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Researches Community health care

 Vũ Thị Minh Hạnh, Trần Vũ Hiệp, Hoàng Thị Mỹ Hạnh, Nguyễn Văn Hùng,

 Hoàng Ly Na,Tường Duy Trinh, Vũ Thị Mai Anh, Trần Thị Hồng Cẩm, Vũ Văn Hoàn
Place of publication: Ministry of  Health
Year of publication: 2012
1. Describe the current status of the provincial and district public health care network in five Central Highland provinces; 
2. Analyze the health services delivery capacity of the public health care network at provincial and district levels in the five Central Highland provinces.
Methodology: Cross-sectional study with analysis, combining quantitative and qualitative approach.
Key findings
While the provincial and district general hospital (GH) network has now had a full coverage, specialized hospitals are virtually absent in the Central Highland.
Four of the five studied provinces have not reached the target of public hospital beds for every 10,000 population. 
Patient bed occupancy is 100% at provincial GHs, 79% at inter-district hospitals, and more than 85% at district hospitals. About 5% of district hospitals, however, are running at less than full load.
The organizational structures of provincial and district hospitals are still being streamlined. Most provincial hospitals have managed to separate fundamental clinical and para-clinical departments. 
At the district level, most hospitals have now had essential back-offices and para-clinical departments. In respect of the clinical wing, most hospitals adopt the Internal Medicine-Pediatrics and Surgery-Obstetrics inter-departmental model. 
The medical workforce at provincial and district hospitals remains insufficient compared to r Circular 08 norm. At the provincial level, rates of medical doctors, bachelor's degree pharmacists and nurses respectively met only 88%, 11.1% to 36.3% and 88.7% of the targets.. At the district level, Dak Nong and Kon Tum are the two provinces that have no hospitals meeting the doctor availability norm. In Dak Lak and Gia Lai provinces, district GHs meeting the doctor benchmark are few (14.4% and 30% respectively).
Infrastructure: 100% of provincial GHs and < 50% of district GHs are now permanently built facilities, meeting physical infrastructure requirements. 
Equipment: At provincial GHs, the Ministry of Health’s official equipment list for the four specialties of Intensive Care, Internal Medicine, Obstetrics, and Pediatrics is adhered to by > 80%. At the district level, Intensive care, followed by Surgery and Internal Medicine, are the specialties with higher percentages of hospitals adequately equipped as required. In the Obstetrics area, , 60-65% of the facilities are properly equipped, while in the pediatric one, only about 58-60% of district GHs are well equipped.
The service delivery capacity by level of care of the provincial GHs in the five specialties of Intensive Care, Internal Medicine, Surgery, Obstetrics and Pediatrics remains weak. At district general hospitals, the ability to provide medical services by level of care is even weaker.  
The disease and mortality patterns by the five top common diseases treated at Central Highland hospitals are very similar to the country’s context. 
The percentage of Central Highland residents seeking health services is on the rise over the years and consistently higher than the country average. The utilization of both outpatient and inpatient health services, at public hospitals in the Central Highland, however, is lower than the country average. 
An increase in planned hospital bed capacity for all provincial and district GHs is advisable for all provinces (except Kon Tum). In the short-term, the bed capacity of 21% of district hospitals currently running at less than full load may be adjusted to replenish other hospitals. 
Further investments are needed to effectively roll out existing policies on recruitment, training and compensation to attract workforce, especially medical doctors and Bachelor's degree pharmacists for provincial GHs in Kon Tum, Dak Nong and Gia Lai provinces, and district hospitals in all the five provinces. Provincial and district hospitals in shortage of nurses should be directed to employ sufficient numbers of nurses as required under Circular 08. 
Further investments are needed to improve the physical infrastructure for GHs/Health centers of 50% of district GHs in the provinces. 
Priorities need to be given to the provision of equipment for the surgical area of provincial GHs and Obstetric and Pediatrics areas of district  GHs/Health Centers.
Advanced training priorities need to be given  in the areas of Obstetrics (including Bachelor nurses and ob-gyn technicians) and Intensive care for all provincial hospitals, while further advanced training for other specialties should be provided, particularly for the provincial GHs of Dak Nong and Lam Dong II . Advanced training for surgery and intensive care will need to be made as a priority, while at the same time, training need assessments should be made for internal medicine, pediatrics and obstetrics for district hospitals of all the provinces, especially Kon Tum and Dak Nong.
A review on type of diseases/causes of death in areas with significantly higher rates of mortality than the country average such as cerebral bleeding, pneumonia, traumatic brain injuries, heart failure, acute bronchitis and bronchiolitis- should be made. Training and in service training activities to upgrade  skills  dealing with these diseases/causes for health workers at all levels of care should be facilitated.
Lessons and experiences drawn from the ADB’s People’s Health care project in Central Highland provinces, 2005-2009, need to be studied in order to design post-graduate, advanced and in-service training courses tailored to the current conditions of district and provincial hospitals in the Central Highland. 

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