“Health is gold”: institutional structures and the realities of health access in the Mekong Delta, Vietnam

Vietnam has dealt historically with health as a valuable asset, a resource that was distributed in an

equal manner to all citizens through the development of a wide and inclusive grassroots health

network during the 1970s. Since then, the health system has developed -in parallel to the country's

economy and shifts in policy- from a free-for-all service of a rather low quality, to a system that is

now better regulated and has overall better quality, but is conditioned to user fees. Following the

liberalization and decentralization policy directions of the Vietnamese state that initiated in the late

1980s, health is now open to private sector activity and competitiveness while still under the general

control and power of the state. The impacts of these changes have been felt more and more recently

as a result of widening socio-economic gaps among the population, which reflect on the way health

services are being offered and accessed.

This paper reviews the literature and delineates the structure and organization of the health care and

health prevention delivery systems in Vietnam. Information is triangulated and enriched with

findings from the field, obtained through qualitative interviews with health officials, doctors and

citizens in rural and urban localities within the Mekong Delta. While examining the function of health

institutions, deficiencies are highlighted: (i) the state is not consistent in monitoring and ensuring the

regulatory compliance of public or private health service providers, (ii) financial autonomy in the

health sector, combined with the withdrawal of central support away from local health units, are

creating inequalities in access while not bettering the quality of offered services, (iii) rurality and

poverty are closely connected to each other and to restricted health access, either due to limited

existing specialized care facilities or the inability to pay for them. Based on secondary data, the paper

also presents the latest statuses of the main health indicators, which not only illustrate the general

improvements achieved, but also indicate the yet unreached goal of effective preventive medicine

that could sustainably control many prominent diseases and could further build better understanding

around health in general.

Panagiota Kotsila

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