Improving the quality of maternal and child health care in mountainous areas

Doctors and nurses examine people in Yen Binh district, Yen Bai.

In recent years, thanks to the attention and investment of the Party and the State, and the efforts of the health sector at all levels, maternal and child health care and reproductive health in our country have achieved remarkable achievements. However, the current maternal mortality rate, child mortality rate, and malnutrition rate still have differences and gaps between urban and rural areas, between plains and mountainous areas, and between ethnic groups. These continue to be challenges for the health sector in mountainous provinces in the coming time.

Point model efficiency

Sitting in the hallway of the Neonatal Unit (Bac Ha District General Hospital, Lao Cai Province) waiting to pick up her granddaughter after a period of treatment here, Ms. Ly Thi Sau (Ban Pho Commune, Bac Ha District) said: When we heard that my grandchild had respiratory failure and jaundice after birth, my family was extremely worried about her health and life.

However, after the doctors explained the disease and treatment plan carefully, my family felt completely secure and confident that the doctors and equipment here were capable of curing my child’s illness, without having to transfer him to a higher level hospital like before.” This not only helps patients receive timely treatment, but also helps reduce costs for patients, because most of the people here are ethnic minorities and have very difficult economic conditions.

According to Dr. Cu Seo Xay (H'Mong ethnic group), the Neonatal Unit of Bac Ha District General Hospital is fully equipped with equipment such as: Incubators, phototherapy lamps, oxygen ventilators, CPAT ventilators... On the other hand, doctors and nurses at the hospital participate in training courses on pediatric emergency care and neonatal resuscitation by experts from the National Children's Hospital and Hai Phong Obstetrics and Gynecology Hospital, so almost all sick and premature newborns are treated promptly and do not have to be transferred to higher levels.

Since the introduction of modern equipment and a team of doctors with solid technical skills, many children born at home with severe respiratory failure or premature births were given timely emergency care and saved when brought to the hospital. Currently, the rate of referral is very low, being cases of failed treatment or cases where the family wishes to transfer.

Director of Bac Ha District General Hospital Nguyen Nhu Tuan said: The district has more than 84% ethnic minorities, there are still some customs and practices that are not good for health such as early marriage, teenage births, and consanguineous marriages, which have significantly affected the health of mothers and children. The rate of mothers and newborns receiving postnatal care in the district is only 77.98%; the rate of births at medical facilities is only 79%; the rate of newborn screening is only 50%... Therefore, the Ministry of Health and the health sector of Lao Cai province have directed and supported the implementation of many activities to improve maternal and child health care and reproductive health for people in the area.

Specifically, the Ministry of Health has directed Hai Phong Obstetrics and Gynecology Hospital to support and transfer techniques in the form of “hands-on” in the fields of reproduction, maternal, fetal and newborn care. In addition, the hospital has also invested in modern equipment such as: 4D color ultrasound machine; ultrasound fetal heart rate monitor; uterine endoscopy and cauterization system; sterile newborn bathtub; patient monitor; newborn incubator, jaundice phototherapy lamp; electric syringe pump; infusion machine; CPAT ventilator...

Thanks to synchronous investment, the hospital has now mastered techniques in the fields of obstetrics and pediatrics such as: cesarean section, hysterectomy, fibroid surgery, infant feeding with incubators... Specifically, in 2023, the hospital examined and treated 2,191 patients, including 223 surgeries, 532 deliveries and gynecological treatment for 767 people. In addition, Hai Phong Obstetrics and Gynecology Hospital also coordinated with related units to organize a program of medical examination, treatment and free medicine for people in Bac Ha district.

Associate Professor, Dr. Vu Van Tam, Director of Hai Phong Obstetrics and Gynecology Hospital said: With the responsibility assigned to direct the field of medical examination and treatment in obstetrics and gynecology for Lao Cai province, Hai Phong Obstetrics and Gynecology Hospital is ready to transfer the best techniques, suitable for human resources conditions as well as medical equipment, disease models of ethnic minorities in the province. In addition to direct training, the hospital is also always ready to help train human resources, hospital management technology, and provide professional support through remote examination and treatment (Telehealth).

Bringing the mountainous areas up to speed with the lowlands

According to the Ministry of Health, the maternal mortality rate has decreased more than five times, from 233/100,000 live births in 1990 to 44/100,000 live births in 2023; the under-five mortality rate has decreased nearly four times, from 58‰ to 18.2‰; the under-one mortality rate has decreased from 44‰ to 11.6‰; the child malnutrition rate has also decreased sharply from 53% to 11%...

In addition, the system of obstetrics and pediatrics examination and treatment has developed strongly from the central to the grassroots level; many advanced scientific and technological achievements in the world have been researched and applied to improve the quality of maternal and child health care and reproductive health of the people. Thanks to these achievements, Vietnam has been assessed by the international community as a bright spot in the implementation of the Millennium Development Goals (now the Sustainable Development Goals on maternal and child health).

However, in reality, the work of maternal and child health care and reproductive health in our country still faces many difficulties and challenges, namely: Maternal mortality, child mortality, and child malnutrition have decreased, but there are still differences and gaps between urban and rural areas, between plains and mountainous areas, and between ethnic groups. Maternal mortality among ethnic minorities is seven times higher than that of Kinh people; child mortality, child malnutrition, especially stunting in mountainous areas of ethnic minorities, is still two to three times higher than the national average.

Deputy Minister of Health Tran Van Thuan said: In order to continue narrowing the gap between regions and gradually bring the mountainous areas up to par with the lowlands, the National Assembly and the Government have approved and implemented the "Socio-economic development program for ethnic minority and mountainous areas for the period 2021 - 2025" which includes many important goals on health and nutrition for mothers and children.

To support mountainous provinces in successfully implementing these goals, on December 6, 2023, the Minister of Health issued Decision No. 4440/QD-BYT assigning the scope of direction to the line in the field of medical examination and treatment in obstetrics and gynecology. Support and direction activities have helped medical facilities in mountainous provinces improve their medical examination and treatment capacity, bring high-quality medical services closer to the people, and continue to contribute to reducing deaths and complications in mothers and newborns in ethnic minority areas.

To continue improving the quality of maternal and child health care and reproductive health; and gradually narrow the gap between mountainous and lowland areas, the Ministry of Health will continue to mobilize resources to support mountainous, remote, border and island districts to upgrade facilities, supplement equipment, and train human resources to strengthen and improve the quality of maternal and child health care and reproductive health services; implement a comprehensive essential obstetric emergency service package at the district level; deploy maternal and child health monitoring books, including an electronic version. On the other hand, the Ministry of Health will restart the Satellite Hospital Project, Project 1816... in which not only central hospitals participate, but also mobilize provincial and city hospitals with strengths in obstetrics and pediatrics to join hands with central hospitals to soon fill the healthcare gap, especially in remote areas, areas with particularly difficult economic conditions.

In addition, localities need to continue to maintain inspection and supervision to support all levels, including private health care. Inspection content should focus on compliance with professional regulations to improve the quality of care, obstetric and neonatal emergencies; pregnancy management, maternal and child nutrition, reproductive support, safety, etc.

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