Health in Vietnam

A health care specialist from the U.S. Army examines a patient in Bắc Ninh Province.

Life expectancy has risen by two years for males and females in Vietnam between 2000 and 2012.[1] This is half of the average rise in life expectancy for other parts of the world during the same time period.[1]

Malnutrition is still common in the provinces, and the life expectancy and infant mortality rates are stagnating. In 2001 government spending on health care corresponded to just 0.9 percent of gross domestic product (GDP). Government subsidies covered only about 20 percent of health care expenses, with the remaining 80 percent coming out of individuals’ own pockets.[2]

In 2012, almost 22% of deaths could be attributed to strokes. This leading cause of death was followed by heart disease with 7% of deaths, and Chronic obstructive pulmonary disease with 4.9% of deaths.[1] The two largest risk factors for adults are tobacco use and raised blood pressure.[1]

Contraception is widely used and most births are attended to by trained healthcare providers. Only about 60% of women receive antenatal care during their pregnancies.[1]

Healthcare system

Vietnam is currently striving towards a universal health care system. At the end of 2014, 71.6% of the population had health insurance. Currently, the government subsidizes 80% of hospital fees for the poor and near-poor, as well as 100% for poor people and ethnic minorities living in disadvantaged areas, and 30% for farmers and fishermen who have average living conditions.[3]

Issues

Beginning in the late 1980s, the quality of health care began to decline as a result of budgetary constraints, a shift of responsibility to the provinces, and the introduction of charges. Inadequate funding has led to delays in planned upgrades to water supply and sewage systems. As a result, almost half the population has no access to clean water, a deficiency that promotes such infectious diseases as malaria, dengue fever, typhoid, and cholera. Inadequate funding also has contributed to a shortage of nurses, midwives, and hospital beds. In 2000 Vietnam had only 250,000 hospital beds, or 14.8 beds per 10,000 people, a very low ratio among Asian nations, according to the World Bank.[2] Government expenditure on health has declined and the health system is largely financed through user-fees which has direct implications for the rural poor, deterring them from accessing health care.[4]

Agent Orange

Several health defects have been correlated with the use of the chemical dioxin, also known as Agent Orange, during the Resistance War Against America (Vietnam War). Dioxin was used in the war as a defoliant and is now considered a carcinogen.[5] Major differences in dioxin levels have been measured in the blood and breast milk of those living in areas that had been sprayed with Agent Orange when compared to other areas of Vietnam.[5] This carcinogen is associated with tumors, immune deficiency, reproductive and developmental disorders, nervous system defects, and a variety of other birth defects including Spina bifida.[5][6] Agent Orange continues to be a risk factor in Vietnam today because of its continued presence in soil, wildlife, and food.[6] In addition, the effects continue to be seen in generations born to those exposed to Agent orange.[6] Beginning in 2007, Vietnam Veterans are now compensated for detrimental health effects due to Exposure.[5]

Malaria

Vietnam has made progress in combating malaria, for which the mortality rate declined sharply, to about 5 percent of the rate in the early 1990s, after the country introduced antimalarial drugs and treatment.

Tuberculosis

The Viet Nam National Tuberculosis Control Program (NTP) worked with a control strategy recommended by the World Health Organization to lower Tuberculosis (TB) rates, and successfully exceeded target goals in 1997.[7] However, although there was a decrease in TB incidence among women and persons over 35, the rates of Tuberculosis among young men in Vietnam significantly increased during this time causing a stabilization of the overall rate.[7] According to the World Health Organization, Vietnam has the 12th highest incidence of Tuberculosis worldwide. There are an estimated 89 positive cases for every 100,000 individuals.[7] With an intensified vaccination program, better hygiene, and foreign assistance, Vietnam hopes to sharply reduce the number of TB cases and annual number of new infections.[2]

A 2012 study of tuberculosis control in Vietnam, identified a shortcoming in the current strategy of attending solely to symptomatic patients, as it has not been marked by any significant decrease in TB rates.[7] Instead the authors of the research advocated for a strategy of contact tracing that would focus on household members of Tuberculosis patients in Hanoi.[7] The study found a high incidence of TB rates in the household contacts tested and concluded that household contact investigation would be a feasible disease management strategy in Vietnam.[7]

HIV and AIDS

As of January 2005, Vietnam had diagnosed 101,291 human immunodeficiency virus (HIV) cases, of which 16,528 developed acquired immune deficiency syndrome (AIDS) and 9,554 died. But the actual number of HIV-positive individuals is estimated to be much higher. An average of 40–50 new infections are reported every day in Vietnam. Vietnam hopes to contain the HIV infection rate at the current official rate of 0.35 percent, which is about average worldwide, by limiting the disease as much as possible to sex workers and intravenous drug users. However, if the current trend continues, the number of infected persons could reach 1 million by 2010. One of the impediments to containing HIV/AIDS is that the victims face discrimination and stigmatization that are more severe than almost anywhere else in the world, according to a United Nations official. However non-governmental organizations, like the Supporting Community Development Initiatives (SCDI) for example, are devoted to improve the situation and quality of life of HIV/AIDS affected people. In June 2004, the Bush Administration announced that Vietnam would be one of 15 nations to receive funding as part of a US$15 billion global AIDS plan.[2]

