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Health Systems Assessment

Assessing Provincial Health Systems: Lessons from Two Provinces in Vietnam

Health Systems 20/20, in collaboration with the ministry of health (MOH) and the Vietnamese Health Strategy and Policy Institute (HSPI), conducted two provincial health system assessments in Nanh Binh and Can Tho provinces in 2008. HSPI, with technical assistance from Health Systems 20/20, adapted and applied the health systems assessment (HSA) tool for use at the provincial level to evaluate the six core health systems building blocks (governance, financing, human resources, service delivery, pharmaceutical management, and health information systems (HIS). Data were collected for pre-determined indicators within each of the major six functions and results were aggregated to identify major health systems strengths and weaknesses.

The assessment activity in Ninh Binh and Can Tho provinces produced substantial results which serve to shape clear points of intervention to strengthen Vietnamese health systems. The activity successfully piloted the application of the HSA tool at the provincial level, provided empirical evidence to policymakers at the provincial and national levels of the strengths and weaknesses of the provincial health care system, and provided targeted recommendations to local and national partners on specific areas for improvement.

In particular, the HSA in Can Tho and Ninh Binh revealed stark weaknesses in Vietnam’s HIS capabilities. It was observed that data use and collection was not adequately supported, there was a major lack of data use at the facility level and overall, there was a general lack of awareness of how to use data gathered. The HSA provided key input and recommendations for the ministry of health in this particularly weak area.

Additionally, Health Systems 20/20 was able to adapt the health systems assessment tool to meet the needs of the government to conduct an assessment at the provincial level. Health Systems 20/20 worked with local partners at HSPI to add additional indicators to the core module to increase the applicability of the tool for a provincial assessment. To build capacity and sustainability at the provincial and national levels, local partners at HSPI were trained and supervised to lead and conduct the assessments.

Following the successful assessments in Ninh Binh and Can Tho provinces, USAID/Vietnam has decided to fund health assessments with Health Systems 20/20 in six additional provinces (Hanoi, Hai Phong, HCMC, An Giang, Nghe An, and Quang Ninh) and the MOH has indicated commitment to scaling up the activity nationally. These commitments indicate the mission and government’s extensive institutional investment, scale-up, and national ownership of the activity. As a result, the ability to carry out future health systems assessments will be sustainable at the country level.

The final report of the health systems assessment in Vietnam with detailed findings for each core module of the assessment will be available soon.