MEDICAL SITUATION IN VIETNAM

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MEDICAL SITUATIONIN VIETNAM

• NGO QUY CHAU
• MD, Ph.D, Assoc.Prof
• Deputy Director Bach Mai Hospital
• Hanoi - Vietnam

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Vietnam

• Red river delta region
• North east region
• North west region
• North central coast region
• South central coast region
• Central highlands region
• North east south region
• Mekong river delta region

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Population, social and economic environment
indicator
No Indicator 2006
1 Population (000) In which Female (000) Female rate Urban Pop. (000) of urban population 84 155,8 42 801.1 50.8 22 823.6 27.12
2 Population density (pers./km2) 254
3 Population grow rate 1.26
4 GDP (Billion VND) 973 790
5 Total state budget for health (Billion VND) 24 694.2
6 Health budget in GDP 2.54
7 Health budget in State budget expenditure 8.39
8 Health budget per capita (1000 VND) 293.4
Source Health statistics yearbook 2006
Ministry of Health
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Medical problem before 1990

• Medical system has downgraded
• Material reduce
• Health expenditure was limited
• Few number of medical station in rural area,
  absence medical station in some commune.
• Health worker distribute unequal
• e.g. Central highland region 2.7 Health
  worker/ commune
• Red river delta region 5 Health worker/
  commune
• Knowledge of health worker in rural area was low.
• Policy in favor for health worker was
  unconsidered.
• Ratio of bed in use 30 40

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Consequences

• Diseases (malaria cause 300 person died in
  1991-1992)
• Patient seem to belittle medical system in local
  and concentrate in cities
• Health worker only interested in working in
  provinces and cities
• The quality of primary care was restricted

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Government policy to improve rural medical system

• Medical insurance policy (1992)
• Hospital fees (1989)
• Ordinance to practice private medicine and
  pharmacy (1993)
• National ordinance about pharmacy
• Decision to improve medicine in rural area (1994)
• Use State budget to support health worker in
  rural area
• Improvement medical infrastructure and medical
  equipment, especially in rural area
• Increase budget for health

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• Infrastructure in a medical station

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Health achievement

• Medical system in rural area are improve both
  quantity and quality
• The whole country has 10748 commune health
  center
• All commune has health center
• Health worker is increasing in number and quality
  
• Medical equipment is innovative
• Primary care is improving

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State health budget by years
Unit billion VND
No Indicator 2005 2006
Health expenditure 18 671.13 24 649.18
1 Development investment 3 456.75 5 063.00
2 Treatment Preventive 14 781.68 19 100.36
3 Scientific research 47.61 60.54
4 Training 295.32 336.57
5 Management 83.70 121.89
6 Others 6.07 11.82
Source Health statistics yearbook 2006
Ministry of Health
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• Percentage of health insurance participation
  of population are increasing. ()

Source Health statistics yearbook 2006
Ministry of Health
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• Beds in health facilities by years 1986 2006
• (No. of beds per 10000 inhabitants)

Source Health statistics yearbook 2006
Ministry of Health
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• Health personnel by years

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• Drug expenditure per capita

Source Health statistics yearbook 2006
Ministry of Health
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State health budget by category 2006
Source Health statistics yearbook 2006
Ministry of Health
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• Health facilities beds by level 2006

No Indicator Facilities Beds
Total (government section) 133433 197684
1 Central level 37 13820
2 Local level In which Provincial level District level Communal level 12585 394 1443 10748 177399 74864 56522 46013
3 Other branches 811 6465
Source Health statistics yearbook 2006
Ministry of Health
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• Health personnel by provincial, district,
  communal level

No Categories Total Commune level District level Provincial level Phar. Bussiness Production
Total 221.365 51.158 67.343 83.693 19.171
1 Medical PhDs and higher 148 0 0 148 0
2 Medical master sciences 1.991 0 251 1.740 0
3 Pharm. PhDs 6 0 0 2 4
4 Pharm. Master sciences 82 0 7 66 9
5 Medical doctor 38.480 6.574 14.049 17.630 227
6 Pharmacists 4.209 2 538 1.294 2.375
7 High degree nurses 544 0 84 460 0
8 High degree medical technicians 665 1 178 486 0
9 Uni. Degree midwives 218 11 64 143 0
10 Assistant doctors 46.864 24.507 15.012 7.345 0
11 2nd degree medical technicians 7.177 169 2.717 4.291 0
12 Assistant pharmacists 9.652 719 2.892 2.826 3.215
13 2nd degree pharm. Technicians 796 7 139 172 478
14 2nd degree nurse 36.257 4.996 11.372 19.874 15
15 2nd degree midwives 16.124 6.866 5.446 3.812 0
16 Elementary nurses 10.064 4.541 3.043 2.469 11
17 Elementary midwives 2.025 1.470 402 153 0
18 Element med. Technician 702 35 330 336 1
19 Traditional medicine practitioners 184 45 64 75 0
20 Elementary pharmacists 7.432 872 921 964 4.675
21 Other bachelor degrees 5.591 0 1.006 3.348 1.237
22 Other 2nd degree level 7.181 22 2.418 3.420 1.321
23 Others 24.973 321 6.410 12.639 5.603
Source Health statistics yearbook 2006
Ministry of Health
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• Health situation at communal level 2006

