Summary of doctoral thesis medicine research on some related factors to dao women health care services in socio cultural aspects in bach thong district, bac kan province

1
BACKGROUND
Health of women and children are the top concerns of countries
around the world including Vietnam. In Vietnam, women health care
have remarkablly achieved results, many indicators related to
reproductive health care has reached and exceeded objectives.
However, economic, cultural, social development in mountainous areas
are still much lower than other areas affected to the healthcare services
for people. Besides factors such as low educational level, low living
standards, traffic difficulties there are cultural elements such as
backward customs, worship the Ghost when sickness that would affect
health services utilization and approach, especially ethnic minorities
including Dao ethnic. Therefore, analyzing the impact of cultural and
social factors to health services of Dao in general and of Dao women in
particular are necessary to contribute solutions in protection and health
care for ethnic minority women.
In Vietnam, many related rerearchs have been conducted. However,
systematic researches concerning health services for Dao people in
general and for Dao women in particular on socio-cultural aspects have
not been carried out. Due to reasons above, we choose Bac Kan
province (province has large number of Dao ethnic that only behind
Tay ethnic) to research topic: "Research on some related factors to Dao
women health care services in socio-cultural aspects in Bach Thong
district, Bac Kan province"
Study objectives
1. To describe and analyze the needs, supply and utilization status of
health care services to Dao women on cultural, ethnic and social
aspects in some communes in Bach Thong district, Bac Kan province.
2. To analyze some related factors concering to supply and
utilization for the existing mother health care services in local areas.

2
NEW CONTRIBUTIONS OF THESIS
1. The first research in Viet Nam studied systematicly and depthly
analyzied about some socio-cultural aspects relating to the supply and
utilization of reproductive health care services of Dao women.
2. The first time using the combination of classic research Methods,
Qualitative Research (PRA) and evaluation methods based on five
indicators by chart CBM logic, along with samples of cases tracked
consecutive 12 months to identify the factors related to health care Dao
woman, as prerequisite for strengthening the activities of health
services for Dao women on some cultural – society aspects. .
IMPLICATION OF THE THESIS
1. Identified the needs, supply and utilization status of Dao women
health care services. A base from which the proposed activities
strengthen health services in the province.
2. Analyzed the factors related to supply and use health services of
Dao women. Among them, cultural - society factors have much
influence to women health. Local activities to enhance health services
reached some initial results based on the identification of factors related
above, a base for operations orientation strengthening health services
for Dao ethnic in particular and for ethnic minorities in general.
LAYOUT OF THE THESIS
Thesis includes 105 pages.
Introduction
Chapter 1: Literature review
Chapter 2: Methodology
Chapter 3: Results of the study
Chapter 4: Discussion
Conclusions and recommendations

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107 deferences were used in the thesis (84 in Vietnamese, 23 in
English), 37 tables, 7 graphs, 29 photos, 4 pictrures.


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Chapter 1
OVERVIEW OF DOCUMENTS
1.1. Cultural definition
Culture is a broad concept with many connotations different
interpretation, involving all aspects of material life and the human
spirit. In 2002, UNESCO has offered this definition of culture: "Culture
should be addressed as a set of characteristics in mind, physical, and
emotional knowledge of a society or group in society and it contains, in
addition to the literature and the arts, both living and modes of living
together, value systems, traditions and beliefs ".

In summary, organic cultural attachment to people, we can understand
an aspect of culture that is the custom, customs, habits, lifestyles of the
people are formed, survive and development of human life. The elements
of culture include nine basic content: language, food, accommodation,
clothing, beliefs, rituals, folk art, folk knowledge and the different
traditions (funeral, marriage, the new house, healing, family...).
1. 2. Some culture charecteristics of Dao ethnic related to the health
1.2.1. Language
Voice of the Mongolian - Daolanguage group, the number of people
fluent in the language of literature is not much. Due to the nature of
language, in the process of communicating health officials face many
difficulties because of language barrier.
1.2.2. Housing
Houses of the Dao is mainly a ground. House has a low roof, small
windows, always low humidity, lack of air and low light. The vast
majority of households do not use the bathroom and toilet.
1.2.3. Eating, drinking
After delivery, women having a personal food, food is mainly meat,
pork and chicken are cooked with herb drugs. Dao people drink tea and
some leaves have an aromatic cool, easy to drink and used to treat diseases.
More common type of drinking is alcohol made from yeast leaves.
1.2.4. The practice of reproductive and take care children
In the past, when women who have children often have to delivery
themself, umbilical cord is cut with sharp bamboo. In recent years, the
birth of the Dao have been many changes, obstetric complications,
mortality in infants ... have been minimized, Dao population increased
significantly.


