Viet Nam: Health Human Resources Sector Development Program

Sovereign Project | 40354-013 Status: Active

Summary

ADB is helping Viet Nam improve health care, particularly in poor, remote communities, which lack skilled workers and quality health facilities. The project supports key policy reform actions in health workforce management and financing. It will also help improve management systems in health service delivery.

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Consulting Notices See also: CMS

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Procurement Notices See also: Operational Procurement

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Procurement Documents


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Project Name Health Human Resources Sector Development Program
Project Number 40354-013
Country Viet Nam
Project Status Active
Project Type / Modality of Assistance Grant
Loan
Source of Funding / Amount
Grant 0209-VIE: Health Human Resources Sector Development Project
Government of Australia US$ 11.00 million
Loan 2642-VIE: Health Human Resources Sector Development Program
Asian Development Fund US$ 31.27 million
Loan 2643-VIE: Health Human Resources Sector Development Project
Asian Development Fund US$ 30.00 million
Strategic Agendas Inclusive economic growth
Drivers of Change Governance and capacity development
Partnerships
Sector / Subsector

Education - Tertiary

Health - Health sector development and reform - Health system development

Gender Equity and Mainstreaming Effective gender mainstreaming
Description The Health Human Resources Sector Development Program (HHRSDP) will address key human and financial resource management challenges and constraints in the health sector to improve access and quality of health services across different regions and segments of the population - women, the poor and ethnic minority communities, especially in remote rural provinces. The HHRSDP is comprised of 2 loans: a program loan that supports key policy reform actions in health workforce management and financing; and a project loan for investments directly linked to and supportive of the policy actions. The program supports the development and implementation of the new Law on Examination and Treatment (LET) governing health facilities and the registration and practice of health professionals, a new comprehensive plan to upgrade teaching institutions, and the adoption of new models for costing and managing service delivery in district hospitals.
Project Rationale and Linkage to Country/Regional Strategy

Viet Nam has made notable progress in reducing poverty and improving the health status of its citizens. The country is on track to achieve most of its health-related Millennium Development Goals (MDGs) by 2015. Key challenges still confront Viet Nam's efforts to provide equitable access to high-quality health services and to improve health outcomes further across the different regions and segments of the population. Much of the improvement in national health indicators has been driven by gains in the heavily populated regions around Hanoi and Ho Chi Minh City. Remote and rural provinces lag significantly and, measured alone, they would not meet the MDGs. The demand for higher-quality health services has increased as a result of growing prosperity and the emerging middle class, particularly in urban areas.

To continue improvements in health status and extend the benefits more broadly and equitably, the government has set out an ambitious plan to address an array of continuing problems in the health sector. The Master Plan for the Health System in Viet Nam to 2010 and Vision to 2020 calls for making access and use of health services more equitable and effective to protect and promote people's health. It aims to improve the quality of health care at all levels, with attention to the poor, women, minority groups, and those living in remote areas.

Impact Improved health status and progress toward meeting the health Millennium Development Goals (MDGs)/Viet Nam Development Goals (VDGs) in Viet Nam

Project Outcome

Description of Outcome Improved quality, efficiency, and equity in the health workforce and health service delivery.
Progress Toward Outcome --
Implementation Progress
Description of Project Outputs

1. Better planning and management of human resources

2. Higher quality of human resources training

3. Improved management systems in health service delivery

Status of Implementation Progress (Outputs, Activities, and Issues)

Output 1 - Better planning and management of human resources: This output, accounting for 22.4% of the total budget, supports the strengthening of human resources policy, planning, and implementation through the joint committee on health human resources (HHR). It has provided technical inputs to guide the legal and administrative arrangements for establishing and monitoring the registration and licensing of health professionals as mandated by the Law on Examination and Treatment (LET). The LET covers the (i) rights and responsibilities of patients, medical practitioners, and health care institutions; (ii) classification, accreditation, and licensing of health professionals and health care facilities; (iii) operational procedures in health services; and (iv) recording and remedying of medical malpractice. Based on the LET and report on HHR reform, 5 policy issuances were made from 2011 to 2014 to strengthen the legal framework for registration and licensing. Sub-output 1B supports the ongoing study on LET implementation and private health system, as well as the expansion of IT system for registration and capacity building for the National Advisory Council involved in providing guidance on registration and licensing. It also supports the ongoing revision of Circular 41/2011/TT-BYT dated 14 November 2011 to provide guidelines on practice certification for the medical practitioners and operation license of medical facilities. 23 of 30 budgeted activities (66.7%) are or will be completed by December 2015. The remaining 7 activities relate to enhancement of the national registration and licensing system and associated training activities. These will be completed in the extension period.

