Brief Report: Study on the current situation of services delivery of commune health centres in some regions and associated factors

MINISTRY OF HEALTH

THE HEALTH SYSTEMS STRENGTHENING PROJECT IN 
SOME SELECTED PROVINCES

BRIEF REPORT

STUDY ON THE CURRENT SITUATION OF 
SERVICES DELIVERY OF COMMUNE HEALTH 
CENTRES IN SOME REGIONS AND ASSOCIATED 
FACTORS

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Hanoi, December 2014
CONTENTS

CONTENTS................................................................................................................................................. 2
ABBREVIATIONS....................................................................................................................................... 4
SUMMARY.................................................................................................................................................. 5
1. BACKGROUND....................................................................................................................................... 7
2. SUBJECTS AND RESEARCH METHODS............................................................................................. 8
2.1. STUDY DESIGN: ACROSS-SECTIONAL STUDY THAT COMBINED QUALITATIVE AND QUANTITATIVE TECHNIQUES. ......8
2.2. SUBJECTS: LOCAL RESIDENTS, MEDICAL STAFFS, AUTHORITIES, LEADERS OF COMMUNAL ORGANIZATION,
LEADERS OF DISTRICT HOSPITAL, HEALTH PROVISIONS AND DISTRICT HEALTH PREVENTION CENTRE, AVAILABLE
SECONDARY DATA........................................................................................................................................ 8
2.3. TIME: 2014......................................................................................................................................... 8
2.4. LOCATION:EIGHT PROVINCES REPRESENTING EIGHT ECOLOGICAL REGIONS, INCLUDING: HA GIANG, HOA BINH,
THAI BINH, HA TINH, QUANG NAM, BINH DUONG, KIEN GIANG, KONTUM. IN EACH PROVINCE, CHCS WERE
SELECTED ACCORDING TO THREE CLUSTERS: URBAN, RURAL AND DIFFICULT AREAS............................................... 8

2.5. SAMPLE SIZE AND SAMPLING TECHNIQUE:................................................................................................. 8
2.6. DATA ANALYSIS: AFTER COLLECTING, QUANTITATIVE DATA WAS CHECKED, CLEANED, CODED AND ENTERED INTO
EPIDATA 3.1, MICROSOFT EXCEL. STATA SOFTWARE WAS USED TO ANALYZE DATA: DESCRIPTIVE STATISTIC (MEAN,
PERCENTAGE %), ANALYTIC STATISTIC (T-TEST, WALLIS TEST, Χ2 TEST,…). QUALITATIVE DATA WAS ANALYZED
REGARDING TO THE THEMES INFORMED BY EACH OBJECTIVE.............................................................................. 9
2.7. ETHICAL APPROVAL: THIS STUDY HAD THE APPROVAL OF COMMUNITIES, THE AGREEMENT OF LOCAL
GOVERNMENT AND THE LEADERS OF HEALTH AUTHORITIES IN THE SETTINGS. PEOPLE WERE VOLUNTARILY ENROLLED
INTO THE STUDY, THE INDIVIDUAL INFORMATION WAS CONFIDENTIAL AND THEIR NAMES WERE NOT RECORDED...........9
3. RESULTS................................................................................................................................................ 9
3.1. THE CURRENT SITUATION OF THE CHC SERVICE NEEDS AND USE OF POPULATION IN SOME VIETNAMESE
REGIONS IN 2014........................................................................................................................................ 9
3.2. THE CAPACITY TO DELIVER HEALTH CARE SERVICES OF CHC IN SOME VIETNAMESE REGIONS IN 2014:.........10
3.3. FACTORS ASSOCIATED WITH THE CAPACITY TO DELIVER HEALTH CARE SERVICES OF CHCS IN SOME
VIETNAMESE REGIONS IN 2014................................................................................................................... 12
4. DISCUSSION......................................................................................................................................... 13
5. CONCLUSIONS.................................................................................................................................... 17
5.1. THE CURRENT SITUATION OF PEOPLE’S NEEDS FOR AND USE OF CHC SERVICES IN SOME VIETNAMESE
2014...................................................................................................................................... 17
5.2. THE CAPACITY TO DELIVER HEALTH CARE SERVICES OF CHCS IN SOME VIETNAMESE REGIONS IN 2014.........17
REGIONS IN