4

1.2.5. Beliefs related to illness
The Dao people concept that when the spirt is full in the human
body that mean they are very well. If the spirit in any position is
absence, it will cause sickness. To avoid negative consequences, it must
invite the sorcerer to call spirit or ransom to come back.
1.2.6. Customs and habits: Worship the Ghost, delivery at home
has been remained.
1.2.7. Some intolerance: When pregnant, women diet of hard
working, a couple living diet, diet food rancid. During pregnancy they
do not talk out, diet in eating so it is easy to decline their health,
affecting the development of the fetus.
1.2.8. Knowledge in folk medicine: Dao people know to process
alot of type of traditional medicine, such as cooking drugs, alcohol
drugs, pure drug, broken bone drugs ... Among them, the outstanding
was bath drug for women postpartum, it helped women to recover
health quickly, it was accepted by the community.
1.3. Health situation, reproductive health of women
Incidence of diseases in women are generally higher than men,
overall rates of 2.5 disease / person, women with diseases of the
reproductive system, urology higher than three times men.
1.4. Women in access and use of health services
Approaching health service depends on four basic groups of factors:
distance from home to medical facilities, economy, health care, culture
- society. The relationship between access and use health care: If the
"supplier" lack the necessary resources, will lead to efficient resource
utilization is low. If the "demand" does not demand the right, not to
accept, do not use the health which the "supplier" ready to offer, this
leads to waste of resources and effective community health care
services is limited.
1.5. Management system of primary health care - assessment

tools to approach and use of health services
CBM - Community Based Monitoring - a method of assessing
access and use of health services. The main goal of CBM is to
determine health care needs have been met or not, how to meet, the
cause of obstructing the use of health services and the existence of the
health services provider through indicators: availability, approach,
using, use enough and use effectively.


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Chapter 2
OBJECTS AND METHODS OF STUDY
2.1. Objects, places and time study
- Married Dao women from 15 to 49 years old in Don Phong and
Duong Phong commune, Bach Thong district, Bac Kan province.
- Research time: 2 years, from 01/2008 to 12/2009
2.2. Research methodology
- Research description: cross-sectional survey combines
quantitative, qualitative (PRA) and track 12 months was conducted on
the whole number of married Dao women from 15 – 49 years old to
describe specific of ethnic Dao and some specific cultural - social;
reality provides and uses health care.
- Research analysis: Evaluating the health care through five logic
indicators (availability, access, use, enough use, efficient use), paper
cases (with check list) to discover trends range of services, the problem
exists, assessing the quality of health service.
- Sample size and choosing a sample: Select the form intent. The
sample size includes all married Dao women who are 15 to 49 years
old, including 329 women, in which 80 women with children under 5
years old and / or are pregnant.

2.3. Research technique
-The variables of population, demographic, housing, water source,
distance from home to medical station; medical personnel, facilities,
medicines and equipment were recorded by survey techniques (surveys
329 married Dao woman from 15 - 49 years old; 60 health staffs who
are working in 17 medical stations belong to Bach Thong district),
observed (photos).
-The variables of characteristics cultural - society relating to health
of Dao woman are collected by using PRA techniques: mapping (2),
ranking (1); life story (1), seasoning(1), matrix (1), in-depth interviews
(5), discussion groups (3).
-The variables of knowledge, skills of its medical staff are
evaluated through the methods of paper case combining the check list.


6
- The variable about tend to health services (5 indicators logic) are
evaluated by CBM chart and track 12 consecutive months.
2.4. Evaluation criteria about indicators research
Index performance evaluation of active primary care: The evaluation
criteria recognized by national standard for commune health.
Index performance evaluation of reproductive health care for the
period 2001 - 2010: folowing The decision of No 136/2000/QD - TT of
the Prime Minister on 28th November 2000.
Index performance evaluation the knowledge of health staff on
reproductive health: excelent = 9 - 10 points; good = 7 - 8 points;
average = 5 - 6 points, bad = 1 - 4 points, a basic error = 0 points
Five logical indicators: According to the formula prescribed by the
Ministry of Health, including:
* Monitor the health care of pregnant women before delivery:

+ The rate of available: (number of days reporting period - Number of
days unavailable) x 100 / number of days reporting period). The number of
days unavailable in iron, albumin urine test paper (or solution to test),
antenatal care and blood pressure check during the next report from the
monitoring book. The number of days not available are the total number of
days without one or more of the things mentioned above.
+ The rate of approaching: (the access number x 100) / Total
population. People approach the total population live in villages where
time travel to the clinic by conventional means available shall not
exceed one hour and each month receive health care of pregnant
women at foreign stations at least once time if more than an hour away.
+ The rate of utilization: (number of women have prenatal care x 100) /
estimated number of women giving birth. As the proportion of pregnant
women were examined at least 1 time before birth during the reporting period.
+ The rate of full utilization: (number of antenatal care enough x
100) / estimated number of women giving birth. As the proportion of
pregnant women for antenatal care at least 3 times before they give
birth during the reporting period.
+ The rate of effective utilization: (number of well-maintained x
100) / estimated number of women giving birth. Number of good care
is the number of prenatal care are three times at three gestation, were
vaccinated against tetanus two times and received the iron before birth
during the reporting period.


