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Renovation of the healthsystem governance towards equity, efficiency, and development Dam Viet Cuong and colleagues Place of publication: Ministry of Heath Year: 2006 This study is a technical report under the project Policy options for renovation and improvement of Vietnam health system towards equity, efficiency, and development. Background Health policy making has not strongly been based on sufficient information and scientific evidence. Little is known and foreseen about the impact of health policy reforms on equal access to treatment and behavioral changes among health service providers and users, quality of health services, and public opinions. There persists a lack of necessary collaboration between policy makers and researchers. The inspection and law enforcement forces lacked human resources, capacity, and legal power to effectively play their inspection and monitoring role, especially in technical monitoring. A consistent, timely and accurate reporting system is not in place yet. There is no relevant criteria to assess the quality of health services and preventive medicine. There is no appropriate, strict and clear incentive structure to award and penalize behaviors accordingly. Inter-departmental dialogue between policy implementing agencies, health officials, and beneficiaries is not common. Mass media channels are not effectively employed. The organizational structure of health sector is not adequate to serve its mission, mandates, and functions. The governance of the health system is, to a large extent, decentralized to local level, but they do not catch up with the fast-growing private health sector. Organizational structural of some health policy management and administration bodies does not fit with their functions and duties. There is a lack of suitable mechanism to enhance the accountability of organizations and personnel in the health system andto ensure the transparency in performing their functions and tasks. Renovating and strengthening the state’s role in health system •There is a need to strengthen the state’s strategic role in planning, managing, regulating, and supervising the health sector while reducing direct involvement in the management of day-to-day service delivery. •In a market economy, the state should take a bigger role in establishing the prerequisite conditions for efficient functioning of the market, correcting the market failure, and increasing equity in healthcare. •In addition to an increasingly complex administrative and managerial role, the state should also be a provider of public health service, primary healthcare and responsible for development of the public health care sector, especially at local levels and in disadvantaged areas. Improving policy making process •Firstly, health policy needs to be largely based on scientific evidence and periodically monitored, evaluated and updated. Studies of community health status and impact of policy implementation must be an integral part of the policy making and revision process. •Secondly, continue to finalize the overall long-term development strategy for the healthcare system, which serves as a foundation to formulate health policy development programs. This overall strategy should include policy directions to ensure equity, efficiency, and development of the health system, correcting the incompatibility of internal health development policies as well as making them conformable with general socioeconomic development policies. •In policy making, it is necessary to get more feedbacks from members of the National Assembly, the People's Councils at all levels as well as voices of the beneficiaries. There is a need to increase the number and enhance analytical capacity of health policy staff at the Ministry of Health and other concerned Ministries. Health policy analytical personnel should be facilitated to make in-depth contribution rather than provide formalistic services. •Thirdly, inter-sectoral collaboration should be further fostered, creating linkages and partnership. The inter-sectoral collaboration should be initiated in an early stage of the policy planning and building process. Dialogues among health agencies, concerned non-health agencies, health service providers and users should be often conducted. •Improve information flow and communication on health policies; organize and train a taskforce of communication specialists in charge of public relations (PR). Organizational restructuring of health management system •Supervision and inspection should be seen as one of the most important tasks of the state management and administration. Supervision and inspection apparatus at ministerial and provincial level need to be strengthened in quantity and quality. •Develop a scientific and objective reporting system on healthcare and preventive health. The reporting system should include criteria and indicators for scientific and reliable measurement of healthcare quality, allowing objective evaluation of public health status and health service quality. •Organizational structure and mandates of the state management apparatus should be re-designed to meet with the changing managerial tasks over thefast-growing private health sector. It is necessary to empower management bodies with legal framework and appropriate mechanism so that they can effectively implement and enforce policy applicable to individuals and entities operating in health services in both private and public sectors. •Finally, accountability remains to be a weakness to be improved in the state management and administration. There is a lack of transparency and clear division of tasks and responsibilities among organizations and individuals. Penalty on unfulfilled performance is not a common practice. Decentralization in the state management and administration •Increase delegation of managerial and administrative roles to health service providiers (treatment, production, etc.) belonging to the Ministry of Health. The Ministry of Health shall have more time to devote to policy making,supervising, and advising at macro level. •Further decentralization to local levels, not only in policy implementation but also in policy-making that is specific to the local context. •Enhance self-control of public hospitals, following a step-by-step schedule in management decentralization when necessary conditions are in place as presented above. Renovating and strengthening inter-sectoral collaboration •Regularly conduct inter-sectoral dialogues, internal dialogues and dialogues between health service providers and users to reach consensus on policy implementation. •Continue to promote the roles of communities, the party network, governments, mass organizations, and social organizations in the coming period. •Exercising with caution decentralization shall better foster integration and inter-sectoral collaboration at local levels and strengthening inter-sectoral cooperation at the national level.
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