Khả năng tiếp cận dịch vụ chăm sóc sức khỏe ban đầu của người cao tuổi

DFC REPORT

ACCESS TO PRIMARY HEALTH CARE SERVICES
BY OLDER PEOPLE IN RURAL AREAS
OF VIETNAM

Project
Task
Award
E

: WPVNM1207061
: 3.8
: 58363 (AC)
: 511-DFC


LIST OF CONTENTS
LIST OF TABLES.......................................................................................................................i
LIST OF FIGURES....................................................................................................................ii
LIST OF ABBREVIATIONS...................................................................................................iii
ABSTRACT................................................................................................................................iv
1...................................................................................BACKGROUND AND RATIONALE
.......................................................................................................................................................1
2.........................................................................................................................OBJECTIVES
.......................................................................................................................................................3
2.1..............................................................................................................General objectives
...............................................................................................................................................3
2.2..............................................................................................................Specific objectives
...............................................................................................................................................3
3..............................................................................................................................METHODS

.......................................................................................................................................................3
3.1.......................................................................................................................Study setting
...............................................................................................................................................3
3.2........................................................................................................................Study design
...............................................................................................................................................4
3.3...................................................................................................Sampling and sample size
...............................................................................................................................................4
3.4........................................................................................................Definition of variables
...............................................................................................................................................4
3.5.........................................................................Variable measurement and data collection
...............................................................................................................................................6
3.6...............................................................................................................Statistical analysis
...............................................................................................................................................6
4................................................................................................................................RESULTS
.......................................................................................................................................................7
4.1............................................................Socio-demographic characteristics of older people
...............................................................................................................................................7
4.2..............................................................................................Health status of older people
.............................................................................................................................................10


4.3.........................................................................Knowledge on health care of older people
.............................................................................................................................................13
4.4.....................................................................Access to PHC services among older people
.............................................................................................................................................13
4.4.1.

CHSs and PHC services available for older people........................................13

4.4.2.

Health insurance status of older people..........................................................17

4.4.3.

The utilization of available PHC services by older people.............................17

4.5...........................................................Factors associated with the access to PHC services
.............................................................................................................................................19
5..........................................................................................................................DISCUSSION
.....................................................................................................................................................24
5.1..............................................................................................Characteristics of the sample
.............................................................................................................................................24
5.2...........................................................Factors associated with the access to PHC services
.............................................................................................................................................24
5.3......................................................................................................Limitations of the study
.............................................................................................................................................26
6....................................................................CONCLUSION AND RECOMMENDATION
.....................................................................................................................................................28
6.1..........................................................................................................................Conclusion
.............................................................................................................................................28
6.2................................................................................................................Recommendation
.............................................................................................................................................29
REFERENCE............................................................................................................................30
APPENDIX................................................................................................................................33


LIST OF TABLES

Table 1. Description of dependent and independent variables................................................5

Table 2. Percentage distribution of Age, Sex and Education of older people.........................7
Table 3. Percentage distribution of Ethnicity, Religion, Marital status and Living
arrangement of older people....................................................................................................8
Table 4. Percentage distribution of Working status and Income of older people.....................9
Table 5. Description of chronic disease status among older people.......................................11
Table 6. Description of functional limitations among older people.......................................12
Table 7. Health troubles occurring within the last four weeks of older people.....................12
Table 8. Knowledge on health care of older people...............................................................13
Table 9. Health insurance status of older people....................................................................17
Table 10. Utilization of health care services among older people.........................................17
Table 11. Percentage distribution of educational level of older people by the utilization of
general health examination....................................................................................................20
Table 12. Percentage distribution of income by the utilization
of general health examination................................................................................................20
Table 13. Percentage distribution of sources of income, amount of income and
self-evaluated household income by the utilization of general health examination..............21
Table 14. Percentage distribution of knowledge on health care of older people with health
troubles by the utilization of regular CD follow-up examination..........................................22
Table 15. Percentage distribution of self-evaluated health status of older people by the
utilization of health care services...........................................................................................22
Table 16. Percentage distribution of self-evaluated impact of health troubles among older
people by the utilization of health trouble examination.........................................................23
Table 17. Percentage distribution of health insurance status of older people by the utilization
of CD follow-up examination................................................................................................23

i


LIST OF FIGURES
Figure 1. Self-evaluated household income by older people.................................................10

