Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, QLD, Australia.
Int J Health Policy Manag. 2018 Jul 1;7(7):593-602. doi: 10.15171/ijhpm.2017.134.
The impact of reorganisation on health services delivery is a recurring issue in every healthcare system. In 2005 Vietnam reorganised the delivery of health services at the district level by splitting preventive, curative, and administrative roles. This qualitative study explored how these reforms impacted on the organisation of maternal health service delivery at district and commune levels.
Forty-three semi-structured interviews were conducted with health staff and managers involved in the provision of maternal health services from the commune to the central level within five districts of two Northern provinces in Vietnam. The data were analysed thematically.
The results showed that 10 years after the reforms created three district-level entities, participants reported difficulties in management of health services at the district and commune levels in Vietnam. The reforms were largely perceived to negatively affect the efficient and effective use of clinical and other resources. At the commune level, the reforms are said to have affected the quality of supervision of the communes and their staff and increased the workload in community health centres.
The findings from this study suggest that the current organisation of district health services in Vietnam may have had unintended negative consequences. It also indicates that countries which decide to reform their systems in a manner similar to Vietnam need to pay attention to coordination between a multiplicity of agencies at the district level.
在每个医疗保健系统中，组织变革对医疗服务提供的影响都是一个反复出现的问题。2005 年，越南对地区一级的卫生服务提供进行了重组，将预防、治疗和行政职能分开。本定性研究探讨了这些改革对地区和乡镇两级孕产妇保健服务提供的组织产生了怎样的影响。
在越南两个北部省份的五个地区，对参与提供孕产妇保健服务的卫生人员和管理人员进行了 43 次半结构式访谈，访谈范围从乡镇一级到中央一级。对数据进行了主题分析。
改革创建了三个地区一级的实体 10 年后，参与者报告说，越南地区和乡镇一级的卫生服务管理存在困难。这些改革在很大程度上被认为对临床和其他资源的有效利用产生了负面影响。在乡镇一级，改革据说影响了乡镇及其工作人员的监督质量，并增加了社区卫生中心的工作量。
本研究的结果表明，越南目前的地区卫生服务组织可能产生了意想不到的负面影响。这也表明，决定以类似于越南的方式改革其系统的国家需要注意地区一级多个机构之间的协调。
