Health workers' views on quality of prevention of mother-to-child transmission and postnatal care for HIV-infected women and their children

<p>Abstract</p> <p>Background</p> <p>Prevention of mother-to-child transmission has been considered as not a simple intervention but a comprehensive set of interventions requiring capable health workers. Viet Nam's extensive health care system reaches the village level, but still HIV-infected mothers and children have received inadequate health care services for prevention of mother-to-child transmission. We report here the health workers' perceptions on factors that lead to their failure to give good quality prevention of mother-to-child transmission services.</p> <p>Methods</p> <p>Semistructured interviews with 53 health workers and unstructured observations in nine health facilities in Hanoi were conducted. Selection of respondents was based on their function, position and experience in the development or implementation of prevention of mother-to-child transmission policies/programmes.</p> <p>Results</p> <p>Factors that lead to health workers' failure to give good quality services for prevention of mother-to-child transmission include their own fear of HIV infection; lack of knowledge on HIV and counselling skills; or high workloads and lack of staff; unavailability of HIV testing at commune level; shortage of antiretroviral drugs; and lack of operational guidelines. A negative attitude during counselling and provision of care, treating in a separate area and avoidance of providing service at all were seen by health workers as the result of fear of being infected, as well as distrust towards almost all HIV-infected patients because of the prevailing association with antisocial behaviours. Additionally, the fragmentation of the health care system into specialized vertical pillars, including a vertical programme for HIV/AIDS, is a major obstacle to providing a continuum of care.</p> <p>Conclusion</p> <p>Many hospital staff were not being able to provide good care or were even unwilling to provide appropriate care for HIV-positive pregnant women The study suggests that the quality of prevention of mother-to-child transmission service could be enhanced by improving communication and other skills of health workers, providing them with greater support and enhancing their motivation. Reduction of workload would also be important. Development of a practical strategy is needed to strengthen and adapt the referral system to meet the needs of patients.</p

Factors associated with antenatal care adequacy in rural and urban contexts-results from two health and demographic surveillance sites in Vietnam

<p>Abstract</p> <p>Background</p> <p>Antenatal Care (ANC) is universally considered important for women and children. This study aims to identify factors, demographic, social and economic, possibly associated with three ANC indicators: number of visits, timing of visits and content of services. The aim is also to compare the patterns of association of such factors between one rural and one urban context in northern Vietnam.</p> <p>Methods</p> <p>Totally 2,132 pregnant women were followed from identification of pregnancy until birth in two Health and Demographic Surveillance Sites (HDSS). Information was obtained through quarterly face to face interviews.</p> <p>Results</p> <p>Living in the rural area was significantly associated with lower adequate use of ANC compared to living in the urban area, both regarding quantity (number and timing of visits) and content. Low education, living in poor households and exclusively using private sector ANC in both sites and self employment, becoming pregnant before 25 years of age and living in poor communities in the rural area turned out to increase the risk for overall inadequate ANC. High risk pregnancy could not be demonstrated to be associated with ANC adequacy in either site. The medical content of services offered was often inadequate, in relation to the national recommendations, especially in the private sector.</p> <p>Conclusion</p> <p>Low education, low economic status, exclusive use of private ANC and living in rural areas were main factors associated with risk for overall inadequate ANC use as related to the national recommendations. Therefore, interventions focussing on poor and less educated women, especially in rural areas should be prioritized. They should focus the importance of early attendance of ANC and sufficient use of core services. Financial support for poor and near poor women should be considered. Providers of ANC should be educated and otherwise influenced to provide sufficient core services. Adherence to ANC content guidelines must be improved through enhanced supervision, particularly in the private sector.</p

Evidence and decision making: tobacco control policy and legislation in Vietnam

The Ministry of Health (MOH) in Vietnam is currently drafting the Tobacco Harm Prevention Law. The government requested the MOH to provide evidence on the strategies proposed in the draft law as part of its submission to the National Assembly. This study examines the availability and strength of evidence and its relationship to policy stakeholders' positions towards policy instruments proposed in the law. Several qualitative methods were employed including documentary analysis, key informant interviews, focus group discussion and a key stakeholders' survey. Contradictory findings were identified over the role of evidence. While there is high demand for local evidence, the availability and strength of evidence are not always aligned with stakeholders' positions with respect to different strategies. Stakeholders' positions are shaped by competing interests on the basis of their perceptions of the socioeconomic implications and health consequences of tobacco control. Claims of limited availability of evidence are often used to justify the maintenance of the status quo, a position that is seen to protect the state-owned tobacco industry and state revenue. Local evidence of the impact of tobacco on population health is argued to be 'one-sided' and evidence of selected interventions discounted. Compelling and comprehensive local evidence, including those addressing economic concerns, is acutely needed in order to proceed with the current legislation process. For evidence to play a critical role, it needs to engage those ministries responsible for the tobacco industry itself and the economic development

Does non-profit health insurance reduce financial burden? Evidence from the Vietnam living standards survey panel

Many low-income countries are implementing non-profit medical insurance to increase access to health services, especially among low-income households, and to raise additional revenue for financing public health services. This paper estimates the effect of insurance on out-of-pocket health expenditures using the Vietnam Living Standards Surveys for 1993 and 1998 and appropriate models for panel data. Our findings suggest that health insurance reduces health expenditure when unobserved heterogeneity is accounted for. Failure to capture unobserved heterogeneity produces contrary results that are consistent with previous cross-sectional studies in the literature. Health insurance is found to reduce out-of-pocket expenditure between 16 and 18% and the reduction in expenditure is more pronounced for individuals with lower incomes. At mean income, the effect of health insurance is to reduce health expenditures between 28 and 35%. Copyright © 2005 John Wiley & Sons, Ltd.