RECOMMENDATIONS............................................................................................................................. 18
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RESEARCH TEAM REPRENTATIVE....................................................................................................... 19
NGUYEN HOANG LONG, PHD................................................................................................................ 19
REFERENCES.......................................................................................................................................... 20
ANNEX – LIST OF RESEARCH TEAM.................................................................................................... 21

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ABBREVIATIONS
CHC
MoH

Commune Health Centre
Ministry of Health

4


SUMMARY
A   cross­sectional   study,   combining   both   qualitative   and   quantitative   approach,   was 
conducted to describe the current situation of services delivery of commune health centres (CHCs) 
in some Vietnamese regions and its associated factors. The quantitative study was conducted on 
600 households (equivalent to 2023 individual residents), while the qualitative studies comprised 
in­depth interviews with 9 leaders at district health levels; focus group discussion with 53 medical 
staffs of CHCs and 63 leaders of government and local organizations at commune level. Facilities 
of ninety CHCs were observed and secondary data of 240 CHCs was collected in eight provinces 
which represented Vietnamese ecological regions in 2014. The findings showed that the proportion 
of residents suffering acute diseases was 8.5%, of which the percentage was the highest in urban 
areas with 10.2%. When having those illness, 44.0% people went to CHCs based on some reasons: 
having health insurance (50%), convenience/near house (20.8%); habit (12%); meanwhile, 25.7% 
people went to the hospital because of: health insurance (61.5%), modern/adequate equipments 
(7.7%). The proportion of residents suffering chronic diseases was 15.2%, of which the percentage 
was the highest in urban areas with 19.3%.When having those illness, 48.7% people went to the 
hospital because of: health insurance (69.4%), transfer from lower levels of health system (13.9%); 
meanwhile, 37.1% people went to CHCs based on some reasons: having health insurance (44.1%), 

convenience/near   house   (20.6%)   and   having   been   treated   before   (13.7%).  The   reason   why 
residents did not use health care services in CHCs  included inadequate equipments (26.1%), 
inadequate drug (19.7%), and inconvenience of health insurance mechanism (18.5%). The findings 
also showed the concerned capacity of CHCs to deliver services: About human resources: 64.4% 
CHCs did not reach the National standards for human resources (insufficiency in both quantity and 
components of medical staffs): 40.4% CHCs did not have a medical doctor, 37.8% did not have 
obstetrical assistant doctors. Facilites and equipments: the proportion of CHCs having laboratory 
and sterilization room was low, of which the lowest proportion was in mountainous areas. CHCs 
had the average of 45/69 equipments as requirement of Ministry of Health (MoH); only a third of 
CHCs reached the National standard of equipments for traditional medicine, ear­nose­throat, dental 
and testing. Drugs: > 70% CHCs had adequate drug categories according to the list of MoH, but 
the quantity of each category was insufficient.  Performing medical techniques at CHCs: 95% 
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CHCs performed <70% of technique compared to the list of decentralized techniques; whereas the 
remains performed <80%; none of CHCs could perform 100%. The research results suggested  to 
authorities at all levels that to inform viable strategies and policies in strengthening and developing 
grassroot health care system, it is crucial to to take into account the the health care needs of 
population and health services delivery capacity of CHCs in the new situation.   

