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World Health Organization (WHO) helps to strengthen Vietnam's health system

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World Health Organization (WHO) helps to strengthen Vietnam's health system

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This article talks about how the Covid-19 pandemic shed light on the issue of a lack of refrigeration available for vaccine storage in Vietnam, which can delay childhood immunization. WHO made efforts to alleviate this problem by delivering fridges to Thanh Hoa Provincial Centres for Disease Control and Prevention and providing training for healthcare workers on maintaining the fridges.

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When Viet Nam wanted to rapidly roll out COVID-19 vaccines in remote communities in Thanh Hoa Province in late 2021, there was a problem.

Many of the province's 500 commune health centres, which serve the population of 3.7 million people, did not have fridges, or had old fridges that could not reliably keep COVID-19 vaccines at the necessary temperature of between +2 °C and +8 °C. Refrigeration is an essential part of the cold chain - the process of manufacturing, storing, and distributing vaccines at temperatures that maintain their potency and safety.

Instead, health workers used motorbikes to drive several hours each way to a district hospital to pick up just enough supplies for one day's vaccination campaign in mountainous villages. Trips had to be repeated each day, with health workers losing precious time to transport, rather than care.

Despite these challenges, which were repeated in many of Viet Nam's provinces, the commitment of local health workers, backed by strong government leadership, ensured the roll-out of the primary series of COVID-19 vaccines quickly, safely and at scale, with vaccines reaching every corner of the country to protect those most vulnerable.

Still, the COVID-19 pandemic brought lessons that could be applied to other challenges, and to strengthen the primary health care system.

Most urgently, the pandemic also brought setbacks to routine immunization coverage for children, resulting in many children missing the routine vaccines that keep them safe from deadly diseases such as measles, diphtheria, and polio. With the end of the emergency phase of the pandemic came the urgent need to do catch-up vaccinations for many children in Viet Nam who missed out on their routine immunization.

The lack of fridges also slowed catch-up immunization for children. To help accelerate this programme and strengthen the capacity of commune health centres, the World Health Organization (WHO), with funding from the Korean International Cooperation Agency (KOICA) delivered 200 fridges to Thanh Hoa Provincial Centres for Disease Control and Prevention. The hardware was accompanied by training for commune health workers in maintaining the fridges to keep vaccines at the correct temperature, as well as data collection, disease surveillance and reporting. A further 54 fridges are being procured for Dak Lak Province.

Thanh Hoa and Dak Lak Provinces were identified as particularly in need because of their high populations living in poverty, often in remote, hard-to-reach locations. Health partners, notably UNICEF, are helping improve the cold chain in other provinces.

WHO Viet Nam Representative Dr Angela Pratt said, "These fridges are more than just another appliance in commune health centres. They are helping accelerate the big catch-up on routine immunization and break down barriers to equal access to life-saving immunization for babies and young children in remoter areas. They will help ensure every child receives all of their routine immunizations now and in the future."

This initiative is part of WHO's work to support the Government of Viet Nam to build on lessons learned from the pandemic to strengthen the health system and health security for the future.

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Viet Nam: Cold chain support helps restore childhood immunization and strengthen primary health care

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When Viet Nam wanted to rapidly roll out COVID-19 vaccines in remote communities in Thanh Hoa Province in late 2021, there was a problem. Many of the province's 500 commune health centres, which serve the population of 3.7 million people, did not have fridges, or had old fridges that could not reliably keep COVID-19 vaccines at the necessary temperature of between +2 °C and +8 °C.

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Peer Reviewed Article: Immunization in Vietnam

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Peer Reviewed Article: Immunization in Vietnam

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This article explores the results of implementing the Expanded Program on Immunization in Vietnam, first proposed by WHO in 1981. The effects of the vaccination efforts as well as barriers to implementation of the program are discussed, and potential solutions are provided within the article.

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Peer Reviewed Article: Requirements for optimal COVID-19 Immunization prgram

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Peer Reviewed Article: Requirements for optimal COVID-19 Immunization prgram

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This article talks about the system established by Vietnam's government to improve the response to COVID-19 and increase vaccination rates by ensuring an efficient way to store and distribute vaccines.

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Peer Reviewed Article: Unmet healthcare needs

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Peer Reviewed Article: Unmet healthcare needs

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This article talks about the factors and social determinants of health that contribute to health inequities and a lack of access to healthcare within Vietnam, especially in rural areas of the country.

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UNICEF provides support for Vietnam's Expanded Programme on Immunization (EPI)

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UNICEF provides support for Vietnam's Expanded Programme on Immunization (EPI)

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UNICEF works with local healthcare authorities and health workers to provide a supply of vaccines, as well as ensuring that communities have access to knowledge about immunizations.

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UNICEF, as a trusted and committed partner, is continuing to support health authorities and local health workers to ensure all children in Viet Nam benefit from life-saving vaccines. To help achieve this, we are working to build and maintain a strong national immunization supply chain system to ensure the quality and supply of vaccines through effective evaluation and management.

We also work closely with partners to equip parents and communities with the knowledge they need to protect their children, with training of frontline health workers on how to inform families about the benefits of immunization. This outreach is critically important to build and retain public trust to combat 'vaccine hesitancy', especially during cases of 'adverse events following immunization' and media misreporting.

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With immunization one of the most cost-effective public health interventions, UNICEF is helping Viet Nam protect children from illness and disability.

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Hospital upgrades result in better health care services for those in rural Vietnam

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Hospital upgrades result in better health care services for those in rural Vietnam

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Investment into local health systems, such as providing new medical techniques and training, has improved treatment capacity at provincial and district level hospitals, helping to reduce crowding at national level hospitals as well as increase access to quality care for people living in rural areas.

