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Indicators based survey serving the National Target Programs to 2010 and vision to 2020
Indicators based survey serving the National Target Programs to 2010 and vision to 2020 Vũ Thị Minh Hạnh and colleagues Objectives To evaluate the implementation of the national health target programs for prevention and control of some social diseases, dangerous epidemics, and HIV/AIDS in phase 2001-2005; To recommend solutions and directions for improving these national health target programs in phase 2006-2010 and vision to 2020. Study subjects Three groups of players and stakeholders directly involved in the implementation of the national health target programs (NHTPs) during phase 2001-2005, including management leaders , implementers, and the beneficiaries. Methods This study combines secondary data analysis with data collection using self administered semi-structured questionnaire conducted at all communes/wards of 64 provinces/municipalities nationwide. In addition, qualitative approach (face to face in-depth interview and focus group discussion) and quantitative approach (health worker and household survey) were combined. Study locations Quantitative data were obtained from all communes/ wards of 64 provinces/ municipalities. Rapid assessment to obtain qualitative data and a household survey were conducted at 48 wards/communes of 8 provinces/municipalities at 8 geographical regions, including Lào Cai, Điện Results •Some programs received relatively strong political commitmentfrom the Party and Government at various levels. There was active participation from social and mass organizations and positive responses from local people. Great experiences and resources were shared by international organizations. •The legal foundation for the implementation of NHTP was step by step established and being completed. •Each NHTP had a unified management structure from central to local level under the direct control of the Ministry of Health and its affiliated agencies. •Each NHTP was taking shape and gradually expanded from the central to the villages with an intersectoral participation of which the health sector played the leading role. •People’s awareness, behavior and practice on NHTPs were improved, reflecting in measurable indicators such as knowledge on epidemic’s harm, transmission routes, causes of transmission, and prevention methods and skills. •Dangerous epidemics were under the control or step by step held back. The incidence of communicable diseases reduced while incidence of non-communicable diseasesincreased. •However, the organizational structure for implementing many NHTPs at all levels, especially at local level was particularly cumbersome, over formalistic, and ineffective. The task forces of NHTPs were neither existent nor capable enough to undertake a strong coordinating role. •Budget allocation mechanism for each program was inadequate and out-of-date in a dynamic reality. •Human resource for NHTPs at all levels was lacking and incapable. No periodical training was provided to the programs’ staff and work incentives was low. •The NHTPs' surveillance and report system were insufficient and unable to provide a timely and accurate information update. •Medical supplies and equipment for some NHTPs were lacking to meet the demand for program implementation. Mechanism for medical supplies and maintenance of physical assets were inadequate. •The implementation of NHTPs in mountainous and remote areas faced many difficulties, resulting in low performance. •Shifts in awareness, behavior and practice on dangerous epidemics were not sustained and did not meet the requirements for each NHTP. •Some NHTPs including the dengue fever program, food safety program, and mental health program did not achieve expected results. Bigger efforts should be made to improve these programs in the coming time. •Epidemic development has become complicated due to changes in climate, ecological environment and socioeconomic conditions while resistance to antibioticsis on a rise. This has been a significant obstacle in epidemic prevention activities. •There was no inter-program cooperation that could have shared resources, improved efficiency and created synergy effects (for instance, TBprogram and HIV/AIDS program are closely related to each other). •Lack of necessary conditions made it difficult to keep the NHTPs in operation and achieve their goals. •The private health sector grew fast and could play an important role in primary healthcare in community but was not mobilized to participate theNHTPs over the last phase. Recommendations •The leading role undertaken by concerned agencies should be enhanced. •The government’s management capacity should be strengthened through the issuance of legal documents to create a stable and synchronized legal foundation for the implementation of NHTPs. •The steering committees of NHTPs should be strengthened and restructured. At each administrative level, it is necessary to consider whether there should be only one steering committee for all 10 NHTPs instead of 10 committees for 10 programs. •The task force for each NHTP at each level should be strengthened so that it would play a leading technical and coordinating role. •The “social mobilization” policy should be promoted through attracting active and effective participation of all sectors and social and mass organizations. •Attention should be paid to ensure the stability and extension of workforce in NTHPs in general and health workers in particular. Incentive policies for the workforce should include special allowance, in-service and advanced training, technical training on program management. There is a need to establish post-training supervision system. •Monitoring and supervision of program implementation and epidemic surveillance should be reformed. Report forms for each program should be revised to be precise and easy for data and information collection. •Investment should be made to upgrade physical conditions and lab capacities to regional and international standards. Local healthcare facilities, especially those in remote areas should be supplied with basic equipment such as freezer (for vaccine storage) and weighting scale. The protection and usage of vaccine, medication, chemicals and bio-products should be improved. In addition, domestic drug production capacity should be improved to meet the demand of NHTPs. •Information, education, and communication activities on NHTPs should be strengthened nationwide, especially in disadvantaged and remote areas. •Budget allocation for NHTPs should be increased and allocation mechanism should be revised. Specialized agencies should be consulted to give advice on cost norms for each program so that resources would be properly allocated. •The existing international cooperation should be strengthened and furthered to make use of all international support, especially technical support and training. •Different NHTPs should be integrated, especially at local level, so that the usage of resources will be more effective. •Indicators to define diseases that made them eligible for national health target programs should be developed. A national committee should be established to determine a list of “eligible” diseases. |
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