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Nguyen Thi Noi, 38, felt a sudden and stabbing pain in her left knee while working on her farm on a scorching summer day. Her husband immediately took her to the biggest hospital in the area ¨C the Yen Bai General Hospital ¨C which is 15 kilometers away from their farm. Her doctor concluded that a ligament in her knee was damaged and ordered a laparoscopic surgery. The operation went well, and she was recovering when we visited.

Things would have been different had the accident happened to Noi four or more years ago. She might have needed to seek care in a bigger hospital in Hanoi ¨C which is a day away from her home in a remote village in Yen Bai Province.

¡°The hospital¡¯s facilities were antiquated. Doctors could treat only a few illnesses. Many of us believed that it would be better to go to central hospitals in Hanoi for serious conditions or if you needed complicated procedures,¡± said Noi. For example, laparoscopic surgeries were not available at the hospital at that time.

Noi¡¯s past thinking reflected what was ¨C and, in many cases, still is ¨C the calculus of many people living in the rural areas of Vietnam when they get sick. For local people, it is true that taking the whole day to travel down to big hospitals in urban areas is a physically and financially taxing endeavor. However, it does not reach the level that could deter them from visiting them as long as they believe they would be in more capable hands.

Nguyen Thi Noi, with the support of her husband, learns to walk again after her knee surgery. (Photo: Anh Thi Quynh Le/ľ¹ÏÓ°Ôº)

For many years, patients from neighboring provinces flocked to tertiary-level hospitals in Hanoi in droves and overloaded them. A survey by the Ministry of Health in 2012 noted that 59% of patients skipped the district/provincial hospitals to go straight to the central hospitals which are better equipped. Two or three patients sharing beds in these hospitals became the norm.

This phenomenon could be traced back to the limited capacity of the health system at the local level. The same survey noted that doctors at provincial hospitals might not able to perform up to 25% of the medical functions required of them. For the district hospitals, the rate went up to 33%. In addition, the local health facilities were much less equipped than their national peers.

. Broad actions have been taken, including significant investments to upgrade medical infrastructure and build capacity for professional health workers with a focus on the local level. The logic is simple: if patients have access to high-quality health services, at an affordable cost, and close to home, there will be no need to seek care elsewhere.

To deepen the government's reform efforts, the World Bank financed a US$126-million project ¨C ¨C in 2013 to strengthen the public hospital systems in 13 provinces in the Northeast and Red River Delta region. The program targeted five intervention areas for which the overcrowding was the most acute: cardiology, obstetrics/gynecology, pediatrics, oncology, and trauma (surgery).

Looking closer, you will find some high-tech, state-of-the-art medical equipment there ¨C those generally available at medical centers only ¨C such as a 32-slice CT scanner or digital subtraction angiography.

A patient receives a scan through a new 32-slice CT scanner at Yen Bai General Hospital. (Photo: Anh Thi Quynh Le/ľ¹ÏÓ°Ôº)

¡°All these shiny expensive pieces would sit here idling without skilled physicians to put them a good use,¡± said Dr. Tran Lan Anh, director of the hospital. ¡°What is special about this project¡¯s approach is the large-scale procurement of new equipment went hand in hand with in-depth skill enhancement. These two components have to go hand in hand to be effective.¡±

To fill the skill gap, this project sent local doctors to medical centers in Hanoi where they would be matched with the nation¡¯s top specialists and learn by working on real cases. Approximately 4,800 doctors benefited from this training, acquiring nearly 3,000 new techniques and now using these procedures on a regular basis on their home turf.  

Dr. Dang Viet Hung ¨C who led this project from Vietnam¡¯s Ministry of Health ¨C said: ¡°This project demonstrated that if we could build a close connection from top-tier hospitals down to the local network, we could facilitate seamless sharing and transfer of knowledge and expertise. With such exchange, doctors at the lower level will continue to be empowered to take on more advanced procedures that otherwise could only be done by doctors at the upper level.¡±

Due to noted improvement in not only technical but also management capacities, 35 out of 74 local hospitals moved to upper hospital classifications by the Ministry of Health. With the expansion of service coverage and improved quality of care, these hospitals became the first-choice provider for more and more local residents. As of November 2020, nearly 42,000 residents used the new clinical services available at both provincial and district hospitals, which resulted in lower self-referral rates. Patients surveyed at these hospitals reported higher levels of satisfaction with the overall quality: 81.3% at the provincial and 88.5% at the district level.

Beaming with smiles in the recovery room, patient Noi said: ¡°I am happy that we no longer have to go to Hanoi if we get sick, even for serious illnesses. It¡¯s good to have a decent hospital nearby to take care of us ¨C it would save us time, expenses and, troubles. Not to mention, our loved ones could always go visit. I wish that everyone would have such a hospital in their community.¡±

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Snapshot on Vietnam¡¯s hospital network structure

Public hospitals in Vietnam are divided into three levels: central level (47 hospitals); provincial level (419 hospitals) and district level (684 hospitals). In addition to the public hospitals, there are 182 private hospitals, most of them are located in urban areas.  

( Vietnam Health Statistics Yearbook 2018)