Scaling-up NCD Interventions in South-East Asia (SUNI-SEA)
Non-communicable diseases (NCDs) are a major cause of death globally and the burden of NCDs is unevenly increasing among countries and low-income populations. Three-quarters of all deaths due to NCDs are in low- and middle-income countries (LMIC).
Hai Duong and Hai Phong are selected to be the study sites of Vietnam SUNI-SEA project. They are two neighbouring provinces located in the Northeast region of Vietnam.
Hai Duong and Haiphong are among the most populous provinces in the region with the population of around 2.5 million citizens each, with 75% and 50% of the population living in rural areas, respectively. Despite the fact that there is no provincial-level data on the prevalence of common NCDs, some small-scale studies conducted in these provinces indicate the high prevalence of hypertension and its associated risk factors in the study sites.
|Hai Duong||Hai Phong|
|Population (million citizens)||2,567||2,352|
|Number of districts||12 districts (10 rural districts and 2 urban districts)||15 district (8 rural district and 7 urban districts)|
|% of rural population||75%||50%|
|Primary health care system:|
|a. District level: (Mono-functional vs. dual functional)|
b. Commune level
c. Community level
|a. The dual-functional district health centre|
b. Commune health stations
c. Village health workers
|a. Mixed (5/12 dual functional district health centres)|
b. Commune health stations
c. Village health workers
|Intergenerational Self-Help Clubs in place||Yes||Yes|
|Health insurance programme at commune health stations (CHSs)||Yes||Yes (on-going inclusion of CHSs)|
|Number of districts selected for the project||3 (1 urban district and 2 rural districts)||3 (1 urban district and 2 rural districts)|
While countries in Europe struggle with ever-increasing costs of chronic diseases, Indonesia, Myanmar and Vietnam have developed innovative strategies to curb the epidemic of cardiovascular diseases and diabetes in an early phase, by
- moving NCD prevention and management from hospitals to primary healthcare facilities;
- involving communities and bringing prevention and self-management to the homes of people;
- linking NCD prevention to socio-economic development;
- introducing integrated financing of health prevention and clinical care for NCDs.
In short, these countries are trying to create innovative synergies within and between sectors. The stakeholders in South-East Asia expect that with a proper evidence base they will optimise their new initiatives in order to reach the full potential in reducing morbidity and mortality caused by NCDs.
SUNI-SEA will use the ongoing scaling-up activities on hypertension and diabetes prevention and management in Indonesia, Myanmar and Vietnam as starting point. It will link the existing activities, enhance the ongoing programmes, combine activities in communities and primary healthcare facilities, and monitor the scaling-up meticulously, in order to produce recommendations for scaling-up of NCD programmes.
Primary health care system/ facilities:
- The model of the district health system: In Vietnam, many districts have dual-functional district health centres (DHCs) undertaking both curative and preventive activities while the others have both district hospitals and district health centres. Studies indicate that the organisational separation of the district-level facilities causes difficulties in collaborating and coordinating the management of commune health stations (CHS) and implementing local health activities. Hence, the availability of the dual-functional DHCs was the key criterion for selection of these provinces, because it guarantees the effective coordination needed to deliver an integrated and comprehensive program on NCD prevention, treatment, and management within the district.
- The implementation of health insurance-based curative services at CHSs: The CHSs, which are the first-contact public health facilities, are designated to provide primary health care services for the community. In Vietnam, the delivery of regular treatment for chronic NCDs at CHS under the health insurance programme is determined as one of the key strategies to combat high-burden conditions. In these two provinces, the majority of CHSs are eligible for providing health insurance-based services.
Community-based services in the study area:
Intergenerational Self-Help Club (ISHC) model is a community-based intervention project which centres around the elderly, aiming to promote the livelihood and the role of elders in their communities. The ISHC model has been developed by HelpAge international in Vietnam, and in 2016, the prime minister announced the Decision 1533/QĐ-TTG which stated that local governments need to allocate funds for the establishment of ISHC throughout the country; mass organisations and local agencies such as the Father Front Land, Women Unions or Elderly Associations will take the lead in the implementation of the Decision. Hai Phong and Hai Duong have been among the leading provinces to embrace the model. Each province has a good number of ISHCs (Hai Phong: 65 ISHCs and Hai Duong: 51 ISHCs).
In health care, the ISHC provides a way of delivering health promotion activities through the synergies between the model and the local health facilities. It also provides home care services through its volunteers, or in some cases, its paid care assistants. The selection of study sites where the community groups have been well established is a crucial foundation to ensure that both the retrospective and prospective studies will be developed and scaled up in a coherent manner.
The study teams leading research work in Vietnam include Health Strategy and Policy Institute, Thai Nguyen University of Medicine and Pharmacy, and HelpAge International (Vietnam Country office). The team will work in collaboration with the Ministry of Health and relevant departments; Vietnam Social Security; Vietnam Association of the Elderly as well as local authorities including Provincial Health Department and community associations (e.g., Elderly Association).
>> SUNI-SEA Project Website
>> For more information about SUNI-SEA project in Vietnam, please contact:
Ms.Trương Mỹ Linh - Project Coordinator in Vietnam