MEDICAL SITUATION MEDICAL SITUATION IN VIETNAM IN VIETNAM NGO QUY CHAU NGO QUY CHAU MD, Ph.D, Assoc.Prof MD, Ph.D, Assoc.Prof Deputy Director Bach Mai Hospital Deputy Director Bach Mai Hospital Hanoi - Vietnam Hanoi - Vietnam
Mar 27, 2015
MEDICAL SITUATIONMEDICAL SITUATION
IN VIETNAMIN VIETNAM
NGO QUY CHAUNGO QUY CHAUMD, Ph.D, Assoc.ProfMD, Ph.D, Assoc.Prof
Deputy Director Bach Mai HospitalDeputy Director Bach Mai HospitalHanoi - VietnamHanoi - Vietnam
Red river delta regionRed river delta region
North east regionNorth east region
North west regionNorth west region
North central coast regionNorth central coast region
South central coast regionSouth central coast region
Central highlands regionCentral highlands region
North east south regionNorth east south region
Mekong river delta regionMekong river delta region
VietnamVietnam
Population, social and Population, social and economic environment indicator economic environment indicator
NoNo IndicatorIndicator 20062006
11 Population (‘000)Population (‘000)
In which: Female (‘000)In which: Female (‘000)
Female rateFemale rate
Urban Pop. (‘000)Urban Pop. (‘000)
% of urban population% of urban population
84 155,884 155,8
42 801.1 42 801.1
50.8% 50.8%
22 823.6 22 823.6
27.1227.12
22 Population density (pers./km2)Population density (pers./km2) 254254
33 Population grow ratePopulation grow rate 1.261.26
44 GDP (Billion VND)GDP (Billion VND) 973 790973 790
55 Total state budget for health (Billion VND)Total state budget for health (Billion VND) 24 694.224 694.2
66 % Health budget in GDP% Health budget in GDP 2.542.54
77 % Health budget in State budget expenditure% Health budget in State budget expenditure 8.398.39
88 Health budget per capita (1000 VND)Health budget per capita (1000 VND) 293.4293.4
Source: Health statistics yearbook 2006 – Ministry of Health
Medical problem before 1990Medical problem before 1990
Medical system has downgradedMedical system has downgraded
Material reduceMaterial reduce
Health expenditure was limitedHealth expenditure was limited
Few number of medical station in rural area, absence Few number of medical station in rural area, absence
medical station in some commune.medical station in some commune.
Health worker distribute unequalHealth worker distribute unequal
e.g. Central highland region: 2.7 Health worker/ communee.g. Central highland region: 2.7 Health worker/ commune
Red river delta region: 5 Health worker/ communeRed river delta region: 5 Health worker/ commune
Knowledge of health worker in rural area was low.Knowledge of health worker in rural area was low.
Policy in favor for health worker was unconsidered.Policy in favor for health worker was unconsidered.
Ratio of bed in use: 30 – 40% Ratio of bed in use: 30 – 40%
ConsequencesConsequences
Diseases (malaria cause 300 person died in 1991-1992)Diseases (malaria cause 300 person died in 1991-1992)
Patient seem to belittle medical system in local and Patient seem to belittle medical system in local and
concentrate in citiesconcentrate in cities
Health worker only interested in working in provinces and Health worker only interested in working in provinces and
citiescities
The quality of primary care was restricted The quality of primary care was restricted
Government policy to improve Government policy to improve rural medical systemrural medical system
Medical insurance policy (1992)Medical insurance policy (1992)
Hospital fees (1989)Hospital fees (1989)
Ordinance to practice private medicine and pharmacy (1993)Ordinance to practice private medicine and pharmacy (1993)
National ordinance about pharmacyNational ordinance about pharmacy
Decision to improve medicine in rural area (1994)Decision to improve medicine in rural area (1994)
Use State budget to support health worker in rural areaUse State budget to support health worker in rural area
Improvement medical infrastructure and medical equipment, Improvement medical infrastructure and medical equipment,
especially in rural areaespecially in rural area
Increase budget for healthIncrease budget for health
