Abstract
ObjectiveThis article provides a comprehensive review of the healthcare reform process driven by the Vietnamese Ministry of Health’s Direction of Healthcare Activities (DOHA) scheme.MethodsWe reviewed policy documents relating to DOHA, along with historical literature and background information describing its formation.ResultsDOHA (Chỉ đạo tuyến in Vietnamese) literally means guidance line or level in English. It requires healthcare facilities at higher government administration levels to support those at lower levels (the four levels being central, provincial, district, and commune), to help lower level hospitals to provide medical services for local communities in primary care settings and reduce the number of patients in higher level (central and provincial) hospitals. Since the 1990s, there have been too many patients attending higher level hospitals, and DOHA has therefore focused on technical skills transfer training to help alleviate this situation. Designated core central hospitals now provide technical skills transfer to provincial hospitals. Professional technical lists for each level of health facility have enabled strong commitment and proactive ownership of the process of training management in both higher and lower level hospitals.ConclusionThe DOHA scheme has accelerated the necessary up-skilling of healthcare at lower level public hospitals across Vietnam. These reforms are highly relevant for other countries with limited healthcare resources.
Highlights
IntroductionThe health status of people in Vietnam has significantly improved in recent years, with the life expectancy at birth increasing from 71 years in 1990 to 76 years in 2015 [1]
Alongside rapid economic development, the health status of people in Vietnam has significantly improved in recent years, with the life expectancy at birth increasing from 71 years in 1990 to 76 years in 2015 [1]
The term Direction of Healthcare Activities (DOHA) has been used as the English translation for some time, and documents translated by the Ministry of Health commonly use phrases such as “Technical Direction” or “Giving guidance to hospitals at lower levels,” with further explanations including “regional medical guidance activities” and “guidance and support from higher to lower level hospitals”
Summary
The health status of people in Vietnam has significantly improved in recent years, with the life expectancy at birth increasing from 71 years in 1990 to 76 years in 2015 [1]. The healthcare workforce in Vietnam is currently insufficient to meet manpower norms and practical needs [4], with the number of physicians in 2015 (around eight per 10,000 population) [4] being quite low when compared to other. Healthcare resources should be appropriately distributed to meet needs [9], but there is currently an imbalanced distribution of human resources and a shortage of manpower in Vietnam, especially of highly specialized physicians in fields such as cancer, palliative care, and mental health [10, 11]. Most healthcare workers in remote areas manage with a shortage of medical equipment and training They have limited opportunities to use advanced diagnosis and treatment methods and maintain and improve their professional ability [4]. The quality of healthcare services is lower in remote areas than more urban regions
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