I. Background

          Management of population/family planning (PFP) and reproductive health care is concerned at different levels among nations, depending on development level and time. In the world there are two models:

 (1) In developed countries when people have knowledge and pay for PFP services, this role is responsible by the health sector.

 (2) In developing countries with high population growth, this job is responsible by the multisectoral committee.

          Vietnam has been through many government PFP management models. In 1961 it is the Family Planning Board, followed by the Board for Protection of Mothers and Children in 1963. In 1978 the Ministry of Health takes over the responsibilities. In 1984, the Population and Family Planning Committee (PFPC) is established. Since 1993 the PFPC has operated independently and attached directly to the Government. In 2002 the Committee for Population, Family and Children (CPFC) is established as a ministry-ranking agency. Following the Decision 1001/2007/QD-TTg the population and family planning (PFP) functions are transferred to MOH. In the context of system change, the Health Strategy and Policy Institute (HSPI) is assigned with the task of conducting ”overall investigation of the population and family planning (PFP) network”.

          Study objectives:

(1) To investigate the current status of PFP organizational structure at level

(2) To evaluate the PFP management mechanism

(3) To evaluate PFP technical activities at levels

          Study methods: include investigation of reports from 63 cities and provinces to describe the organization, structures and physical materials of the network at levels; sampling survey with questionnaires to PFP staff (n = 186) and household questionnaires (n = 091), helping to evaluate management mechanism as well as PFP technical activities.

          Sampling survey:  select locations in 8 cities and provinces of Son La, Tuyen Quang, Hai Phong, Ha Tinh, Khanh Hoa, Kon Tum, Ba Ria – Vung Tau and Dong Thap.

II. Organizational structures and personnel at levels:

          Central level:  In 2008, the General Department of Population, Family Planning (GDPFP) is set up with 6 administrative units: Department of Population and Family Planning, Department of Communication and Education, Department of Planning and Finance, Department of Organization and Manpower, MOH Cabinet and Inspectorate and 03 attached institutions – Research Institute of Population and Development (merged into HSPI in 2009), Center for Population Information and Archives, and the Family and Society Newspaper). GDPFP has 146 permanent staff with 21% at high education level, 74% at university and college levels, and 15%medical and pharmaceutical staffs. In general, after the disolvement of the Committee for Population, Family and Children (CPFC) the PFP personnel remain in the GDPFP.

          Provincial level: In 2009, the provincial PFP sub-departments of 63 cities and provinces have 1,121 personnel (both permanent and contracted staff). On the average, each PFP sub-department has 17.8 staff. The sub-department that have fewest personnel is Phu Yen and Kon Tum with 12 persons and the one with most crowded number is Ha Noi (56 persons). PFP staff at provincial level account for 56%. Staff newly recruited in the last 2 years account for 21%, and medical and pharmaceutical personnel is equal to 27%. Thus at end of 2009 upto one fifth of staffs are new recruits and about one fourth of them are young.

          District level: Most provinces and cities establish PFP Center at district level – administrative unit under PFP Sub-department. Particularly in HCMC, the PFP duties are given to the Health Division. At end of 2009, the district PFP have 3,585 personnel (both permanent and contracted staffs). The contracted staff in these centers account for 20%. On the average each district PFP center has 5.2 staff. Female staff account for more than 65%. Recruitment in two years account for 45% and medical and pharmaceutical staff are equal to 38%. Thus after disolvement, there have been many personnel changes in PFP centers and nearly half of staff are new recruits.

          Commune level and lower: In total, at the survey time the whole country has 11,101 PFP responsible staff at commune level, of which 77% are women, new recruits of less than 2 years account for nearly 22%. To date 4,541 PFP responsible staff (43%) have been transferred to commune health center, about 30% reaching standards regulated in MOH Circular 05. To date there are only 40% of village health workers (VHWs) cum PFP collaborators in the areas. On the average each ward/commune/town has about 14 PFP collaborators. More than 86% of collaborators are in reproduction age.