Infrastructure in a medical stationInfrastructure in a medical station
Health achievementHealth achievement
Medical system in rural area are improve both quantity and Medical system in rural area are improve both quantity and
qualityquality
The whole country has: 10748 commune health centerThe whole country has: 10748 commune health center
All commune has health center All commune has health center
Health workerHealth worker is increasing in number and quality is increasing in number and quality
Medical equipment is innovativeMedical equipment is innovative
Primary care is improvingPrimary care is improving
State health budget by yearsState health budget by years
NoNo IndicatorIndicator 20052005 20062006
Health expenditureHealth expenditure 18 671.1318 671.13 24 649.1824 649.18
11 Development investmentDevelopment investment 3 456.753 456.75 5 063.005 063.00
22 Treatment & Preventive Treatment & Preventive 14 781.6814 781.68 19 100.3619 100.36
33 Scientific researchScientific research 47.6147.61 60.5460.54
44 TrainingTraining 295.32295.32 336.57336.57
55 ManagementManagement 83.7083.70 121.89121.89
66 OthersOthers 6.076.07 11.8211.82
Source: Health statistics yearbook 2006 – Ministry of Health
Unit: billion VND
5.9
9.612.7
13.416.5
21.1
43.9
0
10
20
30
40
50
1994 1996 1998 2000 2002 2004 2006
Percentage of health insurance participation of population are increasing. (%)Percentage of health insurance participation of population are increasing. (%)
Source: Health statistics yearbook 2006 – Ministry of Health
0
5
10
15
20
25
30
35
1986 1990 1993 1994 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Total
Government beds
Beds in health facilities by years 1986 – 2006Beds in health facilities by years 1986 – 2006(No. of beds per 10000 inhabitants)(No. of beds per 10000 inhabitants)
Source: Health statistics yearbook 2006 – Ministry of Health
234,354
241,498244,987
259,583
271,149
200000
220000
240000
260000
280000
2002 2003 2004 2005 2006
Health personnel by yearsHealth personnel by years
0
2
4
6
8
10
12
14
1999 2000 2001 2002 2003 2004 2005 2006
USD
Drug expenditure per capitaDrug expenditure per capita
Source: Health statistics yearbook 2006 – Ministry of Health
State health budget by category 2006State health budget by category 2006
77.35%
20.50%
0.49%
0.05%1.36%
0.25%
1. Development
2. Treatment andPreventive
3. Scientific research
4. Training
5. Management
6. Others
Source: Health statistics yearbook 2006 – Ministry of Health
Health facilities & beds by level 2006Health facilities & beds by level 2006
NoNo IndicatorIndicator FacilitiesFacilities BedsBeds
Total (government section)Total (government section) 133433133433 197684197684
11 Central levelCentral level 3737 1382013820
22 Local levelLocal levelIn which: Provincial levelIn which: Provincial level
District levelDistrict level
Communal levelCommunal level
1258512585
394394
14431443
1074810748
1773991773997486474864
5652256522
4601346013
33 Other branchesOther branches 811811 64656465
Source: Health statistics yearbook 2006 – Ministry of Health
Health personnel by provincial, district, communal levelHealth personnel by provincial, district, communal level
Source: Health statistics yearbook 2006 – Ministry of Health
NoNo Categories Categories TotalTotal Commune Commune levellevel
District District levellevel
Provincial Provincial levellevel
Phar. Bussiness Phar. Bussiness & Production& Production
TotalTotal 221.365221.365 51.15851.158 67.34367.343 83.69383.693 19.17119.171
11 Medical PhDs and higherMedical PhDs and higher 148148 00 00 148148 00
22 Medical master sciencesMedical master sciences 1.9911.991 00 251251 1.7401.740 00
33 Pharm. PhDsPharm. PhDs 66 00 00 22 44
44 Pharm. Master sciencesPharm. Master sciences 8282 00 77 6666 99
55 Medical doctorMedical doctor 38.48038.480 6.5746.574 14.04914.049 17.63017.630 227227
66 PharmacistsPharmacists 4.2094.209 22 538538 1.2941.294 2.3752.375
77 High degree nursesHigh degree nurses 544544 00 8484 460460 00
88 High degree medical techniciansHigh degree medical technicians 665665 11 178178 486486 00
