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Trần Thị Mai Oanh, Nguyễn Khánh Phương, Nguyễn Thị Thủy, Hoàng Thị Phượng, Vương Lan Mai, Dương Huy Lương

Place of publication: Health Strategy and Policy Institute
Year of publication:  2009
The project on health care for Central Highlands people (Central Highlands Healthcare Project) is implemented in 5 Central Highlands provinces in 6 years, from 2004-2009 with the overall objective of improving health status and increasing accessibility to quality health care services, especially for the poor and ethnic minorities. One of the key outputs of the project is the Health care Fund for the Poor (HFP), which has been comprehensively and effectively supported. Costs analysis and impact assessment of project support components is essential to project assessment, in general and providing scientific evidence for managers and policy makers in expanding health care model for the poor in the future. 

This study is conducted to analyze costs of support components within the C2 Component of the Central Highlands Healthcare Project; to clarify advantages and disadvantages in implementing project support components and draw lessons for apply these support measures in other localities.
The study employs ingredient approach in cost analyzing, combination of cross-sectional survey, quantitative and qualitative data collection in 5 project provinces in the Central Highlands. 
The total costs for implementing support components are estimated at 85.7 billion VND, of which project input costs are 68.6 billion VND- accounting for 80%, implementation costs by implementing facilities and institutions are 17.2 billion VND – accounting for more than 20%. 
The percentages of project investment support against total actual expenditures for different support components range 50-60%, with the highest of 65% for community-based examination and treatment support and lowest of 52% for meal support. 
The average meal support rate for each patient visit is 107,000 VND, highest in Kon Tum (126,000 VND) and lowest in Lam Dong (97,000 VND). The project average travel cost support is 80,000 VND, highest in Gia Lai and Dak Nong (97,297 VND and 96,318 VND, respectively) and lowest is Dak Lak (59,970 VND). The average direct support costs in 5 provinces is 1,519,728 VND with great variances due to significant differences in supported patient quantity, highest in Dak Nong (15,610,853 VND) and lowest in Gia Lai (202,691 VND). The average community-based examination and treatment costs is 60,000 VND/person/visit. The rate of project support against total costs covered by patients for meals and travel during treatment course is rather low, 22.3% and 20.9% for meals and travel. At all provincial and district facilities, kitchen setup is the form with more appropriate costs compared with other types of meal voucher or money distribution. 
During implementation there are difficulties and obstacles such as implementing institutions or facilities do not fully understand guidance, support levels are insufficient compared with actual costs, advance level is low and late, lack of standards for identifying severe conditions, high costs, health care facilities with limited responsive conditions and dissatisfactory human resources.
To implement the project, apart from input costs covered by the project there are still a large expenditure mobilized from health facilities.
The average costs for each project support component vary from one to another province, of which there is a greater variance in direct support component. Support for community-based examination and treatment accounts for the highest ratio and that for meal accounts for the lowest in project total support budget. The project support costs account for a small ratio against total costs for meals and travel during treatment course covered by patients. 
With calculation of input and actual costs, in general the project has achieved set forth objectives. However besides advantages, there remain difficulties and obstacles emerging during the implementation process.
Continue to maintain and expand the types of support for the poor upon seeking for medical care, especially meal and travel. For meal support, kitchen setup should be targeted for its appropriate cost levels and practical benefits for patients.
The development of support policies should be based on needs assessment with flexibility and activeness in implementation. Adjustment coefficient based on annual inflation rate can be used to identify support level.
During implementation, it is needed to pay special attention to dissemination and guiding for implementing support policies at the same time strengthen inspection, monitoring to avoid misunderstanding and inability to fulfill policy implementation. 
To ensure timely and fully budget transfer the Central Project Management Unit (CPMU) should cooperate with relevant agencies to re-examine, simplify financial procedures as well as agree with donor to increase advance level for provinces during implementation.
After project termination, there should be commitments by provinces in allocating local budget to maintain project support components, especially support for meals and travel. 

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