Viet Nam has a population of 87,848,000. 86.2% of the population is Kinh (Viet) while local ethnic minorities such as Tay and Hmong make up the remaining population. The country is bordered by China, Laos, Cambodia and the South China Sea. The capital city is Hanoi since the reunification North and South Viet Nam in 1976. 30% of the population live in urban area (compared to a regional average of 50%) and Gross National Income per Capita is USD3,070 (compared to a regional average of USD10,218). Viet Nam was politically isolated and impoverished when it was first reunified under the Communist government, but since the Political and economic reforms (Doi Moi) launched in 1986 Viet Nam has transformed from one of the poorest countries in the world, with per capita income below USD100, to a lower-middle income country with per capita income of USD1,130 in 15 years time.
Life expectancy at birth for male and female is 70 and 74 respectively (compared to a regional average of 72 and 76). 6.8% of the total expenditure is spent on health.
There is a bigger disease burden, especially that of infectious diseases, in Viet Nam compared to neighbouring countries. The prevalence of HIV per 1000 adults aged 15 to 49 is 4 compared to the regional average of 1, while the prevalence of tuberculosis per 100,000 population is 334 compared to the regional average of 139. The prevalence of both diseases is rising steadily in the past decades.
Viet Nam has been introducing social health insurance (SHI) since 1992. The country’s health insurance law was promulgated in 2008, with the goal of universal coverage by 2014. Viet Nam has introduced social health insurance (SHI) to gradually replace a tax-based health financing system since 1992, and currently population coverage for health expenses is 60%. The state subsidises premium payments, and the rest of payment is paid by citizens. Despite its decrease over the years, the share of household out-of-pocket payments for health still accounts for some 55% of total health expenditure.
Public healthcare is funded and governed by the Ministry of Health of Viet Nam - users pay a nominal fee for beds but would need to pay full price for clinical tests and medication.
Political and Socio-economic factors
Modern Viet Nam is a one-party socialist country, but it is no doubt undergoing a transition from a planned to a market economy. Although the GDP per capita is increasing, what accompanies is also a widening income gap and weakened safety net – compared to in the past there was universal coverage of essential health services at little or no direct cost to households. Viet Nam has a developed health service with extensive rural coverage by communes and village health workers, but these rural health services are under threat with the loss of cooperative finances. With the income of poor households not catching up with the ever-increasing cost of healthcare in Viet Nam, study has shown that poor households delayed and minimised healthcare seeking, especially of expensive hospital services. They also had to reduce essential consumption, sell assets and incur debt in order to pay for hospital care. Such inequity may increases their vulnerability to illnesses and in turn their inability to afford healthcare that was previously available, contributing to the downward spiral of health of the poor.
Ethnicity, culture and religion
Vietnamese may attribute illness to biological causes (as defined by Western medicine), spiritual causes or the disruption of balance and harmony. For illnesses that are thought to have a spiritual or supernatural cause, Vietnamese may seek assistance from traditional practitioners or Buddhist monks (Buddhism being the predominant religion of the nation). They generally regard Western medicine as more effective than traditional medicine, but they may discontinue medications or self-adjust to smaller dosages because Western medications are believed to be extremely potent. This might cause problems especially with infectious diseases as they may stop taking antibiotics prematurely and encourage the evolution of multi-drug resistant infections.
Also, despite improving literacy rate and education level, many Vietnamese demonstrate limited knowledge as in how infectious diseases are spread and have little recognition for the concept of preventive medicine. Using tuberculosis as an illustrative example, a sample of Vietnamese people has identified TB causation as malnutrition, excess stress, heredity, sharing eating utensils, and the supernatural. Most people also believe in two forms of TB, namely “psychological TB” (lao tâm) and “physical TB” (lao løc), and often consider themselves as low risk for TB. This may in turn contribute to delayed care seeking and increased risk of transmission because of prolonged period of infective illness.
Viet Nam is a country vulnerable to climate change, with the majority of the country’s poor dependent natural resource exploitation for their living. The problem of poverty is especially high in rural, costal, mountainous, islands and areas prone to climate change – the reason is multifold. First of all, these areas are difficult to access. Local people would find it more difficult to reach points providing healthcare service and equally it is more difficult for healthcare professionals to reach these areas. They are thus more likely to escape health surveillance and early intervention.
Secondly, Viet Nam is one of the world’s most severely flood-prone developing countries with frequent flooding caused by monsoons, typhoons and coastal storms as the major natural disaster. Climate change brings forth more dramatic and adverse weather conditions to the vulnerable areas, resulting in more rife spread of infectious diseases which in turn impact on health. An example would be that floods favour transmission of dengue fever and more frequent and prolonged floods have increased the disease burden on the population living in low areas.
Research has shown that, however, environmental factors can possibly be counteracted by local adaptations. In North Viet Nam for instance, low land housing types, which were transplanted without modification to the highlands, were responsible for the higher rates of malaria among lowland-to-highland migrant populations, whose ground-level dwellings exposed them to low-flying mosquito vectors. Native hill peoples, on the other hand, had adjusted to the malaria threat by constructing stilted houses with living quarters above the mosquito’s 10-foot flight ceiling. People in Viet Nam are aware of their particular vulnerability to infectious diseases because of their geographical location and are constantly working on adapting to adverse conditions and promoting village healthcare to improve access.
Further reading (if you must) |
Centers for Disease Control and Prevention (2008a) Chapter 2. Overview of Vietnamese Culture. Promoting Cultural Sensitivity: A Practical Guide for Tuberculosis Programs That Provide Services to Persons from Viet Nam – US CDC Ethographic Guide to Viet Nam. U.S. Department of Health and Human Services Centers for Disease Control and Prevention
Centers for Disease Control and Prevention (2008b) Chapter 4. Common Perceptions, Attitude and Beliefs About Tuberculosis Among Viet Namese. Promoting Cultural Sensitivity: A Practical Guide for Tuberculosis Programs That Provide Services to Persons from Viet Nam – US CDC Ethographic Guide to Viet Nam. U.S. Department of Health and Human Services Centers for Disease Control and Prevention
Few R, Tran PG and Hong BTT (2004) Living with Floods: Health Risks and Coping Strategies of the Urban Poor in Viet Nam. British Academy (Committee for South East Asian Studies)
Inborn MC and Brown PJ (1990) The Anthropology of Infectious Disease. Annual Reviews of Anthropology 19:89-117
McMichael AJ and Lindgren E (2011) Climate change: present and future risks to health, and necessary responses. Journal of Internal Medicine 270:401-413
Ministry of Planning and Investment, Socialist Republic of Viet Nam (2010) Millennium Development Goals 2010 National Report. Hanoi, Viet Nam
Segall M, Tipping G, Lucas H, Dung TV, Tam NT, Vinh DX, Huong DL (2002) Economic transition should come with a health warning: the case of Viet Nam. Journal of the Epidemiology of Community Health 56:497-505
Tran VT, Hoang TP, Inke M and TKP Nguyen (2011) Health Financing Review of Viet Nam with a Focus on Social health Insurance. World Health Organisation