99 Uni. Degree midwivesUni. Degree midwives 218218 1111 6464 143143 00
1010 Assistant doctorsAssistant doctors 46.86446.864 24.50724.507 15.01215.012 7.3457.345 00
1111 22ndnd degree medical technicians degree medical technicians 7.1777.177 169169 2.7172.717 4.2914.291 00
1212 Assistant pharmacistsAssistant pharmacists 9.6529.652 719719 2.8922.892 2.8262.826 3.2153.215
1313 22ndnd degree pharm. Technicians degree pharm. Technicians 796796 77 139139 172172 478478
1414 22ndnd degree nurse degree nurse 36.25736.257 4.9964.996 11.37211.372 19.87419.874 1515
1515 22ndnd degree midwives degree midwives 16.12416.124 6.8666.866 5.4465.446 3.8123.812 00
1616 Elementary nursesElementary nurses 10.06410.064 4.5414.541 3.0433.043 2.4692.469 1111
1717 Elementary midwivesElementary midwives 2.0252.025 1.4701.470 402402 153153 00
1818 Element med. TechnicianElement med. Technician 702702 3535 330330 336336 11
1919 Traditional medicine practitionersTraditional medicine practitioners 184184 4545 6464 7575 00
2020 Elementary pharmacistsElementary pharmacists 7.4327.432 872872 921921 964964 4.6754.675
2121 Other bachelor degreesOther bachelor degrees 5.5915.591 00 1.0061.006 3.3483.348 1.2371.237
2222 Other 2Other 2ndnd degree level degree level 7.1817.181 2222 2.4182.418 3.4203.420 1.3211.321
2323 Others Others 24.97324.973 321321 6.4106.410 12.63912.639 5.6035.603
Health situation at communal level 2006Health situation at communal level 2006
NoNo RegionRegion No. of No. of CHC have CHC have M. doctorM. doctor
% CHC % CHC have M. have M. doctordoctor
No. CHC No. CHC have have
midwives, midwives, assiss…assiss…
% CHC % CHC reach reach
benchmbenchmarkark
No. of No. of comm comm have have CHCCHC
TotalTotal 7.0817.081 10.19110.191 10.68310.683
11 Red river delta regionRed river delta region 1.7811.781 79,279,2 2.1432.143 56,356,3 2.2392.239
22 North east regionNorth east region 1.2111.211 58,158,1 1.9371.937 35,235,2 2.0782.078
33 North west regionNorth west region 145145 23,723,7 474474 3,13,1 580580
44 North central coast regionNorth central coast region 1.0871.087 59,959,9 1.7291.729 40,040,0 1.8031.803
55 South central coast regionSouth central coast region 456456 53,253,2 822822 19,719,7 844844
66 Central highlands regionCentral highlands region 359359 52,652,6 615615 18,318,3 645645
77 North east south regionNorth east south region 840840 83,583,5 981981 49,149,1 993993
88 Mekong river delta regionMekong river delta region 1.2021.202 78,078,0 1.4901.490 43,343,3 1.5011.501
Source: Health statistics yearbook 2006 – Ministry of Health
CHC: Commune Health Center
Pharmaceutical production and tradingPharmaceutical production and tradingNoNo CategoryCategory 20052005 20062006 Grow rate (%)Grow rate (%)
11 Drug supply systemDrug supply system
Trading companyTrading company 680680 800800 17,617,6
Direct drug import and export companyDirect drug import and export company 7979 8989 12,712,7
Foreign drug supplierForeign drug supplier 270270 320320 18,518,5
Drug retailerDrug retailer 37.50037.500 41.50041.500 10,710,7
22 Drug production systemDrug production system
Drug production companyDrug production company 174174 178178 2,32,3
Drug visa numberDrug visa number 12.34912.349 14.09714.097 14,214,2
33 To stabilize drug pricesTo stabilize drug prices
Consumption price index (%)Consumption price index (%) 8,88,8 6,66,6 -21,4-21,4
Pharmaceutical medical price index (%)Pharmaceutical medical price index (%) 4,94,9 4,34,3 -12,2-12,2
Source: Health statistics yearbook 2006 – Ministry of Health
Equipment up to 31/12/2006Equipment up to 31/12/2006
NoNo RegionRegion MRIMRI CT. CT. ScannerScanner
X-RAYX-RAY Doppler Doppler Ultrasonic Ultrasonic
systemsystem
Endoscopy Endoscopy AmbulanceAmbulance
TotalTotal 55 6161 1.3351.335 1.4211.421 337337 1.1691.169
11 Red river delta regionRed river delta region 11 1111 256256 306306 6969 238238
22 North east regionNorth east region 11 1010 183183 204204 5353 201201
33 North west regionNorth west region 00 11 2828 3333 55 2929