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1. BACKGROUND
Commune   health   centres   (CHC)   is   technically   the   first   medical   unit   in   contact   with 
population,   which   belongs   to   the   public   health   care   system   and   responsible   for   performing 
primary health care services, early epidemic detection and diseases prevention, primary care and 
normal   delivery,   essential   drug   provision,   family   planning   encourangement   and   health 
promotion. The access of population to health care facilities in general and CHC in particular are 

mainly   related   to   geographical,   cultural,   economical   (capacity   to   pay)   and   social   factors. 
However, the decisions of patients about what they want to do or where they want to go when 
having illness depend upon the quality of health care services, prices, income, types of diseases 
and severity of diseases as well as the distance from their house to health care facilities and their 
ability to access health care services. We conducted a study about:  The current situation of 
service   delivery  of  commune health  centre  in   some regions  and  associated  factors.  The 
objectives of this study were: (1) To describe the current situation of the CHC service needs and  
use of population in some Vietnamese regions in 2014; (2) To describe the capacity to deliver  
health care services of CHC in some Vietnamese regions in 2014; (3) To analyze some factors  
associated with the capacity to deliver health care services of CHC in some Vietnamese regions  
in 2014.

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2. SUBJECTS AND RESEARCH METHODS

2.1. Study design: across­sectional study that combined qualitative and quantitative techniques.
2.2. Subjects:   local   residents,   medical   staffs,   authorities,   leaders   of   communal   organization, 
leaders of district hospital, health provisions and district health prevention centre, available 
secondary data.

2.3. Time: 2014
2.4. Location:eight provinces representing eight ecological regions, including: Ha Giang, Hoa 
Binh,   Thai   Binh,   Ha   Tinh,   Quang   Nam,   Binh   Duong,   Kien   Giang,   Kontum.   In   each 
province, CHCs were selected according to three clusters: urban, rural and difficult areas.

2.5. Sample size and sampling technique:
­

Residents:the sample size for cross­sectional study: 600 households.

­

CHCs:the   proposed   minimum   sample   size   for     a   quantitative   study   with   organizational 
sample unit according to Bailey (1982) was 30.In this case, organizational unit was CHCs. 
Because of three clusters: rural, urban and difficult communes, ninety CHCs were needed for 
comparison.

­

Leaders   of   district   prevention   medicine   centre   and   district   hospital   in   settings:   3 
leaders/province x 3 provinces = 9 leaders.

­

Medical staffs of CHCs in settings: 6 staffs/CHC x 9 commune = 54 staffs.

­

Secondary data: from 240 CHCs = 30 CHCs (10 urban CHCs, 10 rural CHCs and 10 CHCs 
at different areas)/province x 8 provinces. 

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2.6. Data analysis: After collecting, quantitative data was checked, cleaned, coded and entered 
into Epidata 3.1, Microsoft Excel. STATA software was used to analyze data: descriptive 
statistic (mean, percentage %), analytic statistic (T­test, wallis test, χ2 test,…). Qualitative 
data was analyzed regarding to the themes informed by each objective.

2.7. Ethical approval:  This  study had the approval of communities,  the agreement  of local 
government and the leaders of health authorities in the settings. People were voluntarily 
enrolled into the study, the individual information was confidential and their names were not 
recorded.

3. RESULTS

3.1. The   current   situation   of   the   CHC   service   needs   and   use   of   population   in   some 
Vietnamese regions in 2014

Figure1–The prevanlence of diseases residents suffering by the regions
The   prevalence  of  acute   diseases   in  urban  residents   was  higher   (10.2%)  than  those   in  rural 
(6.1%) and mountainous ones (9.0%). The prevalence of chronic diseases in urban residents was 
the highest (19.3%) compared to those in mountainous areas (14.1%) and rural areas (11.8%). 
The differences were statistically significant (p=0.02 and p = 0.000, respectively). 
When having those illness, 44.0% people went to CHCs based on some reasons: having health 
insurance (50%), convenience/near house (20.8%); habit (12%); meanwhile, 25.7% people went to 
the hospital because of: health insurance (61.5%), modern/adequate equipments (7.7%). 

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The reason why residents did not use health care services in CHCs:  inadequate equipments 
(26.1%), inadequate drug (19.7%), inconvenience of health insurance mechanism (18.5%). The 
conditions   that   attract   people:   CHCs   had   to   supplement   addition   drugs   (38.9%),   equipments 
(36.4%) and the staffs had to improve their capacities (12.2%).