Figure 2. Self-evaluated health status by older people..........................................................10
Figure 3. Percentage distribution of health care utilization by types of health facilities.......18
Figure 4. Map of Giong Trom district, Ben Tre province, Vietnam.......................................33

ii


LIST OF ABBREVIATIONS

CD

Chronic Disease

CHS
IFA

Commune Health Station
International Federation of Aging

IHPH
MOH
PHC
UN
VEA
WHO

Institute of Hygiene and Public Health
Ministry of Health (Vietnam)
Primary Health Care
United Nations

Vietnam Elderly Association
World Health Organization

iii


ABSTRACT

Primary health care (PHC) for older people has contributed to better health and
mitigation of chronic disease burdens for older people. The study aims to identify
whether older people in rural areas of Vietnam are able to effectively access to PHC
services and what are the barriers preventing them from access to those services.
The study was conducted on January, 2013 at Giong Trom district, Ben Tre province.
A cross-sectional study was applied to collect both quantitative and qualitative data
from 520 older people aged 60 or above and four commune health stations (CHSs).
The findings show that PHC services for older people were inadequate and very
poor. That might prevent older people from access to health services. Lower
educational level and lower self-evaluated health status might be barriers of the
access to general health examination. The older people getting 3,000,000 VND per
month or over and the older people thought that their household income was
“richest” accounted the highest percentage of the utilization of general health
examination compared to others. Health insurance status, knowledge on health care,
and self-evaluated health status among older people were also found to be
significantly associated with the use of CD follow-up examination, especially with
regular CD follow-up examination. No characteristics were found to be related to
health trouble examination except impact levels of health troubles. It might
determine the use of that service by older people.
Some recommendations were given for the improvement of PHC services and for
further studies.

KEY WORDS: access, primary health care, older people, rural areas, Vietnam

iv


1. BACKGROUND AND RATIONALE
The older population in Vietnam is projected to rapidly increase in the next decades
as a result of lower mortality and higher life expectancy. The proportion of older
people (aged 60 and above) was 7.3 percent in 1990, slightly increased to 8.4 percent
in 2010 and will be suddenly reached to 18.3 percent by the year 2030 (UN, 2010).
More than two third of the older people are living in rural areas (IFA, 2008). The
strong flows of laborers from rural to urban areas have increased the proportion of
older people in rural areas and the number of older people living alone or with their
old spouse (who are also older) or with their grandchildren. Moreover, older people
living in rural areas have poorer education level, lifestyles, living conditions (Ninh et
al., 2010) and less access to health care (Hoi, Chuc & Lindholm, 2010) compared to
those living in urban areas. These gaps make older people in rural areas more
vulnerable than others.
Although life expectancy of Vietnamese people has improved, the average healthy
life expectancy has been quite low. It was only 58 years, ranked 116 among 174
countries in the world (MOH, 2008). This also means that older people are living
longer with more illnesses and disability. According to the WHO (2012), chronic
health conditions are the main challenges for older people. In fact, the majority of
older people in Vietnam were suffering from chronic illnesses such as hypertension,
cardiovascular disease, cataracts, joint and born disorders and chronic lung diseases
(Brook, 2008; Hanh et al., 2008). Besides, most of the older people were born, grew
up and experienced long colonial and war periods that caused many difficulties and
unfavourable healthcare conditions for them. In fact, 70 percent of those people “did
not have material accumulation” (IFA, 2008, p. 2). Therefore, burdens of chronic
health illnesses will become heavier and affect not only older people and their

families but also the health system and the society as a whole.
Primary health care (PHC) plays an important role in reducing these burdens. PHC is
estimated to diminish 70 per cent of global disease burden (WHO, 2008). Being
aware of this situation, the Vietnamese government has promulgated the Elderly Law
No. 16/2009-L-CTN in which PHC has been introduced as one of the crucial terms
to improve the health for older people (VEA, 2009). The Law clearly assigned the
1


responsibilities for Commune Health Stations (CHS) in taking PHC for older people
through health education and communication, health management profiles, periodic
health examination or health examination at home for older people who are unable to
go to the stations. All these activities are free for older people. Moreover, older
people also have priorities in receiving cure services available at CHSs in accordance
with the Law.
There have been few studies related on access to PHC services, especially by older
people in Vietnam. Some studies conducted in general population showed the low
percentage of people using PHC services (Thuan, Lofgren, Lindholm & Chuc, 2008;
Cư, 2010). This percentage was higher in a recent study (Tam et al., 2010). However,
all of the studies found that the main reason preventing people from accessing to
PHC was the poor quality of services. In the context of the Elderly Law that has been
put into force since 2010, we conduct this study to identify whether older people in
rural areas of Vietnam are able to effectively access to PHC services and what are the
barriers preventing them from accessing to those services. The access to PHC
services by older people and associated barriers will be measured in three
dimensions: availability, affordability and acceptability.

