Yikai Feng 1,2, Tran Diep Tuan3, Junyi Shi1,2,Zhuo Li4, Mailikezhati Maimaitiming1,2, Yinzi Jin 1,2 , Zhijie Zheng1,2
1. Department of Global Health, School of Public Health, Peking University, Beijing, China
2. Institute for Global Health and Development, Peking University, Beijing, China
3. University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam
4. Institute of Area Studies, Peking University, Beijing, China
Abstract
Introduction One of the ultimate goals of strengthening the health system is to achieve health equity. Vietnam is considered one of the ‘fast-track countries’ to achieve the health-related Millennium Development Goals, but research on its equity strategies remains inadequate.
Methods Using Vietnamese official health statistics, we investigated inequity in four dimensions including health resources, service delivery, service utilisation and residents’ health status from the perspectives of income levels, poverty rates and subnational regions. The Slope Index of Inequality, concentration curve/Concentration Index, absolute difference and Theil Index were used.
Results Four indicators showed ‘pro-poor’ inequality in health resources, including the per capita health budget, per capita health personnel, per capita health personnel at the community level and per capita hospital beds at the community level, while provincial hospital beds showed ‘pro-rich’ inequality. Two health service delivery indicators (delivery of antenatal care ≥3 times and proportion of community health service centres with medical doctors) show ‘pro-rich’ inequality, although two health status indicators, mortality and malnutrition rates for children under five, showed ‘pro-poor’ inequality. The Northern Midlands and Mountain Areas, and the Central Highlands were disadvantaged regarding service delivery and health status. Intraregional differences were the main factors contributing to the inequalities in delivery of antenatal care ≥3 times, provincial hospital beds and percentage of community health centres with medical doctors, with the Red River Delta and the South East region experiencing the greatest inequalities.
Conclusion The overall level of health equity in Vietnam has increased over the past decade, although inequality in health service delivery has hindered progress towards health equity based on income, poverty and subnational regions. Targeted policies need to be introduced to reduce inequities relating to the health workforce and service delivery capacity.
For additional information , please refer to the original source https://doi.org/10.1136/bmjgh-2023-014739