@article{83f6cf09710e48a0a1eddf34da54db41,
title = "The pursuit of equity: a health sector case study from Vietnam",
abstract = "The health care system in Vietnam has long been cited as an example of primary health care that has worked well. The achievements of the system during the past decades have indeed been impressive, but the changing economic situation in Vietnam has consequences for all public sector activities, including health care. Liberalization of economic policies has encouraged private medical practice and free trade in medicines and drugs, while financial support for the state health system is decreasing. Equity has always been an important goal for the Vietnamese health system, but it becomes harder and harder to realize under the new conditions of financing. The restrictions in centralized planning and funding brought about by recent changes also reveal weak points in the system, from planning to training to management at the different levels. This situation is discussed and issues concerning policy, legislation and human resources are highlighted in terms of their effect on equity.",
keywords = "Equity, Financing, Health care management, Health care system, Health care training, Primary health care, Vietnam",
author = "Hien, {Nguyen Tran} and {Thu Ha}, {Le Thi} and Rifkin, {Susan B.} and Wright, {E. Pamela}",
note = "Funding Information: 3.2. Administration The central MOH has 16 different departments, which include the State Pharmaceutical Company, the eight national medical Institutes, the eight medical faculties, and a variety of operational programmes. AU of these are financed directly from a grant from the Ministry of Finance (MOF). The central administration also receives funds directly from donor agencies, particularly the UN agencies and the Swedish International Development Agency (SIDA), for national programmes, a situation which the MOF finds uncomfortable. A steering committee has been set up to manage foreign-funded progammes. At provincial and district levels, a health bureau is responsible for the administration of all public services in the area. This includes curative facilities (i.e. hospitals, polyclinics and health stations) and preventive teams, as well as training and research units. State-run units for pharmaceutical production, procurement and distribution, and technical workshops for medical equipment also belong to the health bureau{\textquoteright}s fields of concern, unless they are run as local branches of a central-level institution. Inspection of the growing number of private medical practices and pharmacies is also included among the regional health bureaus{\textquoteright} duties. Provincial and district health bureaus receive funds and are accountable to the local People{\textquoteright}s Committees, the administrative authority at that level. This is also true on the commune level, where health services have no State financing. Here, funds have, in the past, been raised by the local authority from commune members. Commune level health staff may be professionals or volunteers. One major concern of the MOH is the disappearance of the brigade nurse, who no longer enjoys collective commune support and must seek other income-providing activities. The MOH is seeking funds to support a minimum of two workers at each commune [6]. Fig. 1 illustrates the organisation and responsibility of units below the MOH level.",
year = "1995",
month = sep,
doi = "10.1016/0168-8510(94)00706-K",
language = "English (US)",
volume = "33",
pages = "191--204",
journal = "Health policy",
issn = "0168-8510",
publisher = "Elsevier Ireland Ltd",
number = "3",
}