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Current issues in sector-wide approaches for health development: Viet Nam

Research reports

A case study of experiences with the sector-wide approach for health development in Viet Nam, a country with an impressive record in public health performance. As Viet Nam has no plans to adopt a sector-wide approach, the study focuses on the question of whether such an approach can bring advantages, especially in the area of aid coordination, in a country that already enjoys a good level of health care. The case study is also used to illustrate alternative strategies for improving the effectiveness of donor assistance. These include a reduction in the number of projects through co-financing, use of shared missions, and agreements with donors at the sub-national level.

 The case study opens with an overview of the country's economic, political, and health situation, concentrating on strategies that have led to rapid reductions in poverty and a high level of health care. Trends in health financing and expenditure, and the role played by external assistance are also discussed.

 Against this background, the main section considers whether current needs for health reform might be met through a sector-wide approach. Obstacles to such an approach include lack of a shared vision for reform between donors and the ministry of health, the number of public health services delivered outside the ministry of health, lack of a clear functional mandate for the ministry of health, and the absence of strong political commitment. The reasons why donors are not likely to give up funding of projects in favour of pooled funding are also briefly explored. On the basis of this discussion, the study concludes that successful introduction of a sector-wide approach will require a long period of preparation and building of government ownership.

Tim Conway