3.2. The capacity to deliver health care services of CHC in some Vietnamese regions in 
2014:

Figure2–The proportion of CHCs reaching National standard of human resouces by the 
regions
CHCs reached the National standards about human resources when having adequately five professional 
categories: i) medical doctor; 2) assistant doctor (general/traditional medicine/obstetrict); iii) assistant 
midwifery; iv) assistant nurses; v) assistant pharmacist (elementary pharmacist if mountainous areas, full  
time or part time). The results shows that the proportion of CHCs reaching National standards was low 
(35.6%), of which the proportion was the lowest in mountainous areas (29.0%).  The differences were 

statistically not significant (p>0.05, χ2 test). 

Figure 3 –The prevalence of CHCs’ infrastructure reaching standard by the regions
Basically, CHCs was built following the current standard. In rural/mountainous areas, there were 
at least 10 function rooms, while in urban area, there were at least 6 rooms. The results indicated  

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that 51.9% mountainous CHCs reached the standards, which was much lower than other areas. 
The differences were statistically significant (p<0.05, χ2 test).

Figure4–The situation of basic medical equipments of CHCs
There were noCHCs who had adequate basic medical equipment. Above 70% CHCs had> 50% 
equipment, of which the highest proportion was in mountainous areas with 83.9%. Meanwhile, 
the percentage of CHCs having <50% equipments was the lowest in urban areas (28.1%). The 
differences were statistically not significant (p>0.05, χ2 test)
Table1­ The proportion of techniques performed in CHCs compared to 
the list of decentralized techniques by the regions
Characteristics
Number of technique performed

< 70%
 70%­ < 80%

Rural
± SD
62.2±17.
6
n (%)
76 (95.0)
4 (5.0)

Urban
± SD
63.3±16.
7
n (%)
76 (93.8)
5 (6.2)

Mountainous
± SD

Total
± SD

P

61.9±11.6

62.5±15.5

0.488

n (%)
76 (96.2)
3 (3.8)

n (%)
228 (95.0)
12 (5.0)

0.789

CHCs   in   three   clusters   could   perform   approximately   a   half   of   required   techniques.   The 
differences were statistically not significant(p>0.05;KruskalWallis­test).
Facilites and equipments: the proportion of CHCs having laboratory and sterilization room was 
low, of which the lowest proportion was in mountainous areas. CHCs had the average of 45/69 
equipments as required by Ministry of Health (MoH); only a third of CHCs reached the National 
standard of equipments for traditional medicine, ear­nose­throat, dental and testing. Drugs:> 70% 
CHCs had adequate drug categories according to the list of MoH, but the quantity of each category 
was insufficient. Guidelines: CHCs have inadequate guidelines for malaria, tuberculosis, diabetes, 
cardiovascular.
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Family planning: 8% CHCs had 100% equipments, 50% CHCs reached <70% requirement, the 
contraceptive  methods  provided most were IUDs and male condom.  Antenatal care: 62.2% 
CHCs   reached   70­100%,   well   providing:   tetanus   injection,   irom   supplement,   gestational 
hypertension control.  Sexually tranmissted diseases prevention and treatment: still limited: 
53.3% CHCs reached 70­100% requirements; there was none of CHCs having syphilis testing. 

Tuberculosis   prevention   and   treatment:   only   one   CHC   reached   100%   requirement,   when 
others still reached <70%; 50% CHCs had drugs for tuberculosis treatment. Malaria treatment: 
90% CHCs reached <70% requirements; 54% CHCs did not have testing; 70.4% CHCs had 
paracetamol   and   47.3%   CHCs   had   artemisinin.  Non­communicable   diseases   treatment: 
hypertension: 97.7% CHCs could provide primary diagnosis; diabetes: there was none of CHCs 
reached 100%, mainly because of insufficient drug. Minor surgery: 44.4% CHCs reached <70% 
requirements   because   only   42%   CHCs   had   guidelines   for   diagnosis,   handling   and   surgery. 
Almost CHCs could provide services for burn, first aid, small suture, broken bone aid.

3.3.

