Exploring the coordination and continuity of care and services for patients with chronic conditions in Vietnam (WC2015-072)

Background

Starting date: 01/10/2015

The rise of non-communicable diseases (NCDs) and the continued high prevalence of communicable diseases (CDs) pose a double burden to people and health systems in low- and middle-income countries (LMICs). Health services, staff and finance allocation in many health systems in LMICs are fragmented. The fragmentation of services is becoming a barrier towards providing accessible and equitable health care services. Therefore, integration of services has been suggested as a way to reduce fragmentation, provide person-centered services, and improve overall health system performance. One of the criteria of person-centered care and integrated health services is ensuring coordination and continuity of care for patients. Research on coordination and continuity of care, mainly in high income countries (HICs), has showed their positive impact on improving patients’ outcomes, satisfaction and utilization and on reducing hospitalization rates. The coordination and continuity of services does not mean the merging of different services, but rather the harmonizing of the processes of these different services. Therefore, investigating coordination and continuity of services provides a proxy to detect how patients and health systems experience the integration of health services, especially for people with complex needs.

Vietnam has undertaken demographic, epidemiological and socio-economic transitions since the last 25 years. These transitions have pushed the NCDs into the Vietnamese health policy agenda; therefore, four vertical programs for hypertension, diabetes, cancer and COPD have been developed since 2010. A detailed summary and evaluation of the NCDs interventions is discussed in the Joint Annual Health Review (JAHR) of 2014 published by the Vietnamese Ministry of Health in cooperation with the Health Partnership Group. The report highlighted few risk factors hindering access to health services at the system level, which include: “many changes in the organisational structures; limitations in grassroots and primary health care capacity; lack of continuity of care between levels of the health care network; fragmentation of the curative and preventive care services; and medical services focused mostly on curative care”. An evaluation of the four NCDs vertical programs has showed the variety of extent, resources, achievements, and difficulties, and the lack of adequate investment and funds available to these programs. One of the main recommendations of the report is to “develop and implement the project on reform of health services at the grassroots level (from district and lower) using primary health care as the foundation, implement collaboration, integration of preventive medicine, health promotion, treatment, rehabilitation, ensuring linkages and support between different levels of the health system”. Therefore, the question of fragmentation and lack of linkage between the different levels of care and the different vertical programs is relevant to the context of Vietnam and will help in shedding light on the drivers and challenges facing the promotion of integrated health services in Vietnam.