Executive Summary of Vietnam Report
Implementing the Rapid Assessment Protocol for Insulin Access in Vietnam had as its aim to clearly identify the barriers to medicines and care that people with diabetes in Vietnam face in order to affect sustainable change in addition to increasing the data on diabetes and its financial impact on the health system and people with this condition.
There is a need for the Vietnamese health system to develop models for managing chronic disease in order to address the potential human and economic impact of the rising trend of chronic diseases, which may overburden both the health system and households and therefore impact development.
The Rapid Assessment Protocol for Insulin Access is not a statistical assessment of the health system, but has as its aim to assess in a short time the situation with regards to diabetes care in a given country. Its aim is to get a picture of the health system in order to provide different stakeholders involved in diabetes in a given country recommendations for action.
This protocol was carried out in Hanoi, Ho Chi Minh City, Thai Nguyen Province and Dong Nai Province. The information presented in this report in no means presents the actual situation of diabetes throughout Vietnam. It however illustrates that even in the two main urban areas as well as two relatively wealthy and urban provinces many challenges exist.
One of these challenges is the increasing burden of Non Communicable Diseases which represents 62.2% of the total disease burden in Vietnam. In parallel the risk factors for diabetes such as obesity are increasing throughout the population. Current estimates are 2.5% of the population aged over 20 in Vietnam have Type 2 diabetes, with an expected increase to 3.5% by 2025. Through reviewing statistics and reports high levels of complications exist even in children with Type 1 diabetes. There are an estimated 430 prevalent cases of Type 1 diabetes in Vietnam. During the implementation of the RAPIA all the people described the financial burden of accessing proper care for diabetes, especially Type 1 diabetes, as the main barrier to proper care.
Current estimates for Vietnam in International US dollars show an expenditure on diabetes of US$ 606,251,000 expected to increase to US $1,114,430,000 by 2025. The cost of diabetes is passed on to the individual or Health Insurance in Vietnam, but many provinces and hospitals of the country are already spending high proportions of their health budgets on diabetes, showing the increasing financial burden this condition places on Vietnam as a whole. A large reason for the financial burden of diabetes in Vietnam is the cost of medicines both to the individual and the Health Insurance. There is no centralised purchasing of medicines in Vietnam and as each hospital prepares its own tender this limits the bargaining power it can have with distributors and wholesalers.
In looking at the prices of medicines in Vietnam and comparing them to prices quoted on the International Drug Price Indicator most prices are substantially higher than those from the International Market. On average a unit of insulin cost US$ 0.014, equivalent to US$ 13.56 for a 10ml vial of 100 IU insulin (total of 1,000 units). For oral medicines the issue is also that of using branded versions of medicines. In some cases this meant that facilities were paying 2 to 5 times more per tablet just because they are buying the branded version.
Care in specialised hospitals and units is of good quality, but most care is focused on hospitals. Management of Type 1 diabetes is problematic due to lack of knowledge away from specialised centres. Overall diabetes care is not standardised in Vietnam and problems exist with regards to patient load and referrals. This has an impact on increased cost of transportation for patients and resulted in lack of time for healthcare workers to spend with individual patients for education. To help with patient education some facilities had diabetes clubs that provided some education. Education will be variable depending on the facility mainly due to the dedication and importance placed on patient education by staff. In addition there was the issue of the relevance to the sociocultural situation in Vietnam of some of the materials provided
Adherence to treatment was often poor due to lack of knowledge and cost of treatment including transportation. Estimates from this project found that care for a child with Type 1 diabetes equalled US$ 876 per annum.
In order to address the challenge of diabetes the government has taken some steps with the Prime Minister’s Decision No77/2002/QD-TTy (17 June 2002) which approved a programme to control NCDs for the period of 2002-2010. Based on this decision a preliminary National Plan for Diabetes was prepared for the years 2006-2010. This has led to the development of a National target programme for diabetes and hypertension.
In the past the RAPIA has served as a catalyst for change and raised the profile of diabetes with government authorities, clinicians and people with diabetes. Many existing initiatives and collaborations in Vietnam can be built on in order to improve the management of diabetes in Vietnam. It is hoped that the following recommendations will permit improvements in care in Vietnam.
