 206,131 684,283 129,21 156,058 176,036 198,759 660,070 4,847 5,574 6,410 7,372 24,203 127,043 146,100 168,015 551,630 From the non-husincss revenues Total amount - 1ỉospital charges - Health Insurance - Other charges Tota! amount - Investment - Regular 110,472 48 Shortagc of íinancial 61,293 resources for - Regular - Investment 89,599 76,329 56,894 284,115 9,413 11,509 11,832 13,621 46,375 51,880 78,090 64,497 43,273 237,740 Source: The author calculation and evaluation 5.3 Financỉal resources of the medical Service in Nam Dinh - Local budget: 2011 is considered the íìrst year o f the budget stabilization for the 201 1-2013 period Based on the budget allocation norms stipulated in Decision No 151/2006/ỌD-TTg o f the Prime Minister and based on the ability to tìnancial balance and socio -econom ic development strategy o f the province, the annual increase in expenditures from the local budget íbr the Health Sector o f Nam Dinh is 15% - The Central budget is supplemented for the local budget: Forecast on the basis oí'programs and schemes of the Ministry o f Health - The rcvenues beyond the State budget include hospital charges, hcalth Insurance and other sources such as fees and charges vvill increase because in the íuture the implementation of Circular No 03 wi 11 be more com prehensive, correct and the policies o f hospital charges and health Insurance will bc changcd, and increase in living standards lead to the highcr ability for medical Service payment The increase in annual revenue is assumed to be 15% The Government tends to implement overall health Insurance by 2010; as a result there is a tendency o f increase in revenues from health Insurance and decrease in direct hospital fees Pinancial resources, current summarized in the following table: status and tendency for changes are 49 Table 13: Current status and tendency for íìnancial changes Pinancỉal resources Current tlnancial resources State investment budget State rccurrent of the health care inílation íacilities budget State preventive activities budget Hospital Service tees fees, Revenue Insurance from New financial resources Government for investment health Service Encourage investment Not yet, only support Increase, allovving private socialization for health care Service Health care facilities o f the State Source: The author syrtthesis and evaluation 50 Conclusion, rccommendation and contribution of the thesis Conclusion and recomendation Given the current expenditures and expected recurrent expenditures in accorđance with the norms stipulated in Decision No 15 1/2006/ỌD-TTg of the Prime Ministcr, an annual increasc of about 15% have not ensured adequate tìnancial resources tor minimum expenditure demands ofthe Health Service in Nam Dinh It will lead to budget detìcits and have to cut down some expenditure items, resulting in no guarantee o f expenditures of local health Based on the calculated demand shortíầll, assess the current ílnancial resources and trend analysis o f tìnancial resources can be offset in time to Nam Dinh province, the author makes a number o f recommendations as follows: For expenditures for investment and development - For the local budget: The Province needs to increase investment capitals írom the health budget at least 0% over the previous year, and spend 30% o f the total expenditures tor investment and development trom the local budget for health to implement The scheme o f upgrading the district hospitals and the regional general hospital as detìned in Decision No 47/2008/ỌD-TTg o f the Prime Minister - The province should spend at least 40% oi' lottery revenues (expected lottery source for investment, upgrade o f infrastructure, social welfare, such as education, health, culture and sport is about 50 -70 billion VND/year) for health, especially for investment and upgrade of' the provinciaỉ general hospital, district hospitals and inter-district regional general hospitals, preventive health centers and etc - For Central budget: Although the province regulates the adjustment rate oí' the Central budget, because o f the total provincial budget for investment and development in average level (estimated 800-1000 billion VND/year), it cannot spend more for health Ít requires the Central budget to continue to support the province to upgrade provincial general hospital into regional 51 m edical center; upgrade the district health system, especially thc district hospitals and district preventive Health centers For recurrent expenditure - Ensure that the level of recurrent expenditure on health per capita prescribed by the Prime Minister, including expenditure increase by 20% because the province has adịustment rate of the budget Annual increase in recurrent expenditure over the previous year is 0% to ređuce shortage in recurrent expenditure - Recurrent expenditure íor provincial hospital beds is around 35-45 million VND/year, district hospital beds 30-35 million/year, provincial preventive health centers: 31-35 million VND/staff/year, district preventive health centers: 28-32 million VND/staff/year to ensure regular operation of the unit, so that these units can purchase, repair and maintain assets, equipment and have íìnancial resources tor the ìective implementation of autonomy, selt-responsibility under Decree No 43/2006/ND-CP For the ílnancial managcmcnt * Enhance the role of the Department