Center for Health Market Innovations (CHMI)

Programs

KICH-Key Improvements in Community Health

last updated May 9, 2012

Overview

Implementing organization: 
People’s Committee of Hoa Binh Province, Belgium Development Agency (BTC)
Implementation Partner(s): 
Provincial Health Department of Hoa Binh Province
Legal Status: 
Public-private partnership
Year Launched: 
2005
Stage: 
No longer active
Income Level of Target Population: 
Bottom 20%, 20-60% (lower to lower-middle)

Funding

Primary Source of Funding: 
Donor
Additional Source(s) of Funding: 
Government
Funders: 
Belgian Technical Cooperation, Counter Value Fund, Hoa Binh’s People’s Committee

Scale

Number of Facilities Operated/Networked: 
46 commune health stations, 2 district hospitals
Summary: 

This is pilot project to improve the quality of health services at grassroot levels and increase accessibility of care for the poor in remote areas through the application of different health market mechanisms.

Program goals/rationale: 

Vietnam’s health indicators are generally favourable compared to the surrounding countries. Still, access to good quality primary curative health care services is limited, especially in remote and disadvantaged areas. Today, most people go directly to pharmacies for minor illnesses, and when more severely ill, to higher level overcrowded hospitals. This has resulted in high “out of pocket” spending, making health care costs one of the main reasons for impoverishment in rural areas, as well as overcrowded hospitals. The health insurance payment mechanism has resulted in overconsumption of “high tech” examinations and treatment procedures, leaving the basic examination aside. There are few quality criteria for clinical curative care.

Therefore, the project (2005-2010) aimed to improve access to good quality of primary curative health care services, especially for the poor people in remote and disadvantaged areas.

Key program components: 

Developing health insurance system with functioning provider payment mechanism: The financing for the community health stations (CHS) has been increased as health insurance has been introduced at this level. About 50% of the population is covered by health insurances. The project provided incentives to the Vietnam Social Security Administration (VSS) to identify and enrol the near-poor and the rest of the eligible population into the social health insurance scheme. The project piloting new payment mechanisms starting with capitation in the CHS, and a mixed system with 50% capitation and 50% fee for services, in the district hospitals.

Developing a functioning primary curative care: Primary curative care facilities at commune level have been upgraded with running water, improved sanitation and rooms, as well as being equipped with furniture and basic medical equipment. The technical skills of the medical doctors have been improved by developing clinical and therapeutic guidelines, together with on job training for better diagnostic and treatment procedures. Assistant doctors (42 people) received support to attend medical university and receive medical degrees. Village health workers (150 people) received three months certified training. They also received training on planning and management of health education programs at the village level.

Improving quality secondary curative care hospitals: Support has been given to improve hospital management. Water and sanitation, emergency electricity and good standard pharmacies have been assured.

The project also organized better referral and counter referral system between commune and district levels to secure a better use of the two levels, developed chronic disease management programs for the local levels for diabetes and hypertension (focusing on early detection, evidence-based treatment, monitoring for controlling the disease, self care for the patient, and a coordinated health service) and providing health education to local people about their health insurance rights, the improved function of the CHS and the care for chronic ill.

Program history: 

The Provincial Health Department in Hoa Binh used lessons learned from the piloting project (two districts) in the other nine districts in Hoa Binh.

Central level experts from MoH and Vietnam Social Insurance have been invited as long term consultants, to give technical support and to participate in supervision and evaluations. This has already resulted in informal central level dissemination of project results achieved. Lessons learned were used when the new Law on health insurance was approved.

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