Factors associated with the capacity to deliver health care services of CHCs in some 

Vietnamese regions in 2014
Human resources:  Medical staffs had insufficient training: the proportion of CHCs staffs did 
not have trainingin providing family planning, antenatal care, sexually transmission diseases, 
malaria and surgery services were 20%, 44.4%, 28.2%, 13% and 70%, respectively.
Equipments: 47.8% CHCs did not have adequate contraceptive methods; 50% CHCs did not 
have iron and acid folic; 30% CHCs did not have tetanus vaccine for pregnancies. Sexually 
transmission diseases: 100% CHCs had lack of equipments (e.g syphilis test); 79.3% CHCs has 
lack of rapid toolkits for malaria diagnosis; 54.4% CHCs had inadequate drugs and equipments 
for tuberculosis treatment; 22.2% CHCs had insufficient equipment for minor surgery. 
Drug: 56.7% CHCs had lack of drug for sexually transmission diseases treatment; 85.6% CHCs 
had lack of malaria drug; 13.3% CHCs had lack of non­communicable diseases drugs.
Guidelines:  CHCs   had   insufficient   guidelines   for   performing   family   planning   and   minor 
surgery.

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4. DISCUSSION
4.1. The current situation of the CHC service needs and use of population

Diseases prevalence among population
The study showed that, the prevalence of acute and chronic disease of residents in 
urban (10.16% and 19.32%, respectively) were higher than those in rural (6.06% and 
11.82%, respectively) and mountainous areas (9.02% and 14.7%, respectively). It was 
a   problem   that   the   authorities,   especially   in   health   sectors   with   CHCs   as   the 
firsttechnically   medical   unit,   should   have   solutions   to   attract   people   to   us   CHC’s 
services.   It   would   help   people   detect   disease   early,   and   then   have   effective 
interventions. 
Health services utilization of respondents
The   findings   illustrated   that   CHCs   and   hospitals   were   two   most   popular   health   care 
facilities that people went to when they had illness. In terms of acute diseases, people tended to 
use services in CHCs (44.04%) rather than in hospital (25.69%). The proportion of people in 
mountainous   areas   used   CHCs’   services   was   much   higher   (78.13%)   than   those   in   urban 
(31.48%) and rural (26.09%). This result partly reflected the belief of people on CHCs’ services 
in each regions. It also showed the medical staffs of CHCs provided good health care services to 
local people according to the Decision of MoH. However, in terms of chronic diseases, hospital 
was the most people’s  preference  for treatment  compared to CHCs (48.73% versus 37.09%, 
respectively) and the difference was found among the regions: urban (31.54%), rural (17.46%) 
and mountainous areas (60.98%). The result suggested that people suffering chronic diseases 
need   to   be   monitored   and   treated   in   long   term   by   high   level   medical   staffs   in   specialty 
departments, with appropriate equipments and techniques. Indeed, hospitals in higher levels of 
health care system can meet the needs to treat chronic dieases, while CHCs have lack of human 
resources, especially of medical doctors in different specialties, as well as infrastructure and 
medical equipments. Therefore, people tended to use services in hospitals when they had chronic 
diseases compared to in CHCs.
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Factors related to the preference of people in selecting health care facilities
When people suffering diseases, the main reason for using services was having health 
insurance in health care facilities. Urban and rural residents prefered hospitals for health care 
because of health insurance (58.82% and 16.67%). Meanwhile, mountainous people tended to 
use health services in CHCs because they had health insurance (52.0%). A small proportion of 
respondents choose those health care facilities based on some reasons such as: convenient care 
hours,   mild   severe   disease   which   was   rapid   recovery,   short   waiting   time,   convenience/near 
house, belief and quality. Our findings were different from the study of Tran Thi Kim Ly et al, 
when they showed that residents selected health care facilities for some reasons such as near 
house (70.94%) and having health insurance (52.99%) [3]. This difference was based on the fact 
that the study of Tran Thi Kim Ly was conducted in 3 communes of Gia Lai provinces, where 
minor ethnics lived. However, our results were similar to the study of Trinh Van Manh (2007) . 
The results suggested that if CHCs well performed health insurance mechanism, people would 
believe and would more likely to utilize health care services in CHCs.
The study also suggested that, the main reasons that people did not go to CHCs were insufficient 
drugs (19.68%) and equipments (26.10%). They are difficult problems for not only health sector 
but also local authorities. When asking about the conditions to attract residents to access CHCs 
more, supplementing drug (38.89%) and equipments (36.44%) were the most popular. Of which, 
the proportion of people in mountainous areas was higher than those in urban and rural areas. 
Besides,   CHCs   should   have   appropriate   health   insurance   payment   mechanism   (13.78%), 
improve the qualifications of staffs (12.22%). People in urban areas expected such conditions 
more than those in other areas.
The capacity to deliver service in CHCs
The readiness of basic infrastructure
About infrastructure, according to the Decision No 3447/QD­BYT in 2011, CHCs were 
built based on the designed standard for primary CHCs and current standards of health sector. 
CHCs in rural areas need at least 10 function rooms, while CHCs in urban areas or near to the 
hospital need at least 6 function rooms . Our results showed that almost all of CHCs had basic 
rooms. However, only 40% CHCs had laboratory and sterillization rooms. The findings also 

