Partner response to health financing session at consultative group meetings
Dr Jean-Marc Olivé, WHO Representative to Viet Nam on behalf of the United Nations, the European Commission and the UK's Department for International Development
Firstly, I would like to congratulate the Ministry of Health on a comprehensive presentation to this meeting.
Today - health takes its rightful place on the CG agenda.
It is recognition of the importance of health to the overall economic and human development in Viet Nam - and of the Ministry of Health's many achievements in responding to Viet Nam's health challenges.
In the context of the CG I also want to acknowledge that the quality of genuine and committed dialogue between the Ministry of Health and development partners has improved considerably.
As partners, we very much appreciate the Ministry's increasing openness to discussion and debate.
In this regard the Joint Annual Health Review is a priority process for us, and we are very much encouraged by the Ministry's commitment to institutionalize this into the future.
As you have mentioned, we now have consensus on the text of a "Statement of Intent" to improve the effectiveness of development assistance for health. This is a critical document for health partners and we applaud the leadership that the Ministry has taken in developing it.
Implementation will be the next hurdle but we all remain committed to achieving results.
We are all aware there many health challenges in Viet Nam – both existing and new.
The Ministry’s presentation highlighted that a little more than 5% of the government budget is spent on health. The target is 10%.
This is a real and continuing concern for partners, and we join the Ministry of Health in calling on Ministries of Finance and Planning and Ambassadors to protect investments in this public sector in these difficult economic times.
We would argue that, judged on past performance, health represents a "good investment".
Thanks to its large public health care network, the Vietnamese people enjoy a better standard of health than many countries with comparable levels of income.
But one of the biggest challenges that Viet Nam faces is the ability to reduce the “out of pocket” payments that people face when using health services. These costs deter people from seeking care – some 66% of people with health problems delay visiting health services or they buy drugs over the counter without a doctor’s prescription. We also know that 10 percent of Vietnamese households suffer "financial catastrophe" as a consequence of paying for health care. This impacts directly on government’s poverty reduction efforts, affecting both the poor and those just above the poverty line.
Until the level of out of pocket expenditure is at least halved, Viet Nam will fail to achieve universal coverage of health services.
To overcome this, we need to meet the targets set by the National Assembly to increase investment in preventive care.
And, there needs to be a rapid expansion of health insurance. Health insurance is a challenge in many countries, and Viet Nam has been no exception.
You mentioned that Viet Nam's first health insurance law has just been passed by the National Assembly. This is an important first step. But we now urgently need the guidance and strategies that will allow ambitious objectives set out in the roadmap of the Law to be realized.
Experience from other countries shows us that allowing people to register "as a family" – so that immediate dependents can be covered -- is one of the most effective ways to expand social health insurance.
Of equal importance is protecting those working in the informal sector who are not already covered. As policies on health insurance develop in Viet Nam we urge you to take concrete actions in these two areas. This is an issue not just for the Ministry of Health but for the whole of Government.
Another issue that Partners would like to bring to the attention of the CG is sustainability of financing for HIV. You mentioned that donors provide only a small share of the health budget. This is true overall - but not in HIV, where partners finance around eighty percent of all spending.
As partners we are concerned that public funding will not adequately sustain the recurrent costs of scaling up HIV prevention and control programmes - particularly as Viet Nam faces the prospect of declining development assistance and access to low-cost AIDS medicines as it reaches middle-income status.
If the Government fails to bridge the funding shortfall, this will dramatically impact on the economic benefits of containing the HIV epidemic.
In conclusion I would like to bring my comments full circle and return to my first point.
The world faces severe financial crisis.
No country will be immune from the impact.
As public expenditure belts are tightened, donors may seek to cut their aid budgets and national governments may be tempted to cut social spending.
This temptation should be resisted.
More investment in health and education is needed, not less.
If this can be achieved it will help Viet Nam to build on - and maintain - the healthy and educated workforce needed to cope with the consequences of worldwide economic decline, and in turn quicken the pace of recovery.
In the spirit of dialogue, we would like to hear your views on some of the specific issues raised today:
First, how can we ensure that health captures an increasing share of Vietnam's national budget in future?
Second, how will the Ministry of Health work with other parts of government to develop the innovative strategies needed to implement the health insurance law, and in particular extending coverage to immediate dependents and the informal sector?
Third, what are the Ministry's plans to increase domestic support to HIV to reduce dependence on donors and ensure HIV programmes are sustained?
I hope together we can find solutions to these critical issues and make a commitment to move forward together.
Thank you for listening.