The proposed Local Health Care Sector Development Program will assist the Government of Viet Nam to implement the Master Plan for Strengthening Local Health Care Services, which sets out reforms to improve access to and the quality of the local health care (LHC) system. The design and monitoring framework is in Appendix 1. The problem tree is in Appendix 2.
Project Name | Local Health Care for Disadvantaged Areas Sector Development Program | ||||||||
Project Number | 50285-002 | ||||||||
Country | Viet Nam |
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Project Status | Active | ||||||||
Project Type / Modality of Assistance | Grant Loan |
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Source of Funding / Amount |
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Strategic Agendas | Inclusive economic growth |
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Drivers of Change | Gender Equity and Mainstreaming Governance and capacity development Partnerships |
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Sector / Subsector | Health / Health insurance and subsidized health programs - Health sector development and reform |
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Gender Equity and Mainstreaming | Gender equity | ||||||||
Description | The proposed Local Health Care Sector Development Program will assist the Government of Viet Nam to implement the Master Plan for Strengthening Local Health Care Services, which sets out reforms to improve access to and the quality of the local health care (LHC) system. The design and monitoring framework is in Appendix 1. The problem tree is in Appendix 2. | ||||||||
Project Rationale and Linkage to Country/Regional Strategy | The development problem. Inequitable access to responsive and affordable LHC services is a key cause of health status disparities in Viet Nam. Viet Nam's regions show widely differing performance on key health indicators, which vary by a factor of 2.9 for the infant mortality rate, 3.0 for under-5 child mortality, and 2.7 for child malnutrition (Supplementary Document 1). Remote and mountainous areas have inadequate primary health care (PHC) services, and poorer health outcomes. A deficient LHC system increases vulnerability to an epidemic of emerging noncommunicable diseases (NCDs). Weak LHC in border areas can fail to detect and contain emerging, epidemic-prone transboundary diseases and thus decrease regional health security (RHS). The government is aware that LHC reforms are essential for achieving universal health coverage (UHC), meeting the health-related targets of the Sustainable Development Goals (SDGs), ensuring RHS, and supporting inclusive growth. Binding constraints. Key obstacles to realizing the LHC system reform agenda contained in the master plan are (i) weak public investment management capacity to ensure adequate local health care infrastructure that meets quality standards, (ii) unresponsive service delivery models, and (iii) weak health workforce development and management. The Ministry of Health (MOH) and provincial governments lack an investment framework and robust mechanisms to direct investments under the master plan. Reforms to strengthen public financial management capacity are required to ensure sound government and development partner financing for master plan implementation, particularly in upgrading the commune health station (CHS) infrastructure. The LHC system is unresponsive to Viet Nam's epidemiological profile. Up to 70% of patients referred to provincial hospitals, including for NCD management and illnesses related to ageing, could be treated at the PHC level. Utilization of the LHC system, particularly for maternaland child health, remains low. To reverse this trend, service delivery systems need to be reoriented. In border and remote areas, an accessible CHS network is essential for timely detection of and response to emerging and epidemic-prone threats to RHS. Health financing mechanisms for LHC services are needed, including health insurance benefit packages for NCD management, long-term care, and sexual and reproductive health (SRH) services. Ensuring adequate health staff in CHSs with the requisite skills to provide PHC services is a core reform area under the master plan. The regulatory frameworks that govern health workforce development and staffing require strengthening, including policies for the delivery of continuing medical education and balanced deployment of female, male, and ethnic minority health professionals. Systems for health professional licensing need to be upgraded. Government strategy. The government is prioritizing strengthening of LHC as it seeks to achieve UHC and meet the health-related SDGs. The master plan sets out the framework to (i) consolidate the LHC organizational structure; (ii) reorient operational, service delivery, and financing mechanisms; (iii) strengthen LHC human resources; and (iv) guide investments in LHC system infrastructure (Supplementary Appendix 2). The government is committed to meeting its legal obligations under the International Health Regulations, which require that minimum core public health capacities for responding to health security threats (HSTs) be established. Asian Development Bank engagement. The Asian Development Bank (ADB) has supported strengthening PHC since 1995 in combination with regional cooperation to control communicable disease (Supplementary Appendix 3). The program will consolidate work undertaken by ADB to improve primary health service delivery through better quality management systems and workers, with an intensified focus on the communes. The program is consistent with the ADB strategy for health cooperation, and continues ADB support for health system strengthening and enhanced health security. The program will strengthen PHC services in border areas by improving disease surveillance and control, enhancing outbreak response capacity, and addressing the needs of mobile populations. The program aligns with the medium- to long-term ADB strategy to assist the government achieve UHC through strengthened health service delivery, health human resources (HHR), and health financing. It complements ADB assistance to policy and institutional reforms on HHR and health financing (Supplementary Appendix 4). Development partner coordination. Master plan implementation will be supported by ADB through the program, and by a proposed World Bank project, and will benefit from strong synergies between the proposed interventions (Supplementary Appendix 5). The program will establish the required regulatory frameworks and systems for managing government and development partner investments under the master plan. The World Bank will support investments in infrastructure, equipment, and training. Parallel investments for equipment and training under the program's project grant will complement World Bank investments through delineation in geographic areas of focus. The program will complement the European Union's Health Sector Policy Support Program to enhance health sector policy and planning systems. Proposed modality. A sector development program lending is proposed. The program will support key policy reform actions to strengthen the LHC system, including RHS, by establishing a regulatory and institutional framework to direct investments under the master plan to be financed by the government and development partners. The framework will also be critically important as program loan funds will be used for investment in CHSs, which demonstrates the government's commitment to the implementation of the master plan and RHS. The policy reforms will provide an enabling environment for effective delivery of project grant support, which encompasses investments in capacity building, equipment, quality assurance, and analytical work for enhancing LHC and responsiveness to RHS threats. |
