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

Brief Report: Study on the current situation of services delivery of commune health centres in some regions and associated factors includes subjects and research methods; results; discussion; recommendations.

FACTORS

CONTENTS

CONTENTS 2

ABBREVIATIONS 4

SUMMARY 5

1 BACKGROUND 7

2 SUBJECTS AND RESEARCH METHODS 8

2.1 S TUDY DESIGN : ACROSS - SECTIONAL STUDY THAT COMBINED QUALITATIVE AND QUANTITATIVE TECHNIQUES 8

2.2 S UBJECTS : 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 T IME : 2014 8

2.4 L OCATION : EIGHT PROVINCES REPRESENTING EIGHT ECOLOGICAL REGIONS , INCLUDING : H A G IANG , H OA B INH , T HAI B INH , H A T INH , Q UANG N AM , B INH D UONG , K IEN G IANG , K ONTUM I N EACH PROVINCE , CHC S WERE SELECTED ACCORDING TO THREE CLUSTERS : URBAN , RURAL AND DIFFICULT AREAS 8

2.5 S AMPLE SIZE AND SAMPLING TECHNIQUE : 8

2.6 D ATA ANALYSIS : A FTER COLLECTING , QUANTITATIVE DATA WAS CHECKED , CLEANED , CODED AND ENTERED INTO E PIDATA 3.1, M ICROSOFT E XCEL STATA SOFTWARE WAS USED TO ANALYZE DATA : DESCRIPTIVE STATISTIC ( MEAN ,

PERCENTAGE %), ANALYTIC STATISTIC (T- TEST , WALLIS TEST , Χ 2 TEST ,…) Q UALITATIVE DATA WAS ANALYZED REGARDING TO THE THEMES INFORMED BY EACH OBJECTIVE 9

2.7 E THICAL APPROVAL : T HIS STUDY HAD THE APPROVAL OF COMMUNITIES , THE AGREEMENT OF LOCAL GOVERNMENT AND THE LEADERS OF HEALTH AUTHORITIES IN THE SETTINGS P EOPLE WERE VOLUNTARILY ENROLLED INTO THE STUDY , THE INDIVIDUAL INFORMATION WAS CONFIDENTIAL AND THEIR NAMES WERE NOT RECORDED 9

3 RESULTS 9

3.1 T HE CURRENT SITUATION OF THE CHC SERVICE NEEDS AND USE OF POPULATION IN SOME V IETNAMESE REGIONS IN 2014 9

3.2 T HE CAPACITY TO DELIVER HEALTH CARE SERVICES OF CHC IN SOME V IETNAMESE REGIONS IN 2014: 10

3.3 F ACTORS ASSOCIATED WITH THE CAPACITY TO DELIVER HEALTH CARE SERVICES OF CHC S IN SOME V IETNAMESE REGIONS IN 2014 12

4 DISCUSSION 13

5 CONCLUSIONS 17

5.1 T HE CURRENT SITUATION OF PEOPLE ’ S NEEDS FOR AND USE OF CHC SERVICES IN SOME V IETNAMESE REGIONS IN 2014 17

5.2 T HE CAPACITY TO DELIVER HEALTH CARE SERVICES OF CHC S IN SOME V IETNAMESE REGIONS IN 2014 17

RESEARCH TEAM REPRENTATIVE 19

NGUYEN HOANG LONG, PHD 19

REFERENCES 20

ANNEX – LIST OF RESEARCH TEAM 21

ABBREVIATIONS

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% 

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.   

1. BACKGROUNDCommune  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.

2. SUBJECTS AND RESEARCH METHODS2.1.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. 

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

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 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,  2 test). χ

Figure 3 –The prevalence of CHCs’ infrastructure reaching standard by the regionsBasically, 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 

that 51.9% mountainous CHCs reached the standards, which was much lower than other areas. The differences were statistically significant (p<0.05,  2 test).χ

Figure4–The situation of basic medical equipments of CHCsThere 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,  2 test)χ

Table1­ The proportion of techniques performed in CHCs compared to 

the list of decentralized techniques by the regionsCharacteristics Rural± SD Urban± SD Mountainous Total± SD ± SD PNumber of technique performed 62.2±17.6 63.3±16.7 61.9±11.6 62.5±15.5 0.488

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

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