40354-015: Health Human Resource Sector Development Program–Phase 2 (HHRSDP-2) | Asian Development Bank

Viet Nam: Health Human Resource Sector Development Program–Phase 2 (HHRSDP-2)

Sovereign (Public) Project | 40354-015 Status: Dropped / Terminated

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 Details

Project Officer
Servais, Gerard Southeast Asia Department Request for information
  • Viet Nam
  • Loan
  • Public sector management
Project Name Health Human Resource Sector Development Program–Phase 2 (HHRSDP-2)
Project Number 40354-015
Country Viet Nam
Project Status Dropped / Terminated
Project Type / Modality of Assistance Loan
Source of Funding / Amount
Loan: Health Human Resource Sector Development Program Phase 2 (HHRSDP-2)
concessional ordinary capital resources lending / Asian Development Fund US$ 80.00 million
Strategic Agendas Inclusive economic growth
Drivers of Change Gender Equity and Mainstreaming
Governance and capacity development
Knowledge solutions
Sector / Subsector

Public sector management / Social protection initiatives

Gender Equity and Mainstreaming Gender equity

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.

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.

Project Rationale and Linkage to Country/Regional Strategy

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.

Private sector development and regulation need to be better understood in order to determine opportunities for improving them. Opportunities for public-private partnerships for improving health care need to be explored. External aid is coordinated relatively well by the Ministry of Health (MOH) through mechanisms such as the Joint Annual Health Review (JAHR) and the Health Partnership Group (HPG). Continued efforts are needed to achieve higher levels of efficiency in aid delivery such as improved sector planning and use of programmatic approaches to health systems development.

Further strengthening of regulatory and operating framework for improved health care delivery. The country needs further support to ensure the sustainability of HHRSDP benefits and to assist health professional training facilities (HPTF) achieve international standards. Key priorities for HHRSDP-2 include: (i) expansion of health professional registration and licensing with links to training accreditation processes; (ii) investment support for HPTFs to further improve technical infrastructure and mechanisms for practical training and continuing medical education; and (iii) further provider payment reforms to strengthen the underlying systems and mechanisms required for case-based funding. Centers of excellence (COE) will be established as replicable models of best practice in health workforce education and training. The COEs will assist HPTFs reach world ranking by obtaining international accreditation standards. Supplementary Appendix B outlines the international accreditation domains.

Government plan and strategy. The proposed program is aligned with Viet Nam's Socio-Economic Development Plan 2011-2020, which aims to increase the trained workforce to and have medical universities and training schools meet international standards. It is consistent with the Viet Nam Health Sector Development Strategy 2016-2020 and the SDGs. It supports the Master Plan for HHR development, which seeks to strengthen the capacities of educational and training institutions, improve access to medical education and training, and ensure adequacy and improve quality of the health workforce. The proposed program is aligned with the UHC as the overarching goal of health sector.

Impact Strengthened management of health workforce towards improved universal health coverage and achievement of health-related sustainable development goals (Socio-Economic Development Strategy 2011-2020)
Project Outcome
Description of Outcome Increased supply of competent and qualified health workforce
Progress Toward Outcome
Implementation Progress
Description of Project Outputs


1. Institutional framework for HHR development strengthened

2. HHR management systems improved

3. Education and training of health professionals enhanced

Status of Implementation Progress (Outputs, Activities, and Issues)
Geographical Location Nation-wide
Safeguard Categories
Environment C
Involuntary Resettlement C
Indigenous Peoples B
Summary of Environmental and Social Aspects
Environmental Aspects
Involuntary Resettlement
Indigenous Peoples
Stakeholder Communication, Participation, and Consultation
During Project Design The main stakeholders are the incumbent and incoming faculty and staff of medical educational institutions, health professionals, MOH staff, civil society organizations, and current and incoming medical students. The poor, women, and ethnic minority groups will be consulted in designing the proposed project. The TRTA will involve close consultations with stakeholders to ensure that their concerns are integrated in the project design. Risk assessment and social analysis will also involve the participation of stakeholders to determine how the project can provide maximum benefits to them, and how they can participate in implementation.
During Project Implementation To be determined
Responsible ADB Officer Servais, Gerard
Responsible ADB Department Southeast Asia Department
Responsible ADB Division Human and Social Development Division, SERD
Executing Agencies
Ministry of Health
138A Giang Vo Str.
Hanoi, Viet Nam
Concept Clearance 15 Dec 2015
Fact Finding 16 Apr 2018 to 27 Apr 2018
MRM 11 Jun 2018
Approval -
Last Review Mission -
Last PDS Update 28 Mar 2018

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