DOI: 10.5176/2251-3833_GHC13.22

Authors: Tran Thi Mai Oanh, Khuong Anh Tuan, Hoang Thu Thuy, Hoang Thi Phuong, Nguyen Thi Thang, Nguyen Minh Hieu, Nguyen Thi Thuy, Trinh Ngoc Thanh, Trinh Ngoc Thanh, Trinh Ngoc Thanh, Nguyen Hoang Giang, Do Tra My, John Rule, Graham Roberts, Richard Taylor and Ngo Duc Anh


Abstract:
Introduction
Health system reform in Vietnam, marked by a transition from the state-monopoly to a market-oriented health system, has been accompanied by the shift of qualified human resources to private or tertiary level of health care located in major economic centers or urban and township areas. In the past five years, in attempts to reverse the situation, government has promulgated decrees and developed policies that aim to attract and retain the health workforce in socioeconomically disadvantaged areas. Through this case study conducted in in two mountainous provinces of Dien Bien and Lam Dong, we are able to describe some problems facing the human resource for health (HRH) in the primary health care network. We document initial outcomes and emerging challenges associated with the implementation of HRH policies. We then discuss ways to improve policy implementation in order to mitigate the distributional imbalance in HRH in Vietnam.

Methods
Several qualitative methods were employed including documentary review, focus group discussion, and key informant interview. Thematic analyses were performed on textual data. Secondary quantitative data analysis was also conducted.
Findings
The study results show that the health sector in the two study provinces has multiple human resource problems. There were serious shortages of medical doctors and pharmacists, even at the secondary level of health care. A high level of staff turnover is being experienced and few commune health stations are staffed by a medical doctor. The implementation of policies on financial incentives for health workers at commune health station and village level have, in the short term, improved health staff attitudes, performance, and job satisfaction. However, limited budget, difficulties in identifying eligible communes and lack of financial and technical guidelines for post-college professional training have emerged as major barriers to effective implementation, leading to delayed implementation and limited coverage. The implementation of the policies related to the local nomination of candidates for college and university training appeared to be problematic. Specifically, there were problems with regards to recruitment eligibility criteria and training quotas for the medical profession, and additionally, there was a lack of health sector’s involvement in the recruitment of training candidates.

Conclusions
The problems of HRH post-health sector reform have been well-recognized by policy makers in Vietnam. The recently promulgated policies to attract and retain the health workforce in disadvantaged areas reflects a positive government response to reverse the situation. This case study has provided evidence that for effective policy implementation, special attention is required to adapt the implementation to specific local needs and to elaborate working guidelines and instructions. In addition, it is necessary to improve interdepartmental coordination among responsible government agencies and to involve the health sector in the implementation process.
Key words: Human resources for health, health policy, primary health care, financial incentives, Vietnam

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