showed the difference amongst the areas. Specifically, the proportion of CHCs in mountainous 
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area reaching the standard was lower than in others. This findings was consistent to with the 
difficult situation of infrastructure in mountainous and rural areas. 
The readiness of basic equipments
The   amount   of   equipments   was   insufficient   compared   to   requirements   of   MoH   in 
Decision No 1020/QD­BYT issued on 22/3/2004 .The mean number of equipments was 45 per 
CHC compared to 69 types of required equipments; each CHC had an average of 9/23 traditional 
medicine equipments. The amount of equipments for ear­nose­throad and dental only met  ½ 
requirements   (7/17   equipments).   Especially,   the   amount   of   testing   equipments   only   met   1/3 
requirements (1.5/6). Similarly, obstetric, delivery, sterillization and common equipments also 
met about 1/3 to 1/2 requirements  of MoH. Thus, none of CHCs in settings  were equipped 
sufficient   basic   equipments   as   regulations.   Above   70%   CHCs   had   more   than   50%   basic 
equipments, in which the proportion of mountainous CHCs was the highest (83.9%). Meanwhile, 
the percentage of CHCs in urban areas having less than 50% basic medical equipments was high 
(28.1%).
Essential drugs
Overall, the majority of drug categories in the required list of MoH were available in 
CHCs.   Some   types   of   drugs   inavailable   in   CHCs   comprised   anti­allergy/hypersensitivity, 
hormone, anti­psychosis, detoxification, diagnosis, serum/immunoglobulin drugs. Most of CHCs 
had more than 50% essential drug categories; however, the proportion of CHCs having 90% to 
100% as required by MoH was very low. Therefore, the issue of essential drug availability in 
CHCs was also needed to be considered.
The readiness of human resources
Inadequate   manpower   (in   both   quality   and  quantity)     was   popupar  in   the   researched 
settings. About 64.4% CHCs did not reach the National standard for human resource, of which 
the proportion of mountainous CHCs was the highest with 71%. It can be explained that even in 
urban areas, the proportion of CHCs reaching the standard was low (35.6%).