2

2. OBJECTIVES
2.1. General objectives
To measure the access to PHC services by older people and associated factors in
rural areas of Vietnam
2.2. Specific objectives
1. To describe socio-demographic characteristics, health status and knowledge
on health care of older people in rural areas of Vietnam
2. To measure the access to PHC services by older people in rural areas of
Vietnam in three dimensions: availability, affordability and acceptability
3. To identify factors associated with the access to PHC services by older people
in rural areas of Vietnam

3. METHODS
3.1. Study setting

The study was conducted in Giong Trom district of Ben Tre province in 2012. Giong
Trom is a rural district, located in Mekong Delta region of Vietnam, 120 km far from
Ho Chi Minh city. This district covers an area of 311.4 km 2 and divided into Giong
Trom town and 21 other communes. The total population is around 182,400. The
main economic sector in the district is agriculture with the development of fruittrees, sugar-cane, rice, cattle, poultry, and aquaculture. The cottage industry
professions like locally special cakes, products made of coconut fiber and shell are
also developed.
Giong Trom district has the highest proportion of older people compared to other
districts of Ben Tre province. The number of people aged 60 and above in the district
is 19,075, accounting for over 10 per cent of the total population. Most of the older
people live with their children or other relations while others live alone, without any
pensions, with disability or with poverty.

3

3.2. Study design
A cross-sectional study design was applied to collect both quantitative and
qualitative data from older people and CHSs.
3.3. Sampling and sample size
Two-stage cluster sampling was used for this study. First, four communes were
randomly selected from 21 communes of Ben Tre province. Lists of older people
aged 60 and above of the four communes were established. Then, four random
samples withdrew from these lists. Size of each random sample was proportional to
size of older population of each corresponding commune. All CHSs of the four
communes were selected for health facility survey.
The sample size of 520 older people aged 60 and above was required for this study,
including the design effect of two and non-response rate of five percent.
3.4. Definition of variables
3.4.1. Independent variables:
Independent variables in the study include variables that may be factors associated
with the access to PHC services by older people. They are socio-demographic
characteristics including age, sex, educational level, living arrangement and income
status; knowledge on health care; health status and health insurance status of older
people. These variables are described in Table 1.
3.4.2. Dependent variables:

Dependent variables include variables related to the access to PHC services by older
people that may be determined by the independent variables. The utilization of PHC
services of older people represents the actual access. They are considered as
dependent variables and include: the utilization of general health examination;
chronic disease (CD) follow-up examination; regular CD follow-up examination; and
health trouble examination. These variables are described in Table 1.

4

Table 1. Description of dependent and independent variables
Research variables
Independent variables
Age

Description
The age of older people at that time of the
year 2012 and divided into three groups

Categories




Sex

The sex of older people




Educational level

The highest level of education that older
people completed






Living arrangement

People living in the same household with
older people at least four months in total
during the last six months






Income status
Sources of income

Having or not having money from any
sources monthly
Sources where older people get money
from









Amount of income

Total amount of money per month that
older people get; and classified into 5
groups







Self-evaluated household
income by older people

Classified into different levels based on
the comparison with other households in
the commune by older people







Knowledge on health care
Self-evaluated health status
by older people

Knowing at least one way of disease
prevention or health improvement

Classified into different levels based on
the evaluation of older people about their
health









Self-evaluated impact
levels of health troubles by
older people
Health insurance status
Dependent variable
General health examination
CD follow-up examination
Regular CD follow-up
examination
Health trouble examination

Classified into different levels based on
the evaluation of older people about the
impacts of health troubles
Having or not having a health insurance
card at the survey time



Going to a health facility for general
health examination by older people
Going to a health facility for CD followup examination by older people with CD
Using CD follow-up examination
according to doctor’s appointment or
periodically by older people with CD
Going to a health facility for health trouble
examination by older people with health
troubles within the last four weeks
















