Research o­n the real situation and

model construction of health socialization in order to ensure equity and effectiveness in health care for people

National scientific project

Approved in 2003 at the committee of Ministry of

Science and Technology

Introduction

Over the historical periods of struggles for independence, construction of socialism, country unification and socio-economic development, the Health sector has made great distributions to the cause of health care and protection for people.

Since the beginning of "Doi moi" (the period of renovation), health system of Vietnam has seen many changes: because of the lack of funding, many treatment units have applied partly hospital charges, subsidy has been cancelled at the commune level, the system of health care providers has been diversified with private medicine provision and health care sector... The Ordinance about private health care practice was issued in 1993. Fee exemption and reduction have been applied for the prioritized groups: poor people, people who had made great contributions to the country, mothers-heroines of Vietnam... o­n the 21 August 1997, the Government issued Resolution 90/CP about the socialisation of culture, education and health activities; Decree No 73/1999/ND-CP about the policy of encouragement for socialisation of the activities in the fields of education, health, culture and sport. On the 22 January 2002, the Party Central Committee issued instruction No 06-CT/TW about the reinforcement and improvement of the health care network, which mentioned the responsibility of the local authorities in social mobilization for this process.

In reality, the implementation of the policy of health socialization in recent years has yielded positive results: mobilization of different financial sources for health, diversification of health care services, especially increasing activeness and creativity of localities, sectors, social organisations and all the people in health care participation. The human as the key factor has been put forwards.

However, health activites sometimes and at some places have not met expectations. People's needs have not been satisfied, especially for poor people and people living in remote areas. Increasing gap between the rich and the poor has reduced accessibility of health care services for poor people. o­ne of the reasons is the lack of funding for infrastructure and equipments. The other reason is the lack of awareness and adequate understanding of the essence and contents of socialization in health care activities. Health socialisation is simply understood by some people and staff as mobilization of people's contributions through the policies of health insurance and hospital fee. In many places, socialization is understood as charges for the use of expensive and special medical equipments and facilities ("socialized equipment", "socialized bed"), or as privatization of health services...

A research o­n the reality and the construction of a model for social mobilization for health in order to ensure equity and effectiveness in health care is therefore necessary.

Objectives

General objectives: Build a model of health care for people suitable for the socio-economic conditions of Vietnam, aiming at society mobilization for health socialization, ensure equity and effectiveness in health care.

Specific objectives:

1. Evaluate the reality of society mobilization in health care after 10 years of renovation, then proposea model of society mobilization for equity and effectiveness, including:

a. Clarification of the term socialization in health care;

b. Evaluation of the participation of committees and sectors (intersector activities), organisations, communities, families and individuals in health care and protection for people in order to propose suitable modes of intersector activities and community participation.

c. Evaluation of social mobilized sources to meet the health needs according to the criteria of equity and effectiveness, analysis of market push and loss in health care;

d. Evaluation of the funds for providing health care services and diseases prevention, the proportion between subsidied and fee sectors in different socio-economic environments;

e. Evaluation of financial provision types, organisation and mechanism of health care in the last 10 years, research o­n and proposal of a suitable model.

2. Implementation of the proposed model of society mobilization.

3. Effectiveness evaluation of the pilot model according to the specific characteristics of localities based o­n the criteria of equity and effectiveness.

The research was conducted in three stages:

Stage 1:

- Research o­n the definitions and understanding of socialization, equity, effectiveness in health care for people in the world and in Vietnam.

- Research o­n the reality of society mobilisation for health socialization.

Stage 2: Forming intervention model at the researched localities.

Stage 3: Post-intervention research and evaluation.

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(see more in attached file)