services more affordable for the poor; and fourthly, strengthening emergency services and equipping hospitals in remote areas with skilled personnel and equipment (ADB and WHO, 2002).

# Goal Six: Combat HIV/AIDs, malaria ancl communicable diseases

## Achievements

HIV/AIDS prevalence is low but rising fast. HIV/AIDS has spread to all 61 provinces since 1990 when the first case was detected in Vietnam. Between 1990 and 2000 the number of reported HIV/AIDS cases rose at 7 percent per annum. WHO estimates that by the end of 2000, the number of HIV infected people in the 15-49 years old population was between 122,000 and 130,000 or around 0.29% (WHO, 2001). At the early stages of the epidemic the disease was confined mainly to injecting drug users. However, it has now spread to other population groups including sex workers, patients with tuberculosis and the general population. The Government’s policy towards promotion of condoms and safe needles has been ambiguous in Vietnam. In the absence of clear commitment from the Ministry of Health, local authorities have sometimes opposed promotion of condoms and safe needles for HIV/AIDS prevention (ADB and WHO, 2002).

Achievements in controlling malaria and tuberculosis have been spectacular and are perhaps Vietnam’s greatest success stories in improving health outcomes (Box 7)

## Box 7. The successful fight against malaria and Tuberculosis in Vietnam

Malaria - Vietnam is known to have one of the most successful malaria control programs in the world. Malaria incidence has fallen from 16 cases per 1000 persons in 1991 to merely 6 in 1998. At the same time, the number of malaria deaths dropped nearly one tenth of what it was in 1991, with fewer than three deaths out of 10,000 malaria cases. This success followed a radical change of approach in 1991, when Vietnam moved from a malaria eradication program, which involved DDT spraying and mass drug treatment, to a malaria control approach. This involved distributing impregnated bed nets, which currently protect over 10 million people, house spraying with an insecticide that has a one-year residual effect, distribution of free drugs (including locally produced artemisinin and its derivatives to treat falciparum malaria), and intensive health education of village heads and commune health staff in endemic areas. Key elements to this success have been: ®° High-level political and financial commitment leading to mobilization of activities from the central to the village level, leading to up to 2000 people working in the public sector on malaria control.

- © Offering free drugs and insecticides to the effected population.

- 9 Having an initial vertical structure that followed WHO guidelines for malaria control.

Tuberculosis - Vietnam’s Tuberculosis (TB) control program is also known to be among the most successful in the world. The program currently covers 99% of the population, up from 23% in 1985. The number of pulmonary smear-positive TB cases increased nine-fold from 6600 in 1986 to 55000 in 1998, but this is the result of many cases being undetected and untreated in the past, which are correctly diagnosed and treated today.

Source: World Bank et al (2001) and Schuftan and Le Dinh Cong (2001) 30