PEDIATRIC HEALTH CARE SYSTEM PEDIATRIC HEALTH CARE SYSTEM

IN VIETNAM:IN VIETNAM:

REALITY AND CHALLENGES REALITY AND CHALLENGES

TABLE OF CONTENTSTABLE OF CONTENTS

Pediatric heath care system in Vietnam

Developmental orientation

Proposals

Vietnamese health care system in general and

Vietnamese pediatric care system in particular are in

the process of reforming and developing. It focuses

on:

Effectiveness

Equity

Quality

INTRODUCTIONINTRODUCTION

VIETNAM’S HEALTH CARE VIETNAM’S HEALTH CARE SYSTEMSYSTEM

CURRENT RESOURCES IN THE CURRENT RESOURCES IN THE MEDICAL FIELDMEDICAL FIELD

Medical care providers per 10,000 citizens

Number of hospital/clinic beds

Physicians Nurses and Midwives

PEDIATRIC HOSPITAL PEDIATRIC HOSPITAL NETWORKNETWORK

PUBLIC National level

Provincial, District,Township & CountyLevels

Town & Commune level

PRIVATE

Pediatric department in

private hospitals

Private clinics

3Nationa

l hospit

als

12 pediatric hospitals11 obstetric and pediatric

hospital 84,2% general hospitals at

provincial level offer pediatric care

General doctors provides pediatric care.645 county hospitals

and 48 general hospitals

No pediatricians10,748 local health centers.

TRENDS OF POPULATION PROPORTIONTRENDS OF POPULATION PROPORTION(1989-2050)(1989-2050)

Red line: Proportion of children under the age of 15 Blue line: Proportion of adults over the age of 65 Nguồn: Tổng cục thống kê (GSO), UN

CONNECTION BETWEEN CONNECTION BETWEEN POPULATION AND PEDIATRIC POPULATION AND PEDIATRIC

CARE CARE

(Nguồn: Dân số và cơ cấu dân số Việt Nam vào năm 2014 - 2019, Tổng cục dân số và kế hoạch hóa gia đình VÀ Báo cáo tổng quan ngành Y tế năm 2013, Bộ Y tế)

HUMAN RESOURCES IN HUMAN RESOURCES IN PEDIATRIC BRANCHPEDIATRIC BRANCH

Huge shortage of medical staff

- 0.6 pediatrician/10,000 children under the age of 16( ≈ 1.800 peditricians)

- Pediatrician/Medical doctors: 3% Doctors/Patient beds: 0,2%

- Discontinuation of pediatric training since 1998

Uneven distribution of human resources

Quality of training program

CURRENT PEDIATRIC SYSTEM CURRENT PEDIATRIC SYSTEM MODELMODEL

DISEASE TRENDSDISEASE TRENDS

Source: WHO 2010

Communicable diseases

Non-Communicable diseases

Accident, poisoning & other injuries

• Possibility of

disease outbreak

during the process

of differential

diagnosis or

treatment: measles

• Possibility of

new disease

outbreak: MERS

CoV

DISEASE TRENDS DISEASE TRENDS (CONT.)(CONT.)

ENVIRONMENTAL EFFECTS ON ENVIRONMENTAL EFFECTS ON CHILDREN’S HEALTHCHILDREN’S HEALTH

Air pollutionWater pollutionFood safetySmoke Unknown factors Other factors Industrial pollutionWeather and climateWaste managementArthritis and respiratory diseases Environment safetySchool

INFLUENCING FACTORS TO INFLUENCING FACTORS TO THE THE PEDIATRICPEDIATRIC CARE SYSTEM CARE SYSTEM

Administration from Vietnamese government

and the Ministry of Health

Administration from Vietnamese government

and the Ministry of Health

PEDIATRIC FIELD PEDIATRIC FIELD PEDIATRIC FIELD PEDIATRIC FIELD

Human resources: - Doctors - Nurses…

Human resources: - Doctors - Nurses…

-Available training program for staff-- Research

-Available training program for staff-- Research

- Social insurance-Medical budget allotted from the government

- Social insurance-Medical budget allotted from the government

People’s knowledge and awareness of medical

prevention and treatment for children

People’s knowledge and awareness of medical

prevention and treatment for children

- Medical equipments- Medications and other pharmacological products

- Medical equipments- Medications and other pharmacological products

Support from charity and humanity organizations. Support from charity and humanity organizations.