44 North central coast regionNorth central coast region 11 44 139139 130130 88 119119
55 South central coast regionSouth central coast region 00 22 3939 4242 11 4040
66 Central highlands regionCentral highlands region 00 22 6868 7373 77 8080
77 North east south regionNorth east south region 11 2020 333333 322322 138138 232232
88 Mekong river delta regionMekong river delta region 11 1111 289289 311311 5656 230230
Note: Including equipment of government health facilities belong management locals.Source: Health statistics yearbook 2006 – Ministry of Health
Health proposal for considerationHealth proposal for consideration
Central hospitals are overloaded cause patients still do Central hospitals are overloaded cause patients still do
not have confidence in local medical system. not have confidence in local medical system.
Improve primary care, quality and convenient of rural Improve primary care, quality and convenient of rural
medical system.medical system.
Renew content and programme educationRenew content and programme education
Encourage investment in traditional medicineEncourage investment in traditional medicine
Upgrade medical infrastructure and equipmentsUpgrade medical infrastructure and equipments
Traditional medicineTraditional medicine
Healthcare Informatics in VietnamHealthcare Informatics in Vietnam
Ministry of Health started to develop LAN and WAN Ministry of Health started to develop LAN and WAN
networks in hospital and schools of medicinenetworks in hospital and schools of medicine
Currently deploying successful applications and software Currently deploying successful applications and software
packages in hospital and medicine schoolspackages in hospital and medicine schools
Some leading research projects, such as Teleradiology, Some leading research projects, such as Teleradiology,
have recently been carried out by the Institute of have recently been carried out by the Institute of
Information Technology and the National Center for Information Technology and the National Center for
Natural Science and TechnologyNatural Science and Technology
Growing collaboration between Vietnamese researchers Growing collaboration between Vietnamese researchers
and international scientists, engineers and practitionersand international scientists, engineers and practitioners
Telemedicine recently use in Vietnam Telemedicine recently use in Vietnam
Only have in few Central Hospital Only have in few Central Hospital
Remote medicine is not yet common technical in Remote medicine is not yet common technical in
VietnamVietnam
Video Conference System is use to exchange medical Video Conference System is use to exchange medical
information, experience and to hold a consultation information, experience and to hold a consultation
Mostly between Central hospitals or with foreign Mostly between Central hospitals or with foreign
hospitalshospitals
Healthcare Informatics in VietnamHealthcare Informatics in Vietnam
Lack of equipmentsLack of equipments
Network infrastructure is not adequate to the demandNetwork infrastructure is not adequate to the demand
Lack of technical staff in manage and use equipmentsLack of technical staff in manage and use equipments
Investment in remote medicine is still unappreciatedInvestment 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
Healthcare Informatics in VietnamHealthcare Informatics in Vietnam
Video communication device IPELA - SONY with high video and
high speed network connection. This is a multi point
videoconferencing device with H.323 protocol.
BMH telemedicine equipmentsBMH telemedicine equipments
VIDAR Digitizer machine, using this
device we can scan X ray and CT
scanner film with high quality images.
BMH telemedicine equipmentsBMH telemedicine equipments
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.
COOLSCOPE- NIKON
BMH telemedicine equipmentsBMH telemedicine equipments
VPN ROUTER
DATASOLUTION BOXBeside 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.
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.
Thank you for your attention!Thank you for your attention!