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* Monitor the health care of women during and after birth:
+ The rate of available: Following the above formula. The dates of
oxytocin is unavailable, sterilize instruments, delivered tools during the
reporting period from the monitor book.

+ The rate of access: Folloing the formula above.
+ The rate of utilization: (number of women delivered by medical
staffs x 100) / number of women giving birth (estimated). If having
exactly number of delivered women, not the estimated number of
women giving birth.
+ The rate of full utilization: (The care enough x 100) / estimated
number of women giving birth. Number of care enough are the number of
women who have at least 3 times antenatal care, giving birth by health care
staffs and received postnatal care (at least 2 times within 42 days after birth).
+ The rate of effective utilization: (number of well-care x 100) /
estimated number of women giving birth. Number of good care is the
number of women who have at least 3 times examination in 3 periods
of pregnancy, giving birth by health care staffs, received postnatal care
(at least 2 times within 42 days after birth) and give birth in medical
station with the support of the means of delivered (the clean package
delivered and the set of delivered tools) during the reporting period.
* How to read CBM charts
The vertical axis indicates the rate of the factors related to health
issues. The horizontal axis indicates the factors that are related closely.
Diagram is drawn when the results of the target factors, the availability,
access, use, full utilization and effective utilization has been made in
tracking together. If the path of the chart tend to decline that means
have some problems in public health care and this matters should be
resolved. More and more declining level that means have more and
more health care problems in community and priority needs to be
resolved. Level of decline of the chart decreases means that activity
medical progress.
2.5. Data processing method
Research data is processed and analyzed by using statistical
software SPSS. The qualitative research data are presented as methods

for qualitative and complement the results of quantitative research.


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Chapter 3
RESULTS OF STUDY
3.1. Some cultural - social charateristics of the Dao people in
Bach Thong district, Bac Kan province
Table 3.2. Characteristics of married Dao women aged 15 to 49 in
two research communes in 2009
Number
Characteristics of Dao women
%
(n = 329)
Education level
Illiteracy
65
19.8
Can read and write
53
16.1
Primary school
126
38.3
Secondary school
68
20.7
Hight school
16
4.9

Colleges, universities
1
0.3
Dao women's career
Farming, upland
321
97.6
Civil servants
2
0.6
Other
6
1.8
Comments: Education of Dao women are very low, occupation
mainly is in farming.
Table 3.4. Characteristics of house, water source and stable of Dao
people in two research communes
Number
Housing, water source, stable
%
(n = 329)
Type of accommodation
Strongly built house
6
1.8
Semi-permanent
124
37.7
Provisional
199

60.5
Water source
Stream water
178
54.1
Rainwater
54
16.41
Wellwater
19
5.78
Carrying water
78
23.71
Barn
From house ≤ 10 m
198
60.18
From house > 10m
131
39.82


9
Comments: House is mainly a temporary (60.5%). Stream water is
mainly water source of the Dao (54.1%). Most of barns near the house
so that it is very unhygienic.
Table 3.6. Characteristics of distance, time and vehicles to the
nearest health facility
Number

Variable
%
(n = 329)
Distance from home to CHCs
≤ 5 km
94
28.6
From 6 to 10 km
197
59.9
From 10 km or more
38
11.6
Min = 2 Max = 30 Mean = 7.84
The time from home to CHC by
ussually used vehicles
Under 60 minutes
78
23.71
More than 60 minutes
251
76.29
Vehicles
Walk
76
23.1
Bicycles
45
13.7
Motorcycles

197
59.9
Other
11
3.3
Comments: Having 76.29% of households take more than an hour to
the nearest CHCs by ussually used vehicles.
* The result of depth interviews, life story to understand the
concept of Dao people in health, disease, customs that related to
childbirth, Mr. Ban Van K (Priest), Ms. Ban Thi K (village leader) ,
Ms. Trieu Thi H said that: Dao people concept that disease was made
by Ghost so that they attach much important to worship. When sicknes,
they both worship at home and go to the health care. When Dao women
giving birth, they are cared carefully with traditional herbs, typically is
bathherb for women after giving birth. The habit of Dao people is to
reserve medicine at home. When sickness, they take the traditional
medicine theirself or self-purchase model medicine. If their health are
not better, they go to medical facilities later.


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3.2. Supply status of health services at basic health system
Table 3.7. Human resource of 17 CHCs in Bach Thong district in 2009
Human resource
Number
%
Total of health staffs of 17 medical stations
65
100
The rate of commune with doctor

8
47.05
The rate of commune with midwifery
10
58.82
Graduate Medical Polyclinic
19
29.23
Nursing
23
35.38
Druggist
1
1.54
Herbalist
4
6.15
Medical man / total villages
148/148
100
Collaborater of population / total villages
94/148
63.51
Health staff/1000 people (65/5657)
1.15
Midwifery / women aged 15-49 (10/1659)
0.6
Average of health staff / CHC
3.82
Comments: The rate of doctors in CHCs is still low (47.05%),

midwives are about 58.82%.
Table 3.9. Infrastructure, drugs and equipment at 17 CHCs in 2009
Index
1. Facilities
Health station
Function rooms
Water source
Kitchen
Sanitary toilet
Electric
2. Basic equipment
Blood pressure
Thermograph
Stethoscope
3. Required equipment
Set of dental
Set of ENT
Set of ophthalmology

