Health Financing and Delivery in Vietnam
stocks were reduced over the period 1997–2002 at the CHC level, but increased at the district hospital level. Staff numbers increased at both levels, but especially at the district level. Both CHCs and district hospitals increased the number of stocked items and services relevant to maternal and child health—common indirect measures of quality in the first level of care in developing countries. Despite these changes, the number of outpatients seen at both the CHC level and at the district level did not, according to the DHS data, change over the period. This is not consistent with the MOH administrative data, which even in this period showed some increase. In Vietnam, as in many—if not most—other countries, very little routine data are collected that shed light on the quality of care. Limited—and very dated—evidence on quality is available from health facility surveys undertaken by WHO that focus on care administered to small children (World Health Organization 1998). Children with diarrhea appear to receive care that is high quality by international standards (figure 5.2). A high fraction of children with Figure 5.2: Quality of Care to Children with Diarrhea, Late 1990s 100 90 80 70 % of children seen
60 50 40 30 20 10
% correctly assessed
% correctly rehydrated
correctly managed Source: WHO.
Vietnam
Sudan
Bangladesh
Indonesia
Ethiopia
0 Egypt
116
correctly advised
correctly treated for dysentery