Especially in rural regions and low-income households, access to healthcare services remains a serious challenge in Viet Nam. Low health knowledge, inadequate infrastructure, and economic disparity serve to explain continuous changes in health outcomes all over the country. Moreover, worsening health inequalities in rural regions are insufficient medical professionals and suitable infrastructure. Accepting these challenges will help one to develop rational responses for health equality. This essay will explore the problems of access to multifaceted health care in Viet Nam, focusing on three main aspects: economic inequality that limits access to essential treatments for low-income groups, inadequate health infrastructure in rural areas leads to poor health outcomes, and low levels of health knowledge hinder informed health decision-making. Every issue will have relevant solutions suggested in the article: government-sponsored health care programs for low-income families; statewide health education campaigns to increase health literacy and growing mobile health units in outlying areas.
To begin with, low-income groups have difficulty paying for necessary treatments, which leads to unequal access to health care services due to financial inequality. For instance, according to a World Bank report (2022, p.7), the percentage of poor households that have to pay for health in excess of 10% of their total income is 3.5 times higher than that of the richest group. “Households in slum areas, with people aged 60 years and older, and in the poorest socioeconomic group were significantly associated with higher disaster health costs” (Kien et al., 2016, p.14). Health costs mean that poor households, especially those with older people living in slums, are at risk of rising catastrophic health bills and poverty. In short, simultaneous development of both facilities and high-quality medical human resources would generate fundamental and long-term gains in expanding access to health care services for rural populations, therefore helping to eliminate inequality gaps and enhance public health.
A possible solution to addressing inequalities in access to health care in rural areas is that Viet Nam needs to adopt a multifaceted approach. It is necessary to prioritize the expansion of the network of mobile health stations in rural areas that are still difficult. These units can provide basic health care services such as medical examinations, maternity care, immunizations, and health counseling. By bringing health services closer to people, especially those living in rural areas, mobile units contribute to significantly improving access to health care (Quan & Taylor-Robinson, 2023, p.3). As an illustration, within the framework of the National Target Program on Health, the Ministry of Health has deployed more than 1,000 mobile medical vehicles in 62 provinces and cities, prioritizing mountainous, remote, and island areas, in order to provide medical examination and treatment services, reproductive health care, and capacity building for grassroots health (Mekong Plus, 2024, p.1). This can be effective if Vietnam create policies to motivate medical professionals to work in rural areas in conjunction with network expansion.
Second, rural areas have fewer facilities and health workers, which makes it more difficult for people living in remote areas to access high-quality health care. Nguyen et al. (2016, p.5) have pointed out that: “Health workers are disproportionately distributed among economic regions. For example, the density of doctors in the Southeast region is 7.8 per 10,000 inhabitants, compared with 5.7 in Central Highlands. Meanwhile, the Southeast region, being a richer region, attracts nearly three times the total number of health workers in the Central Highlands.”. In this context, the importance of healthcare workers cannot be underestimated. For example, in the period of 2021-2030, Son La province has implemented a project to attract high-quality medical human resources to work in areas with extremely difficult socio-economic conditions, with an initial support of up to 200 million VND per doctor and many other preferential policies on housing, training, and promotion (LawNet, 2021). It can be seen that the distribution of health professionals is very different across all economic regions of Vietnam. To conclude, disparities in infrastructure and medical human resources between regions in Viet Nam have led to inequality in access to health care.
A key solution to address this problem include implementing policies to attract and retain healthcare professionals in disadvantaged areas, offering salary increases, subsidies, and career development opportunities. If Vietnam aspires to reduce variations in access to health care in rural areas, it must focus on building a network of mobile health units in underdeveloped areas. As an example, the government can implement the Scheme to encourage young doctors to volunteer to work in mountainous, remote areas, borders, and islands. Along with that, it is necessary to mobilize on-the-ground resources, including training and support for the role of midwives, especially for ethnic minorities in remote areas, thereby expanding human resources and improving maternal health care (Khosravi et al., 2022, p.4). This might work if the Vietnamese Government ensures the expansion of the mobile health network, promulgating policies to attract and maintain medical personnel, especially focusing on training and supporting midwives in disadvantaged areas.
Finally, low levels of education limit health awareness, making understanding disease prevention and health care habits difficult, especially in rural areas of Vietnam. Tuan and Pham (2024, p.547) point out that primary health care providers lack the skills needed to provide mental health care: “The lack of skills to identify and manage mental health issues in pregnant women and the limited communication time were identified as the main reasons for the lack of trust and low demand for mental health in maternal healthcare networks.”. To illustrate this, if a doctor’s consultation time is limited to just 5-7 minutes, it may not adequately address patients' concerns. Thus, the main challenges that create a lack of trust and insufficient demand for mental health treatment in the maternal health care system are the lack of capacity of healthcare workers to detect and manage mental health issues along with limited communication time.
A practical solution is the need to improve working conditions so that healthcare workers have enough time to communicate and interact with patients as well as enhance mental health training for them. According to Nguyen et al. (2016, p.9-10s), in order to attract and retain health workers to work in disadvantaged areas, the Government needs to promulgate and implement preferential policies such as salary increases, allowance support, improvement of accommodation conditions, and equipment of facilities. On-site training programs also need to be promoted, in which, in addition to sending experienced medical experts to support and direct guidance, it is necessary to focus on training and improving the capacity of local health workers themselves (Kiem Phuong, & Thao, 2024, p.33). As an example, the family doctor model has been piloted in 28 provinces and cities and initially showed effectiveness in reducing the load on upper-level hospitals, improving service quality and people's satisfaction. This is likely to work if the Vietnamese Government may be implement health communication and education campaigns across the country, paying special attention to rural communities and low-income groups.
In conclusion, this essay has mostly focused on three main aspects of disparity in access to health care in Viet Nam: Low levels of health knowledge affect informed health decision-making; poor health outcomes arising from inadequate health infrastructure in rural areas; and economic inequities restricting access to fundamental treatments for low-income groups. If Viet Nam intends to solve these issues, it must design policies to motivate health professionals to work there, set up mobile health units in rural areas, and implement government-subsidized health care programs for low-income families. These solutions must be implemented holistically and synchronistical with government, stakeholder, and society as a whole support and commitment in mind to close inequality gaps and forward equitable access to health care services.
References
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