Sufficient
n
%
17
4
6
7
4
4

100

23.53
35.29
41.18
23.53
23.53

16
16
17

94.12
94.12
100

7

41.18

Insufficient
n
%

13
8

76.47
47.06

13

No have
n
%

76.47

11.76
23.53
11.76

17.65
58.82
76.47

1
1

2
4
2

3
10
13

5.88
5.88

8
13

15

47.06
76.47
88.24


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Index
4. Drugs
Number
Kind of drugs
Pharmacy

Sufficient
n
%
9
15
3

52.9
88.2
17.6

Insufficient
n
%
8
2

No have
n
%

47.1
11.8
14

82.4

Comments: Most CHCs lack functional departments and requred
instruments. About 47,06% CHCs have no dental instruments; 76,47%
without ENT instruments; no eye examination instruments (88,24%).
Not enought sufficient drugs (47,1%). About 82,4% have no pharmacy.
Table 3.10. Obstetric equipments at 17 CHCs in Bach Thong
district in 2009
Index
1.Facilities, instruments
O & G department
Gynecology table
Tools of antenatal
Tools of delivered
Tools of family planning
Scale for new born
Scale for adults
2. Drugs
Oxytoxin
Ion
3. Other equipments

Antenatal sheets
Albumin paper test
Wire size

Sufficient
n
%

Insufficient
n
%

No have
n
%

4
10
7
8
7
15
13

23.53
58.82
41.18
47.06
41.18
88.24

76.47

10
4
10
6
6
0
0

58.82
23.53
58.82
35.29
35.29

3
3
0
3
4
2
4

17.65
17.65

11
5

64.71
29.41

3
9

17.65
52.94

3
3

17.65
17.65

5
0
17

29.41

12
17

70.59
100

0
0

17.65
23.53
11.76
23.53

100

Comments: Most of CHCs lack O&G treament rooms. About 17.65
% stations do not have any tool to use; 23.53% stations do not have
family planning tools; 17.65% have no oxytocin and iron. The rate of
stations lack iron is 52.94%. About 70.59% missing sheets for antenatal
care and 100% do not test albumin urine.


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Table 3.11. Knowledge of CHC’s staffs on reproductive health care
(n = 60)
Doctors
Midwives
Nurses
Total
Ranking
n
%
n
%
n
%
n
%

Excellent
0
0
0
0
Good
8
13.33
4
6.67
5
8.33 17 28.33
Average
16 26.67
6
10
12
20
43 56.67
Not good
3
5
0
6
10
9
15
Total
27
10

23
60
100
Comment: Knowledge of health staffs about obstetric care is still
limitted, have no scored well, bad on knowledge is 15%.
Table 3.12. Antenatal care skills of health workers (n = 60)
Ranking
Doctors
Midwives
Nurses
Total
n
%
n
%
n
%
n
%
Excellent
0
0
0
0
Good
7
11.67
4
6.67
4

6.67
15
25
Average
13 21.67
4
6.67
11 18.33 28 46.67
Not good
7
11.67
2
3.33
8
13.33 17 28.33
Total
27
10
23
60
100
Comment: Skills of health staffs about antenatal care are very weak, have
no good ratings. The rate of not good practice are very high (28.33%).
3.3. Disease patterns, healthcare needs and how to treat when sick
Table 3.13. Situation of sickness of Dao’families in the two weeks
before survey at two communes
Number
Variable
%
(n = 329)

99
30.1
Have sickness
Sick members in family (n = 99)
Wife
23
23.23
Husband
16
16.16
Children
38
38.38
Other
22
22.22


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Comment: In two-weeks preceding the survey, nearly one-third of
households have sickness (30.1%), sickpersons were mostly children
(38.38%) and women (23.23 %).
Table 3.14. Number visits to CHCs at two research communes in 2009
Diseases group
Respiratory
Digest
Cardiovascular
Urology
Gynaecology
Musculo, bone

Injury
Eyes
Dental
Dermatology
Other
Total

Dao ethnic
(n = 1676)
SL
%
710
42.36
71
4.24
52
3.1
26
1.55
292
17.42
124
7.4
27
1.61
33
1.97
309
18.44
24

1.43
8
0.48
1.676
100

Other ethnic
(n = 3657)
SL
%
1608 43.97
183
5.00
105
2.87
67
1.83
372 10.17
430 11.76
66
1.80
53
1.45
701 19.17
41
1.12
31
0.85
3.657 100

Total
p
(n = 5.333)
SL
%
2318 43.47
254
4.76
>0.05
157
2.94
93
1.74
664 12.45
<0.05
554 10.39
93
1.74
86
1.61
1010 18.94 >0.05
65
1.22
39
0.73
5.333 100

Comment: Respiratory infections accounted for the highest
percentage (43.47%). The rate of gynecological diseases of the Dao
women (17.42%) is higher than the other ethnic (10.17%) with p <0.05.

