Success Factors for Women’S and Children’S Health
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Success Factors for Women’s and Children’s Health VIET NAM Ministry of Health, Viet Nam “Success factors for women’s and children’s health: Viet Nam” is a document of the Ministry of Health, Viet Nam. This report is the result of a collaboration between the Ministry of Health and multiple stakeholders in Viet Nam, supported by the Partnership for Maternal, Newborn and Child Health (PMNCH), the World Health Organization, other H4+ and health and development partners who provided input and review. Success Factors for Women’s and Children’s Health is a three-year multidisciplinary, multi-country series of studies coordinated by PMNCH, WHO, World Bank and the Alliance for Health Policy and Systems Research, working closely with Ministries of Health, academic institutions and other partners. The objective is to understand how some countries accelerated progress to reduce preventable maternal and child deaths. The Success Factors studies include: statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis (QCA); a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a.1, 2 For more details see the Success Factors for Women’s and Children’s health website: available at http://www.who.int/pmnch/successfactors/en/ WHO Library Cataloguing-in-Publication Data Success factors for women’s and children’s health: Vietnam I.World Health Organization. ISBN 978 92 4 150905 3 Subject headings are available from WHO institutional repository © World Health Organization 2015 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed in Switzerland Suggested citation: Ministry of Health Viet Nam, Partnership for Maternal, Newborn & Child Health, WHO, World Bank and Alliance for Health Policy and Systems Research. Success factors for women’s and children’s health: Viet Nam. Geneva: World Health Organisation; 2014. 2 Index 1. Executive Summary ......................................................................................................4 2. Introduction .................................................................................................................6 3. Country Context ...........................................................................................................7 4. Key Trends, Timelines and Challenges ........................................................................... 11 5. Health Sector Initiatives and Investments ....................................................................... 14 6. Initiatives and Investments Outside the Health Sector ...................................................... 20 7. Key Actors and Political Economy ................................................................................. 24 8. Governance and Leadership ......................................................................................... 24 9. Lessons Learned and Future Priorities ........................................................................... 25 10. Annex 1 .................................................................................................................... 28 11. Annex 2 .................................................................................................................... 29 12. References ................................................................................................................ 30 13. Acronyms .................................................................................................................. 33 14. Acknowledgements .....................................................................................................34 3 Success Factors for Women’s and Children’s Health 1. Executive Summary Progress: Health sector: Viet Nam has made significant progress in reducing Per capita government spending on health has infant (under 1 year), child (under 5 years), and increased almost five-fold since 1995, and Viet Nam maternal mortality and is on track to achieve has also expanded the network of health care Millennium Development Goal (MDG) 4 to reduce facilities and workers. The overarching reproductive child mortality and MDG 5a to reduce maternal health strategy has been a key mechanism for mortality. Viet Nam has reduced under 5 mortality prioritizing essential maternal health interventions by 60%, from 58/1000 to 23.2/1000 live births including family planning services, tetanus vaccination between 1990 and 2012. Viet Nam has reduced of pregnant women and children, skilled birth maternal mortality by 70%, from 233/100 000 to attendance, emergency obstetric and newborn care 69/100 000 live births from 1990 to 2009 and services. The increased coverage of the Expanded has made good progress towards achieving 5b Programme on Immunization, child survival and (universal access to reproductive health) although nutrition interventions contributed to the reduction meeting unmet need for family planning especially in child mortality. Universal coverage is a stated among unmarried young people remains a objective of Viet Nam’s health systems and challenge. Several health sector, multisector and investment policies, and both legal and financial cross-cutting strategies have played a key role in provisions are in place. These include social health driving this progress. insurance, which specifically targets the poorest and most vulnerable. 4 VIET NAM Multisector: Challenges: Viet Nam has made significant progress in Despite the progress in improving health outcomes increasing access to improved drinking-water and in all groups, inequity between groups is increasing sanitation; changes have been helped by key due to geographical, ethnic and financial barriers. government policies and programmes targeted at Despite the poorest being covered by social health marginalized, poor and ethnic minority households. insurance, co-payments and other costs result in Laws on universal education have supported high out-of-pocket expenditure disadvantaging the improvements in school enrolment and literacy poor and near poor. Addressing the equity gap is a rates, while the implementation of several nutrition challenge that Viet Nam needs to address to ensure programmes and policies have created a positive further progress towards the MDGs. Viet Nam is enabling environment for significant reductions in now classified as a lower-middle-income country underweight and stunting, severe malnutrition and and is facing reduced support from international micronutrients deficiencies. Economic development donors. Government commitment to adequate has markedly advanced. financing of health, particularly maternal, newborn and child health will be crucial to maintain the Cross-cutting: considerable gains to date. Other areas of priority Viet Nam has focused on and made considerable include improving the quality and coverage of progress in poverty alleviation, reducing poverty maternal, neonatal (first month of life), and child levels from 58% in 1993 to 14.5% in 2008. care interventions; reducing the prevalence of Through good governance and leadership, the Doi stunting; focusing on improved health care and Moi reforms allowed a managed devolution and access for disadvantaged groups such as ethnic decentralization that stimulated production and minorities; and improving youth awareness, attitudes growth in farmers and firms. The devolution also and behaviour about reproductive health issues, impacted provincial and lower levels of government, particularly in marginalized groups, and rural and administration and service delivery, the media, and mountainous areas where access to information and civil society - promoting capacity and progress. services is still limited. Gender equality in education was strongly advanced. Viet Nam is also in the phase of demographic bonus when the number of children