Output 2 - Higher quality of human resources training: This component accounts for the biggest share of total budget (69.4%). It enhances the capacities of educational institutions for pre-service training and continuing education of the health workforce, including the application of modern teaching and learning methods and transformation of educational institutions into teaching and learning hubs for other institutions. Specifically, this output supports the upgrading of teaching laboratories and equipment in 17 medical colleges, training of about 600 teachers in modern teaching methods, provision of pre-service and in-service training for ethnic minority groups, and conduct of learning exchange programs. It also includes laboratory renovation and upgrading of basic sciences equipment, as well as establishment of e-learning network and national virtual library in the medical sciences. 48 of 51 budgeted activities (94.1%) are or will be completed by December 2015. The remaining 3 activities relate to completion of scholarships and eLearning activities. These will be completed in the extension period.

Output 3- Improved management systems in health service delivery: This output, accounting for 8.2% of the total budget, aims to organize and standardize clinical processes and link them to provider payment mechanism in line with the following policy commitments: (i) development, benchmarking and costing of 20 care pathways in at least 6 hospitals, including at least 3 pathways directly related to medical care for women or primary level, and (ii) formulation of guidelines on provider payment per case associated with care pathways. This output has supported capacity building on care pathway development, clinical coding and hospital costing, monitoring and evaluation, and development of case mix database for MOH team. 24 of 30 budgeted activities (80.0%) are or will be completed by December 2015. The remaining 6 activities relate to costing studies and simulation of the case-based payment model. These will be completed in the extension period. The endorsement of the care pathways by the professional committee established by the MOH Administration of Medical Service is yet to be completed. The preliminary cost outcomes and cost per case covering 30 case types have been produced, and analysis of cost outcomes is continuing. A proposal has been submitted for further in-depth analysis concerning the variation between groups of inpatient having care with and without CPs, and if approved, the activity is expected to commence in Q4 2015.

The extension is needed to allow the simulation and actual implementation of the payment model. The proposal for the simulation has been submitted to PMU/ MoH and now under the approval process and is to be accelerated so the simulation can be conducted immediately.

Geographical Location

Safeguard Categories

Environment C
Involuntary Resettlement C
Indigenous Peoples B

Summary of Environmental and Social Aspects

Environmental Aspects
Involuntary Resettlement
Indigenous Peoples

Poverty rates and health indicators lag substantially among marginalized ethnic groups. It is estimated that nearly half of poor women and over 70% of women in mountainous areas delivered at home, compared with about 5% of well-off women. Long distances to the nearest health facility; lack of qualified health staff; and lack of ethnic minority health workers or health workers in the local health facilities discourage poor, rural and ethnic minority groups, especially women, from seeking health care.

The Program presents a number of opportunities to address inequities in health status and in the access and utilization of the health care system, particularly through improvements in the training of health workers and in the management and utilization of the health workforce. These opportunities will be outlined in a detailed gender and ethnic minority strategy for the Program. The strategy will build on the Government's law and policy commitments to poverty reduction, gender equality, ethnic inclusion and health equity. It will include specific measures to address poverty, gender and ethnic minority concerns in each of the three Program components, including (i) targets, financial assistance and other measures to increase the participation of women and ethnic minorities in health workforce training; (ii) integrating gender and ethnic minority concerns and patient-centered approaches in health workforce training; (iii) highlighting poverty, gender and ethnic minority concerns in the work of the proposed Health Human Resources Development Task Force and the proposed Medical Council; (iv) piloting patient-centered care pathways for normal and emergency obstetric care; and (v) assessing the feasibility of extending care pathways and case-based payment systems to district hospitals in poor and remote areas. The gender and ethnic minority strategy will also provide for gender and ethnic minority specialists to support the implementation of the strategy, including the collection of data disaggregated by sex and ethnicity, and regular reporting on progress in implementing the strategy.

Stakeholder Communication, Participation, and Consultation
During Project Design Program preparation included intensive and extensive stakeholder consultation. The design team, along with counterparts from the Department of Science and Technology - Ministry of Health, visited training institutions and hospitals in and around Hanoi and Ho Chi Minh City and a consultation workshop, with the participation of representatives of teaching centers from around the country, was held in Hai Phong on 12 and 13 May. Members of the design team interviewed staff from MOH departments, teaching, research and policy institutions, donors, NGOs, and hospitals (including hospital clients) and reviewed an extensive array of relevant papers and documents. The design phase also included a field trip to teaching institutions, hospitals, and community clinics in out-lying provinces in northern Viet Nam and a survey of teaching centers throughout the country. Survey results assisted the program investment strategy in the final stages of program preparation. Multiple meetings with donor partners were held in Hanoi leading up to and during the program preparation phase.
During Project Implementation The Program is designed to maximize stakeholder participation throughout implementation. The project supports the development of regional activities among teaching institutions, to enhance exchanges, and to share teaching resources. It supports the creation of a Human Resources Development Coordinating Committee that engages representatives from various MOH departments in planning and implementing HR strategies. The project also supports the creation of an Inter-Ministerial Task Force to facilitate greater coordination among various departments within the MOH and with other departments and ministries in piloting the introduction of care pathway methods and case-based payment systems. During implementation, extensive stakeholder participation and consultation mechanisms will be included in the design to ensure local communities, provincial and district governments, mass organization groups, the private sector and interested development partners and importantly, health consumers, are included in all aspects of implementation.