For other diseases, there are no significant difference (p>0.05).
Table 3.17. Use of prenatal care of Dao women in two research
communes in 2009
Variable
Number of antenatal visits
No prenatal visit
Only one time before birth
Only two times before birth
At least three times before birth
Number of using tetanus vaccine
Do not inject any time
One time
≥ 2 times

Number
(n = 80)

%

18
59
2
19

22.5
73.75
2.5
23.75

7

30
43

8.8
37.5
53.8


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Comment: The majority (73.75%) of Dao women have only one
time visit CHCs for antenatal care. The rate of pregnant women who
examined from three or more times are lower (23.75%).
Table 3.18. Use during and postnatal care of Dao women at two
research communes in 2009
Variable

Number
(n = 80)

%

Place of birth
Community health center
13
16.25
Hospital
51
63.75
At home with medical support
10

12.5
At home without medical support
6
7.5
Place of treatmen when women have
abnormal after giving birth
Self-treatment
14
17.5
Community health center
18
22.5
Hospital
5
6.25
73
91.25
Not be examined within 42 days after geving birth
Comment: About 20% of women give birth at home, in which 7.5%
delivery at home without medical staff. Delivering at CHCs accounted for
the low rate (16.25%), even lower than delivery at home (20%). Most
women (91.25%) are not examinated within 42 days after giving birth .
Table 3.19. Comment of the Dao women about the activities of
community health centers (n = 329)
Satisfied
Unsatisfied
Health's activities
n
%
n

%
Wait examination
249
75.7
80
24.3
Medical procedures
208
63.2
121
36.8
Qualification
169
51.4
160
48.6
Drugs
53
16.1
276
83.9
The attitude of physicians
134
40.73
195
59.27
Price
248
75.4
81

24.6
Equipment
62
18.8
267
81.2
Open hour
285
86.6
44
13.4
Comment: Most of Dao women are not satisfied with drug supply
(83.9%); equipment (81.2%). About 59.27% of women who are
unhappy with physician attitude; professional quality (48.6%).


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Table 3.21. Initial treatment of Dao woman when sickness in two
weeks before survey
The way of treatments
Do not use anything (or spell)

Number
(n = 99)
37

%
37.37

29

29.29
Self treated with herb
13
13.13
Self-purchase medicine
9
9.09
To the health-care
7
7.07
Worshiping at home
0
0
Private Clinics
4
4.04
Other
Comments: When they had sickness, they did not use any thing or
just spelled at home (37.37%), self-treated with herb (29.29%), selfpurchase medicine (13.13%), to the health care (9.09%); only worship
at home (7.07%).
Table 3.22. The reason for not going to health facilties of sick Dao
within 2 weeks before conducting a survey
Number
%
(n = 99)
Mild disease
72
72.73
Not enough money
69

69.7
Health facilities too far
53
53.54
The attitude of doctors is not good
50
50.51
Do not believe the doctor
37
37.37
Many times to treat patient but not well.
19
19.19
No time (Busy season)
11
11.11
Incurable disease
3
3.03
Other
15
15.15
Comment: They do not seek medical care because of mild disease
(72.73%), not enough money (69.7%); health facilities too far
(53.54%); 50.51% by physician's attitude is not good and 37.37% do
not believe the doctor. The reaseons such as no time or busy season
occupies 11.11%.
Reasons for not seek medical

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3.4. Utilization status of health services of Dao women
Table 3.25. The coverage of health care services for pregnant women
before giving birth from 2007 to 2009 in two research communes
Percentage
2007
2008
2009
Available
72
85
94
Approachable
61
65.5
76.04
Utilization
39.34
70
73.75
Full utilization
21.31
24.28
23.75
Efficient utlization
14.75
17.14
17.94
120
2007

100
94

100

2008
76,04

2009

73,75

80
72
60

61

40

23,75

39,34

17,94

20
21,31

14,75

0
Target

Available

Approachable

Utilization

Full utilization

Efficient utilization

Chart 3.1. Coverage of health care services chart for pregnant women
before giving birth from 2007 to 2009 in two research communes
Comment: Health care service for pregnant before giving birth are
still remaining 5 stages from inputs to outputs. In which, the biggest
trouble is full utilization. There is great disparity between the number
and quality of service. The coverage of the service tends to increase,
especially the utilization rate.
Table 3.27. The coverage of health care services for pregnant women during
and after giving birth from 2007 to 2009 in two research communes
Percentage
Available
Approachable
Utilization
Full utilization
Efficient utlization