According to the national criteria for CHCs in the period 2011­2020 (issued along with 
Decision   No   344/QD­BYT   on   22/9/2011),   CHCs   are   required   to   have   five   professional 
categories:  i) medical  doctor;  2) assistant doctor  (general/traditional  medicine/obstetrics);  iii) 
assistant midwifery; iv) assistant nurses; v) assistant pharmacist [3]. However, the proportion of 
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CHCs without medical doctor was high (40%). The percentage of CHCs having medical doctor 
(60%) was significantly  lower than 76% CHCs having medical  doctor nationwide in 2012 . 
Notably, the proportion of CHCs without medical doctor was the highest in urban areas (59.4%). 
Lack of specialists in CHCs was also at emergency situation, which only one CHC in rural areas, 
one CHC in mountainous areas and 6 CHCs in urban areas had specialists. Otherwise, each CHC 
had   the   average   of   under   one   medical   doctor   (0,6±0,49),   and   10   CHCs   had   one   specialist 
(0,09±0,29). It is the consequence of imbalanced distribution in specialist category among health 
care levels. Besides, more than 95% CHCs did not have bachelor of public health, pharmacist 
and traditional medical doctor. The proportion of CHCs having midwifery and obstetric assistant 
doctor was significantly different from that reported in the Joint Annual Health Review in 2013. 
The study showed that only 37.8% CHCs had obstetric assistant doctor and 77.8% CHCs had 
assistant midwifery, while in Joint Annual Health Review in   2013, the percentage of CHCs 
having obstetric assistant doctor and midwifery in 2012 was 93.4%.
The capacity to deliver specific services in CHCs
Overall,  the   capacity  to   deliver   services  for  family   planning,  antenatal  care,  sexually 
transmissed diseases, tuberculosis, malaria, non­communicable diseases and minor surgery were 
similar to the results from Vietnam Health Economic Association, Health Strategy and Policy 
Institute , and other studies.
Regarding   those   specific   services,   manpower,   essential   drugs,   equipments   and 
infrastructure, the proportion of CHCs among three areas performing primary health care was 
high.   About   decentralized   techniques,   CHCs   could   implement   only   about   a   half   of   MoH 
requirements   (>   60%   CHCs).   However,   the   proportion   of   CHCs   performing   70%­80% 
decentralized   techniques   was   low   (5%),   and   none   of   them   could   implement   100%   required 

techniques. No difference was found amongst three areas. Thus, in three areas, the capacity to 
deliver basic services in CHCs is one of the critical issues for intervention.
4.2. Factors associated with the capacity to deliver health care services of CHCs

The results showed that CHCs had confronted with some difficulties which affected the 
capacity   to   deliver   services.   They   included   insufficient   trained   medical   staffs,   medical 
equipments and drugs. The findings also showed the difference among areas, in which CHCs in 
mountainous and rural areas had more difficulties than those in urban areas.  The results were in 
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concert with the fact that mountainous and rural communes had difficulties about infrastructure, 
qualification of staffs and capacity to deliver health care services.

5. CONCLUSIONS
5.1.  The   current   situation   of  people’s   needs   for   and   use   of  CHC   services  in   some 
Vietnamese regions in 2014
Acute   diseases:the   proportion   of   residents   suffering   acute   diseases   was   8.5%,   of   which   the 
percentage was the highest in urban areas with 10.2%. When having those illnesses, 44.0% people 
went to CHCs based on some reasons: having health insurance (50%), convenience/near house 
(20.8%);   habit   (12%),   while   25.7%   people   went   to   the   hospital   because   of   health   insurance 
(61.5%), modern/adequate equipments (7.7%).
Chronic diseases:The proportion of residents suffering chronic diseases was 15.2%, of which the 
percentage was the highest in urban areas with 19.3%. When having those illness, 48.7% people 
went to the hospital because of health insurance (69.4%), transfer from lower levels of health 
system (13.9%), while 37.1% people went to CHCs for some reasons: having health insurance 
(44.1%), convenience/near house (20.6%) and being treated before (13.7%).
The reasons why residents did not use health care services in CHCs: inadequate equipments 
(26.1%),   inadequate   drug   (19.7%),   inconvenient   health   insurance   mechanism   (18.5%).  The 
conditions that attract people: CHCs had to supplement addition drugs (38.9%), equipments 

(36.4%) and the staffs had to improve their capacities (12.2%)..

5.2.