Business Opportunities

Consulting Services All consultants and nongovernment organizations (NGOs) will be recruited according to ADB's Guidelines on the Use of Consultants by Asian Development Bank and its borrowers (2007, as amended from time to time). Under output 1: strengthening the quality of training of human resources, the project will provide 33 international person months and 126 national person months (of which 16 through a local organization). Under output 2: improving planning and management of human resources, the project will provide 127 international person months and 103 national person months, and under the output 3: Improvement of management systems in health service delivery, the project will provide 124 international person months and 720 national person months. Consulting firms will be engaged using the quality- and cost-based selection (QCBS) method with a standard quality:cost ratio of 90:10.
Procurement Procurement to be done under the Investment project. All procurement of goods and works will be undertaken in accordance with ADB's Procurement Guidelines (2007, as amended from time to time). International competitive bidding procedures will be used for goods estimated to cost above $500,000. National competitive bidding procedures will be used for civil works contracts estimated to cost below $1 million and above $100,000; and supply contracts valued below $500,000 and above $100,000. Shopping will be used for contracts for procurement of works and goods worth less than $100,000.

Responsible Staff

Responsible ADB Officer Joel Mangahas
Responsible ADB Department Southeast Asia Department
Responsible ADB Division Human and Social Development Division, SERD
Executing Agencies
Ministry of Health
Dr Tran Quoc Kham
[email protected]
138A Giang Vo Street, Ba Dinh District Ha Noi

Timetable

Concept Clearance 01 Oct 2008
Fact Finding 22 Sep 2008 to 03 Oct 2008
MRM 18 Nov 2008
Approval 22 Jun 2010
Last Review Mission -
PDS Creation Date 03 Oct 2008
Last PDS Update 30 Mar 2016

Grant 0209-VIE

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
22 Jun 2010 07 Sep 2010 06 Jan 2011 30 Jun 2016 30 Jun 2017 -
Financing Plan Grant Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 16.30 Cumulative Contract Awards
ADB 0.00 22 Jun 2010 0.00 9.70 88%
Counterpart 5.30 Cumulative Disbursements
Cofinancing 11.00 22 Jun 2010 0.00 9.31 85%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating - - - - - Satisfactory

Loan 2642-VIE

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
22 Jun 2010 07 Sep 2010 06 Jan 2011 31 Dec 2012 31 Dec 2013 07 Apr 2014
Financing Plan Loan Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 31.27 Cumulative Contract Awards
ADB 31.27 22 Jun 2010 31.27 0.00 100%
Counterpart 0.00 Cumulative Disbursements
Cofinancing 0.00 22 Jun 2010 31.27 0.00 100%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating - - - - - Satisfactory

Loan 2643-VIE

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
22 Jun 2010 07 Sep 2010 06 Jan 2011 30 Jun 2016 30 Jun 2017 -
Financing Plan Loan Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 30.00 Cumulative Contract Awards
ADB 30.00 22 Jun 2010 25.22 0.00 87%
Counterpart 0.00 Cumulative Disbursements
Cofinancing 0.00 22 Jun 2010 22.91 0.00 79%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating - - - - - Satisfactory
Title Document Type Document Date
Health Human Resources Sector Development Program - Second Tranche: Progress Report on Tranche Release Progress Reports on Tranche Releases Nov 2013
Health Human Resource Sector Development Program Procurement Plans Aug 2013
Loan Agreement for Health Human Resources Sector Development Program between Socialist Republic of Viet Nam and Asian Development Bank dated 7 September 2010 Loan Agreement (Special Operations) Sep 2010
Grant Agreement for Health Human Resources Sector Development Project between Socialist Republic of Viet Nam and Asian Development Bank dated 7 September 2010 Grant Agreement Sep 2010
Loan Agreement for Health Human Resources Sector Development Project between Socialist Republic of Viet Nam and Asian Development Bank dated 7 September 2010 Loan Agreement (Special Operations) Sep 2010
Health Human Resources Sector Development Program: Summary Gender and Ethnic Minority Strategy Gender Action Plans May 2010
Health Human Resources Sector Development Program Reports and Recommendations of the President May 2010
Health Human Resources Sector Development Program Summary Poverty Reduction and Social Strategies May 2010
Health Human Resources Sector Development Program Project/Program Administration Manual May 2010
Health Human Resources Sector Development Project (Investment) (formerly Support to Health Systems Development) Design and Monitoring Frameworks Nov 2008
Health Human Resources Sectors Development Program Design and Monitoring Frameworks Nov 2008

Safeguard Documents See also: Safeguards

Safeguard documents provided at the time of project/facility approval may also be found in the list of linked documents provided with the Report and Recommendation of the President.

Title Document Type Document Date
Health Human Resources Sector Development Program: Summary Gender and Ethnic Minority Strategy Indigenous Peoples Planning Frameworks/Indigenous Peoples Development Frameworks Dec 2008

Evaluation Documents See also: Independent Evaluation

None currently available.

Related Publications

None currently available.


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