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Maternal Health Workforce Management in Vietnamese Health Communes

Author(s) Thi Hoai Thu Nguyen1, Andrew Wilson2, Fiona McDonald3
Affiliation(s) 1Faculty of Health, The Queensland University of Technology, Hanoi, Vietnam, 2Menzies Centre for Health Policy, The University of Sydney, Brisbane, Australia, 3Faculty of Law, The Queensland University of Technology, Brisbane, Australia.
Country - ies of focus Vietnam
Relevant to the conference tracks Health Workforce
Summary As part of a study into the governance of health workforce in Vietnam, this study examined the impact of staff qualifications, training opportunities and other factors on reported ability to perform Essential Obstetric Care services (EOCs) in two provinces. While qualifications and training were the most important factors, national and district policies, such as which health professionals can prescribe essential medications, were also important factors in limiting provision of EOCs.
Background Vietnam’s national policies recognise the importance for an effective health system to ensure sufficient human resources (Politburo Resolution No. 46/NQ-TW dated 23 February). However, current analysis indicates a number of issues, including an imbalance and maldistribution of the essential health workforce, shortages of appropriately skilled health workers and constraints in management and utilization of health workers. Parallel studies on the impact of health policies on the health workforce, the implementation of health policies and provision of health care services in Vietnam have identified a number of governance-related issues, including a lack of staff accountability, quality control measures in relation to workforce training and skills maintenance, inadequate participation of community and civil society organizations, and an unreliable health information system. Underdevelopment of governance mechanisms may be a significant barrier to the effective implementation of policies. However, so far there has been no systematic analysis to identify the points of weakness and gaps in the governance and internal management of human resources in the health care system at the provincial and district levels in Vietnam.
Objectives Ensuring access to good maternal health services is critical for Vietnam to achieve the relevant Millennium Development Goals and this requires a well-qualified maternal health workforce able to provide the EOCs. This study aims to examine the impact of national and district policies relevant to human resource management and organisational factors on the maternal health services. Specific objectives were:a) To identify the availability and qualifications of maternal healthcare providers at commune level in two provinces.
b) To identify the ability of maternal healthcare providers to provide the EOCs and the barriers to providing these services.
c) To understand how the existing organizational and policy factors influence maternal healthcare provider’s ability to provide EOCs.
Methodology The research has been conducted in five districts in two provinces in the Northern mountainous area of Vietnam. A mixed methods approach was used consisting of a self-administered questionnaire given to commune level staff and in-depth interviews with commune maternal healthcare providers and managers engaged in maternal health at district and provincial levels. The questionnaire consisted of four sections namely: demographic information relevant to maternal healthcare providers, the training opportunities they attended, self-rated ability to perform EOCs and a scale to measure elements of work motivation.The sample for the quantitative survey is 192 maternal healthcare staff who volunteered to complete the questionnaire. In-depth interviews were conducted with 60 participants of whom 18 chosen to represent the different workforce groupings and have been fully analysed.Initial analysis to explore the differences in maternal health workforce between the two provinces consisted of two way tabulations with statistical significance testing using the Chi-square test. All variables found to be significant in this analysis and the potentially confounding variables were incorporated into multivariate regression analysis to identify the independent associations with the ability to perform EOCs.

For the qualitative analysis the subset of 18 interviews was transcribed. Inductive analysis was used to identify, code and organize themes arising from the raw data, with quotations servings as units of analysis. Data was analysed for consistently occurring themes or categories using a qualitative research package, N-Vivo software.

Results Analysis of the survey indicates there are distinct differences between the provinces as to the mix of maternal health professionals, their qualifications, their access to further training, and their self-reported ability to perform EOCs at the commune levels.The multiple logistic regression analysis showed that staff were more likely to report having training on all EOCs if they worked at district level, had higher qualifications (university and equivalent or higher) and obstetric expertise.In both provinces, only 21.6% of staff reported being able to perform all EOCs. The most common reasons reported by staff for not being able to perform EOC services is “Because I am not allowed to do this”, followed by “Lack of training” and “Lack of drugs and equipment”.

The most important determinants of ability to perform the EOCs were qualification and training. Although having attended training course in the last 12 months was not significantly associated with ability to perform EOCs in univariate analysis, in the multivariate analysis it was significant.

Data from the in-depth interviews confirms a common theme that respondents felt constrained in their potential roles by policies. It is also identified other organizational, policy and resource constraints faced by staff and managers at the commune and district levels.

Conclusion 1. The study provides a better understanding of the factors influencing the health workforce’s capacity and capability in the maternal health context in Vietnam.
2. The restrictions on who can perform EOCs should be reviewed to improve access to full EOCs.
3. To use health workforce most efficiently and effectively, all appropriately trained staff need to be given the authority to carry out all EOCs including prescription of essential medicine regardless of qualifications.Given that access to maternal health services provided by appropriately trained health care workers has been shown to be important to better maternal and child health, this reform would assist Vietnam to achieve the MDGs.