2007
84.36
61.27
48.34
9.83
0

2008
100
65.5
50.1
10.42
5.65

2009
100
76.04
62.3
11.53
8.2


17
120
100

2007

100

2008

100
76,04

2009

80
84,36

62,3

60
61,27
48,34

40

11,53
20

8,2
9,83

0
Target

Available

Approachable

Utilization

Full utilization

0
Efficient utilization

Chart 3.3. Coverage of health care services chart for pregnant women
during and after giving birth from 2007 to 2009 in two research communes
Comments: The coverage of the service tends to increase over the
years, the biggest problem is full utilization.
Table 3.31. Health services utilization for Dao pregnant women
during giving birth in two research communes
Variable
2007
2008
2009
n
%
n
%
n
%
Number child alive/year
43
40
30
Delivery at CHCs

11 25.58
7
17.5
5
16.67
Delivery in the hospital
20 46.51 23
57.5
19 63.33
Home delivery with staff
8
18.6
7
17.5
4
13.33
Home delivery without staff
4
9.3
3
7.5
2
6.67
Comments:The rate of delivery in hospitals tend to increase. The
percentage of children are delivered at CHCs and at home tends to
decrease. However, at the present, children are delivered at home,
especially without health staff.
Table 3.33. The coverage of expand vaccination services for
children from 2007 to 2009 in two research communes
Ration

2007
2008
2009
Available
91
92.5
94.5
Approachable
72.6
79.82
76.04
Utilization
97.01
97.4
97.5
Full utilization
95.52
96.1
95
Efficient utlization
0
0
0
Comments: Expand vaccination services for children has been quite
good, but the effective utilization rate is 0% due to the cold chain is not
satisfactory and this rate has not improved in 3 years.


18
Table 3.34. Effectiveness of solutions in enhancing equipment,

drugs and professional training in two research communes
2008
2009
Variables
(Before intervene)

(After intervene)

Equipment
Dental seats
1/2
2/2
Adult dental care
0/2
2/2
Child dental care
1/2
2/2
Microscope
0/2
1/2
Training
Dental Technician
0/2
2/2
Pap technique
0/5
5/5
Full drugs for cure gynecological
0/2

2/2
The fund's average for CHC (million / year)
By people’s committee
3.9
4.25
By District Health Department
1.25
2.85
By District People's Committee
0
1.5
By self - CHCs
0.27
1.24
By the project, organization donors
3
12.2
Comment: Equipments, drugs and instruments have been equipped
enought for CHCs. Health workers have been training. In particular, funds that
made by CHCs were increased from 0.27 to 1.24 million VND.
Table 3.35. The number of visits to CHCs at two research
communes in 2009
Number of visits to
Before
After
CHCs
P value
intervention intervention
(6-first monthst)

n

%

(6-last months)

n

%
Dao ethnic
Total visits
703 41.95 973
58.05
Gynecological
58
19.85 234
80.15
<0.01
Periodontal disease
55
17.8
254
82.2
Other ethnic
Total visits
1838 50.26 1819 49.74
>0.05
Gynecological
79
21.23 293

78.77
<0.01
Periodontal disease
133 18.98 568
81.02
<0.01
Comments: Total medical gynecological and dental diseases of the
Dao and other ethnic groups increased significantly (p <0,01). Total
examination of the Dao increased from 41.95% to 58.05% (p <0,01).


19
Chapter 4
DISCUSSION
4.1. Some cultural - social characteristics of Dao people
related to health
- Housing: mainly temporary account for 60.5% (Table 3.4),
barn near the house. Perhap, due to housing is unhealthy so that
percentage of sick children in two weeks preceding the survey was
38.38% (Table 3.13) and the rate of respiratory infection was
42.36% (Table 3.14).
- The water source: used was mostly stream water, carryingwater.
Most families have no bathroom. Perhaps, because of the water source
is not guarantee so gynecological rate in Dao women higher than other
ethnic (17.4% versus 10.1%) (Table 3.14).
- Traffics: About 76.29% of households take more than an hour
to get to CHCs (Table 3.6). Distances so far is one of the reasons for
the 53.54% who did not seek medical (Table 3.22). This result is
consistent with the findings of the Health Ministry's investigation.
- Herb bath and reproductive habits: Bath with medicinal herbs

after giving birth of Dao women is a specific culture of the Dao. All
postpartum women who Dao bath with Vietnamese traditional
medicine (Table 3.30) to quickly recover their health. Herb - bath is
one of a good custom need to promote this custom. However, up to
now Dao women have still given birth at home (20%), although the
tends of giving birth at home is decreasing. It is noted that birth rate
in medical station also tend to decrease (Table 3.18), the cause is
due to reproductive health services at the station does not meet the
demand, lack of obstetric and gynecology department, lack of
medicine, weak professional ... make Dao people do not believe in
medical staffs and station (Table 3.19, Table 3.22). Because of
ethnic beliefs, so Dao women who are pregnant and when the birth
are great abstinence, especially not for strangers to come in their
home and they themselves do not go outside. Perhaps this is one of
the reasons make 91.25% of Dao women are not examined after
birth? (Table 3.18). Dao women avoid hard working, rancid food
during pregnancy and childbirth. They are cared carefully by the
family in order to have enough breastfeeding... These are good
abstinence for healthy, so health staff should communicate widely
to members of the family to take care pregnant women during and
after birth well, helping to reduce the rate of fetal malnutrition,
improving race .


