Capacity of Primary Healthcare Facilities on Prevention and Management of Cardiovascular Diseases in a Resource-limited Area in Vietnam

Background: Vietnam is in the process of an epidemiological transition, with cardiovascular diseases now ranked as the leading cause of death. This study assessed the commune health centers in selected rural and urban communities in Vietnam in terms of their capacity for prevention and management of cardiovascular diseases by using a mixed method approach.

Methods: The study was conducted in July 2016 in Chi Linh district, Hai Duong province – a mountainous area located in northern Vietnam. Structured questionnaire surveys and in-depth interviews were used to collect data on the current capacity of commune health centers in Chi Linh district. The capacity included six aspects: equipment and service availability, medicine, medical record system, service utilization and referral, financing and human resources. Ten facility staff members in the selected commune health centers were surveyed and interviewed. Five policy makers from the local level, the regional level, and the national level were also interviewed.

Results: A description of Chi Linh district’s commune health center capacity on CVD prevention and management was reported. (1) Equipment & Service Availability: Not all essential equipment and health services recommended by WHO was available at commune health centers. A few centers owned glucometers and no center had an ECG machine. (2) Medicine: No diabetic medicines were available in the commune health center; the essential medicines for other CVD conditions were inadequate in terms of quantity and diversity. (3) Medical record system: One fifth of the commune health centers had an electronic medical record system, others used a paper-based record. (4) Service Utilization & Referral: On average, each facility admitted 63 CVD out-patients per month (urban 152, rural 29); none of the facilities could provide in-patient service. (5) Financing: Government budget and social health insurance were the main sources of facility revenue. (6) Human resources: The human resources specialized in CVD were inadequate in commune health centers. On average, there were 0.328 medical doctors, 0.182 nurses and midwives and 0.009 pharmaceutical personnel per 1000 population.

Conclusion: The capacity of commune health centers to prevent and manage cardiovascular diseases in Vietnam is inadequate. The results of this study show critical gaps in primary healthcare facilities in Vietnam in six key areas. They include service delivery, health workforce, health information system, access to essential medicine, financing and governance. Thus, there is an urgent need to improve the capacity of commune health centers.