60-69
70-79
80+
Male

Female
No education
Primary
Secondary or higher
Alone
With only spouse
With only grand children
Others
Yes
No
Retirement pension
Work income
Allowance from relatives
Social allowance
Others
Lowest - <500,000 VND
500,000 - < 1 mil. VND
1 mil. - < 2 mil. VND
2 mil. - < 3 mil. VND
≥ 3 mil. VND
Richest
Over moderate
Moderate
Under moderate
Poorest
Yes
No
Very good
Good
Moderate

Poor
Very poor
Mild
Average
Severe
Yes
No
Used
Not used
Used
Not used
Used
Not used
Used
Not used

5


3.5. Variable measurement and data collection
- Quantitative data: Face-to-face interviews using a structured questionnaire were
implemented with all older people, who were ability and willing to participate in the
interview, at every of selected households. The questionnaire included the questions
on socio-demographic characteristics of older people such as age, sex, education,
religion, ethnicity, marital status, working status, household size, living arrangement,
and household income; on their health status like chronic illnesses, functional
limitations and health troubles within the last four weeks; on their use of health care
services and on some other factors related to access to health care services like health
insurance and travel time.
Trained interviewers from the Institute of Hygiene and Public Health at Ho Chi Minh

city (IHPH) were responsible for the survey to assure the objectivity of the
assessment of health care services at CHSs. A supervisor checked all completed
questionnaires at the field site and all missed information was asked for completing
by re-visiting corresponding households.
- Qualitative data: In-depth interviews with the leaders and staff of CHSs and
observations of CHSs were conducted by a senior interviewer and an interviewer’s
assistant from IHPH. Open-ended questions and guidelines for in-depth responses
and a check list for health facility observations were prepared for the survey to assess
the availability of PHC services for older people of CHSs such as equipment, drugs,
commodities, and health staff. A tape recorder was used during in-depth interviews
conducted. The latest annual reports of CHSs were also collected.
3.6. Statistical analysis
Data was processed and analyzed by Epi data 3.0 and SPSS 16.
Descriptive statistics was applied to all variables to identify the frequencies of each
categorical variable or the mean of each continuous variable.
Chi-square test for independence was used to identify the relationships between
socio-demographic characteristics, health status and knowledge on health care of
older people and their access to PHC services.
6


4. RESULTS
Information related to characteristics of older women and factors might influence the
access to PHC services was collated, analyzed and presented in the following tables.
4.1.

Socio-demographic characteristics of older people

Socio-demographic characteristics of older people involving in the study are
presented in Table 2, 3 and 4. The average age was 72.4 and the highest percentage

was at the age of 60-69 years old accounting for 42.3% (Table 2). Two third of older
people were women. Education level of older people was low. Over haft of older
people had no education including illiteracy and literacy (only read and write); and
17% of them got secondary or higher.
Table 2. Percentage distribution of Age, Sex and Education of older people
Findings
Characteristics
n

%

60-69

46.2

42.3

70-79

34.1

30.7

80+

19.7

27.0

Male

38.6

30.7

Female

61.4

69.3

No education

292

56.4

Primary

138

26.6

Secondary or higher

88

17.0

Age

Sex

Educational level

Table 3 shows that almost all older people were Kinh, the majority ethnicity of
Vietnam. Over 50 per cent of older people followed religion; and Buddhism was
their main religion. About marital status, 48% of older people were widower or
widowed; 46.7% were married; 4.7% were single and only 0.6% were divorced.
Although most of older people lived with their children and other members like their
spouse and grandchildren, there were 14.7% of older people living alone, 13.3%
living with only the spouse and 3.5% living with only their grand children.

7


Table 3. Percentage distribution of Ethnicity, Religion, Marital status and
Living arrangement of older people
Percentages
Characteristics

n

%

510

99

6

1

None

241

46.5

Buddhism

221

42.7

Hoa Hao

44

8.5

Others

12

2.3

Single

24

4.7

Married

241

46.7

Divorced

3

0.6

248

48.0

Alone

76

14.7

With only spouse

69

13.3

With only grand children

18

3.5

Others

431

83,2

Ethnicity (N=516)
Kinh
Others
Religion (N=518)

Marital status (N=516)

Widower/Widowed
Living arrangement (N=518)

About haft of older people still worked. The works they did most were farming and
housework. Others did small business, handicraft, freelance or worked as volunteers
for social organizations like Veterans association and Elderly association. When
asked about income or pension, 72% of older people responded that they had income
or pension every month. Among them, 44.5% got income or pension from social
policies. According to Article 17 of the Elderly Law of Vietnam, subjects getting
allowance include the older people aged 60 and above who live alone or live with

persons also living based on social allowance in poor households; the older people
aged 80 and above who do not have retirement or social insurance pension. Besides,
other social policies were also considered in the study such as pension for the older
women whose husbands or sons were martyr in Vietnam war.

