JOINT ANNUAL HEALTH REVIEW 2013

Ministry of Health Health Partnership Group JOINT ANNUAL HEALTH REVIEW 2013 Towards Universal Health Coverage Hanoi, November 2013 Editorial board Assoc Prof Nguyen Thi Kim Tien, PhD – Chief Editor Assoc Prof Pham Le Tuan, PhD Nguyen Hoang Long, PhD Assoc Prof Pham Trong Thanh, PhD Sarah Bales, MS Coordinators Nguyen Hoang Long, PhD – Team leader Assoc Prof Pham Trong Thanh, PhD Sarah Bales, MS Tran Khanh Toan, PhD Nguyen Thi Thu Cuc, MS Experts who compiled the report Nguyen Hoang Long, PhD Sarah Bales, MS Assoc Prof Pham Trong Thanh, PhD Tran Khanh Toan, PhD Duong Duc Thien, MS Tran Thi Mai Oanh, PhD Nguyen Khanh Phuong, PhD Assoc Prof Nguyen Thi Kim Chuc, PhD Hoang Thanh Huong, MS Khuong Anh Tuan, PhD Nguyen Trong Khoa, MS Ha Anh Duc, PhD Tran Van Tien, PhD Assoc Prof Hoang Van Minh, PhD Assoc Prof Nguyen Thanh Huong, PhD Vu Van Chinh, MS i Joint Annual Health Review 2013 Table of Contents Acknowledgements Introduction Purpose of the JAHR report Contents and structure of JAHR 2013 Implementation methods Organization of implementation PART ONE: UPDATE ON THE SITUATION OF THE HEALTH SYSTEM Chapter I: Update on the situation of the health system Major tasks of the health sector in 2013 Implementation of the Plan for the protection, care and promotion of the people’s health for the period 2011–2015 2.1 Health sector governance 2.2 Human resources for health 17 2.3 Health financing 22 2.4 Pharmaceuticals and medical equipment 30 2.5 Health management information systems 37 2.6 PHC, preventive medicine, national health target programs, reproductive health and population-family planning services 44 2.7 Medical service delivery 53 Status of implementing targets of the Five-year plan 2011–2015 59 Status of implementing the MDGs 61 PART TWO: TOWARDS UNIVERSAL HEALTH COVERAGE 69 Chapter II: Theoretical framework and concepts related to universal health coverage (UHC) 70 Conceptualization of “universal health coverage” 70 Key requirements to achieve universal health coverage 71 2.1 Health systems to meet the need for universal health coverage 71 2.2 Selection of health financing mechanism for universal health coverage 73 Experience of UHC from selected developing countries in the region 75 Vietnamese policies on UHC 76 Indicators of universal health coverage 77 Analytical framework used in the report 77 Chapter III: Healthcare service coverage 79 Concepts and policy orientation 79 1.1 Concepts 79 1.2 Policy orientation for basic health service delivery 82 Coverage of preventive medicine, PHC, reproductive health and population-family planning services 82 2.1 Situation assessment 82 2.2 Priority issues 88 2.3 Recommendations 88 Coverage of medical services, rehabilitation and traditional medicine 91 3.1 Situation assessment 91 3.2 Priority issues 99 3.3 Recommendations 99 Access to essential medicines for universal health care 101 4.1 Situation Assessment 102 4.2 Priority issues 109 4.3 Recommendations 109 Chapter IV: Financial protection in universal coverage 111 Reducing household out-of-pocket spending on health 111 1.1 Out-of-pocket payments, catastrophic health expenditures and impoverishment due to outof-pocket payments in Vietnam 112 1.2 Factors affecting out-of-pocket payments, catastrophic expenditure and impoverishment due to health care spending in Vietnam 115 1.3 Recommendations 119 Financial protection for disadvantaged and vulnerable groups 119 2.1 Situation assessment 119 2.2 Priority issues 128 ii 2.3 Recommendations 128 Development of universal health insurance 129 3.1 Situation assessment 129 3.2 Priority issues 135 3.3 Recommendations 136 Mobilization of financial resources for UHC 137 4.1 Situation assessment 138 4.2 Priority issues 143 4.3 Recommendations 144 Increase efficiency of available resources 144 5.1 Situation assessment 145 5.2 Priority issues 149 5.3 Recommendations 149 Renovating payment modes in the UHC process 150 6.1 Role of provider payment methods 150 6.2 Application of different payment methods in Vietnam 151 6.3 General evaluation 154 6.4 Priority issues 157 6.5 Recommendations 158 PART THREE: CONCLUSIONS AND RECOMMENDATIONS 160 Chapter V: Conclusions 161 Update on the situation of the health system 161 1.1 Major tasks of the health sector in 2013 161 1.2 Implementation of the Plan for the protection, care and promotion of the people’s health for the period 2011–2015 161 1.3 Status of implementing targets of the Five-year plan 2011–2015 172 1.4 Implementation of the Millennium Development Goals in Vietnam 173 Towards universal health coverage 175 2.1 Healthcare service coverage 175 2.2 Financial protection in health care 180 Chapter VI: Recommendations 187 Health sector governance 187 Human resources for health 188 Health management information system 188 Pharmaceuticals and medical equipment 189 Coverage of preventive medicine, PHC, reproductive health and population-family planning services 190 Coverage of medical services 191 Health financing 193 Appendix: JAHR monitoring and evaluation indicators 197 iii Joint Annual Health Review 2013 List of Tables Table 1: Status of implementing basic