Vietnam has dealt historically with health as a valuable asset, a resource that was distributed in an equal manner to all citizens through the development of a wide and inclusive grassroots health network during the 1970s. Since then, the health system has developed - in parallel to the country's economy and shifts in policy - from a free-for-all service of a rather low quality, to a system that is now better regulated and has overall better quality, but is conditioned to user fees. Following the liberalization and decentralization policy directions of the Vietnamese state that initiated in the late 1980s, health is now open to private sector activity and competitiveness while still under the general control and power of the state. The impacts of these changes have been felt more and more recently as a result of widening socio-economic gaps among the population, which reflect on the way health services are being offered and accessed. This paper reviews the literature and delineates the structure and organization of the health care and health prevention delivery systems in Vietnam. Information is triangulated and enriched with findings from the field, obtained through qualitative interviews with health officials, doctors and citizens in rural and urban localities within the Mekong Delta. While examining the function of health institutions, deficiencies are highlighted: (i) the state is not consistent in monitoring and ensuring the regulatory compliance of public or private health service providers, (ii) financial autonomy in the health sector, combined with the withdrawal of central support away from local health units, are creating inequalities in access while not bettering the quality of offered services, (iii) rurality and poverty are closely connected to each other and to restricted health access, either due to limited existing specialized care facilities or the inability to pay for them. Based on secondary data, the paper also presents the latest statuses of the main health indicators, which not only illustrate the general improvements achieved, but also indicate the yet unreached goal of effective preventive medicine that could sustainably control many prominent diseases and could further build better understanding around health in general.
health institutions health care Vietnam economic liberalization equity poverty