Maternal and child healthcare

In June 2011, the United Nations Population Fund released a report on The State of the World's Midwifery. It contained new data on the midwifery workforce and policies relating to newborn and maternal mortality for 59 countries. The 2015 maternal mortality rate per 1,000,000 births for Vietnam is 567. This is compared with 64.3 in 2008 and 157.9 in 1990. The under-5 mortality rate, per 1,000 births, is 24, and the neonatal mortality as a percentage of under-5's mortality is 52. The aim of this report is to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal death. In Vietnam the number of midwives per 1,000 live births is unavailable and the lifetime risk of death for pregnant women 1 in 850. [8]

Prenatal screening

Tine M. Gammeltoft, an anthropologist at the University of Copenhagen has described the interplay between the individual and the state during prenatal screening, "In the realm of reproduction, intense sentiments of anxiety, dread, desire, ambition, and hope tie together the state and [Vietnam's] citizens, animating individual aspirations as well as national population policies".

An increase in the prevalence of ultrasound technology in the country has led to more screening for abnormal fetuses.[9] While women in the Western world are commonly offered one or two ultrasounds throughout the entire duration of their pregnancy, it is not uncommon for Vietnamese women to have more than 20 ultrasounds during one pregnancy.[9] The focus of these ultrasounds are often much different than in Western countries, where parents look forward to determining the sex of their baby or seeing photos of the developing fetus. Because of the prevalence of birth defects due to Agent Orange in Vietnam, ultrasounds are often a means for quelling the fears of expectant mothers.[9] The Vietnamese Commission for Population, Family, and Children, gave a statement in 2004 describing their support for prenatal screening in hopes that it may promote population quality that would allow Vietnam to enter into a phase of modernization and industrialization alongside other Southeast Asian countries.[9] This focus on Vietnam's national "stock" was in part based on Japan's efforts beginning in 1945 to strengthen the physicality and quality of their population through genetics programs, encouraging scientists to have many children, and the legalization of marriage with foreigners.[9]

Because of the particularly high prevalence of HIV infections in women of childbearing age world wide, in addition to Vietnam's high HIV/AIDS diagnosis rate, health counseling during the prenatal period is also focused on HIV positive expectant mothers. Since 1996, women have had access to programs designed to reduce transmission of HIV from mother to child, but still face the decision of whether or not to terminate their pregnancy out of concern for the child's long term care. Many women decide to have an abortion because of the fear that they will not be able to care for the child. This is common even when the family desires to have a child.

Providers

Public sector

Private sector

Hoan My Medical Corporation is the largest and most prestigious chain hospitals (7 hospitals and 1 clinic) across Viet Nam, serving 1.8 Million patient visits a year, with medical centers of Excellence in a wide spectrum of specialties, i.e., Cardiology, Orthopedics, Obstetrics, Gynecology, Pediatric, Gerontology, Ophthalmology, Hepatology and Gastroenterology

References

  1. 1 2 3 4 5 "Viet Nam: WHO statistical profile" (PDF). World Health Organization. World Health Organization. January 2015. Retrieved Oct. 28th, 2016. Check date values in: |access-date= (help)
  2. 1 2 3 Vietnam country profile. Library of Congress Federal Research Division (December 2005). This article incorporates text from this source, which is in the public domain.
  3. ↑ http://www.jointlearningnetwork.org/news/vietnam-accelerates-universal-health-insurance
  4. ↑ Huong, D; et al. (2007). "Ensuring health care for the rural poor: Social aims and commercial means in Vietnam and China". Int J of Health Services. 37 (3): 555–572. Retrieved 26 May 2012.
  5. 1 2 3 4 Dwyer, J. H.; Flesch-Janys, D. (1995). "Agent Orange in Vietnam". American Journal of Public Health,. 85 (4).
  6. 1 2 3 "Agent Orange". American Public Health Association: For science. For action. For health. American Public Health Association. 2016. Retrieved Oct 11, 2016.
  7. 1 2 3 Fox, Gregory; Viet Nhung, Nguyen; Ngoc Sy, Dinh; Thi Lien, Luu; Kim Cuong, Nguyen; Britton, Warwick; Marks, Guy (2012). "Contact Investigation in Households of Patients with Tuberculosis in Hanoi, Vietnam: A Prospective Cohort Study". PLOS ONE. 7: 1–7.
  8. ↑ "The State Of The World's Midwifery". United Nations Population Fund. Retrieved August 2011. Check date values in: |access-date= (help)
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