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Impact | Universal health coverage for all citizens achieved (National Action Plan for the Implementation of the 2030 Sustainable Development Agenda) |
Project Outcome | |
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Description of Outcome | Quality of and access to LHC services for women and men, particularly in disadvantaged and remote areas improved |
Progress Toward Outcome | |
Implementation Progress | |
Description of Project Outputs | Public investment management for local health care Service delivery models for local health care network Local health care workforce development and management |
Status of Implementation Progress (Outputs, Activities, and Issues) | |
Geographical Location | Nation-wide |
Safeguard Categories | |
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Environment | C |
Involuntary Resettlement | C |
Indigenous Peoples | B |
Summary of Environmental and Social Aspects | |
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Environmental Aspects | The program is categorized C for environment because none of the policy reform actions and the investment in district hospitals involves civil works are anticipated to result in adverse environmental impacts or increased health and safety risks. The CPMU and DOH in each province will be responsible for ensuring compliance with applicable laws and regulations of Vietnam relating to environment, health and safety requirements; attention should be paid to occupational health and safety and waste management requirements. |
Involuntary Resettlement | The program is categorized C for involuntary resettlement as it is not expected to have impacts on land acquisition and resettlement. None of the policy actions or project grant activities involve civil works. |
Indigenous Peoples | The program is expected to bring positive impacts to ethnic minorities such as improving the capacity of ethnic minority health care staffers, improving access to and quality of health services for ethnic minorities, especially in disadvantaged and remote areas. As positive impacts on ethnic groups are expected, the program is classified category B for indigenous peoples. An EMDP was prepared to ensure project grant activities benefit ethnic minorities during implementation. The CPMU and DOH in each province will ensure full implementation of the EMDP. The project will assist with training and capacity building of MOH/CPMU and DOH, including for implementation of the EMDP, through training and field visits. The EA will hire a gender and ethnic minority specialist (18 person-months) and a communications specialist (15 person-months) to assist the project in implementing and monitoring the measures described in the EMDP. |
Stakeholder Communication, Participation, and Consultation | |
During Project Design | During project preparation, several consultations with key stakeholders, including local authorities and representatives of two ethnic minority groups (Khmer and Xe Dang) were carried out. The project will utilize a broad range of effective channels to disseminate key information and messages, particularly for isolated and hard-to-reach communities. These will include mobilization of village health committees, village health workers and volunteers in the project sites and the conduct of public awareness campaigns and community outreach activities. Relevant communication materials and knowledge products will be developed for targeted audience, with consideration on gender and ethnicity appropriateness. The communications strategy that will be elaborated early during project implementation will be based on specific characteristics of ethnic minorities in the project areas, including analysis of factors that limit their access to local health care services. |
During Project Implementation |
Responsible ADB Officer | Elfving, Rikard N. |
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 |
Timetable | |
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Concept Clearance | 29 Sep 2017 |
Fact Finding | 23 Jan 2018 to 09 Feb 2018 |
MRM | 09 Jul 2018 |
Approval | 10 Dec 2018 |
Last Review Mission | - |
Last PDS Update | 31 Mar 2020 |
Grant 0636-VIE
Milestones | |||||
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Approval | Signing Date | Effectivity Date | Closing | ||
Original | Revised | Actual | |||
10 Dec 2018 | 06 Aug 2019 | 04 Feb 2020 | 30 Sep 2025 | - | - |
Financing Plan | Grant Utilization | ||||
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Total (Amount in US$ million) | Date | ADB | Others | Net Percentage | |
Project Cost | 12.00 | Cumulative Contract Awards | |||
ADB | 12.00 | 10 Dec 2018 | 0.00 | 0.00 | 0% |
Counterpart | 0.00 | Cumulative Disbursements | |||
Cofinancing | 0.00 | 10 Dec 2018 | 0.10 | 0.00 | 1% |
Status of Covenants | ||||||
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Category | Sector | Safeguards | Social | Financial | Economic | Others |
Rating | - | - | - | - | - | Satisfactory |
Loan 3758-VIE
Milestones | |||||
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Approval | Signing Date | Effectivity Date | Closing | ||
Original | Revised | Actual | |||
10 Dec 2018 | 06 Aug 2019 | 04 Feb 2020 | 31 Mar 2020 | 31 Mar 2021 | - |
Financing Plan | Loan Utilization | ||||
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Total (Amount in US$ million) | Date | ADB | Others | Net Percentage | |
Project Cost | 90.20 | Cumulative Contract Awards | |||
ADB | 88.60 | 10 Dec 2018 | 0.00 | 0.00 | 0% |
Counterpart | 1.60 | Cumulative Disbursements | |||
Cofinancing | 0.00 | 10 Dec 2018 | 0.00 | 0.00 | 0% |
Status of Covenants | ||||||
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Category | Sector | Safeguards | Social | Financial | Economic | Others |
Rating | - | - | - | - | - | Satisfactory |
Project Data Sheets (PDS) contain summary information on the project or program. Because the PDS is a work in progress, some information may not be included in its initial version but will be added as it becomes available. Information about proposed projects is tentative and indicative.