20
- Beliefs related diseases: Dao people concept that disease is caused by
Ghost, so when they have sickness they spell and witchcraft firstly, it
occupied the highest rate of 37.37%; worshiping in home was 7.07%
(Table 3.21), with mild disease they witchcraft or using oil lamp, if it was
not better then they used Vietnamese traditional herb or buy drugs, with a

serious sickness, they also has taken to the health station and worship at
home at the same time (Matrix). Belief in worshiping Ghost (Spirit) when
sickness also helps sick people have confidence in mysterious power, but
if they only believe in worshiping and not go to medical facilities it may be
dangerous to life. Therefore, we need to widely communicate for Dao
people to the medical facilities when sick on time.
4.2. Health care needs, supply status and utilization of health
services for Dao women
4.2.1. Health care needs
Percentage of sick Dao people for 2 weeks before the survey
was 30.1%. The rate of sick Dao women was 23.23% this was
lower than sick children (38.38%). The rate of Dao women with
gynecological was 17.42% higher than women of other ethnic
groups (p <0.05).
4.2.2. Supply status and utilization of health services for Dao
women
4.2.2.1. The human resource, facilities, medical equipment in
general and reproductive health care in particular
- Human resources: The rate of doctors was low (47,05%), rate
of midwives was 58.82% (Table 3.7). Lack of doctors and midwives
causes quality and safety of services. Qualification of health staffs
about obstetric care is still limited (Table 3.11 and 3.12). This leads
48.6% Dao peope are unhappy about professionals (Table 3.19);
37.37% Dao people disbelieve health staffs and it is the reason that
they do not go to CHCs for examination (Table 3.22). As well as the
reproductive health service is not good so that Dao peope tend
choosing hospitals instead of CHCs in giving birth (Table 3.31).
- About facilities: Most of the CHCs lack O&G rooms. About
7.65% of CHC have no type of this department (Table 3.10).
- About obstetric equipment : More than 1/3 the number of

CHCs do not have enough deliver tools and family planning tools
(Table 3.10). A lack of obstetric equipment has prevented medical
staff doing health service at medical well.


21
- About drugs: About 47.1% of CHCs did not have enough drugs to
allocate; 82.4% of CHCs have no pharmacy; 17.65% of CHCs have no
oxytocin and iron. Percentage of stations lack of iron is 52.94%;
70.59% lack of ticket for antenatal care and 100% do not test albumin
urine (Table 3.9 and 3.10). Lack of drugs is also the reason why health
officials are not assured when the procedure and the mother is not
assured to give birth at the station.
As a result, lack of facilities, health stations, O & G department, lack of
specialized instruments, lack of medicine, not high professional
qualifications, training incoherent... were great difficulty to be able to
deploy the work of health care for the woman. This has reduced the rate of
utilization before, during and after the birth service (Table 3.25, Table
3.27).
4.2.2.2. The situation provides health care services for pregnant
women before birth
Health care services for pregnant women before birth has existed in
five stages from inputs to outputs. In particular, the biggest problem is
full utilization. However, services tend to increase (Table 3.25).
4.2.2.3. The situation provides health care services for pregnant
women during and after birth
The coverage this service tend to increase (Table 3.27), however,
the rate of effective utilization is 0%. This indicates a problem to
overcome here is to improve the quality of service.
4.3. Some factors affecting Dao women's health care services in

the areas of research
- Effects of some socio-cultural aspects:
+ Due to the high rate of the Dao poor (30.03%), low educational
level (Table 3.1 and 3.2) therefor when they have sickness they do not
used anything or only Cast spells and witchcraft at first, occupied the
highest percentage 37.37% (Table 3.21).
+ Due to the concept that disease is caused by ghost so that if want
to be treated well must worship the Ghost, Therefore, only 7.07% of
Dao people worship at home, not going to the health facilities (Table
3.21).
+ Due to a number of backward customs and habits as delivery at
home 20% (Table 18.3), 100% abstinence is not a stranger into
pregnancy women (Table 30.3) has made effective utilization rate of
the service postnatal health care was 0% (Table 3.28).


