Research o­n management mechanism and evaluation of the effectiveness of health system management at district level in some provinces
in Northern delta

Le Quang Hoanh, Nguyen Thi Thanh, Tran Thi Mai Oanh,

Phan Hong Van, Duong Huy Luong,

Trinh Hung Cuong, Khuong Anh Tuan

Place of publication: Health strategy and policy institute

Year of publication: 2005

The research aims at reality evaluation of the state health management at district level at present in order to propose ways to improve the capacity of the state health management at district level in some provinces in Northern delta.

The research used the method of secondary data analysis and method of qualitative research (in-depth interview, group discussion) in four provinces: Ninh Binh, Hai Duong, Bac Ninh and Thai Binh. 14 towns/districts were chosen to be the study site, and the workshop was organised in Hanoi.

The research findings showed that: It is necessary to separate state health management from district health centres. Decree 12 of the Government is an appropriate policy. However, the Circular of instruction for this Decree realisation is still not sufficient: it lacks information concerning operating mechanism, rights and roles of health specialists, training and providing state management knowledge for health specialists. People's Committees of provinces and cities already have documents of instruction for this Decree, but it has been realised not in all the provinces and cities. Even in o­ne province the realisation of the Decree is not the same in all districts. In those districts where the Decree was realised, many difficulties have been encountered.

The reasons for not implemeting or ineffective implementation of the Decree are as follows: inadequate preparation of the staff (quantity and health state management skills); lack of a suitable cooperation mechanism; unclear statement of the financial sources for the realisation of the duties which have been mentioned.

To summarize: The Decree was issued, but it was not synchronous and did not consider the correspondence between the functions and duties being assigned and the real situation of the localities. There was not a clear regulation about the functions of and the cooperation mechanism between the professional management agency (Department of Health) and the state management agency (district people's committee). In order to make Decree 12 really operative, it is necessary to have sufficient resources: human, financial and a clear function distribution.