International Journal of Health Policy and Management

International Journal of Health Policy and Management

“Three Nooses on Our Head”: The Influence of District Health Reforms on Maternal Health Service Delivery in Vietnam

Document Type : Original Article

Authors
Nguyen Thi Hoai Thu 1
Fiona McDonald 2
Sophie Witter 3
Andrew Wilson 4
1 Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
2 Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, QLD, Australia
3 Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
4 Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia
10.15171/ijhpm.2017.134
Abstract
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.
Keywords
District Health Reforms
Health System Governance
Health Policy
Fragmentation of Services
Maternal Health
Vietnam
Subjects

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International Journal of Health Policy and Management
Volume 7, Issue 7
2018
Pages 593-602

  • Received Date 12 May 2017
  • Revised Date 08 November 2017
  • Accepted Date 11 November 2017
  • First Published Date 01 July 2018
  • Published Date 01 July 2018