22
+ Due to farming practices, busy season has made about 11,11% of
Dao women does not have time to seek medical care (Table 3.22).
+ Difficult traffic, far away from medical stations are also factors
that hinder Dao pepole from approaching to health service (Table 3.6).
+ Due to reside in the sacred forest, far from medical facilities so
Dao pepole have experienced in using the forest trees as medicines, has
29.29% of Dao women who self-treated by traditional medicine so they
do not go to health facilities (Table 3.21), 100% of Dao women use the
herb bath after birth to recover their health more quickly.
- Effect of the economic: In 2009, the rate of poor households in
Bac Kan Province was 25.18% and the whole country was 11%. As
a result, the rate of poor Dao households in Bach Thong district is
still higher than the rate of poor households in Bac Kan province

and country. Economic factors also influence the decision to use
medical services of the Dao pepole. About 37.37% Dao people do
not treat when they have sickness (Table 3.21); has 69.7% of Dao
women who did not seek medical because they have not enough
money, the money paid to borrow a share and loan lending
accounted for 15.2% overall and 19.2% (Table 3.22 ). Our results
match the results of the Ministry of Health.
- Effect of providing health services: CHCs do not meet the
health care needs of the Dao people. The status of missing drugs,
lack of equipment, weak qualifications, chilly attitude, lack of
medical information... was the reasons has made 83.9% of Dao
people unhappy with drugs; 37.37% do not trust the physician
(Table 22.3).
4.4. Assessment and analysis of factors related to supply and
utilization of mother health care services available at the local
By research methods in medical classic combines PRA methods
helped provide local that measures to strengthen health care services
for Dao women effectively: total examination of the Dao increased
from 41. 95% to 58.05% is statistically significant (p <0.01). This
expenditure by health stations increased from 0.27 to 1.24 million
per year.


23
CONCLUSION
1. Health care needs, supply status and utilization of health care
service of Dao woman in Bach Thong district, Bac Kan
The needs of Dao health care is high requirement, illness rate is
30.1%, of which the needs of Dao women is 23.23% lower than the
needs of child health care (38.38%). Dao women were gynecological

(17.41%) higher than other ethnic women (10.17%) with p <0.05.
Health care services for pregnant women before giving birth tend to
rise, but uneven and still have many troubles. Existing from input to
output, the biggest trouble is full utilization (23.75%).
Health care services for pregnant women during and after birth rate
achieved was 100% available, the ratio also tends to increase but not
significantly. The biggest trouble is full utilization (11.53%).
Child health care services have rather good results.
2. The factors that affect health care of Dao women
- Some cultural factors:
+ Have not good influence on health care of Dao women: The
concept of disease is due to make by Ghost, so worship was very
common when they have illness, abstain from strangers entering their
home after birth, busy season... to restrict women go to health care after
birth (91.25% of Dao women are not examined after birth).
Geographical distance, the terrain is also a factor obstructing Dao
people to access health service (76.29% go to medical stations for 60
minutes or more). Still have 20% of Dao women delivered at home
with medical or without medical help.
+ Have a good affecting on health care to Dao women: 100% of Dao
woman use herb bath after birth to recover health quickly. They avoid
to work hard when having pregnance, abstaining from eating stale.
During pregnancy and childbirth period, they are taken care of family
menbers with mental and material that help women recover quickly to
breast feeding.
- Some of the factors of economy, society and ethnic: the high rate
of poor households Dao (30.03%), low education level, little receives
health information led to poor awareness about the disease as well as
how treatment when sickness are very difficulty: About 37.37% of sick
Dao women did not use any drugs or just the Cast spells and witchcraft;

self treated with a traditional medicine (29.29%); self buy the medicine
(13.13%); to the health office (9.09%); only worship at home accounts
for 7.07%; no one go to the private clinics.


24
- Some factors about health service supply (insufficience and poor
quality): poor facilities, drugs and equipment, lack of required
equipments for specialized departments and gynecology. Qualifications
of health staffs are not high, there is no excellent point, not good in
knowledge was 15%, practice was 28.33%. Dao people were unhappy
about the activities at CHCs: 83.9% due to lack of drugs; 81.2% due to
lack of medical equipment; poor attitude of physicians (59.27%); poor
professional qualification (48.6%). Therefore, about 50.51% of Dao
people did not seek medical facilities because of doctors’ attitude and
37.37% did not trust phycians.
3. A number of factors related to supply and utilization of
mothers health care services available at local
After providing the activities such as purchasing new and additional
equipments (dental, gynecological), training health staffs (Dental Technician,
Technical Pap diagnosis and treatment of gynecological diseases), patients
were in charge of fee in some services, enhanced funding for clinics,
mobilizing support from organizations and individuals, strengthening the
CHC’s abilities in examination, treatment, and health education... have
obtained some results: Number of visits for gynecologist and periodontal
disease increased significantly. Gynecological visits of Dao woman
increased from 19.85% to 80.15%, number of periodontal visits increased
from 17.8% up 82.2%. Similarly to Dao people, The number of
gynecological visits and periodontal disease of other ethnic groups also
increased. The total number of clinic visits increased from 41.95% of Dao

people to 58.05% (p <0.01).
RECOMMENDATIONS
- Continuing to strengthen and enhance the CHC: investing essential
equipments used for comon disease examination and treatment,
enhancing training health staffs.
- Monitoring and supporting CHCs: Using the coverd chart, paper
case, the checklist.
- Coordinating other social organizations to strengthen health education.
- Mobilizing the community participation in health care activities
based on the ethnic-cultural traditional aspects.