Asia Times: Vietnam shows the way to health with little wealth



	April 08, 1999	atimes.com

Southeast Asia

Vietnam shows the way to health with little wealth
By Satyajit Singh

HANOI - Two years ago, equating health with height, someVietnamese state officials claimed that by the year 2020 theaverage Vietnamese will stand 165 centimeters tall - a full sixcentimeters more than now.

Mesmerized by foreign media projections of their country as thenext Asian ''tiger economy,'' Vietnam's authorities believed thatrapidly rising standards of living would also improve the averagelife expectancy of its citizens.

Now, with the Asian economic crisis banging at the doors, thebets are off. But experts point out that Vietnam's impressivepublic health achievements using its scarce resources meansfuture generations could still be walking tall - if not taller.

''Vietnam's past record on health and fertility improvementshave been matched by few low-income countries,'' acknowledges arecent report for a health project funded by the World Bank, AsianDevelopment Bank and the German and Vietnamese governments.

Despite decades of war and turmoil, Vietnam's socialistplanners have always shown a strong political commitment tohealth, allocating substantial resources to it.

This means that while Vietnam remains one of the world'spoorest countries, with a per capita income only slightly morethan $200, its public health infrastructure can leave farricher neighbors green with envy.

Vietnam has 170 primary health clinics at the village level permillion population, compared to 32 in Indonesia, 63 in China and141 in Thailand.

There is a hospital bed for every 389 Vietnamese, compared to465 Chinese, 665 Thai and 1,743 Indonesians.

In 1993, according to World Bank figures, nearly 97 percent ofVietnam's population of 76 million had access to basichealth services. Figures for life expectancy, infant mortalityrates and literacy levels are all good.

Since the late 1980s, however,doubts have arisen because an increasingly ''market friendly''government has favored greater involvement of the private sectorin providing curative services and the sales of pharmaceuticalsproducts.

''The Vietnamese government is still strongly committed tomaintaining a strong public health network but there have beenrapid changes in our society due to the transition to the marketeconomy which are not yet fully understood,'' says Prof. Pham HuyDung, deputy director of the Center for Social Sciences forHealth of the Vietnamese Ministry of Health in Hanoi.

The dilemma appears to be that while political commitmentremains, money is hard to find. The Health Ministry, for instance,has drawn up a long-term 'Strategy for Health for All by the Year2000' and launched many national programs to address priorityhealth issues and strengthen public health facilities.

But, at $228 million, the money allocated for healthcarein 1998 was less in real terms than in 1997. Per capita healthexpenditure stood at 3.50 dollars in 1997.

Experts say the clearest symptom of recent decline in theVietnamese health sector is the marked reduction in the use ofhealth services.

According to the Ministry of Health, the number of outpatientconsultations in state-run health centers has halved since thelate 1980s - from an annual rate of 2.1 visits per person in 1987to 0.9 in 1993. Lack of funds to replace old medical equipment iscited as a reason.

The changing face of the Vietnamese economy has also given riseto new public health problems - such as those stemming fromgrowing urban slums, environmental degradation and rapid butunsafe industrialization. In 1997, 402 workers died and 1,870 were injured in industrialaccidents - an 80 percent jump from the year before.

A substantial threat to public health is the HIV/AIDS epidemic,spreading in tandem with increasing commercial sex activity anddrug use. According to government estimates, about 100,000 Vietnamesewere carrying the HIV virus at the end of 1998 and the numbercould increase to 350,000 people by the year 2000.

Rising costs of pharmaceutical products, a bulk of which areimported and hence affected by currency fluctuations, mean that alarger number of citizens are now resorting to self-medication ortraditional remedies - not all of which are safe or effective.

''At one level the expansion of the private sector into healthcare can be seen as an example of markets addressing public healthproblems and improving efficiency. But it can also be seen asevidence of the need for more effective public healthintervention,'' says the Hanoi-based Nguyen Hong Anh of Oxfam, anon-governmental organization.

Health experts say the lesson so far is that Vietnam cannotafford to be complacent because its main health problems are stillpoverty-linked, as in many other developing countries.

Chronic malnutrition still affects more than half of allVietnamese children between one and five years of age and inrecent years there has been a resurgence of preventable diseaseslike malaria and tuberculosis. But international agencies workingin Vietnam remain upbeat about the country's ability to cope withthese problems.

Officials at the United Nations Development Program (UNDP)report that in the decade since 1986, when economic reformswere made, poverty levels in Vietnam have actually come down by over35 percent, alongside improvements in life expectancy and adultliteracy.

''There are lessons for all countries from Vietnam's experienceof emphasizing growth, stability and equity,'' says a senior UNDPofficial in Hanoi.

According to most health experts in Vietnam, the twin agendafor the 21st century should be to improve the quality of publichealth services while controlling increasing incidences of overpricingand fraud among private health providers.

With its long experience in fighting battles simultaneously onmany fronts, they hope this will not be too tall an order for Vietnam.

(PANOS)

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©1999 Asia Times Online Co., Ltd.

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