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Support to the Primary Health Care

07/13/2016 14:41
EU-HF is providing technical assistance to the Ministry of Health in development of the clinical guidelines for early detection of non-communicable diseases and improvement of the primary health care quality. Primary Health Care (PHC) has been universally recognised as a fundamental element of health systems and made a focus of attention in health services development since 1978 when the International Conference on Primary Health Care organized by the World Health Organisation (WHO) proclaimed the Alma-Ata Declaration[1]. Later, the World Health Report of 2008[2] “Primary Health Care: Now More Than Ever” promotes a renewed effort in PHC to deliver better and more accessible services and improve health system performance. PHC is an essential element of the Health for All strategy, contributing, among others, to the reduction of exclusion and social disparities in health, the organization of health services around people's needs and expectations and to the increase in stakeholder participation[3]. The Government of Vietnam, through the Ministry of Health (MoH), has made efforts to improve the primary level of health care services and the upcoming 2016-2020 Plan for People’s Health Protection, Care and Improvement[4] pursues the improvement of capacity in the grassroots health care network. Accordingly, a Masterplan for Grassroots Reform is under development.
Non Communicable Diseases (NCDs) are becoming an increasing burden to all health systems, which struggle to cope with the prevention, care and rehabilitation of cases of cardiovascular diseases cancers, diabetes and chronic respiratory diseases[5]. Precisely in February 2016 the First WHO Global Meeting of National NCD Programme Directors and Managers[6] has taken place and emphasized the importance of early detection and diagnosis of NCDs.
The Vietnam National 2016-2020 Plan for People’s Health Protection, Care and Improvement acknowledges the increasing challenges presented by the changes in disease patterns and the emergence of NCDs. Recent Joint Annual Health Reports (JAHR) produced by the MoH and the Health Partnership Group (HPG) noted that “Of the 20 most important causes of disease burden in 1990, only 9 were NCDs, however by 2010 that number had increased to 15, and all of the top 5 causes of disease burden were NCDs” (JAHR 2014)[7]. More in detail, “The NCD share of disease burden rose from 45.5% in 1990 to 48.7% in 2000 to 60.1% in 2010 and 66.2% in 2012.” (JAHR 2015)[8].
There exist in Vietnam regulations and guidelines for the management of NCDs. Decision No. 2919 of MoH, from 2014[9], covers a series of Guidelines for examination and treatment at Commune Health Centres, elaborated with the support of the Health Sector Capacity Support Project of the EU. The Decision includes guidelines for three chronic diseases: hypertension, diabetes and asthma. An earlier MoH Decision of 2013[10] detailed 279 oncologic procedures mainly directed to hospital services. Of the guidelines reviewed the only with a section on early detection was the one for diabetes; hence the need to provide the primary care services in the country with guidelines for the early detection of the most common NCDs that contribute the highest disease burden.
The Medical Services Administration (MSA) of the MoH has requested the EU-Health Facility technical assistance in the production and distribution of clinical guidelines for the early detection of NCDs in the Vietnamese PHC services. The MSA choose Hypertension, Diabetes Mellitus, Chronic Respiratory Disease, Breast, Cervical, Thyroid cancers in women, Mouth and Prostatic cancers in men, Colorectal cancer in women and men and Mental Disorders.
 
The EU Health Facility will provide the following support:
 
