After the Viet Nam War, the Communist Party of Vietnam adopted a set of reforms aimed at establishing a market-centered socialist economy in order to achieve rapid growth and speed industrialization. The movement, entitled "doi moi," changed the role of the state dramatically, from one where the state was greatly responsible for education, health care and other social safety nets in the public sector to that of individual household responsibility and privatization. Statistically, while the country has enjoyed benefits such as substantial economic growth (from 1990's $146 GDP per capita to $1,155 in 2010) and poverty reduction (from 58% in 1993 to 12.3% in 2010), the spread has been unstable and unequal. While the urban poor have decreased, increased income and regional disparities, as well as access to social services for disadvantaged household have been a result of the doi moi policies. In terms of impact on health care, basic health care was once formally fere to all prior to doi moi, but now that health is seen as a good of the market, health care cost and access for the poor have been spotty and unregulated. Patients have largely shifted towards self-prescription and reliance on foreign support. Access to doctors in rural communities is poor and many children lack screening and preventive care to maintain their health.
This summer, I will be doing my practice experience in Ha Noi, Viet Nam, with the Project Viet Nam Foundation (PVNF), an organization based in Fountain Valley, CA. PVNF works in the rural and needy provinces to provide medical care, medical training, and patient awareness campaigns/policy work to advocate for better children's health, mental care, preventive care, and health education. Currently, Viet Nam is pushing for health care reform in the areas of mental health, disability rights, health insurance and access, and children's preventive care. Besides the medical clinic work that is delivered to rural villages and medical training offered to medical professionals in the area, the most important work PVNF does is collaboration with other NGOs and educational institutions to address the needs of the most disadvantaged communities. The link below is an article on the health system in Viet Nam and the policy debates that are occurring in the country: http://www.globalhealthcheck.org/?p=423 (originally an orticle from the Oxford Analytica)
Hi Diane!
ReplyDeleteOur practice experience really share some parallels!
Despite China’s exponential economic growth curve, not much of that wealth has been successfully transferred back to the public domain either. Public services that were once well funded under a more socialist reign disintegrated by the 1980s and left rural sectors bereft of affordable health care. In the 1930’s, the Chinese government had a nation-wide, egalitarian health care system known as the Socialist Medical Cooperation (SMC) that provided primary care to urban and rural populations alike. But by the late 1970’s, a market shift reformed the health care system into a voluntary structure where members could join by paying a premium to certify membership. This became problematic as insurance coverage progressively dropped over the two decades until it was little less than 12% in 1997, and less than 8% by 1998.
In an effort to increase the health care capacity within China, China Cal bridges volunteer faculty from California hospitals with faculty from Kunming and Dali Medical Colleges to empower local village healers through training and certification. Participating student interns also have the chance to take part in this training and learn how to differentiate between the different heart murmurs, to take blood pressures, and give diagnostic exams so that they can assist with field screening and data collection. On average, each brigade screens “20,000 children and provides …necessary surgical and catheter-based intervention [for about] 60 cases of congenital heart disease,” with each brigade.
In addition to technical training, China Cal Heartwatch has also created a shared space where health care workers and pre-med students of a variety of international backgrounds can meet and exchange knowledge/practices. Student interns will engage in afternoon seminars led by local doctors to help grasp a better understanding of some of the root social/economical causes behind this rising hypertension epidemic