Viet Nam has made notable progress in reducing poverty and improving the health status of its citizens. Despite this, significant disparities in access to health services and health status continue to be observed across geographic regions and population subgroups. In 2005, the government set out an ambitious plan to improve the equity and efficiency of the health sector and the quality of health care at all levels. Several priority areas for policy development and investment were identified, leading the government and the Ministry of Health (MOH), in consultation with the Asian Development Bank (ADB), to agree on using the sector development program (SDP) as the most appropriate financing modality to achieve the envisioned reforms.
Against this backdrop, ADB approved the Health Human Resources Sector Development Program in June 2010. The program comprised of (i) a $30 million policy-based loan (PBL) to establish the required policy and regulatory frameworks for operationalizing key reforms; and (ii) a $30 million project loan and $11 million project grant to support stimulus investments to translate the reform agenda into tangible results. The program’s envisaged impact was improved health status of the population and progress toward the health-related Millennium Development Goals (MDGs). Its intended outcome was improved quality, efficiency, and equity in the health workforce and health service delivery. The program’s policy actions and project outputs intended to support (i) better planning and management of human resources, (ii) higher quality human resources training, and (iii) improved management systems in health service delivery.
To achieve output 1: the Joint Committee on Human Resources Planning and Management, which serves as a focal point for health human resources (HHR) management and development in the MOH, was created and strengthened; postgraduate trainings in human resources planning and management were provided; and the number of women holding senior positions in the MOH was increased by 20% between 2010 and 2015, against a 10% target.
Establishment and strengthening of a registration and licensing system to regulate the quality of medical examination and treatment within health facilities ─ a priority reform area under Viet Nam’s Law on Examination and Treatment, 2009 (LET) ─ constituted a significant program achievement. As of February 2017, 349,288 health practitioners across eight practitioner categories had been registered, including 100% of doctors and 100% of nurses in the public hospital system. In addition, 1,142 public hospitals had been licensed, exceeding targets.
Under output 2, an HHR training network master plan, which sets out a comprehensive approach for increasing investment in staffing, curriculum development, and equipment for health professional training institutions (HPTIs), was developed. Equipment standards for medical universities and colleges were issued, followed by the renovation of the laboratory facilities of 17 HPTIs, and the provision of laboratory and clinical skills teaching equipment to 10 HPTIs and e-learning equipment to 17 HPTIs, all in excess of targets. In parallel with equipment provision, a comprehensive training program was conducted for HPTI staff. Scholarships provided under the project ensured female students and female staff of HPTIs and health services had equitable access to training.
Guidelines for the accreditation of health professional training programs were issued, and pilot testing of standards for institutional accreditation of HPTIs. HPTIs were provided support to strengthen systems for internal quality assurance. By program completion, six priority medical universities had completed the internal and external assessment stages of the Ministry of Education and Training accreditation, meeting national university accreditation standards.
Access to HPTIs of students from ethnic minority backgrounds was enhanced through the provision of study preparation and support courses for ethnic minority students and 8,053 supplementary scholarships, for which 69% of the recipients were female.
Under output 3, the care pathways was pilot-tested as a mechanism for improving hospital service quality and a system of case-based payments in hub hospitals. The pilot testing was intended to result in a 0.15% reduction of the average length of stay specified by each pilot tested case type, which was overachieved. The project further intended that 50% of the revenue in each of the 20 pilot hospitals would be generated via a case-based payment mechanism, but this was not achieved. Translating the results of the pilot program into a reform of hospital financing mechanisms required engagement with other relevant agencies, apart from the individual hospitals, such as the Viet Nam Social Security, which proved an obstacle. Despite this, the pilot activities contributed to the MOH’s wider efforts on provider payment reform and their application to hospitals nationwide.
Substantial delivery of the planned outputs, in many cases surpassing targets, enabled the program to achieve its intended outcome, likely contributing to Viet Nam’s MDG achievements and laying the foundation for efforts to achieve the Sustainable Development Goal targets. ADB’s value addition as a provider of knowledge and innovative solutions was exemplified through the program’s work on practitioner licensing and the care pathways pilot project.
Lessons and recommendations from the program have been drawn on to inform the planned revision of the LET by the National Assembly in 2019.
The project had the MOH as executing agency. An interdepartmental program management unit, with a focal point in the Administration of Science, Technology and Training, was established by the MOH to coordinate program implementation at the central level. At the subcentral level, 17 program implementation units were established in the beneficiary universities, enabling the devolution of planning, management, and monitoring functions, including the management of civil works for facility upgrades.
