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Current practice of governance of health care at grass root level in some selected areas Dam Viet Cuong, Khuong Anh Tuan and colleagues Place of publication: Health Strategy and Policy Institute Year: 2006 Objectives: 1)To analyze the current situation of health care management at grass root level 2)To identify problems and provide suggestions to improve the effeciency of governance of health care at grass root level Methodology Secondary data analysis, combination of qualitative and quantitative methods, and expert consultation workshop. Study locations: in four provinces of Nam Định, Thừa Thiên – Huế, Trà Vinh, and Lạng Sơn. Results: -Implementation of the Decree 172/2004/NĐ-CP: Paces of the implementation varied by provinces and districts. The preparation phase was very short (8 months on average), which was not long enough to establish a good foundation and neccesary conditions in terms of human resources and physical facilities for the policy implementation. -The governance ofhealth care system:Capacity of the district health departments was not adequate to fulfill the managerial tasks specified in Decree 172/2004/NĐ-CP and inter-ministrial circular 11/2005/TTLV-BYT-BNV. The role ofthe Government in governance was not clearly defined and overlapping. Some main causes were: lack of human resources (both quality and quantity), under-equipped facility, lack of finance, uncoordinated mechanism among district health facilities (district hospitals, prevention health center, commune health stations) -Technical management: The guidance and coordination role from the provincial health bureau to commune health stations (CHSs) and other health facilities were complicated and incompatible. There were overlapping functions and tasks among district health departments (DHDs), district hospitals (DHs) and prevention health centers (PHCs), resulting in a lack of concentration of resources. -Threats to CHSs: CHSs faced a great risk of discontinuation due to various difficulties including lack of human and financial resources, technical incompetency, poor reporting system. It became difficult to retainhealth professional staff, especially physicians and nurses, based in the villages. The CHSs were directed and burdened by many administrative levels (DHDs, DHs, PHCs) and could not control their agenda. They had to undertake a series of procedural work and report to various agencies. -Resources for local healthcare: resources were not efficiently managed. It was difficult to implement health progams at communities. There was lack of good coordination among healthcare agencies. Recommendations: The structure of health care system at grass root level needs to be adjusted. The grass root level health facilities should be managed by one focal pointwith an effective coordination among health agencies and the local government. The Circular 11/2005/TTLB-BYT-BNV needs to be revised.
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