health targets in the Five-year plan, 2011–2015 59 Table 2: Malnutrition rate (underweight) of children under age by region, 1990, 2012 and 2015 goal 62 Table 3: Tuberculosis control situation (MDG 6), 2011 65 Table 4: Progress towards achieving MDGs in Vietnam, 1990, 2012 66 Table 5: Average monthly out-of-pocket health payments per household (current and constant 2010 prices), 2002~2010 113 Table 6: Current situation of catastrophic health expenditure and impoverishment due to health spending in Vietnam, 2002–2010 114 Table 7: Average monthly out-of-pocket spending per household by household characteristics, 2002~2010 116 Table 8: The proportion of households facing catastrophic spending by household characteristics, 2002~2010 116 Table 9: Proportion of households impoverished due to health spending by household characteristics, 2002~2010 117 Table 10: Total state budget allocation, subsidy per card and total insurance reimbursement per card for the poor and near poor, 2003–2011 122 Table 11: Health insurance coverage among the poor and other disadvantaged groups, 2011 122 List of Figures Figure 1: Division of responsibility of the Minister and Vice Ministers of Health, 2013 10 Figure 2: Structure of the groups participating in health insurance, 2012 25 Figure 3: Health insurance coverage rate by insured groups, 2011 25 Figure 4: Gap in prices between brand name and generic drugs by type of pharmaceutical outlet, 2011 33 Figure 5: Operating units in the health management information system 41 Figure 6: Morbidity and mortality from hand, foot and mouth disease, 2012 46 Figure 7: Dengue fever morbidity, 2012 46 Figure 8: HIV/AIDS morbidity and mortality, 2000–2012 47 Figure 9: Trends in infant and U5MR, 1990~2012 and goal by 2015 62 Figure 10: The diversion of the health system from primary health care (PHC) core values 73 Figure 11: Analytical framework used in the Report 78 Figure 12: Preventive care from service delivery management approach 81 Figure 13: Proportion of drugs available at studied sites, 2010 104 Figure 14: Proportion of prescriptions containing antibiotics at public medical facilities, 2010 107 Figure 15: Structure of health financial sources in Vietnam, 1999–2010 112 Figure 16: The out-of-pocket share of total health expenditures in selected Asian countries, 2007 112 Figure 17: Annual health service contacts per capita, 2002~2010 113 Figure 18: Out-of-pocket payments compared with capacity-to-pay and total households expenditure, 2002~2010 114 Figure 19: Catastrophic spending and impoverishment due to health spending in selected Asian countries, 2007~2009 115 Figure 20: Health insurance coverage in Vietnam, 2005–2012 130 Figure 21: Real growth rates in state health recurrent spending and overall state recurrent spending, 2004–2012 139 Figure 22: State budget recurrent expenditure on health as a share of overall state budget expenditure and as a share of GDP, 2008–2013 140 Figure 23: Structure of state budget expenditure on health (including external assistance) by health sector activity, 2009 146 Figure 24: State budget health spending per capita by region, 2012 147 Figure 25: Comparison of outpatient service use with inpatient service use of health insurance enrollees in Vietnam, Thailand and Taiwan 148 iv Abbreviations ADB AFB+ ARV ASEAN CDC COPD DOTS GAVI GDP GDP GLP GMP GPP GSO HIV/AIDS HPG ICD IHP+ IMR ISO JAHR JANS MDG MMR MOH NGO ODA OECD PHC PPP U5MR UHC UNFPA UNICEF USAID USD VND VSS WHO Asian Development Bank Acid Fast Bacilli (test for Tuberculosis) Anti-retroviral Association of South East Asian Nations Centers for Disease Control Chronic obstructive pulmonary disease Directly observed treatment short course Global Alliance of Vaccines and Immunization Gross domestic product Good distribution practice Good laboratory practice Good manufacturing practice Good pharmacy practice General Statistics Office Human immuno-deficiency virus/ Acquired immuno-deficiency syndrome Health Partnership Group International Classification of Disease International Health Partnership Infant mortality rate International Standards Organization Joint Annual Health Review Joint Assessment of National Strategies Millennium Development Goal Maternal mortality ratio Ministry of Health Non-governmental organization Official Development Assistance Organization for Economic Cooperation and Development Primary Health Care Public Private Partnership Under-five mortality rate Universal Health Coverage United Nations Population Fund United Nations Children’s Fund United States Agency for International Development United States Dollar Vietnam Dong (currency) Vietnam Social Security World Health Organization v Acknowledgements The Joint Annual Health Review 2013 (JAHR 2013) is the seventh annual review implemented under the direction of the Ministry of Health together with the Health Partnership Group (HPG) The JAHR 2013 report assesses progress in implementing the tasks laid out in the Five-year health plan 2011–2015, as well as results of implementing the Five-year plan targets and Millennium Development Goals (MDGs) At the same time the report contains an