Hospital’s infrastructureHospital’s infrastructure

HOSPITALS WITH EXCEEDING HOSPITALS WITH EXCEEDING CAPACITYCAPACITY

A congested pediatric systemA congested pediatric system

National level:

-Filled to capacity, not enough staff

-Shortage of hospital beds (requires 110-130%)

-Great pressure on physicians, nurses and other staff

-Challenge in staff management and overall operation

National level:

-Filled to capacity, not enough staff

-Shortage of hospital beds (requires 110-130%)

-Great pressure on physicians, nurses and other staff

-Challenge in staff management and overall operation

Local level :

-Preference in transferring complicated cases to national levels

-Limitation in specialty training results in distrust and noncompliance in care

-Outdated infrastructure and medical supplies

-Abandonment of advanced medical equipments

-Low wage fails to motivate medical staffs at work

Local level :

-Preference in transferring complicated cases to national levels

-Limitation in specialty training results in distrust and noncompliance in care

-Outdated infrastructure and medical supplies

-Abandonment of advanced medical equipments

-Low wage fails to motivate medical staffs at work

Private care:

-Private hospitals: target people with higher income

-Private clinics: quality of care and patient safety are not yet regulated by any authority

Private care:

-Private hospitals: target people with higher income

-Private clinics: quality of care and patient safety are not yet regulated by any authority

SUMMARY OF THE CURRENT SUMMARY OF THE CURRENT STATE OF VIETNAMESE HEALTH STATE OF VIETNAMESE HEALTH

CARE SYSTEM CARE SYSTEM

Sparse network of pediatric care is unable to fully support local health providers or provide

adequate care for children nationwide

Overloading and Uneven distribution of resources between lower levels and regions

(geographic and/or socio-economic)

Infrastructure update fails to match up with the socio-economic development

Missing latest evaluation and statistics on child health’s need

Healthcare policies, systematical management, and investment still face many challenges

Ineffective campaign for communication and public health.

Modest wage and employment benefit package for workers in public hospitals

Lack of strategies and policies to retain highly skilled employees

Under pressure from the community because of many limitations in the field

DEVELOPMENTAL ORIENTATION

Effectiveness

Equity

Quality

Community oriented

Development

DIAGRAM FOR QUALITY IMPROVEMENT

Improvement scale for Vietnamese hospital quality

Long-termed goals

AcceptableStandard

Warning!Need to concentrate resources to improve

hospital quality(Prioritization)

Level 1: -No attempt to improve quality-Regulation violation

Level 2: -Follow quality assurance guideline-Implement some activities to improve quality-Deliver some input factors

Level 3: -Sufficient performing regulations-Establish and complete structure organization-Activities deployment

Level 4: -Strictly abide to rules and regulations-Output assessment- Achieve some positive results

Level 5: -Excellent outcome-“Gold en” quality -Reach international standard

SOLUTIONS???SOLUTIONS???

SUGGESTED FRAMEWORK SUGGESTED FRAMEWORK BY WHOBY WHO

PEDIATRIC STAFF TRAININGPEDIATRIC STAFF TRAINING

Pediatric Branch provide training for pediatric system

Providing adequate pediatric health workers supply for pediatric hospitals

according to population size, geographical and economic features

(pediatrician/doctor: 30%, nurse/doctor: 2)

Training programs:

– Formal training programs: First-degree and second-degree specialist program, resident doctors training, and post-graduates training program.

– Continuous training: specialty training program, module training session, and technology transfer training program,

– Training program via workshop, seminar, conference

– Cooperative training programs with other medical centers and universities national and international

EXPANDING PEDIATRIC CARE NET WORK

Narrowing the disparity in health among regions

Broadening pediatric health network in remote areas and for minority groups....

Appointing doctors to work in underserved areas

Targeted ratio of 1 doctor per 1000 children for primary care

Reducing mortality rate in children under 5 years old

Reproductive care program and obstetric hospitals

Pediatric emergency, safety in patient transferring

Enhancing and improving neonatal and pediatric departments at provincial and district levels

Redeveloping/accelerating the development of community pediatric program

IMCI, GOBIFFF, APLS, Newborn care, nutrion...

TECHNOLOGICAL TECHNOLOGICAL APPLICATION TO PEDIATRIC APPLICATION TO PEDIATRIC

CARECARE

Efficient medical practice

Effective hospital management

Enhancing professional knowledge

High-tech diagnostic and treatment equipments

M-Health, telemedicine

CONCLUSIONCONCLUSION

Current state: DIFFICULT

Challenges: IMMENSE

Demand: numerous, high, expandable, affordable

SUGGESTIONS FOR URGENT ACTION SUGGESTIONS FOR URGENT ACTION

Reopening pediatric specialist training program, opening pediatric nursing program: Pediatric Association, universities/colleges…

Ensuring consistency for all training programs (CME) within different organizations, national hospitals as well as medical school

Bring back pediatric care programs for the communities with the collaboration from all hospitals

Formalize all clinical guidelines and other medical training materials for all organizations, hospitals (including private entities), schools, etc.

An excellent system requires: connection, two-way communication

Private Health

care

Public Health

careNational security