of I lealth in Consulting the People's Committee to allocation of local health budget, both regular and investments; the Department o f Health is allowed to manage the gcneral hudget; the Department o f Health is responsible tor: - Guiding the business units under Department o f Construction to estimate budget to report to the Department of Finance, Department of Planning and Investment and the People's Committee, People's Council for consideration and decision - Preparing a plan for allocation of the budget íor health services in local units, including provincial, district and commune health facilities Consult the Department of Finance, Department of Planning and Investment to the People's Committee for approval - Delivering estimates, adịusted estimates for the health units in the province, the preventive medicine centers and district hospitals - With regard to the communal lcvel, bascd on the annual budget allocation for each district Health department, the Department o f Finance implements supplementation to the district budget to assign estimates of recurrent expenditure, expenditures for medical statTs in communes, allowances for medical staffs in villages in the CHS The allocation íor each commune is decided by the district People's Committee * Promote the implementation of sociali/.ation of local health activities such as: Encourage the development of non-public heulth íầcilities; the province needs to take land and allocate land without collection o f land use tees tor private hospitals; when planning residential areas and new urban areas and industrial zones, the province needs to regulate land areas tbr hospital construction Encourage the public medical tầcility to borrow capitals, implement joint ventures and associate to install machinery and equipment to serve medical examination * Recommend the Provincial People's Committee to base on the actual situation in the localitv, the People's Council to issue íee levels of some basic health services at commune to raise revenues tbr the operation of coimnune health centers such as health Insurance, health care lund for the poor in order to improve the quality and períorinance of Cl 1S 6.2 Contribution of thc thcsis This study provides direction tor changes in the management and use of íìnancial resources of Nam Dinh province The study also providcs useíul recommendations in attracting revenue to ensure expenditures for the medical Service o f Nam Dinh province This is a reference to the officers involved in reasonably and efficiently planning and allocating iìnancial resources 53 Rerence Books 11J ADB (1999), Managing Government ExpencHture (Asian Development Bank, Manila) [2] Dunn, William N (2008), Public Policv Analysis: An introduction (New Jersey: Pearson) [3] Jody Zall Kusek, Ray c Rist (2004), Ten Steps to a Results-Based Monitoring and Evaluation System (The World Bank, Washington, D.C) [4] Owen E Hughes (2003), Public Management & Administration: An ỉntroduction Thirđ Edition.(Palgrave macmillan, New York) [5] Peter, Guy B (1996), American Public Poỉicy: Promise and Per/ormance Pourth Edition (Chatham, Nevv Jersey: Chatham house publishers, Inc.) |6| World Bank (1998), Public Expenditurc Management Reviews Ị7Ị Ministry o f Health, Health coordination group 2011 Strengthening the management capabiỉitv and rẹ/orm o f heaỉthcare ỷìnancing for implementation o f the 5-vear Plan ọf Health sector /rom 20 ì Ị-2015 Joint Annual Health Revievv (JA11R) Ị8 ] Ministry o f Health, Health coordination group 2013 Towards universa! heaỉth Insurance Joint Annua! I lcalth Review (JAHR) [9] DFỈD 2010 Solving corruption in the health sector [10] People's Council o f Nam Dinh province 2013 On the task o f socio-economic development Nam Dinh province in 2014 Resolution No 25/2013/NỌ-HDND dated December 12, 2013 [11] People's Council o f Nam Dinh province 2013 On ratiỷìcation o f esíimates o f revenues and expenditures and the aỉỉocation o f investment and development Capital belonging to budget of Nam Dinh province in 2014 Resolution No 26/2013 / NQ -HDND dated December 12, 2013 54 I 121 Health Department o f Nam Dinh province l i n a l report o f the medical work in years 201 / 2012, 2013 [13] Health Department of Nam Dinh province Settlement report o f years 2011, 2012, 2013 [14] People’s committee o f Nam Dinh province Decỉsions on alỉocating targets o f the State budget in 2009-2013 A ppendix List o f interviewees w 'íi " • >*Ti^ịrỊffl! p R ii& *x& £ f Unit Bui Thi M inh T hu T ran T hu I ỉuong N g u y e n Thị Binh D o N goe D ung N g u y e n V an H oa Do V an Đuoc H oang M anh Viet T ran Thi T hu I long 10 N gu von Van U ong 11 Vu Thi D uong 12 13 P h am T ien D ung Pham H ung C u o n g 14 N g u y en V an Tinh N g u y e n T rong T huy ... management in Nam Dinh Province, based on interviews with leaders ()f the Department of Health, essays identiíying strengths and weaknesses of Nam Dinh Province in management of health financing are listed... and use o f health financing in Nam Dinh province in recent years, then, propose some solutions to improve the efficiency of use of health financing Interview wi 11 help researcher reintbrce the... Nam Dinh province? - Pormation of estimate and minimum expenditure needs for Nam Dinh province and identification of short fall funding compared to the revenue - What should Nam Dinh province