Improving access to health care services Healthcare system in Vietnam is organized by 4 levels, central, provincial, district and commune levels. Among which, commune healthcare stations play an important role in implementing most of activities on preventive healthcare, prevention of and response to diseases, health checkup and primary healthcare services for people, as well as implementing commune level population and family planning program; providing monitoring and oversight of healthcare activities in communes, towns and villages; facilitating participation of communities in healthcare activities.

Commune healthcare stations are of importance for the people, especially in remote areas with difficult economic circumstances and transportation infrastructure. According to an assessment, ethnic minority communities and poor people have limited access to higher level healthcare services given their habits and challenging economic and transportation conditions. Surveys carried out by CDI in 2014 in #akrong district, Quang Tri province and in 2012 in Da Bac district, Hoa Binh province, with samples of almost 400 households/ each district, among people who had accessed commune or district based healthcare services within 12 months prior to the surveys found that in Quang Tri province, 88,65% of surveyed people used commune healthcare services, 11,4% used district level services. While in Hoa Binh, numbers of people accessing commune and district level healthcare servicesfor treatment purposes accounted for only 40% and 60% respectively within previous 12 months.

However, services provided at commune healthcare stations are of low quality, inadequately responsive to the people#s needs for health check and treatment. In remoted areas, the percentage of health stations having doctors is quite low. In Quang Tri, currently, only 60% of commune level healthcare stations having doctors as required. On the other hand, findings from surveys in Quang Tri and Hoa Binh provinces with regards to quality of commune healthcare stations included insufficient facilities; unfriendly attitude of healthcare officials; high costs charged to patients even though they were covered by healthcare insurance, which was assessed to be unaffordable for the people; unsupportive attitude and behavior of commune healthcareofficials against patients applying for upstream transfer and the people#s inconfidence in quality of commune level services. As result, people prefers to either go up to higher level or pay for private services usingtheir pocket money.

Low quality healthcare services at grass-root level increases inequality in access to healthcare. Commune healthcare stations are far from being able to meet the local needs for health checkup and treatment which results in people having to access higher level servicesat provincial or central level hospital for instance. However, this is not commonly the case for poor people and ethnic minority people given their habits and economic/ transportation difficulties. It means currently the health insurancefund is basicallyused to cover the healthcare payments of mid-income populations. Healthcare insurance policies are inadequately benefiting the poor.

Ministry of Health is planning for the improvement of system of commune healhcare stations and development of #household doctors# model. However, this plan so far has not been successfully implemented in reality due to the lack of concrete measures. Additionally, provincial authorities have their ownership in allocating public budget for local healthcare. Normally, threshold of budget allocated for commune healthcare is approximately 20-30 million/ station/ year. With this limited funding level, it is challenging for commune healthcare stations to function properly. Not to mention that they are operated in an inflexiblemanner, not responsive to actual needs of local people.

After a field trip to a commune healthcare station in August of 2016, Deputy Prime Minister, Vu Duc Dam, requested Ministry of Health and Vietnam Social Security to push up their cooperation to elaborate specific and practical solutions to enhance the role of local healthcare system, which might include: Regulations on establishment of health tracking book for each individual citizen in localities; list of drugs, list of services provided at local healthcare stations;  up to 20% of the fund for medical services for outpatients calculated on the number of individuals registering with primary healthcare providers at commune level. This is seen as an opportunity for local communities to make the actualsituations as well as urgent needs for healthcare and treatment recognized by policy makers at central and local levels.

Pursuant to the Decision No. 2151/Q#- BYT dated onJune 4th, 2015 of MOH on #Innovation of serving manner and attitude of health officials toward the satisfaction of patients#, assessment of patients# level of satisfaction has been implemented in some localities through public opinions polls, hotlines, etc.,. This is actually a welcomed policy though its implementation remains limited at the level of some big hospitals and so far, it has beenacknowledged as a mean of encouraging, motivating and rewarding only.

This proposed project is based on MOH#s decision on #Innovation of serving manner and attitude of health officials towardthe satisfaction of patients# at local level, which is most accessible level for the local people, especially for those living in remote areas and ethnic minority communities. Findings of the assessment will not only be used as an evidence to requestforhigher quality services delivered by service providers, but also help to inform advocacy efforts since they are considered as criteria used to formulate budget allocation with the principle that #higher quality of healthcare services provided by health stations increases demand, higher demand requires higher funding#.

On the other hand, by further enabling dialogue with local people, understanding their needs, the project aims to influence policies which allow commune healthcare stations to develop demand based plans, which is appropriate to the local characterized contexts instead of the current imposed planning approach. This project is designed with expected results as below:

Result 1: Contribute to the improved awareness and accountabilityon the critical role of local healthcare system for the local community.
Result 2: Contribute to the improved capacity of local healthcare system in delivering service (including management capacity, quantity and quality of services) through interventionson budget allocation process to make sure it is implemented in a more transparent and targeted manner