A SURVEY ON THE POPULATION – FAMILY PLANNING SYSTEM
Đoàn Minh Lộc et al.
Place of publication: Ministry of Health
Year of publication: 2012
The survey on Population - Family Planning (PFP) is a ministerial level research, which was carried out between 2010 and 2011. The survey provided an overall assessment of the organizational status, policies, investment resource at different levels in 63 provinces/cities. In addition, in-depth findings are given on the disadvantages, advantages of organizational models, management mechanism and technical activities on PFP at different levels in 8 provinces/cities representing 3 regions of the country.
1. To investigate the current status of PFP system/PFP organizational structure at different levels; and evaluate PFP management mechanism;
2. To evaluate the PFP technical activities at different levels
3. To make recommendations on solutions to strengthen capacity and efficiency of PFP system
The survey employed multiple methods to collect information: statistical data collection with statistical forms collected from 63 provinces/cities; 658 districts and 11,052 communes/wards/ towns; In-depth interviewing method with 114 in-depth interviews conducted at different levels; Group Discussion: 56 Group Discussion at 3 levels of 8 surveyed provinces/cities; Questionnaires: 960 Questionnaires for married couples in reproductive age and 200 questionnaires to PFP staff in the survey sites.
Organizational structures and personnel at different levels:
• At Central level: After the disbandment of the Vietnam Committee for Population, Family and Children (VCPFC), the PFP personnel remain in the General Office of Population and Family Planning (GOPFP). However, GOPFP has to retain almost all offices of the former VCPFC.
• At Provincial level: In 2009, Provincial office for PFP of 63 provinces/ cities were assigned with 1,150 personnel, and now the current total staff number is 1,121 (both permanent and contracted staff), accounting for 97% of the plan.
• At District level: Most provinces and cities establish PFP Center at district level – a unit under the Provincial office for PFP (except for some provinces where those units belong to District People’s Committee). Particularly in Hochiminh city, PFP Center is not established at district level and the District Health office takes responsibility for PFP tasks.
• At Commune level: In total, there are 11,101 full-time PFP staff at commune level across the country, with over 77% of women among them, and 155,571 PFP collaborators, with women accounting for 88%.
• Circular No. 05 stipulates that Provincial office for PFP may have a minimum of 20 permanent staff (excluding contracted staff), and PFP Center with a minimum of 6 staff (excluding contracted staff). So far, on the average, each Provincial PFP office has 17.8 staff (including contracted staff), and each district PFP center has 5.2 staff (including contracted staff). Circular No. 05 also stipulates that Provincial PFP office can have 03 divisions, and PFP center can have 2 sections. In fact, there are 2 – 3 divisions set up at Provincial PFP offices only while there are no sections set up at most District PFP centers.
Facilities and funding for PFP
• On the average, each Provincial/City Office for PFP and each District PFP center are provided with 1,135 m2 and 364 m2, respectively for building office.
• Equipments for working are sufficiently provided. Each staff at GOPFP uses 01 computer while 4 staff at Provincial PFP use 03 computers, and 03 staff at District PFP use 02 computers.
• The total funding from all sources invested for PFP program in 63 provinces/cities in 2009 was 623,603.9 million VND, in which allocation from the state budget was 489,131.0 million VND, accounting for 80% of the total, from provincial budget was 83,448.8 million VND, accounting for 13,6%, and from other sources were 14,216.2 million VND, accounting for 2.3%.
Evaluation of PFP activities and National Targeted Program Management
• The PFP organizational structure from central to provincial levels is fairly good but problematic at lower levels to some extent. In the current system, the leading role of the People’s Committee at different levels is limited due to the vertical management maner of health care system.
• Most of PFP staff at different levels think that contraceptive management is generally good. However, some staff think that contraceptive management at provincial and district levels is not always effective in timely manner. Sometimes, a temporary shortage of contraceptive happens and grassroots level staff‘s monitoring, documenting and reporting are too much and complicated.
Evaluation of Technical Activities
• PFP staff with Medical - Pharmaceutical training account for 32.2% at provincial level and 41.2 % at district level. Organizational structure at provincial level is unstable to some extent. Up to one fifth of total staff are newly recruited. Particularly, new staff recruitment at district and commune level is 45% and 22%, respectively.
• Service delivery network at commune level does not meet the need on Reproductive Health/ FP of the people, such as implant, injection, condoms. Especially, there is a shortage of counseling staff and equipment for service provision.
• Reproductive Health care Centers are made available in all provinces/cities while Reproductive Health Departments are seen at most of District Health Centers. At commune level, 98.6% of communes have commune health station (CHS); 55.5% meets the National Standard; 65.9% of CHS have doctors; 93.0% of CHS have mid-wife or obstetric-pediatric physician; 84.4% of villages have Health workers; and 100% of villages have PFP collaborators.
The current PFP system status
Organizational system: In general, the organization at central level is stable, and the majority of personnel and resources remain unchanged.
Personnel and organizational structure: Personnel and organizational structure at provincial and district levels are both fewer than those defined in Circular No. 05/2008/TT-BYT dated May 14, 2008 on PFP function, duty and organizational structure at different levels.
Management from central to provincial levels is rather stable but the People’s Committees at grassroots level are in a more passive due to the vertical health system management.
Contraceptive management has some problems, for example, a lot of documentation has been made and but a temporary shortage of contraceptive method still happens.
Training: after disbandment, PFP staff have been changed, moved and the current staff number does not satisfy the number defined in Circular No.05. Therefore, there is a big demand of training demand for PFP staff.
Service delivery network: the most important thing is that service delivery network at commune level does not meet the customers’ need due to insufficient number of personnel, equipment and poor management as mentioned above.
Recommendations and Solutions
The Current PFP system
• If the current organizational structure remains unchanged (district PFP center is an independent unit), the entire PFP activities at grassroots level (excluding clinical services) should be coordinated and implemented by PFP centers in collaboration with other local sectors. All resources for PFP should be transferred from the Provincial Department of Health to District PFP Center. And PFP center will then recruit and pay salary to PFP staff at commune level. Commune PFP staff can work at CHS or commune people’s committee office. In addition, a coordinated mechanism is needed among Health Center, PFP Center, District Health Unit and CHS.
• If the organization structure changes, PFP Center and Health Center should be merged to coordinate and implement activities because the CHS is a unit under the District Health Center according to the current stipulation.
• The “ideal” model proposed by GOPFP and some provinces is that PFP department at local levels should belong to the People’s Committee
• In order to move the Family Planning Team to District PFP Center, preparation is needed firstly at provincial level. The Provincial Office for PFP and Reproductive Health Center should be merged. By so doing, justification for transferring Reproductive Health Unit to PFP Center can be made. Besides, this matter is related to the central model.
If PFP Center at district level still exists fairly independently as at current time, the National Targeted Program Budget for PFP should be transferred to PFP Center for management and co-ordination. Step by step guidance for unified implementation of two management modes of clinical services should be made to promote effectiveness of the National Targeted Program.
• Developing training plans for different levels: training is provided by the Central level to provincial and district staff via 2-month training courses. Besides, the central level should also provide training of trainers for provincial level. Provincial level trainers should be responsible for training PFP staff at commune level.
• It is needed to have a population service agency at central level to perform administrative functions and technical assistance for PFP offices in provinces and cities, PFP center in districts, to create the united network in the country at different levels for providing PFP service and counseling.