TY - JOUR ID - 3439 TI - “Three Nooses on Our Head”: The Influence of District Health Reforms on Maternal Health Service Delivery in Vietnam JO - International Journal of Health Policy and Management JA - IJHPM LA - en SN - AU - Thi Hoai Thu, Nguyen AU - McDonald, Fiona AU - Witter, Sophie AU - Wilson, Andrew AD - Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam AD - Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, QLD, Australia AD - Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK AD - Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia Y1 - 2018 PY - 2018 VL - 7 IS - 7 SP - 593 EP - 602 KW - District Health Reforms KW - Health System Governance KW - Health Policy KW - Fragmentation of Services KW - Maternal Health KW - Vietnam DO - 10.15171/ijhpm.2017.134 N2 - Background The impact of reorganisation on health services delivery is a recurring issue in every healthcare system. In 2005 Vietnam reorganised the delivery of health services at the district level by splitting preventive, curative, and administrative roles. This qualitative study explored how these reforms impacted on the organisation of maternal health service delivery at district and commune levels.   Methods Forty-three semi-structured interviews were conducted with health staff and managers involved in the provision of maternal health services from the commune to the central level within five districts of two Northern provinces in Vietnam. The data were analysed thematically.   Results The results showed that 10 years after the reforms created three district-level entities, participants reported difficulties in management of health services at the district and commune levels in Vietnam. The reforms were largely perceived to negatively affect the efficient and effective use of clinical and other resources. At the commune level, the reforms are said to have affected the quality of supervision of the communes and their staff and increased the workload in community health centres.   Conclusion The findings from this study suggest that the current organisation of district health services in Vietnam may have had unintended negative consequences. It also indicates that countries which decide to reform their systems in a manner similar to Vietnam need to pay attention to coordination between a multiplicity of agencies at the district level. UR - https://www.ijhpm.com/article_3439.html L1 - https://www.ijhpm.com/article_3439_c676536f3d3399cd835958f46cf2b54c.pdf ER -