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An assessment of the implementation of the Political Bureau’s Resolution 46-CT/TW on healthcare of people in face of the new era and the Party Central Committee's Directive 06-CT/TW Vũ Thị Minh Hạnh and colleagues Place of publication: Ministry of Health Year of publication: 2008 Objectives •To examine the process of introducing and implementing Resolution 46 and Directive 54 by the Party and Government agencies at different levels with a focus on orgnization, implementation, and preliminary results •To identify weaknesses, difficulties, and their causes during the implementation process, and thus provide recommendations for improvements Study subjects 3 groups at commune, district and provincial levels: leaders and managers, health service providers, and beneficiaries Study location 8 provinces/municipalities of Tuyên Quang, Thái Bình, Hà Nội, Đà Nẵng, Đắc Nông, Phú Yên, Bình Dương and Cà Mau Methods Secondary data analysis, in-depth interviews conducted in all 8 provinces/municipalities at communal, district and provincial levels Results Implementation of Resolution 46 and Directive 06 in the provinces started 6 to 9 months after the issuance date. The Resolution and Directive were disseminated through diverse channels and means suitable to different target groups. Coverage of the target groups was rather large in most of studied locations. Majority of the party cells organized learning activities for the party members and people in communities. The training and learning of Resolution 46 and Directive 06 was however still over formalistic and not contextualized to the local conditions. As a consequence,there was low mobilization and participation of the party members. The issuance of guiding documents on the implementation of the Resolution 46 and Directive 06 at the Party, Government, people’s council, and other concerned agencies at some location was mechanical, inflexible, and generic, resulting in low applicability. Although the guiding documents were developed closely to the spirit and focal issues of the Resolution and Directive, these documents were not articulate, and lack of details and depth. The party, government, people’s council, and other concerned agencies at various levels did not pay adequate attention to the tasks of monitoring and supervising the implementation of the Resolution and Directive. Their approach was rather top-down and activities were mostly centered around compiling information based on reports from lower levels. There was no fieldwork for technical advice, on-site monitoring, adjustments, and problem analysis for lessons learned. After more than 5 years of implementationof the Resolution 46 and 2 years of implementation of Directive 06, the health system in general and at grassroots level in particularly was strengthened and developed in all areas, from preventive care to treatment and rehabilitation, and from pharmaceutical facilities to medical equipment. As a result, quality of healthcare was improved. Population health status at the studied locations was improved. However, resources allocated for healthcare activities were very limited especially in impoverished, remote and mountainous areas. Health workforce at all levels, especially at local level was in shortage. Compensation policies for health workers, especially for those at grassroots level and working in preventive medicine were inadequate. District and commune public health agencies especially the preventive medicine branch faced a great deal of difficulties in attracting, recruiting, retaining, and maintaining a stable human resource base for their operation. The party and government at all levels took an increasing leadership role in healthcare activities for people. There was a substantially positive shift in the awareness among the party, government and people on central tasks of the healthcare mission. The state management’s effectiveness was improved gradually through enhanced activities in inspection,supervision and management of private medical operation, pharmaceutical service, and food safety compliance in most locations.These activities were however not regularly conducted, and thus limiting the state management’s role. The implementation of Resolution 46 and Directive 06 helped raise the awareness on healthcare mission among not only the party and government but also other organizations, agencies, communities, and people, contributing to an enhancement of socialization of healthcare activities. Effects of the information, education, and communication (IEC) activities were improved gradually. However, in some mountainous provinces, due to low education among the population and language barrier, IEC activities faced many difficulties. Poor practice of environmental hygiene, backward health-related custom were still common, posing potential risks of disease outbreak. Recommendations •The Party’s Secretariat should continue the issuance of guiding documents to direct the Party, Government, and their agencies to increase their leadership role in healthcare activities in the new era. •It is necessary to closely maintain the monitoring and evaluation of the implementation of Resolution 46 and Directive 06 in the provinces/municipalities. Annual evaluation is suggested to draw experiences, identify rising issues, and propose changes and solutions accordingly. •The Ministry of Health should continue to develop proposals thatarticulate and specify the tasks stipulated in Resolution 46 to serve as the base for local implementation of the resolution. •Investment in healthcare should be increased by raising its public funding, especially for mountainous and disadvantaged provinces. In addition, budget allocation should be reasonably adjusted across the administrative levels and areas of the health sector. •It is important to revise, supplement, and improve health policies especially those that aim to enhance resources for and socialization of healthcare activities and raise financial compensation for the healthcare forces. The legal framework should reformed and synchronized to facilitate the efforts of enhancing healthcare quality. •Strategies on education, training, recruitment, and employment of the health workforce should be formulated to respond to the increasing demand of human resource in the public health sector at different levels, especially in the communities and preventive medicine.
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