The capacity to deliver health care services of CHCs in some Vietnamese regions in 

2014
Human   resources:   64.4%   CHCs   did   not   reach   the   national   standard   for   human   resources 
(insufficiency in both quantity and components  of medical staffs): 40.4% CHCs did not have 
medical doctors, 37.8% did not have obstetric assistant doctors.
Water   sources:  18.9%   CHCs   used   untreated   well   water;   72.2%   CHCs   had   sewage   system 
within 500m.
Basic equipments:  None of CHCs had adequate basic equipments; 56.7% CHCs had <50% 
basic equipments; 63.3% CHCs had loudspeakers (48.4% in mountainous areas); 71.1% CHCs 
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did not have emergency transportation (78.1% in urban areas); 13% CHCs did not have regular 
electricity, mainly in mountainous areas.
Facilities and equipments: the proportion of CHCs having laboratory and sterilization room was 
low, of which the lowest proportion was found in mountainous areas. CHCs had the average of 
45/69 equipments as requirement of Ministry of Health (MoH); only a third of CHCs reached the 
national   standard   of   equipments   for   traditional   medicine,   ear­nose­throat,   dental   and   testing 
services.Drugs:> 70% CHCs had adequate drug categories according to the required list of MoH, 
but the quantity of each category was insufficient. Guidelines: CHCs have inadequate guidelines 
for malaria, tuberculosis, diabetes, cardiovascular.
Performing medical techniques at CHCs: 95% CHCs performed less than 70% of technique 
compared to the list of decentralized techniques; whereas the remains performed less than 80%; 
none of CHCs could perform 100%.

RECOMMENDATIONS
For Ministry of Health: strategies and policies should be tailor­made including:
­

Continue   to   invest   and   strengthen   commune   health   levels   about   infrastructure, 
equipments, drug and guidelines 

­

Seek to attract manpower to work in the commune levels, especially in difficult areas.

­

Train to improve the performace capacity of medical staffs in CHCs.

For higher health care levels:
­

Gradually improve facilities and supplement equipments for CHCs

­

Improve the quality of services in CHCs through mentoring, monitoring, supervising and 
support. 

For CHCs:
­

Determine the change of diseases and health care needs of population.

­

Develop services that can meet the health care needs of local people.

Acknowledgements:  We would like to thank leaders and staffs of Distric Health Department, 
Dsitric Health Centres, District Hospital, Commune Health Centres in Ha Giang, Hoa Binh, Thai 
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Binh, ha Tinh, Quang Nam, Binh Duong, Kon Tum and Kien Giang for the close collaboration 
us in data collection in the field. We also would like to acknowledge the Health Systems on 
Strengthening  Project  In Some Selected  Provices  ­ Ministry of Health for co­ordination  and 
financial support for our entire study. We also thank thefield research teams who helped us to 
collectdata in accordance with the technical requirements; and thank the respondents who were 
involved and in and provided valid information for this study.

Hanoi, Date MonthYear 2014
RESEARCH TEAM REPRENTATIVE

Nguyen Hoang Long, PhD

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REFERENCES

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ANNEX – LIST OF RESEARCH TEAM

No

Full name

Office

Title

1

Nguyen Hoang Long

Project   management   provision   – 
Principle investigator

PhD

2

Duong Duc Thien

Project management provision

MSc

3

Hoang Thi Giang

Project management provision

MSc

4

Tran Tuan Anh

Project management provision

MSc

5

To Anh Toan

Project management provision

MSc

6

Nguyen Thi Minh Trang

Project management provision

MSc

7

Tran Thi Nga

Hanoi Medical University

MSc

8

Nguyen Van Huy

Hanoi Medical University

PhD

9

Truong Viet Dung

Hanoi Medical University

Professor, PhD

10

Nguyen Duy Luat

Hanoi Medical University

Assoc. Prof, PhD

11

Vu Khac Luong

Hanoi Medical University

Assoc. Prof, PhD

12

Nguyen Huu Cau

Hanoi Medical University

PhD

13

Nguyen Huu Thang

Hanoi Medical University ­ Secretary

MSc

14

Ngo Tri Tuan

Hanoi Medical University

MSc

15

Nguyen Thi Thu Ha

Hanoi Medical University

MD

16

Nguyen Hoang Long

Hanoi Medical University

BPH

17

Nguyen Thi Phuong Thao

Hanoi Medical University

Student

21