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Researches Health System

Vũ Thị Minh Hạnh, Trần Thị Hồng Cẩm, Trần Vũ Hiệp, Hoàng Thị Mỹ Hạnh, Đậu Thị Hà Hải, Vũ Thị Mai Anh, Hoàng Ly Na

Place of publication: Ministry of Health
Year of publication: 2010
In 2005, the Minister of Health released the Action plan to combat human pandemic influenza in Vietnam. After four years the plan being in implementation, there is a need for evidence on outcomes as well as challenges and drawbacks of the action plan, whereby recommendations for amendment of the Action plan to combat human influenza A (H1N1) pandemic can be made and solutions to improve the feasibility and performance of the plan can be proposed.

1. Describe the process of development and implementation of the action plan to combat human influenza pandemic at central level agencies and selected locations; 
2. Explore advantages and challenges in implementation; 
3. Examine the practicability of the Action plan to combat human influenza A (H1N1) pandemic in Vietnam; 
4. Propose specific actions to enhance the performance in combating human pandemic flu in the next period.
Survey sites: The study was conducted at a number of health facilities representing both the preventive and curative sub-sectors at the national level and in the six provinces of Ha Nam, Hoa Binh, Quang Tri, Quang Nam, Tra Vinh and Đak Nong.
Methodology: Cross-sectional descriptive study, combining both quantitative (data collection with statistical questionnaires) and qualitative (in-depth interview – 51; focus group discussions – 18) studies.
The National action plan to combat human flu pandemic enacted by the Ministry of Health in 2005 has been expeditiously rolled out with consistent steps taken in various line agencies, levels and sectors. 
Pandemic control Steering committees have been quickly streamlined at specific central ministries and line agencies, provinces and most districts and communes, medical practices located in the survey sites, and have successfully played the role of advisors to Party committees and the government in introducing vital leadership guidelines, providing a political and legal framework for pandemic control activities and pooling considerable all-round resources for pandemic response purposes. Nevertheless, at some entities, the steering committee’s formation and operation still remain superficial.
Information, education and communication on influenza A (H5N1) control has been increased at both the central and sub-national levels, with a view to community outreach and disseminating to the population more specific, accurate, alerting and guiding, but not intimidating and distressing information. Education and communication on influenza A H5N1 control, however, remains scattered and spontaneous, and lacks the coordination of dedicated agencies from relevant sectors.
Training and capacity building for pandemic control staff have been emphasized in relevant sectors and various levels in surveyed sites.
Pandemic control contingency plans and exercises have been practiced in specific locations, with the involvement and strong support of various sectors and civil society.   
Outbreak surveillance and alert have been highly focused over the years. Resources constraints, however, have resulted in overstretching of the testing capacity of these facilities in time of outbreak.
Zoning for control and management of outbreaks has been done expressly and systematically, involving various line agencies and civil society.
Medicines, chemicals and protective supplies have basically been provided and stockpiled on site and can sufficiently meet the need for outbreak control in the past few years. Again, resources constraints only allow limited stockpiles, which will likely be insufficient to meet users’ needs in case widespread outbreaks take place.
Physical facilities and equipment for use in treatment of influenza A (H5N1) patients have also received utmost attention from all medical practices from the central to sub-national levels in the past few years. The curative capacity of most district hospitals and even some provincial and national level hospitals, however, remains inadequate. 
International cooperation in outbreak control has been emphasized in areas with shared national borders.
Existing gaps that need to be filled quickly: deficiencies in the outbreak control mechanism involving entities in and outside the health sector, decentralization and empowerment systems in definitive testing, outbreak reporting, management of specific drugs etc., deficiencies in infrastructure, human resources and equipment at some province and district level institutions; limited outbreak control funding; undesirable compensation schemes and particularly carelessness and neglect in outbreak control at the frontline level in specific locations.
Implementing arrangements for the Action plan to combat the human influenza pandemic show no significant variance between provinces with and without outbreaks in the past years.

Further strengthening the role of steering committees at various levels in outbreak surveillance and supervision; Expeditious development and coordination of collaborating mechanisms in outbreak control between different sectors, levels and agencies in the health sector; Possible revision and update of specific regulations: authorized levels for outbreak notification, allowing provincial Health Departments to initiate small and medium scale outbreak notices, licensing bio-safety laboratories for specific frontline curative facilities in capable areas, permitting the district level to have control over specific drugs, and so on;  Selection of CPR installation sites to put the equipment to full use; Channeling resources to develop international standard laboratories in 4 or 5 areas in the country; Development of advanced rehabilitation and respiration centers for frontline hospitals to cope with viral pneumonia incidents; Regular maintenance of continuum of training to upgrade knowledge, professional skills and user skills of protective supplies for health workers of various levels through a TOT approach; Focusing more on technical transfer through one-to-one coaching between upper and lower level medical practices; Adjusting specific regulations on remuneration for employees directly involved in outbreak control; The epidemic response funding allocation scheme needs to be revised with priority given to poor provinces, provinces in epidemic emergency, among others.


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