8


Table 4. Percentage distribution of Working status and Income of older
people
Findings
Characteristics

n

%

No works

257

49.6

Housework

62

12.0

Farming

115

22.2

Others

84

16.2

Yes

372

72.0

No

139

26.8

7

1.2

Retirement pension

21

5.6

Work income

148

39.7

Allowance from relatives

96

25.7

Social allowance

166

44.5

1

0.2

Lowest - < 500,000 VND

113

31.2

500,000 - < 1,000,000 VND

76

21.0

1,000,000 - < 2,000,000 VND

109

30.1

2,000,000 VND- <3,000,000 VND

45

12.4

≥ 3,000,000 VND

19

5.2

Working status (N=518)

Income/ Pension (N=518)

No answer

Income/Pension sources (N=373)

Interest from savings account
Total amount of income/pension per
month (N=362)

Apart from the income source from social allowance, other income sources were also
mentioned including retirement pension (5.6%); income from present work (39.7%);
monthly allowance from children or other relatives (25.7%); and interest from
savings account (0.2%). Total amount of income per month were classified into five
groups and presented in Table 4. The first income group (less than 500,000 VND per
month) mainly contained the older people who received social allowance as defined
in Article 17 with the two income levels: 180,000 VND and 270,000 VND per
month.

9


Comparing to other household income in the same commune, 62.7% of older people
evaluated by themselves that their household income was moderate; 27.4% was
under moderate or poorest; and only 1.7% was richest (Figure 1).

Figure 1. Self-evaluated household income by older people

4.2.

Health status of older people

Health status of older people was first evaluated by respondents themselves. Then
information about chronic diseases, functional limitations and health troubles

occurring within the last four weeks of older people were collected.

Figure 2. Self-evaluated health status by older people
10


Figure 2 describes that nearly haft of older people evaluated that their health was
moderate. The percentages of older people thinking that their health was “good or
very good” and “poor or very poor” were 23.3% and 30.4% respectively.
Around three fourths of older people had at least one chronic disease (Table 5).
Hypertension, joint and bone diseases and cardiovascular disease were three types of
disease that they were most suffer from. Other diseases related to respiratory,
endocrine, neural, urinary and digestive system were also recognized.
In the study, disease duration was the duration time that a respondent had suffered
from a chronic disease. If he or she had more than one disease, his or her disease
duration was the duration time of the chronic disease identified first. Disease
duration of most of older people was from one to five years (43.7%) and over five
years (43.9%).
Table 5. Description of chronic disease status among older
people
Findings
Variables
Having at least one chronic disease
(N=518)
Types of chronic diseases (N=380)
Hypertension
Chronic Osteopathy/Arthropathy
Cardiovascular disease
Chronic Respiratory disease/ asthma
Diabetes

Neurological diseases
Others
Disease duration (N=380)
Less than 1 year
From 1 to 5 years
Over 5 years
No answer

n

%

380

73.4

194
167
109
55
30
27
95

51.1
43.9
28.7
14.5
7.9
7.1

25.0

46
166
167
1

12.1
43.7
43.9
0.3

Table 6 indicates that 15.8% of older people having functional limitations. Most of
older people with functional limitations had troubles with mobility (91.5%). Haft of
those people had limitations when bathing or going to toilet. Difficulties in putting
on or off clothes and in eating or drinking accounted 33% and 28% respectively.
11


Level of functional limitations was evaluated by asking older people how much they
needed support from other persons to overcome their limitations. There were three
levels of limitations: mild, moderate and severe.
Table 6. Description of functional limitations among older people
Findings
Variables
N
%
Having functional limitations (N=518)
82
15.8

Types of functional limitations (N=82)
Mobility
75
91.5
Bathing
45
54.9
Going to toilet
35
42.7
Putting on/off clothes
27
32.9
Eating/ Drinking
23
28.0
Levels of functional limitations
(N=81)
Mild
20
24.4
Moderate
51
62.2
Severe
10
12.2

