Causes and determinants of inequity in maternal and child health in Vietnam.

Mats Målqvist,Sarah Thomsen,Dinh Thi Phuong Hoa

doi:10.1186/1471-2458-12-641

Abstract

BackgroundInequities in health are a major challenge for health care planners and policymakers globally. In Vietnam, rapid societal development presents a considerable risk for disadvantaged populations to be left behind. The aim of this review is to map the known causes and determinants of inequity in maternal and child health in Vietnam in order to promote policy action.MethodsA review was performed through systematic searches of Pubmed and Proquest and manual searches of “grey literature.” A thematic content analysis guided by the conceptual framework suggested by the Commission on Social Determinants of Health was performed.ResultsMore than thirty different causes and determinants of inequity in maternal and child health were identified. Some determinants worth highlighting were the influence of informal fees and the many testimonies of discrimination and negative attitudes from health staff towards women in general and ethnic minorities in particular. Research gaps were identified, such as a lack of studies investigating the influence of education on health care utilization, informal costs of care, and how psychosocial factors mediate inequity.ConclusionsThe evidence of corruption and discrimination as mediators of health inequity in Vietnam calls for attention and indicates a need for more structural interventions such as better governance and anti-discriminatory laws. More research is needed in order to fully understand the pathways of inequities in health in Vietnam and suggest areas for intervention for policy action to reach disadvantaged populations.

Highlights

Inequities in health are a major challenge for health care planners and policymakers globally
Even though maternal and child health is at the core of global public health, projections show that the Millennium Development Goals in this area (MDG 4 & 5) are not going to be met by 2015 [1]
Despite various successes of these different initiatives it has been noted that economic factors play a relatively minor role as generator of inequity in Vietnam compared to determinants like ethnicity and education in Vietnam [8,11]

Summary

Introduction

Inequities in health are a major challenge for health care planners and policymakers globally. Even though maternal and child health is at the core of global public health, projections show that the Millennium Development Goals in this area (MDG 4 & 5) are not going to be met by 2015 [1]. There are disadvantaged groups that do not benefit from development to the same extent, resulting in increasing inequity in health [2,3]. Directives like Program 135 (Program for Socioeconomic Development in Communes Faced with Extreme Difficulties) [10], a program that aims to increase living standards in selected communes and includes benefits such as health care free of charge for the communes’ entire populations, have been initiated but have not been fully effective [12] and inequity along ethnic lines in maternal and child survival persist [8,13]

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