Views by health professionals on the responsiveness of commune health stations regarding non-communicable diseases in urban Hanoi, Vietnam: a qualitative study

Vu Duy Kien,Hoang Van Minh,Le Thanh Tuan,Kim Bao Giang,Malin Eriksson,Nawi Ng,Viet Nguyen

doi:10.1186/s12913-018-3217-4

Abstract

BackgroundPrimary health care plays an important role in addressing the burden of non-communicable diseases (NCDs) in low- and middle-income countries. In light of the rapid urbanization of Vietnam, this study aims to explore health professionals’ views about the responsiveness of primary health care services at commune health stations, particularly regarding the increase of NCDs in urban settings.MethodsThis qualitative study was conducted in Hanoi from July to August 2015. We implemented 19 in-depth interviews with health staff at four purposely selected commune health stations and conducted a brief inventory of existing NCD activities at these commune health stations. We also interviewed NCD managers at national, provincial, and district levels. The interview guides reflected six components of the WHO health system framework, including service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance. A thematic analysis approach was applied to analyze the interview data in this study.ResultsSix themes, related to the six building blocks of the WHO health systems framework, were identified. These themes explored the responsiveness of commune health stations to NCDs in urban Hanoi. Health staff at commune health stations were not aware of the national strategy for NCDs. Health workers noted the lack of NCD informational materials for management and planning. The limited workforce at health commune stations would benefit from more health workers in general and those with NCD-specific training and skills. In addition, the budget for NCDs at commune health stations remains very limited, with large differences in the implementation of national targeted NCD programs. Some commune health stations had no NCD services available, while others had some programming. A lack of NCD treatment drugs was also noted, with a negative impact on the provision of NCD-related services at commune health stations. These themes were also reflected in the inventory of existing NCD related activities.ConclusionsHealth professionals view the responsiveness of commune health stations to NCDs in urban Hanoi, Vietnam as weak. Appropriate policies should be implemented to improve the primary health care services on NCDs at commune health stations in urban Hanoi, Vietnam.

Highlights

Primary health care plays an important role in addressing the burden of non-communicable diseases (NCDs) in low- and middle-income countries
The analysis resulted in six themes describing the responsiveness of commune health stations to NCDs and one theme describing needs for improvement for primary health care NCD services
This study explored the ability of commune health stations to respond to NCDs through the perspective and experiences of health professionals in urban Hanoi

Summary

Introduction

Primary health care plays an important role in addressing the burden of non-communicable diseases (NCDs) in low- and middle-income countries. Most deaths (28 million) occurred in low- and middle- income countries (LMICs) [1]. Rapid urbanization challenged population health in developing countries [3]. This has been accompanied by an increase in urban poverty and the development of slums [4, 5]. Populations afflicted with poverty and those living in slums are the most vulnerable urban groups, bearing a double burden of both communicable and non-communicable diseases [6]. Primary health care services are vital to addressing NCDs, especially in LMICs [7]. The World Health Organization highlighted the role of primary health care systems to execute NCD interventions [8, 9]

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