Located in Southeast Asia, Vietnam has become one of the fastest-growing economies and has plans on becoming a developed nation within the next decade. With a population of 96.1 million, Vietnam is a densely populated developing country that has been adjusting since 1986 from the rigors of a centrally planned, urban economy to a more industrial and market-based economy, and it has raised incomes significantly. While the government of Vietnam has made commendable efforts in improving the health of the country’s citizens, certain public health issues have the potential to threaten sustained economic progress.
Vietnam has a young population, a stable political system, commitment to sustainable growth, relatively low inflation, stable currency, strong FDI inflows, and a strong manufacturing sector. The overall quality of healthcare is regarded as good, as reflected by 2017 estimates of life expectancy (71.5 years) and infant mortality (17.3 per 1,000 live births – with no difference between male and females). From 1990 to 2017, the maternal mortality rate fell from 233 to 43 deaths per 100,000 live births. However, the life expectancy and infant mortality rates are stagnating, and malnutrition is just very much common in these regions and provinces. As of 2018, the birth rate (15.2 per 1,000) and death rate (5.8 per 1,000) have remained steady in recent years. The current health expenditure in Vietnam is 7.1% of GDP. Government subsidies cover about 40% of health care expenses, with the remaining 60% coming out of individuals’ own pockets. Including government and out-of-pocket spending, a total of $119 was spent on health per person in 2017, which is expected to increase to $362 by 2050. While the 2017 GDP per capita was at a mere $6,143, Vietnam exceeded its 2017 GDP growth target of 6.7% with growth of 6.8% primarily due to unexpected increases in domestic demand, and strong manufacturing exports. These improvements are accredited to a widespread health care delivery network, increasing numbers of qualified health workers, and expanding national public health programs.
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Being one of the highest population densities in the world, the population is not evenly dispersed. The biggest clusters of population are located along the South China Sea and Gulf of Tonkin, with the Mekong Delta and the Red River Valley having the lowest concentrations of people. The Healthcare Access and Quality (HAQ) Index in 2017 was 60.3%. The average percent change per year between 1990-2017 was 2% for personal healthcare access and quality. With over 8 million people belonging to ethnic minorities, the majority of live in mountainous and isolated areas of Vietnam. In terms of socioeconomic status (SES), these populations are comparatively more disadvantaged. Small-scale protests led by human rights activists still occur today, with majority of these protests pertaining to land-use issues, calls for increased political space or the lack of equitable mechanisms for resolving disputes. These protests involve various ethnic minorities like the Montagnards, the Hmong and the Khmer Krom. Limited number of health services spread throughout the provinces, especially in ethnic minorities, have substantial gaps resulting in lower health indicators and reduced economic opportunities.
The degree of risk for major infectious diseases in Vietnam is very high. The emergence of drug-resistant tuberculosis, outbreaks of influenza in animals and humans, the continued threat of the HIV epidemic, unstable health systems, and human resource constraints could limit Vietnam’s economic progression in terms of health. Stroke is the top cause of death generally and prematurely. Strokes in Vietnam (2,619.5 per 100,000) are significantly higher compared to countries like Columbia (594.8 per 100,000) and Mexico (683.1 per 100,000). Other major causes of deaths include ischemic heart disease, lung cancer, COPD, Alzheimer’s disease, tuberculosis, diabetes, cirrhosis and road injuries. Risk factors that drive the most death and disability combined are dietary risks, tobacco, high blood pressure, alcohol use, air pollution, malnutrition and high fasting plasma glucose. Insufficient funding has led to delays in planned upgrades to water supply and sewerage systems in some of the poorer regions and provinces. Vietnam has adopted a national strategy to introduce influenza vaccine, targeting health workers first. Vaccines have protected 6.7 million Vietnamese children and prevented 42,000 deaths from deadly diseases. Inadequate finances have also contributed to a shortage of nurses, midwives, and hospital beds. Patients’ average total expenditures with health insurance for both outpatients and inpatients are higher in Hanoi (52 & 1,721) compared to Dien Bien (34 & 588). This is in comparison to patients with no health insurance for outpatients and inpatients in Hanoi (470 & 5,235) and Dien Bien (20 & 1,985). Although there has been an increased significant amount of health workers in the past decade, there are still critical shortages in remote and underprivileged areas.
Vietnam continues to face growing pressure on energy infrastructure and overall, fails to meet the needs of an expanding middle class. Vietnam has demonstrated a commitment to sustainable growth over the last several years, but despite the recent speed-up in economic growth, the government remains cautious about the risk of external shocks. Policymakers, managers, health staff and other health system stakeholders in Vietnam are committed to ensuring that all people attain a level of health that enables them to participate actively in the social and economic life of the communities in which they live.
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