Vietnam marks 40-year primary health care campaign with a photo contest

Doctor Nong Be Giang, head of the Kim Dong commune's medical station in the northern province of Cao Bang, speaks to local people who come to the facility for a checkup.

As the sun set, guests and participants in a public event found their seats right on the street in Hanoi downtown. In front of them, a small stage was surrounded by dozens of photos in wooden frames which caught the eyes of passersby, foreign tourists and locals alike. The crowd chatted happily in the tune of Lionel Richie's "Hello" from loudspeakers as cars and motorbikes were passing by ahead of the main proceedings.

The audience, including representatives from the Health Ministry, the World Bank and the European Union (EU) delegation in Vietnam, was awaiting the start of a ceremony to hand out prizes in a national contest to pick the best photos illustrating Vietnam's efforts in providing primary health care (PHC) to the people.

The photo contest under the theme "Primary Health Care for Vietnamese People", an initiative put ahead by the World Bank in Vietnam, supported by the EU and hosted by the country's national radio channel Voice of Vietnam, is a unique event to mark Vietnam's 40th anniversary of its participation in the 1978 Alma-Ata Declaration on PHC.

A World Bank representative said the contest has made Vietnam the only country among more than 100 signatory states of the pact to have organized such an event this year to mark the global attempt in ensuring decent PHC to the people.

After its launch in late August and within the two months ending October, the contest has attracted more than 1,200 pictures from 350 people, many of them members of PHC teams in the grassroots level nationwide, the organizing committee said.

“We recognized that health care teams working at the grassroots level are key to ensure immediate primary level treatment, particularly in remote and underserved areas,” Koen Duchateau, Head of Development and Cooperation at the EU Delegation, told participants before handing out prizes to the award winning photographers. The EU has been the biggest donor in Vietnam’s health sector.

Interestingly, the contestant who won the first prize is a doctor who has spent 37 years for the job, nearly the time since Vietnam entered the Alma-Ata pact. Pham Quoc Hung, now head of a commune-based medical station in the southern province of Dong Nai, bagged the prize of 50 million Vietnamese dong (US$2,100) for capturing a moment when a boy administered Vitamin A.

A major milestone

In September 1978, just three years into the country reconstruction after the Vietnam War ended, the Southeast Asian nation signed the Alma Ata Declaration in Alma Ata, the capital of former Soviet republic Kazakhstan, to demonstrate commitments to ensuring citizens’ health. The declaration is "a major milestone of the twentieth century in the field of public health, and it identified primary health care as the key to the attainment of the goal of Health for All," said the World Health Organization.

Vietnam has since not only developed a supportive legal corridor backed by the government, but also built a medical station in each of its 11,100 communes nationwide to ensure the delivery of PHC. It has continuously been strengthening the capacity of the medical workforce and improving infrastructure as it has set out specific targets to ensure access to health care for each of its 95 million citizens.

“The network of medical facilities has been developed widely,” the ruling Communist Party of Vietnam stated in a resolution on strengthening people's health protection. “The staff of doctors and medical workers has been developed in quantity and quality”, helping improve all the indicators of health and average life expectancy, said the resolution in setting out goals by 2030.

“Without a commune-based medical system, it is tough for people to access medical facilities at a higher level due to the distance they have to travel. Many simply lack conditions to go,” said doctor Luan Van Tuan, deputy head of the medical centre in Thach An district of the northern mountainous province of Cao Bang.

Residents in the most remote area of Thach An would have to travel up to 80 km (50 miles) for a medical checkup at the district's hospital, while commune-based clinics were now able to perform early checkups, helping people save the cost for treatment, he said.

Tiny clinics help realise major national targets

A clinic is designed to have at least five workers, including a physician who also its head, an assistant physician, a nurse, a midwife and an assistant pharmacist. Since not all of the country's 11,000 communes have their station chief, the Health Ministry has rolled out a plan on doctor rotation to address the lack of highly-qualified medical staff in clinics.

But the dispatch of doctors to communes has brought more than just a realisation of a policy.

"After a while working in the district's medical centre, where I only worked with superiors, I started feeling so close to the people, to my patients as soon as I moved here," doctor Nong Be Giang said in her Kim Dong commune's clinic, where she has worked since 2016 and now heads the facility.

Doctor Nong Be Giang, head of the Kim Dong commune's medical station (Cao Bang province), checks the pulse of Nong Thi La, 56, of Nung ethnic minority group, during a routine checkup as La has been treated for diabetes.

As Giang spoke, several local adults and a little boy emerged for a checkup from the busy road that runs past the clinic and links Cao Bang with Lang Son province, home to one of Vietnam's main border gates with China. Among them was Nong Thi La, 56, of Nung ethnic minority group who came for a routine checkup on her diabetes.

"The staff of the clinic are very good. Sometimes we have to call them at night for an emergency and they come right away," said a 60-year-old Kim Dong resident.

The clinic, now with four staff including Giang as they are short of a pharmacist, serves a community of around 3,200 people, most of them from Tay and Nung ethnic minority groups.

"The network of commune-based medical stations has been very effective in ensuring success for the government's (national) target programmes," said doctor Tuan from Thach An medical centre.

He was referring to major health-focused campaigns designed to help fight various diseases within certain periods, under which the government would focus resources to improve the medical sector's capacity. Such programmes include vitamin administration for children, vaccination against several diseases, care of reproductive health, measures to fight infectious and noncommunicable diseases, population control and food safety.

A resident collects medicine for her son at the Kim Dong commune's medical station (Cao Bang province).

Training for improvements

Built on previous success in providing PHC to people, the Health Ministry has set out specific measures on improving the capacity for medical workers, providing clinics with modern equipment, working out better financing and insurance mechanism. 

Medical workers, like Giang and her staff in Cao Bang province, have attended training this year to improve knowledge under HPET project, fully known as the Health Professionals Education and Training for Health System Reforms project.

HPET, approved by the government in late 2013 for implementation by the Health Ministry between 2014 and 2020 and with funding mainly sourced from the World Bank and the EU, aims to improve the quality of education and training for the health workforce and strengthen the capacity for PHC in Vietnam's 15 poorest provinces, thus to partly reduce pressure at overloaded hospitals at higher levels.

The funding would also go to refurbishing 26 model clinics under a Health Ministry initiative, where the Family Medicine principle is applied. The ministry plans to expand the model nationwide by 2023.

Many of the activities at commune-based clinics nationwide have been captured in the photos from the contest and which were on display at Hanoi's downtown on Dec 7-9.