Traditional medicine: More effective services in rural areas

Abstract

Rural areas in Vietnam encompass 9,068 communes, which are the lowest territorial and administrative units in the country where 60.7 million people (67.67% of total population) reside^1-3. Despite a remarkable development in the past decades, these areas are still economically and socially disadvantaged. A rural inhabitant’s income per capita GDP is low: 1,124 USD/year, i.e. about half of the nationwide 2,109 USD/year and far less than that of the urban one⁴. Moreover, poor and ethnic minorities live mostly in rural areas. While the poverty rate for households nationwide is 4.5-5%, the poverty rate in rural  areas is about 8.2%⁵.

Vietnam’s health system is organized into central, provincial, district and commune levels. Almost all hospitals and clinics belong to the first three levels and are located in cities or towns. The nearest commune district hospitals are usually small and the number of their beds account for only 36% of total hospital beds. At the commune level, health stations (CHSs) are only state-owned health facilities. The ratios of medical doctors, nurses and midwives per 10,000 inhabitants in rural areas are apparently very low at 1.3, 2.3 and 1.9, respectively. Whereas those numbers in urban areas are much higher at 17.5, 25.5 and 5.5⁶.

Such distributions of medical facilities and staff are evidently  unfavorable for rural dwellers whose opportunities to access to full and qualified health services are very limited, namely because: (i) The hospitals are located tens to hundreds of kilometers far away from their homes and are often  overcrowded. The CHS’s capacitis are very limited due to lack of medical equipment and highly qualified medical workers (only 76% of CHSs have doctors). Therefore, these CHSs can provide only preliminary and simple medical services as first aid, temporary or emergency treatment for simple cases and midwife services. In cases beyond capacity, patients are subject to being transferred to the district or higher level hospitals. (ii) Due to financial constraints, most rural inhabitants find it burdensome to go to these hospitals, as the transportation and communication infrastructure is still poor. These issues are one of the main reasons of  inequity between rural and urban people in accessing  quality health services^7,8.