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Complementary reforms and investments in service delivery and financing result in the sustained expansion of access to health care services.

During project appraisal in 2008, Viet Nam wanted to improve health sector efficiency as it moved toward a sector approach to the delivery of public health services. Accordingly, the project represented a transition in the assistance of the Asian Development Bank (ADB) to the health sector in Viet Nam. This transition as well as Viet Nam’s shift toward an integrated sector approach would not have been possible without the success of earlier complementary reforms and investments that enabled the sustained expansion and enhancement of public health services in the country.

A sound design, developed through a consultative process, is critical to the success of a complex project.

The project preparation process involved numerous meetings and workshops with stakeholders at the national level and in all the eight participating provinces. Each province was assisted in preparing provincial health accounts, a 5-year plan, and a medium-term expenditure framework that indicated the funding requirements and resource envelope to be used in setting priorities. The comprehensive project design that emerged reflected a near-consensus among the various stakeholders and was an important factor in the project’s success.

Background

Until project appraisal in 2008, Viet Nam’s public health sector was burdened with aged, physically degraded, and poorly equipped infrastructure. Congestion in the provincial facilities was common as patients bypassed less equipped district− and commune−level facilities. Provincial health staff knowledge and skills also needed improvement.

To address the situation, the government requested the Asian Development Bank (ADB) to support the Health Care in the South Central Coast Region (SCCR) Project, for which, ADB approved a loan of $72 million in November 2008. The project aimed to improve the health status of the population in the region, with a focus on the poor, women and children, and ethnic groups. This aim was to be achieved by supporting the development of comprehensive, well-managed, and better-used provincial health systems. The project had 4 planned outputs: (i) improved health facilities, (ii) strengthened provincial human resources, (iii) improved health care access by the poor, and (iv) strengthened provincial health systems.

Under output 1: 25 health facilities were supported, 8 of which were new, and the others upgraded. These facilities included district, regional, and provincial/city hospitals; preventive and traditional medicine centers, and secondary medical schools. Wastewater treatment facilities were also upgraded and waste management equipment such as incinerators and infection control equipment were provided. Staff trainings in facility and equipment operation and maintenance and comprehensive waste management were conducted.

Under output 2: the preparation and implementation of provincial−level human resource development plans 2012–2020 and Gender Action Plan and Ethnic Minority Action Plan for 2015–2017 were assisted; a system for continuous medical education was established and strengthened through trainers’ training and the development of an inventory of master trainers in each province; and provincial health staff specialist trainings and attendance in relevant postgraduate courses were supported.

Under output 3: a comprehensive capacity building program for village health workers was implemented; a comprehensive reproductive health care and nutrition behavior change communication and education campaign for ethnic minorities was carried out; and a regionwide training on the new health insurance law and mechanisms for health insurance implementation, with a focus on ensuring access by the poor and ethnic groups, was conducted.

Under output 4: participation of health staff in hospital management higher level courses and trainings, and international study tours on health systems administration and management, and health financing were sponsored; a health management information systems (HMIS) was developed; and equipment to support HMIS operation in 20 facilities were provided.

Substantial delivery of the output targets allowed the project to achieve or exceed its intended outcome targets, encouraging greater use of the facilities by the target beneficiaries. Overall outpatients’ utilization rates of health facilities in the region, according to the Ministry of Health (MOH), increased by 44%, and for inpatients by 13%. Improved outpatient services in commune health centers led to a lower increase in hospital admission rates.

ADB’s Southeast Asia Department rated the project successful. The MOH was the executing agency. The provincial people’s committees through the departments of health were the implementing agencies.

Project Information
Project/Modality: 
Loan
Report Date: 
June 2017
Report Rating: 
Successful

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