The proposed Health Human Resources Sector Development Program _ Phase 2 (HHRSDP-2) will assist the Government of Viet Nam achieve universal health coverage (UHC) and progress toward meeting health-related sustainable development goals (SDGs) through a combination of policy and investment support to ensure the steady supply of competent and qualified health workforce. It builds on the achievements of Health Human Resources Sector Development Program (HHRSDP). The design and monitoring framework is in Appendix 1.
|Project Name||Health Human Resource Sector Development Program–Phase 2 (HHRSDP-2)|
|Project Type / Modality of Assistance||Technical Assistance
|Source of Funding / Amount||
|Strategic Agendas||Inclusive economic growth
|Drivers of Change||Governance and capacity development
|Sector / Subsector||
Public sector management - Social protection initiatives
|Gender Equity and Mainstreaming||Gender equity|
|Description||The proposed Health Human Resources Sector Development Program _ Phase 2 (HHRSDP-2) will assist the Government of Viet Nam achieve universal health coverage (UHC) and progress toward meeting health-related sustainable development goals (SDGs) through a combination of policy and investment support to ensure the steady supply of competent and qualified health workforce. It builds on the achievements of Health Human Resources Sector Development Program (HHRSDP). The design and monitoring framework is in Appendix 1.|
|Project Rationale and Linkage to Country/Regional Strategy||
Health care needs to be more responsive. The overall health status of the Vietnamese people has improved significantly. The country is likely to meet the health-related Millennium Development Goals by end of 2015. However, the lack of access to quality and affordable health care services continues to be a key challenge especially among the poor. Viet Nam is coping with the increased demand for health services associated with the aging population, growing burden of non-communicable diseases, higher insurance coverage, and rising incomes. Viet Nam's total health expenditure decreased from 6.4% of the gross domestic product in 2010 to 6% in 2013. The out-of-pocket spending on health was 50% in 2013, which was higher than those of neighboring countries. The national health insurance covered 71.6% of the population in 2015. Appendix 2 presents the problem tree.
Overcrowding of hospitals. Tertiary level and specialist hospitals across the country are overcrowded due to deficiencies in primary care and preventive medicine. Health care at the lower levels are commonly by-passed due to insufficient capacity of health units and poor quality of services. In 2013, only 40% of commune health stations (CHS) met national standards. Financing of preventive health services remains limited, with revenues insufficient to cover costs.
Shortage of health workforce. There is lack of medical specialists, nurses, pharmacists, rehabilitation workers, preventive medicine or public health workers, and specialist managers (particularly for hospitals), at provincial, district, and commune levels. Out of the 424,237 health personnel in 2013, there were 104,948 (25%) and 70,367 (17%) assigned at the district and commune levels, respectively. About a quarter of the CHS do not have physicians. To achieve the 2015 staffing benchmarks of 8 doctors per 10,000 people and 3.5 nurses per doctor by 2020, the country needs to double its current output of graduates.
Limited quality of skilled health workforce. Many health personnel, particularly at the lower levels, do not have appropriate professional education and training. Out of the 100,526 health workers at the district level, about 58,305 (58%) are secondary school graduates and about 42,221 (32%) have college or university and post-graduate degrees. A survey of commune level health staff in 2012 found that only 17.3% of doctors had appropriate first aid skills, 17% could identify risk factors during pregnancy, 50.5% of health workers knew could diagnosis hypertension, and 15.6% understood the appropriate response to an epidemic.
The performance of medical universities and schools is constrained by old and under-resourced facilities, inadequate practice facilities and training equipment, lack of qualified instructors, and outdated curricula and teaching methods. The curricula place insufficient emphasis on practice, soft skills, public health, and clinical skills development. There is a need to develop quality standards for teaching and enhance quality assurance and accreditation system of training institutions.
Slow pace of health governance reform. Management capacities and operating systems at different levels of health care need to be enhanced. Only 30% of hospital administrators were trained in management although they have been working as managers for many years; 95% of hospital administrators indicated that they lack management skills. Procurement and financial management systems are weak. Evidence-based policy making and capacities to implement policies remain limited. Monitoring and evaluation of the health system are constrained by inadequate resources and standardized methodologies, which weaken the ability to measure performance and identify responsibilities and accountabilities.
|Description of Outcome|
|Progress Toward Outcome|
|Description of Project Outputs|
|Status of Implementation Progress (Outputs, Activities, and Issues)|
Summary of Environmental and Social Aspects
|Stakeholder Communication, Participation, and Consultation|
|During Project Design|
|During Project Implementation|
|Responsible ADB Officer||Mangahas, Joel V.|
|Responsible ADB Department||Southeast Asia Department|
|Responsible ADB Division||Human and Social Development Division, SERD|
Asian Development Bank
6 ADB Avenue,
Mandaluyong City 1550, Philippines
|Approval||15 Dec 2015|
|Last Review Mission||-|
|PDS Creation Date||15 Apr 2010|
|Last PDS Update||30 Mar 2017|
|Approval||Signing Date||Effectivity Date||Closing|
|15 Dec 2015||-||-||30 Jun 2017||-||-|
|Financing Plan/TA Utilization||Cumulative Disbursements|
|800,000.00||0.00||0.00||0.00||0.00||0.00||800,000.00||15 Dec 2015||0.00|
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|Title||Document Type||Document Date|
|Health Human Resource Sector Development Program–Phase 2: Initial Poverty and Social Analysis||Initial Poverty and Social Analysis||Jan 2016|
|Second Health Human Resources Sector Development Program: Project Preparatory Technical Assistance Report||Project Preparatory Technical Assistance Reports||Dec 2015|
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