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!