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Looking closer, you will find some high-tech, state-of-the-art medical equipment there - those generally available at medical centers only - such as a 32-slice CT scanner or digital subtraction angiography.

" All these shiny expensive pieces would sit here idling without skilled physicians to put them a good use," said Dr. Tran Lan Anh, director of the hospital. " What is special about this project's approach is the large-scale procurement of new equipment went hand in hand with in-depth skill enhancement. These two components have to go hand in hand to be effective."

To fill the skill gap, this project sent local doctors to medical centers in Hanoi where they would be matched with the nation's top specialists and learn by working on real cases. Approximately 4,800 doctors benefited from this training, acquiring nearly 3,000 new techniques and now using these procedures on a regular basis on their home turf.

Dr. Dang Viet Hung - who led this project from Vietnam's Ministry of Health - said: " This project demonstrated that if we could build a close connection from top-tier hospitals down to the local network, we could facilitate seamless sharing and transfer of knowledge and expertise. With such exchange, doctors at the lower level will continue to be empowered to take on more advanced procedures that otherwise could only be done by doctors at the upper level."

Due to noted improvement in not only technical but also management capacities, 35 out of 74 local hospitals moved to upper hospital classifications by the Ministry of Health. With the expansion of service coverage and improved quality of care, these hospitals became the first-choice provider for more and more local residents. As of November 2020, nearly 42,000 residents used the new clinical services available at both provincial and district hospitals, which resulted in lower self-referral rates. Patients surveyed at these hospitals reported higher levels of satisfaction with the overall quality: 81.3% at the provincial and 88.5% at the district level.

Beaming with smiles in the recovery room, patient Noi said: " I am happy that we no longer have to go to Hanoi if we get sick, even for serious illnesses. It's good to have a decent hospital nearby to take care of us - it would save us time, expenses and, troubles. Not to mention, our loved ones could always go visit. I wish that everyone would have such a hospital in their community."

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Snapshot on Vietnam's hospital network structure

Public hospitals in Vietnam are divided into three levels: central level (47 hospitals); provincial level (419 hospitals) and district level (684 hospitals). In addition to the public hospitals, there are 182 private hospitals, most of them are located in urban areas.
( Vietnam Health Statistics Yearbook 2018)

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A World Bank-financed project helps improve the public health service delivery in the northern part of Vietnam, benefiting millions of people.

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A World Bank-financed project helps improve the public health service delivery in the northern part of Vietnam, benefiting millions of people.

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This article talks about the effects of the COVID-19 pandemic on routine immunizations and the current efforts to ensure that all children receive the necessary vaccines. It also discusses some of the roadblocks to this goal, such as lack of access and vaccine hesitancy.

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It was early morning, but the yard in the Tan Hoa Commune Health Centre, Buon Don District in Dak Lak Province, was already packed. Dozens of people queued, holding children who were about to be vaccinated. Families were diverse, reflecting the large number of ethnic minority groups in the area, particularly Jrai and Ede.

As in many countries, the COVID-19 pandemic has disrupted routine immunization in Viet Nam, leaving some children in this commune unprotected against vaccine-preventable diseases.

For the past two years, health-care workers at Tan Hoa Commune Health Centre, which was already stretched thin with limited resources and funding, had to focus on pandemic measures and the rollout of COVID-19 vaccines.

Although at the end of 2022, routine immunization resumed, there were challenges to ensuring all children in the area received critical early childhood vaccines. These included vaccine hesitancy among some ethnic minority people due to religious and cultural beliefs, and remoteness - with some community members living far from health centres, often in places without road access. In addition, like many families around the world, some parents were suffering from vaccine fatigue after the COVID-19 vaccination rollout for both adults and children. For these reasons, the Central Highlands of Viet Nam, which includes Dak Lak, has one of the lowest rates of fully immunized children in Viet Nam, with only 27 out of 52 districts meeting national immunization targets.

Despite these challenges, the doctors and nurses at Tan Hoa Commune Health Centre are committed to ensuring as many children as possible are fully vaccinated. They continue to work through the list of children registered in the local immunization registry, contacting families and encouraging them to bring their children to get doses they missed during the acute phase of the COVID-19 pandemic.

Vaccines protect against more than 20 diseases including measles, rubella, polio, hepatitis B and diphtheria that pose serious risks to children, making routine childhood immunization critical to a child's healthy development.

By midday, with the sun blazing, the queue was shorter, the day's session was almost over. But the immunization work in Buon Don District, and more broadly across the Central Highland's Region and the country, now requires sustained effort and extensive collaboration between the government, communities and partners. Many more of these immunization sessions are needed along with increased efforts to address accessibility issues and tackle vaccine hesitancy. This combined work is critical to ensure that every child in every corner of the country is safer and healthier through receiving all their recommended routine immunizations.

WHO Viet Nam, along with other partners, has been working with the government to resume childhood vaccination efforts. WHO Viet Nam is also committed to help strengthening the primary health-care system, as grassroots health-care facilities are vital not only for childhood immunization efforts, but also for disease management and control, especially when the number of children who missed out childhood vaccinations is large enough to trigger an outbreak.
Scroll through the photos below to learn more about the children and adults attending a catch-up vaccination session at the Tan Hoa Commune Health Centre.

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Viet Nam's big catch-up - protecting children through routine immunization in the Central Highlands

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It was early morning, but the yard in the Tan Hoa Commune Health Centre, Buon Don District in Dak Lak Province, was already packed. Dozens of people queued, holding children who were about to be vaccinated.

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This video talks about the primary health care system in Vietnam and how communities benefit from it.

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World Health Organization Regional Office for the Western Pacific