Over 60% of functional limitations among older people were estimated to be
moderate (older people partly requiring supports from other persons); 24.4% was

mild (older people could overcome by themselves); and 12.2% was severe (older
people completely depending on other persons, they could not do anything by
themselves).
Table 7. Health troubles occurring within the last four weeks of
older people
Findings
Variables
n
%
Having health troubles (N=518)
409
79.0
Types of health troubles (N=409)
Headache
255
62.3
Backache/ Arthralgia
193
47.2
Dizziness
185
45.2
Cough
121
29.6
Fever
66
16.1
Difficulty in breathing
56

13.7
Others
98
23.9
Levels of health troubles (N=407)
12


Mild
Moderate
Severe

201
155
52

49.1
37.9
12.7

13


Table 7 indicates that 79% of older people had health troubles that made they feel
uncomfortable or unhealthy or prevented them from doing daily activities. Headache,
backache, dizziness and cough were common symptoms. Among those older people,
49% felt that the troubles did not or insignificantly influence their daily activities
(mild); 38% was moderate; and remaining older people reported that they could not
do anything and had to lie on bed almost all day.
4.3.

Knowledge on health care of older people

Older people had knowledge on health care when they knew at least one right way to
improve health or prevent diseases. One third of older people knew some kinds of
healthy foods for chronic disease prevention such as low fat food. Besides, smoking
and alcohol restrictions and regular exercise were also mentioned as the ways to
improve health.
Table 8. Knowledge on health care of older people
Findings
Variables
n
Having knowledge on health care
Yes
179
No
339
Total
518

4.4.

%
34.6
65.4
100

Access to PHC services among older people

4.4.1. CHSs and PHC services available for older people

Vietnamese government has promulgated the Elderly Law No. 16/2009-L-CTN in
which PHC for older people has been assigned for local authorities, CHSs and
communities. The Law has officially taken effect since the first of July, 2010. Article
13 of the Law has defined responsibilities of CHSs in providing PHC services for
older people including: health education and communication; instruction of health
care and disease prevention skills; medical file supervision and management;
examination and treatment diseases in accordance with CHSs’capacity; periodic
health examination (cooperating with district health center or hospital); health care at
home for older people living alone and not able to go to a health facility. Authorities
are responsible for providing financial supports of transportation for health staff to
14


implement “health care at home” service. Authorities also have responsibility to
support for poor older people with money to travel from a health facility to their
home and vice versa.
In the context of the Law, all CHSs of the four selected communes were surveyed to
identify PHC services available for older people in Giong Trom district. Some other
information related to the availability of PHC services was also collected from older
people. The results show that PHC services for older people of all the CHSs were
very poor. No CHSs had enough PHC services as assigned by the Law.
Examination and treatment diseases in accordance with CHSs’capacity was the main
service that all CHSs had been implementing. However, the service was intended to
all people and there were no special activities for older people. Only one CHS head
mentioned that “older people will get priorities when they went to the CHS for
examination”. Besides, the service quality also had many limitations caused by the
shortage of human and financial resources, work overload and poor infrastructure.
Among CHSs surveyed, two CHSs had no medical doctors. The total number of
health staff was around 6 people including CHS head. “The human resource is too
inadequate and not able to meet the job well” said one CHS head. On average, each

health staff had to be in charge of “three to four National Health Programs” and they
were “really overloaded”. Apart from that, another difficulty was the large amount of
people with health insurance cards examining at CHSs. The difficulty was
recognized by a head of the CHS where older people from not only the commune
that the CHS located on, but also other communes went to for health insurance
examination. “The number of health insurance cards now is 11,411 while the
commune’s population is only 6,000”. About infrastructure, some CHSs were
severely degraded: One CHS was built in 1975 and another was built in 1988. The
remaining CHSs were too small to meet the people’s requirement for health care.
Even one CHS temporarily located on a school area. Equipments and drugs were
inadequate. Functional rooms did not meet the criteria of Ministry of Health in terms
of quantity and quality.
Health education and communication and instruction of health care and disease
prevention skills were implemented by all selected CHSs. “About health education
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and communication, we do not have enough materials so we rarely implement the
activity. We only mobilize people to exam their health annually; people having health
insurance card should go to CHS for health examination, especially hypertension
cases. Each examination time, we also advice patients to check their blood pressure
everyday” said one health staff. The common forms of health education
communication of other CHSs were implemented through commune radios or
meetings organized by the Elderly associations. Hypertension and diabetes
prevention were the main content of health education and communication in all
selected communes. However, the activity was carried out only one or two three
times during the last year. Only one CHS mentioned the involvement of the hamlet
health network in the activity. “We invited hamlet health to meet at CHSs every
month. I assigned the hamlet health to disseminate to each population group per
month. They report to us every month. Besides, we also had volunteer network”.