III. Evaluation of PFP organizational structures

          The current organizational structure is considered relevant by sectoral staff: more than 80% at provincial level, more than 73% at district level and more than 60% at commune level. However, at commune level, nearly 40% interviewees believe that such model is not relevant. Half of them say that PFP staff should be managed by People’s Committees. More than 70% agree with the idea of establishment of Counseling and Services Centers and 74% believe that such center will function effectively. Nearly 60% agree with the merging of the Family Planning Team into the District PFP Center. More than 71% are for the idea of permitting the District PFP Center to recruit commune PFP staff.

IV. Evaluation of the PFP performance

          Communication activities: More than 90% interviewees know about the message ”few children family”. More than 87% of people know more than 3 reproductive health (RH) contents. 95% of PFP collaborator pay home visit and 85% of PFP staff visit commune to update information and advocate for family planning. The organizational changes at grassroots levels have created impacts on grassroots personnel. However according to interviewees, 80% of PFP collaborators and 65% of staff have worked for more than 2 years. Nearly 90% of people consider ”good” performance by grassroots staffs; 32.8% believe that the service delivery network “fully meet” the needs; upto 45.7% say it only partially meet and 21.5% interviewees comment it does not meet. Particularly, 64.5% of commune staff comment that the service delivery network does not meet the needs.

V. Conclusions

          More than one year after PFP work transferred to MOH, following the policies by the Party and Government on multisectoral management, the central organizational structures remain stable. In the meanwhile there are changes at provincial level and upto one fifth of total staff must be newly recruited and that at district and commune level is 45% and 22%, respectively.

          In general, the PFP organizational structures at provincial level are relevant to central level. The PFP sub-department is under provincial health departments and the GDPFP is under MOH. There remain different ideas of the PFP model at district level. To some extent it is separated from the Party and local authorities and yet meet operational difficulties. However the establishment of PFP steering committee has partially addressed such limitation.

          With regard to PFP service delivery, 32.8% interviewees say that the service delivery network ”fully meet” the needs. Nevertheless commune staff still remark that the service delivery network almost do not meet the needs (64.5), naming some contraceptive methods like pills, condoms, injections. Communication remain limited. Particularly of the 10 RH contents, very few PFP staff know more than 5 (23.1%), especially at commune level (5%).

VI. Recommendations

          - Continue to complete the organization and management mechanism for the PFP network at central and provincial level, to put it into stable operation. At district and commune levels, adjustment should be made to secure management ties. At present the PFP center (under provincial PFP sub-department) directly manages resources and signs contracts with commune PFP staff and they work at commune health center or People’s Committee. Besides reference should be made for the PFP center under district People’s Committee’s management as well as merging the family planning team into the PFP center, as carried out in some pilot provinces.

          - With regard to organization and manpower, it is needed to issue an interministerial circular jointly with Ministry of Home Affairs (MOHA) to uniformly apply personnel quota for PFP sub-department at minimum 20 personnel and PFP at minimum 6 personnel. Responsible allowances for leaders of PFP sub-department and center should be uniformly regulation. Technical standards for recruiting commune PFP staff to commune health center should be lowered for mountainous and remote areas.

          - Developing training plans for levels. Central level train provincial and district staff via 2-month courses. Besides, the central level should train trainers for provincial level. Provincial level should be responsible for training PFP staff at commune level.

          - MOH issues circular on logistic management of contraceptive facilities, essential drugs and medical devices and supplies for the PFP program to unify a management and organizational focal point for implementation. It is needed to have a population service agency at central level to perform administrative functions and technical assistance for PFP centers in provinces and cities.

          - The participation and leadership of Party committees and local authorities at level should be maintained. Sectors should be mobilized to run PFP programs in the locality. “The Central level is requested to issue directive documents on PFP implementation at grassroots level”.