A full copy of the report can be downloaded here:
There is a need for the Vietnamese health system to develop models for managing chronic disease in order to address the potential human and economic impact of the rising trend of chronic diseases, which may overburden both the health system and households and therefore impact development.
The Rapid Assessment Protocol for Insulin Access is not a statistical assessment of the health system, but has as its aim to assess in a short time the situation with regards to diabetes care in a given country. Its aim is to get a picture of the health system in order to provide different stakeholders involved in diabetes in a given country recommendations for action.
This protocol was carried out in Hanoi, Ho Chi Minh City, Thai Nguyen Province and Dong Nai Province. The information presented in this report in no means presents the actual situation of diabetes throughout Vietnam. It however illustrates that even in the two main urban areas as well as two relatively wealthy and urban provinces many challenges exist.
One of these challenges is the increasing burden of Non Communicable Diseases which represents 62.2% of the total disease burden in Vietnam. In parallel the risk factors for diabetes such as obesity are increasing throughout the population. Current estimates are 2.5% of the population aged over 20 in Vietnam have Type 2 diabetes, with an expected increase to 3.5% by 2025. Through reviewing statistics and reports high levels of complications exist even in children with Type 1 diabetes. There are an estimated 430 prevalent cases of Type 1 diabetes in Vietnam. During the implementation of the RAPIA all the people described the financial burden of accessing proper care for diabetes, especially Type 1 diabetes, as the main barrier to proper care.
Current estimates for Vietnam in International US dollars show an expenditure on diabetes of US$ 606,251,000 expected to increase to US $1,114,430,000 by 2025. The cost of diabetes is passed on to the individual or Health Insurance in Vietnam, but many provinces and hospitals of the country are already spending high proportions of their health budgets on diabetes, showing the increasing financial burden this condition places on Vietnam as a whole. A large reason for the financial burden of diabetes in Vietnam is the cost of medicines both to the individual and the Health Insurance. There is no centralised purchasing of medicines in Vietnam and as each hospital prepares its own tender this limits the bargaining power it can have with distributors and wholesalers.
In looking at the prices of medicines in Vietnam and comparing them to prices quoted on the International Drug Price Indicator most prices are substantially higher than those from the International Market. On average a unit of insulin cost US$ 0.014, equivalent to US$ 13.56 for a 10ml vial of 100 IU insulin (total of 1,000 units). For oral medicines the issue is also that of using branded versions of medicines. In some cases this meant that facilities were paying 2 to 5 times more per tablet just because they are buying the branded version.
Care in specialised hospitals and units is of good quality, but most care is focused on hospitals. Management of Type 1 diabetes is problematic due to lack of knowledge away from specialised centres. Overall diabetes care is not standardised in Vietnam and problems exist with regards to patient load and referrals. This has an impact on increased cost of transportation for patients and resulted in lack of time for healthcare workers to spend with individual patients for education. To help with patient education some facilities had diabetes clubs that provided some education. Education will be variable depending on the facility mainly due to the dedication and importance placed on patient education by staff. In addition there was the issue of the relevance to the sociocultural situation in Vietnam of some of the materials provided
Adherence to treatment was often poor due to lack of knowledge and cost of treatment including transportation. Estimates from this project found that care for a child with Type 1 diabetes equalled US$ 876 per annum.
In order to address the challenge of diabetes the government has taken some steps with the Prime Minister’s Decision No77/2002/QD-TTy (17 June 2002) which approved a programme to control NCDs for the period of 2002-2010. Based on this decision a preliminary National Plan for Diabetes was prepared for the years 2006-2010. This has led to the development of a National target programme for diabetes and hypertension.
In the past the RAPIA has served as a catalyst for change and raised the profile of diabetes with government authorities, clinicians and people with diabetes. Many existing initiatives and collaborations in Vietnam can be built on in order to improve the management of diabetes in Vietnam. It is hoped that the following recommendations will permit improvements in care in Vietnam.
A full copy of the report can be downloaded here:
Vietnam RAPIA Report |