The Access to Information Policy (AIP) recognizes that transparency and accountability are essential to development effectiveness. It establishes the disclosure requirements for documents and information ADB produces or requires to be produced.
The Accountability Mechanism provides a forum where people adversely affected by ADB-assisted projects can voice and seek solutions to their problems and report alleged noncompliance of ADB's operational policies and procedures.
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Title | Document Type | Document Date |
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Local Health Care for Disadvantaged Areas Sector Development Program: Procurement Plan | Procurement Plans | Oct 2020 |
Loan Agreement (Ordinary Operations [Concessional]) for Loan 3758-VIE: Local Health Care for Disadvantaged Areas Sector Development Program | Loan Agreement (Ordinary Resources) | Aug 2019 |
Grant Agreement (Special Operations) for Grant 0636-VIE: Local Health Care for Disadvantaged Areas Sector Development Program | Grant Agreement | Aug 2019 |
Local Health Care for Disadvantaged Areas Sector Development Program: Project Administration Manual | Project/Program Administration Manual | Nov 2018 |
Local Health Care for Disadvantaged Areas Sector Development Program: Gender Action Plan | Gender Action Plans | Nov 2018 |
Local Health Care for Disadvantaged Areas Sector Development Program: Report and Recommendation of the President | Reports and Recommendations of the President | Nov 2018 |
Local Health Care Sector Development Program: Concept Paper | Concept Papers | Sep 2017 |
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 |
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Local Health Care Sector Development Program: Ethnic Minority Development Plan | Indigenous Peoples Plans/Indigenous Peoples Development Plans | Feb 2018 |
Evaluation Documents See also: Independent Evaluation
None currently available.
Related Publications
None currently available.
The Access to Information Policy (AIP) establishes the disclosure requirements for documents and information ADB produces or requires to be produced in its operations to facilitate stakeholder participation in ADB's decision-making. For more information, refer to the Safeguard Policy Statement, Operations Manual F1, and Operations Manual L3.
Requests for information may also be directed to the InfoUnit.
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ADB Project to Improve Health Care in Disadvantaged Areas in Viet Nam
ADB has approved $100.6 million in financing to support the Government of Viet Nam’s reform effort to improve health service delivery and the quality of health care providers, especially in poor, border areas.
Tenders
Tender Title | Type | Status | Posting Date | Deadline |
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Coordinating and planning consultant (Coordinating) | Individual - Consulting | Closed | 12 Jan 2021 | 14 Jan 2021 |
Financial management consultant | Individual - Consulting | Closed | 07 Jan 2021 | 10 Jan 2021 |
Procurement consultant | Individual - Consulting | Closed | 07 Jan 2021 | 10 Jan 2021 |
Coordinating and consulting consultant (Position 2 - Planning) | Individual - Consulting | Closed | 05 Jan 2021 | 11 Jan 2021 |
Contracts Awarded
Contract Title | Approval Number | Contract Date | Contractor | Contractor Address | Executing Agency | Contract Description | Total Contract Amount (US$) | Contract Amount Financed by ADB (US$) |
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PACKAGE 3: FM CONSULTANT; 4: COORDINATING & PLANNING CONSULTANT; 6: PROCUREMENT CONSULTANT | Grant 0636 | 15 Jan 2021 | VARIOUS | VARIOUS VIET NAM SOC REP OF | Ministry of Health | 163,357.80 | — |
Procurement Plan
Title | Document Type | Document Date |
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Local Health Care for Disadvantaged Areas Sector Development Program: Procurement Plan | Procurement Plans | Oct 2020 |