in-depth analysis on “Universal health care coverage” The process of implementing the JAHR 2013 has received enthusiastic support from many stakeholders We are sincerely grateful for the ideas contributed and valuable advice given by the Ministry of Health departments, administrations, institutes and other units, by other ministries and by sectoral agencies during the process of developing this report We would especially like to thank and show our appreciation for the technical support and advice from the HPG and other organizations and individuals, and give thanks for financial support from WHO, the Global Alliance for Vaccines and Immunization (GAVI) and the Rockefeller Foundation We would like to express our thanks to national and international experts who have directly participated in analyzing the available information, gathering and processing feedback and ideas from stakeholders in order to compile the chapters of the report; thanks to the coordinators of the JAHR under the direction of Nguyen Hoang Long, deputy director of the Department of Planning and Finance, with the other coordinators including Associate Professor Pham Trong Thanh, Sarah Bales, Tran Khanh Toan and Nguyen Thi Thu Cuc, who have actively participated in the process of organizing, developing and completing this review Editorial board Joint Annual Health Review 2013 Introduction Purpose of the JAHR report As agreed upon by the Health Partnership Group (HPG) since 2007, the Joint Annual Health Review (JAHR) has the overall objective of a situation assessment and determination of priority issues of the health sector, in order to support annual planning of the Ministry of Health, and at the same time to serve as the basis for choosing focal issues for cooperation and dialogue between the Vietnamese health sector and international partners Specific goals of the JAHR include the following: (i) an update on the health sector situation, including new policies, assessment of progress in implementation of tasks and achievement of health sector targets laid out in the health sector plans, and progress implementing MDGs and (ii) in-depth analysis and evaluation of one aspect of the health system, or one important topic that is the focus of policy-maker attention Contents and structure of JAHR 2013 Depending on the situation in each year, the JAHR report varies the contents and structure to satisfy the goals and concrete requirements of health sector planning and choice of focal areas for cooperation and dialogue between the Vietnamese health sector and international development partners In 2007, the first JAHR report was compiled, providing a comprehensive update of the major building blocks of the Vietnamese health system, including the following topics: (i) health status and determinants; (ii) organization and management of the health system; (iii) human resources for health; (iv) health financing; and v) health service provision The 2008 and 2009 JAHR reports, in addition to the health system update section, covered the specific topics of Health financing and Human resources for Health respectively The 2010 JAHR report was developed during the final year of implementing the fiveyear health sector plan for the period 2006–2010, and the focus was placed on a comprehensive update of health system building blocks, in order to support development of the five-year health sector plan for 2011–2015 The 2011 JAHR was developed in the first year of implementing the five-year plan for the period 2011–2015, and had the task of updating the new orientation that was decided upon in the Eleventh National Party Congress, and in the five-year socio-economic development plan, in order to promote implementation of the socio-economic plan and support development of the 2012 annual health sector plan The 2012 JAHR was developed in the second year of the five-year planning cycle, with the task of supporting development of the 2013 annual health sector plan, through updates on new policies and assessment of progress in implementing tasks in each of the six building blocks of the health system and in-depth analysis of medical service quality with related policy recommendations The 2013 JAHR was developed in the third year of the five-year planning cycle, with a task similar to the 2012 JAHR, but with the in-depth analysis focused on Universal health coverage (UHC), a topic that is currently receiving global attention PART ONE: Update on the Situation of the Health System, has the following contents: Appendix Monitoring indicators 24 Proportion of women aged 15–49 with unmet need for family planning 25 Units Year Disaggregation 2009 2010 2011 2012 2015 Indicator Information type source % National 4.3 TB case detection rate (all forms) Per 100 000 people National 114.1 113.9 114.0 113.9 26 Pulmonary TB (AFB+) case detection rate Per 100 000 people National 52.2 (59.6) 52.7 (60.0) 57.7 57.5 MOH-NTP (HSYB 2011) 27 Cure rate for new cases of pulmonary TB (AFB+) National 90.6 90.5 90.8 91.1 MOH-NTP 28 HIV detection rate National 16.1 15.9 16.1 15.9 NTP MOH-NTP 29 HIV/AIDS prevalence National 187.0 211.3 224.4 237.5