Actually, about half of older people interviewed (52.2%) said that they received
information about disease prevention and health improvement from health staff.
Dietary with salt reduction, fat reduction and sweet reduction were mentioned by
most of those people.
No CHSs provided activities for health care at home for older people living alone
and not able to go to a health facility. The lack of time and the quantity of health staff
at CHSs was the main reason why they could not deploy those activities. Another
reason was that they did not any “fee for transportation”. Some health staff said that
they did examine and treat for older people at home when they were asked and the
older people or their relatives paid for them. Besides, they said that the program on
management and rehabilitation for people with disabilities could partly supports for
older people. However, only two CHSs reported on the number of disabled people
managed at communities and hospitals during last year and some activities such as
visits and guidelines for rehabilitation process.
Similarly, other activities such as medical file supervision and management and
periodic health examination (cooperating with district health center or hospital)
were still not deployed. Heads of CHSs said that they started managing the older
people’s health through getting the list of older people from the Commune’s Elderly
16


associations or provincial hospitals. One CHS only got the list of older people aged
80 years and above. About periodic health examination, CHSs did not actively
cooperate with district health center or hospital to organize examination phases for
older people. The Commune’s Elderly associations played a crucial role in
implementing the activity. Other organizations like Red Cross association were
sometimes organized “free health examination for older people on the occasion of
27-7, the Vietnamese martyr’s day”. They normally combined health examination to
other activities like visits and gifts for older people at special occasions. CHSs were
only invited to participate in those occasions instead of actively making plans on

periodic health examination for older people annually. Moreover, the Elderly
associations did not have any regular funds for operations and had to mobilize
sponsors. Their operation totally depended on the amount of money they mobilized.
Therefore, health examination for older people would not be periodic; it was
different from year to year and among different communes. Actually, most of CHSs
participated in one to two examination phases during last year while one CHS did
not.

Head of the CHS said: “Recent years we have not had any funds for

examination. However, we have sent medical doctors to the longevity ceremonies of
the Elderly association to provide health consultancy for older people”. Besides, not
all older people could benefit from those examination phases. Only “older people
aged 85 or over” or “older people living in hamlet 5 and hamlet 6” were received
examination. One head of CHS gave the reason: “the Elderly association asked how,
I do so”.
In general, PHC services for older people at all selected CHSs were inadequate and
had many limitations. They did not actively implement health care activities for older
people. They also unclearly recognize their responsibilities in doing those activities
as assigned by the Elderly Law. Even some health staff did not know about the Law.
To enhance PHC services for older people, CHSs recommended that they needed
guidelines from authorities to carry out health care activities for older people; other
recommended that there should be put PHC for older people into National Health
Programs. Financial resources were also indispensable for implementation and
maintenance of those activities.
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4.4.2. Health insurance status of older people
Lack of health insurance may prevent people, especially older people and people

living in rural areas, from access to health care services. Table 9 shows that the
percentage of older people having a health insurance card was 84%. Among them,
62.3% were provided free health insurance cards and 37.7% were purchased.
Table 9. Health insurance status of older people
Findings
Variables
n
%
Having health insurance card
435
84
(N=518)
Type of health insurance card
(N=432)
Free health insurance card
269
62.3
Self-purchased health insurance card
163
37.7

4.4.3. The utilization of available PHC services by older people
The results from CHSs survey show that PHC services available for older people
were very poor. Examination and treatment for older people with illnesses were the
main service. Therefore, the percentage of older people used the health care services
represented the actual access to available PHC services by older people and partly
expressed the acceptability of older people to those services.
Table 10. Utilization of health care services among older people
Findings
Variables

n
%
General health examination
Used
177
34.3
Not used
339
65.7
CD follow-up examination
Used
294
77.6
Not used
85
22.4
Regular CD follow-up examination
Used
187
49.2
Not used
193
50.8
Health trouble examination (N=409)
Used
159
30.7
Not used
250
48.3

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