The National Assembly's monitoring delegation believes that the organization and human resources of the preventive health system are still weak, and policies for medical staff are not guaranteed.
The assessment was made by the National Assembly's Supervisory Delegation in its report on the results of the thematic supervision of the mobilization, management and use of resources for the prevention and control of the Covid-19 pandemic; the implementation of policies and laws on grassroots health care and preventive medicine. This is the content reported to the National Assembly and discussed by delegates on May 29.
The monitoring team assessed that the pandemic "exposed weaknesses in the primary health care and preventive health system". The organization and apparatus of this system have changed a lot over the years, human resources are lacking, and quality is not guaranteed. Policies for the medical staff are not commensurate with the task.
Investment in primary health care and preventive medicine has not received due attention. Conditions for drugs, medical equipment and facilities are limited. The ability to provide health services at district and commune levels has not met the basic needs of the people; there are still shortcomings in financial mechanisms, autonomy mechanisms and health insurance policies. The role of preventive medicine has not been fully and comprehensively recognized.
Medical staff in Ha Tinh province inject Covid-19 vaccine to people, June 2021. Photo: Duc Hung
Regarding the cause, the Monitoring Team pointed out that the proportion of expenditure on primary health care out of total social health care expenditure decreased from 32.4% in 2017 to 23.1% in 2019. The proportion of expenditure on medical examination and treatment covered by health insurance at primary health care reached 34.5% in 2022, of which the commune level only reached 1.7%.
The allocation of regular expenditures other than salaries for commune health stations is still low, with some localities only reaching 10-20 million VND per station per year, just enough to cover electricity, water, and administration. Commune health stations are not independent accounting units but depend on district health care, and there are no specific regulations on expenditures at commune health care.
Along with that, the total number of staff working in preventive medicine from the central to district levels only meets 42% of human resource needs, a shortage of about 23,800 people. Of which, there is a shortage of 8,075 preventive medicine doctors, and a shortage of nearly 4,000 public health bachelors.
Low income and benefits, and a lot of pressure in the context of the epidemic, make it difficult for staff to concentrate on their work. The support level for village and commune health workers is only 0.3 and 0.5 compared to the basic salary (equivalent to 447,000 and 745,000 VND), which does not encourage them to maintain their jobs and is the main reason why people working in preventive medicine change jobs and resign more and more.
The monitoring delegation recommended that the National Assembly strengthen supervision of policy implementation and improve the legal system on primary health care and preventive medicine; and requested the Government to submit to the National Assembly a bill related to this field by 2025 at the latest.
The Ministry of Health urgently completes and submits to the Prime Minister for consideration and promulgation a plan for the network of medical facilities and the system of medical examination and treatment facilities to meet the needs of medical examination and treatment in each region and locality, avoiding scattered investment causing waste.
The Ministry of Health is interested in investing in developing and improving the quality of primary health care instead of just focusing on investing in building new hospitals; developing the family doctor model, mobilizing the participation of private health care to contribute to reducing the overload at upper-level hospitals.
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