CHC Commune Health Center
No Region No. of CHC have M. doctor CHC have M. doctor No. CHC have midwives, assiss CHC reach benchmark No. of comm have CHC
Total 7.081 10.191 10.683
1 Red river delta region 1.781 79,2 2.143 56,3 2.239
2 North east region 1.211 58,1 1.937 35,2 2.078
3 North west region 145 23,7 474 3,1 580
4 North central coast region 1.087 59,9 1.729 40,0 1.803
5 South central coast region 456 53,2 822 19,7 844
6 Central highlands region 359 52,6 615 18,3 645
7 North east south region 840 83,5 981 49,1 993
8 Mekong river delta region 1.202 78,0 1.490 43,3 1.501
Source Health statistics yearbook 2006
Ministry of Health
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• Pharmaceutical production and trading

No Category 2005 2006 Grow rate ()
1 Drug supply system Drug supply system Drug supply system Drug supply system
Trading company 680 800 17,6
Direct drug import and export company 79 89 12,7
Foreign drug supplier 270 320 18,5
Drug retailer 37.500 41.500 10,7
2 Drug production system Drug production system Drug production system Drug production system
Drug production company 174 178 2,3
Drug visa number 12.349 14.097 14,2
3 To stabilize drug prices To stabilize drug prices To stabilize drug prices To stabilize drug prices
Consumption price index () 8,8 6,6 -21,4
Pharmaceutical medical price index () 4,9 4,3 -12,2
Source Health statistics yearbook 2006
Ministry of Health
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• Equipment up to 31/12/2006

No Region MRI CT. Scanner X-RAY Doppler Ultrasonic system Endoscopy Ambulance
Total 5 61 1.335 1.421 337 1.169
1 Red river delta region 1 11 256 306 69 238
2 North east region 1 10 183 204 53 201
3 North west region 0 1 28 33 5 29
4 North central coast region 1 4 139 130 8 119
5 South central coast region 0 2 39 42 1 40
6 Central highlands region 0 2 68 73 7 80
7 North east south region 1 20 333 322 138 232
8 Mekong river delta region 1 11 289 311 56 230
Note Including equipment of government health
facilities belong management locals. Source
Health statistics yearbook 2006 Ministry of
Health
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Health proposal for consideration

• Central hospitals are overloaded cause patients
  still do not have confidence in local medical
  system.
• Improve primary care, quality and convenient of
  rural medical system.
• Renew content and programme education
• Encourage investment in traditional medicine
• Upgrade medical infrastructure and equipments

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• Traditional medicine

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Healthcare Informatics in Vietnam

• Ministry of Health started to develop LAN and WAN
  networks in hospital and schools of medicine
• Currently deploying successful applications and
  software packages in hospital and medicine
  schools
• Some leading research projects, such as
  Teleradiology, have recently been carried out by
  the Institute of Information Technology and the
  National Center for Natural Science and
  Technology
• Growing collaboration between Vietnamese
  researchers and international scientists,
  engineers and practitioners

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Healthcare Informatics in Vietnam

• Telemedicine recently use in Vietnam
• Only have in few Central Hospital
• Remote medicine is not yet common technical in
  Vietnam
• Video Conference System is use to exchange
  medical information, experience and to hold a
  consultation
• Mostly between Central hospitals or with foreign
  hospitals

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Healthcare Informatics in Vietnam

• Lack of equipments
• Network infrastructure is not adequate to the
  demand
• Lack of technical staff in manage and use
  equipments
• Investment in remote medicine is still
  unappreciated
• Manager still not recognize telemedicine are very
  meaningful for training and researches in order
  to reduce expense and bring benefit to doctors
  and patients

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BMH telemedicine equipments
Video communication device IPELA - SONY with
high video and high speed network connection.
This is a multi point videoconferencing device
with H.323 protocol.
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BMH telemedicine equipments
VIDAR Digitizer machine, using this device we
can scan X ray and CT scanner film with high
quality images.
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BMH telemedicine equipments
COOLSCOPE- NIKON
Coolscope is a microscope can be connected to
the system by an IP address. It provides high
solution pathological image and transfer them
through the network.
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VPN ROUTER
DATASOLUTION BOX
Beside our system has some extra devices
switch, VPN router, transducer, projector etc.
Network line is fiber cable with 2 Mbps bandwidth
suitable the medical conference.
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By using the telemedicine system, we have
organized different international medical
conferences between BMH, International Medical
Center of Japan, Sydney university, National
Taiwan University Hospital, Medicine Pharmacy
University of HoChiMinh city.
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Thank you for your attention!