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Phuong H. Nguyen, Tung Q. Mai, Quang Nguyen,
Hanh B. Duong,
James
F. Phillips, and Jane Hughes. "Impact of poverty
reduction policy on commune-level primary health care in Thai Nguyen
Province of Vietnam."
ABSTRACT
Objectives
Although Vietnam leads the developing world in creating
universal coverage of essential health services, economic
restructuring and privatization of health services have been
associated with emerging social and economic health care inequity.
In response, the Government of Vietnam has promulgated “People's
Decree 135” providing resources to poor communes for cost-free
commune health center (CHC) services. This analysis aims to examine
the service utilization equity effects of this policy and its
interaction with health service investments in Thai Nguyen Province
designed to achieve minimal quality “benchmark” standard investments
in equipment, facilities, and staff.
Methods
Quarterly health management information system reports from all
180 communes of Thai Nguyen Province are analyzed for the period 1 January
2004–31 March 2006 with generalized regression
methods to explain caseload variance with commune exposure to
poverty policies and CHC service benchmarks, controlling for poverty
level, remoteness, and ethnic composition.
Outcomes
Fixed effect regression results show that poor and remote CHCs
have higher utilization rates than CHCs located in communes that are
less poor and less remote and that this effect is amplified by
Policy 135 exposure. Policy 135 effects are more pronounced if
service quality standards are met at “benchmark” service input
levels. Investments in staff, equipment, and facilities directly
affect overall and under-5 caseloads in all communes, irrespective
of commune poverty status. In Policy 135 non-benchmark communes,
caseloads increase directly with levels of commune poverty,
suggesting that prosperous families abandon CHC care if quality is
poor. Achieving benchmarks elevates caseloads in all exposed
communes, reducing inequity by accelerating demand for CHC services
among all segments of society.
Conclusion
Findings suggest that poverty policies promote utilization,
particularly in poor communes. However, if quality is poor, the poor
are left behind as the less poor seek services elsewhere. Combining
Policy 135 with quality investments reduces the gap between CHC
caseloads in poor communes versus those that are less poor. Findings
lend support to the hypothesis that Vietnam's CHC policies
differentially benefit the relatively poor, but corresponding
prioritization of investment in quality benchmark standards would
further reduce inequity in health care services.
Learning objectives
By the end of this presentation, conference attendees will:
- be able to describe the impact of poverty reduction policy on
primary health care caseloads in Thai Nguyen Province of Vietnam;
and
- learn about ways to use existing health management
information data to assess the effects and interactions of
poverty reduction and service quality improvement policies.
Poster Session 5016.0—Perspectives on Community-based Primary
Health Care
Wednesday, 7 November 2007,
8:30–9:30
am
APHA 2007 Conference Web site
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