Health / Health sector development and reform

Achievements of outputs are detailed below.

Project implementation has been physically completed in June 2015. Closing of loan account is ongoing.

Output 1: Improved Health Facilities

1.1 New and upgraded health facilities and equipment

1.2 Improved water, sanitation, and waste management

Output 2: Strengthened Provincial HRD

2.1 Improved provincial human resource planning and management

2.2 Improved provincial training capacity

2.3 Improved quality and availability of staff

2.4 HRD provincial studies are used in policy formulation

Output 3: Improved Access to Health Care for the Poor

3.1 Better village health care in remote communes

3.2 Health and nutrition promoted in ethnic minority communes.

3.3 Reduced barriers to health care funds for the poor

Output 4: Strengthened Provincial Health Systems

4.1 Strengthened provincial health systems management

4.2 Strengthened hospital management

4.3 Better health management information systems

4.4 Effective project management support

All 25 health facilities meet MOH service standards.

Eight (8) new and 17 upgraded new facilities

The change in the number of district hospitals with capacity for EMOC in SCCR provinces from 2009 to 2013:

Da Nang =

Data not available

Quang Nam

2009 = 3 district hospitals

2014 = 4 district hospitals

Quang Ngai

2009 = 1 district hospitals

2014 = 4 district hospitals

Binh Dinh

2009 = 3 district hospitals

2014 = 8 district hospitals

Phu Yen

2009 = 2 district hospitals

2014 = 8 district hospitals

Khanh Hoa

2009 = 1 district hospitals

2014 = 6 district hospitals

Ninh Thuan

2009 = 0 district hospitals

2014 = 1 district hospitals

Binh Thuan

2009 = 2 district hospitals

2014 = 8 district hospitals

8 provinces developed by 2013 HRD plans. Of these:

" 5 provinces had their HRD plan approved by the PPC

" 6 provinces' plans included targets for training of EM CHW and VHW

" 6 provinces' plans included targets for training of female CHWs and VHWs.

The project trained:

" 739 master trainers in the Medical Pedagogy (47% female; 2% EM).

" 375 core trainers in TOT for various topics (54% female; 1% EM).

86% of master trainers apply skills based training techniques.

100% CHS have had at least trained female staff.

The number of female health care professionals participating in the Project's short term trainings was 19,074 (69% of total participants).

The number of EM health care professionals participating in the Project's short term trainings was 3,196 (12% of total participants).

7 studies conducted by MOH/Provinces, including 2 focusing on gender and ethnic minority issues.

In addition 2 HRD studies focusing on (i) staff retention; (ii) improving the competency of female and EM health staff.

18/18 (100%) of poor communes in endline survey had at least 1 female staff trained by the project.

83% of VHW apply 7 or more activities from the standard reproductive health care package (10 activities).

VHWs conducted health and nutrition campaigns to 302 ethnic minority communes.

By 2014:

" 81% of EM women and 79% of poor women accessed information on health care from VHWs.

" 44% of EM women received information on health care in EM language.

" 72% of both EM and poor women accessed information on HI from VHWs.

" 34% of EM women received information on health care in EM language.

By 2014:

" provinces prepare annual provincial health plans and budgets.

" provinces developed HRD plans (5 approved by the PPC).

" 8 provinces developed Gender Action Plans and Ethnic Minority Action Plans for the period 2015-2017.

The percentage of hospital managers in SCCR provinces that are female (and percentage of these who attended training):

Da Nang = 8% (23%)

Quang Nam = 17% (100%)

Quang Ngai = not available

Binh Dinh = 13% (75%)

Phu Yen = 22% (20%)

Khanh Hoa = 21% (79%)

Ninh Thuan = 45% (21%)

Binh Thuan = 21% (86%)

Under the Project's short course training program 405 managers participated in management training of which 23% were female.

The Project fielded 16 postgraduate candidates in Master of Hospital and Master of Public Management of which 75% were female.

The percentage of district hospitals in SCCR provinces applying MIS (at endline):

Da Nang = not available

Quang Nam = 7%

Quang Ngai = not available

Binh Dinh = 75%

Phu Yen = 57%

Khanh Hoa = 100%

Ninh Thuan = 50%

Binh Thuan = 25%

Project procurement and financial management met ADB's standards.

The Project will help safeguard the environment by upgrading or

constructing water, sanitation, and medical waste management

systems and training hospital staff in waste management theory

and practice, thereby significantly improving the handling and

disposal of medical wastes in these facilities and reducing

environmental threats to their surrounding communities. In

addition to disturbance and resettlement during construction, the

new and upgraded health facilities may pose future health

hazards due to poor maintenance, lack of supplies and other

reasons. The Project will support the development of

environmental plans and a waste management plan for each

hospital.

The Project is expected to acquire 186,141 square meters of land, excluding the sites for

5 DPMCs, which will be identified during implementation. At the assessed sites, 112 households

(499 people) will be affected by the Project, 52 households will lose more than 10% of their

productive land, and 32 households will be required to relocate. A full resettlement plan has

been prepared for the subprojects where sites have been identified, and a resettlement

framework has been prepared to guide any resettlement or land acquisition that may occur for

the DPMCs and any other subprojects identified during implementation (Supplementary

Appendix D). The base cost of land acquisition and resettlement activities is estimated at $0.86

million. All households will be compensated for their losses at full replacement costs and current

market value. Residential and employment arrangements will be restored to pre-project

standards, if not better. As detailed designs of civil works are finalized and approved, MOH, with

the assistance of the PHBs, will be required to revise and update the resettlement plans for all

civil works. MOH will be responsible for approving the resettlement plans and supervising all

resettlement-related issues.

The Project falls into indigenous people impact category A. Specific activities directly

targeting ethnic groups as beneficiaries have been mainstreamed in the Project, which therefore

serves as the ethnic minority development plan. An ethnic minority strategy (Appendix 12) has

been developed to (i) ensure that ethnic minorities are consulted, participate, and benefit from

the project throughout project implementation; and (ii) guide the implementation of information,

education, and participation methodologies so that they are sustainable and appropriately

targeted to ethnic minority needs. The ethnic minority strategy is based on (i) consultations with

ethnic minorities, government officials, local organizations, and other key stakeholders; and

(ii) secondary sources and past ADB projects. The strategy is in accordance with current Viet

Nam regulations and complies with ADB's Policy on Indigenous Peoples (1998).