Comparative quality of private and public health services in rural Vietnam

BACKGROUND: Private health care services were officially recognized in Vietnam in 1989, and for the last 15 years have competed with the public health system in providing primary curative care and pharmaceutical sales to rural populations. However, the quality of these private and public health care services has not been evaluated and compared. METHODS: A community-based survey was conducted in 30 of the 160 communes in Hung Yen, which were selected by probability proportional to population size (PPS) sampling. All commune health centres (CHCs) and private health care providers in the selected communes were surveyed on human resources, services provided, availability of medical equipment and pharmaceuticals, knowledge and clinical performance for acute and chronic problems. Patient satisfaction and cost of care associated with recent illness were measured using a random household survey covering 30 households from each of the selected communes. RESULTS: There were 11.5 private providers per 10,000 population, compared with 6.7 public providers per 10,000. A quarter of private providers were employees of the public health sector. Less than 20% of the private providers had registered their practice with the government system. Eleven per cent (26/234) had no professional qualifications. Fifty-eight per cent (135/234) provided treatment as well as selling medications. Public sector infrastructure was superior to that of the private providers. The quality of services provided by public providers was poor but significantly better than that of private providers. Patient satisfaction and costs of care were similar between the two groups. CONCLUSIONS: Private providers are successfully competing with the public health centre system in rural areas but not because they provide cheaper or better services. The quality of private health care services is not controlled and is significantly poorer than public services. Current practice in both systems falls below the national standard, especially for the management of chronic health problems. The low quality of health care services at a community level may help explain the previously observed phenomena of high levels of self-medicating, low utilization of commune health centres and over-utilization of tertiary health care facilities.     

创新引领学科健康筑梦中国——中华医学会健康管理学分会\

为提高临床医学类专业的预防医学课程的整体性、系统性和实用性,培养学生的综合应用能力,通过整合基于学生自我体验的参与型课程体系,建立跨学科综合协作教学模式等,探索阶梯型学生预防医学实践培养体系,以强化医学生的预防医学理念,提高预防医学实践和研究技能,为培养实现“健康中国”战略的具有预防医学理念的现代医生打下基础。     

Unpacking capacity to utilize research: A tale of the Burkina Faso public health association

One of the most important challenges in addressing global health is for institutions to monitor and use research in policy-making. In low- and middle-income countries (LMICs), civil society organizations such as health professional associations can be key contributors to effective national health systems. However, there is little empirical data on their capacity to use research. This case study was used to gain insight into the factors that affect the knowledge translation performance of health professional associations in LMICs by describing the organizational elements and processes constituting capacity to use research, and examining the potential determinants of this capacity. Case study methodology was chosen for its flexibility to capture the multiple and often tacit processes within organizational routines. The Burkina Faso Public Health Association (ABSP) was studied, using in-depth, semi-structured interviews and key documents review. Five key dimensions that affect the association's capacity to use research to influence health policy emerged: organizational motivation; catalysts; organizational capacity to acquire and organizational capacity to transform research findings; moderating organizational factors. Also examined were the dissemination strategies used by ABSP and its abilities to enhance its capacity through networking, to advocate for more relevant research and to develop its potential role as knowledge broker, as well as limitations due to scarce resources. We conclude that a better understanding of the organizational capacity to use research of health professional associations in LMICs is needed to assess, improve and reinforce such capacity. Increased knowledge translation potential may leverage research resources and promote knowledge-sharing.     

Health system research in Vietnam: Generating policy-relevant knowledge

Vietnam's health system continues to make great progress in improving its capacities and performance. However, despite the many significant achievements that have been made, this paper summaries 11 health system research papers from different perspectives with the aim of providing scientific evidence for policy actions in Vietnam. Health system research is ultimately concerned with improving the health of people and communities, by enhancing the efficiency and effectiveness of the health system as an integral part of the overall process of socioeconomic development, with full involvement of all actors. We hope the findings from this cluster of papers provide some insights into issues of importance for the continued advancement and strengthening of the health system in Vietnam and can be considered a valid and reliable resource to inform planning, management and policy-making decisions.     

英国基于“提高研究价值”理念的医学研究运行模式及启示

目的 本文介绍英国国立健康研究院围绕“提高研究价值”采取的相应举措,以期对我国医学研究监管与支持体系建设有所启示。方法 结合相关理念探讨,梳理“提高研究价值”在英国医学研究监管与支持体系建设中的实践应用。结果 医学研究的监管与支持体系及机制建设应关注研究优先资助领域的确定、搭建研究设计平台、建立全程管理机制及可公开访问的共享平台和有效推广应用研究结果等方面。结论 我国医学研究监管部门、研究机构、资助方和研究团队等相关方应关注如何能真正“提升研究价值”并思考相关机制的建立。     

Building public health skills and capacity in the English regions

Local public health departments have variable access to a public health intelligence function, and information skills are scarce. Public health observatories are supporting the development of professional standards for public health intelligence specialists and offer training opportunities for both defined public health specialists and generalist public health specialists. In addition observatories support public health practice through educational programmes in health impact assessment, health equity audit, public health intelligence, and the provision of toolkits and advice on methods. Observatories have a key role in supporting and developing networks, in particular public health analysts, and the use of interoperable websites is enhancing these opportunities.     

Reducing unmet needs: a prevocational medical training program in public health medicine and primary health care in remote Australia

OBJECTIVES: To describe the development and implementation of a prevocational medical training program in public health medicine and primary health care in remote Australia and to evaluate the program's adherence to adult learning principles. METHODS: Reports, funding applications and other relevant material relating to the program were reviewed to document learning objectives, and teaching and program implementation strategies. RESULTS: The 24-week program employs two prevocational medical practitioners each year and comprises four weeks at Fremantle Hospital's sexual health clinic followed by 20 weeks in the Kimberley. Curriculum objectives include clinical and public health aspects of sexually transmitted infection management, immunisation, clinical audit and quality improvement, primary health care in remote Aboriginal communities, oral and written presentation skills and working as part of an interdisciplinary team. Teaching strategies used were in accordance with adult learning principles. CONCLUSIONS: Prevocational medical training in public health medicine and primary health care in remote Australia is achievable and reduces current gaps in prevocational medical education.