Upon the request of the MSA, MoH, technical assistance supported by the EU through the EU-Health Facility will focus on the following activities:
Early Detection of NCDs at the PHC level
  • Compile and analyse  the current clinical guidelines and related regulation for medical examination and treatment that apply to the PHC level of services
  • Produce a brief updated review on the relevant internationally literature on the early detection guidelines of the conditions selected
  • Implement a rapid assessment of the knowledge, acceptance, actual use and recording of the MoH Guidelines for Examination and Treatment for Commune Health Centres (MoH Decision No. 2919/QD-ByT) in a reduced sample of the programme target provinces
  • Facilitate two consultation workshops to discuss approaches to the Early Detection of NCDs at the PHC level in Vietnam.
  • Recommend the review of specific guidelines MoH Decision No. 2919/QD-ByT if necessary highlighting the areas that would need revision
  • Produce a draft revised version of the Guidelines for Examination and Treatment for Commune Health Centres if requested
  • Produce Draft Guidelines for the early detection of:
    • Three priority NCDs (Diabetes M, HBP, chronic respiratory disease)
    • Cancers in women: Breast, Cervical, Thyroid
    • Cancers in men: Mouth, Prostatic
    • Cancers in women and men: Colorectal
    • Mental health disorders
  • The Draft Guidelines will include next steps for a complete diagnosis and case management at PHC level and criteria for referral to higher, more complex service levels
  • Assist the MoH in the organisation of review meetings of the Technical Evaluation Board (when set up by the MSA) for the guidelines as necessary: 1 meeting for diabetes M, 1 meeting for HBP, 1 meeting for chronic respiratory disease, 2 meetings for cancers.
  • Compile the Guidelines on early detection of the NCDs selected newly produced and revised by the Technical Evaluation Board.
  • Draft the outline for a monitoring and evaluation plan on the use of early detection Guidelines once they have been circulated to the health facilities
  • Produce a report with a summary of findings, products, conclusions and recommendations on the use of clinical guidelines for the early detection of NCDs in Vietnam.
  • Assist the MoH in the organisation workshop to disseminate Guidelines for early detection of NCD.
Periodic Health Examination
  • Produce a brief updated review on the different approaches and  relevant international literature
  • Review the current implementation of the periodical medical examination of workers and regular employees
  • Facilitate two consultation workshops to discuss the design and implementation of the Periodic Health Examination in Vietnam
  • Produce guidelines for the frequency and contents of a periodic health examination of the general population making use of guidelines for early detection of NCDs
  • Produce a model instrument to record the results of the periodic health examination of the general population
  • Assist the MoH in the organisation of two review meetings of the Technical Evaluation Board on the periodic health examination guidelines and recording instrument as necessary
  • Test the guidelines and recording instrument in a sample of Primary Health Care units
  • Draft the outline for a monitoring and evaluation plan on the use of the periodic health examination of the general population
  • Produce a report with a summary of findings, products, conclusions and recommendations on the implementation of the periodic health examination of the general adult population in Vietnam.
Quality in Primary Health Care
  • Produce a brief review of the current regulation on quality management that applies to Primary Health Care
  • Produce a brief updated review on the different international approaches to quality management in PHC, their applicability to the case of Vietnam and make recommendations
  • Facilitate two consultation workshops to discuss possible approaches to quality management in PHC in Vietnam
  • Develop simple guidelines, templates, indicators and monitoring tools for the overall assessment the quality of PHC services
  • Assist the MoH in the organisation of three review meetings of the Technical Evaluation Board  for the Quality in Primary Health Care instruments as necessary
  • Assist the MoH in the organisation of four meetings of a TWG for Quality Improvement in Primary Health Care instruments
  • Organize two events of Training of Trainers in Quality Improvement in Primary Health Care
  • Outline a monitoring and evaluation plan on the implementation of Quality Improvement Management Plans at district level
The assignment links with EU-HF work in the area of Health Financing related in particular to the introduction of the reliable capitation payment method at the time that VSS Health Insurance card holders register with a provider for insured Primary Health Care services.
 

[4] A draft under development has been shared by the MoH
[7] JAHR 2014 “Strengthening Prevention and Control of Non-communicable Diseases”
[8] JAHR 2015 “Strengthening Primary Health Care at the Grassroots towards Universal Health Coverage”
[9] MoH Decision No. 2919/QD-ByT. Guidelines for Examination and Treatment for Commune Health Centres
[10] MoH Decision No. 3338/QD-ByT. Guiding Technical Procedures in Oncology Area
Other News
  • 06/07/2016
    The EU has been supporting the Ministry of Health since many years in improving and operationalizing the quality management system. Circular No. 19 on the Introduction of the Quality Indicators in Hospitals was developed and launched in 2013 with the support of the EU funded Health Sector Capacity Support Project. It is hoped that sufficient fundsfrom the SCR 2 budget support will be allocated for quality improvement at district and grassroots levels to improve to quality health services in communes and districts and also to overcome the overcrowding of higher level hospitals.
  • 04/11/2016
    The Delegation of the European Union to Vietnam, in collaboration with the Ministry of Health of Viet Nam, the World Health Organization (WHO) and the World Bank organised the first International Conference on "Enhancing Grassroots Health for improving Primary Health Care toward Universal Health Care" in Hue on March 24 - 25, 2015.
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