WHO representative prioritises high-quality health care for all

(10-09-2007)

Dr Jean-Marc Olive, the new WHO representative in Viet Nam, recently spoke to Viet Nam News about his views on the current healthcare situation and plans for his tenure.

How would you evaluate the healthcare situation in Viet Nam? What similarities and differences have you seen in Viet Nam compared with other developing countries you have been in?

In terms of health status, Viet Nam is in a very encouraging position, better than countries with a similar level of income. Compared with the Philippines, where I was the WHO representative for five years prior to my posting here, Viet Nam has a lower birth rate, which means that the Vietnamese Government has more to invest in health. Slower population growth is often linked to a reverse phenomenon in economic growth rate. The Philippines has now surpassed Viet Nam in total population due to a higher fertility rate, which currently stands at 3.5, compared to 2.23 in Viet Nam.

I think we have more opportunities to improve health services here in Viet Nam than in other developing countries. Viet Nam has a comprehensive network of health care, and the level of health awareness among the general population is quite high. Viet Nam’s accession to the World Trade Organisation has also opened up many opportunities in the health sector. One of the greatest challenges I foresee however is the speed of economic growth, which may widen the disparity between the rich and the poor. It’s vital to ensure that the poor are not left behind while the economy continues to grow. It’s costly and difficult to provide access to effective health care to the poorest sections of the population.

What are your plans for Viet Nam while you’re posted here?

WHO has what we call a country co-operation strategy (CCS)- a document that is shared and prepared with the Government, which sets forth a five-year plan. In this strategy, we have six main focal areas:

Health policy regulation and legislation is one important area, which focuses on the health care infrastructure of the country, to help the system deliver better quality health services.

A second is communicable disease surveillance, prevention and control. This incorporates the excellent work that Viet Nam is doing in the prevention and control of HIV, dengue and other communicable diseases.

A third priority is to promote a healthy environment and healthy lifestyles, and prevent noncommunicable diseases. With the country growing at such a rapid rate, Viet Nam faces a double burden epidemiologically speaking. On the one side you have diseases that tend to affect more disadvantaged communities- diseases such as tuberculosis (TB), pneumonia, malaria. On the other side of the spectrum, you have diseases of the developed world like diabetes, cardiac disease and obesity. People whose daily diet would usually include healthier foods are now eating more occidental food, which is much less healthy. We are seeing this all over South East Asia. We’re also seeing an increase in tobacco use, and with the popularity of motorbikes instead of bicycles, this means less exercise and more traffic accidents.

Family and community health, and nutrition is another important priority within the strategy. We want to be sure that children and members of the poorest communities are properly vaccinated, that mothers receive the appropriate follow-up prenatal care, exclusively breastfeed their new-borns up to six months of age, and have an adequate, healthy diet.

Another important area is HIV/AIDS. Viet Nam is not yet a high burden country. If we put in place a proper strategy to prevent and control the disease in high-risk groups, there is still a chance to prevent the disease from becoming widespread and expanding into the entire population. We still have a window of opportunity if we act now.

Tuberculosis (TB) is also a major epidemic. Viet Nam was one of first countries to reach the global standard for TB control. But the rise in cases of HIV/AIDS has had a negative impact on the number of reported TB cases we see today. HIV and TB are diseases that often go together. We have an opportunity now to take advantage of two very strong, existing health programmes (HIV/AIDS and Tuberculosis), to maximise efforts to tackle these epidemics.

Blood safety is also very important. With diseases such as hepatitis and HIV, which can be transmitted through blood transfusions, there needs to be a sufficient supply of safe, high-quality blood available.

The last pillar or priority reflects WHO’s overarching role: partnership and co-ordination with all sectors and partners. We try to support the Ministry of Health to reach out to other ministries, to ensure that health is taken as an important issue of economic development. We will also make all efforts to make one UN a reality that secures better support to the Government.

Viet Nam has recently named a new Minister of Health, who has vowed to improve health care quality in Viet Nam. With over 20 years of experience working for WHO, what suggestions can you offer him?

It’s very good news that the new Minister has raised health as a high-level issue in the Government. In order to improve the quality of health care the leadership needs to be committed to making health a priority. Good practices need to be promoted so that they trickle down through the general population. A supportive work environment for health personnel, for example, will encourage an effective workforce. It’s also important that the client or the recipient of health care sees the benefits of the health system so that they trust it and use it. If it’s well decentralised, it will reduce the pressure on the city’s high-level institutes. The clients must be confident in the system.

Many Vietnamese women consider this year – the Year of the Pig – a good year to give birth so there are many expectant mothers around the city. Do you have a message for them to better protect themselves and their babies?

First, you need to be prepared for the birth of a child. You need to be in good health and abstain from drinking and smoking. This doesn’t just apply to the mothers, the whole family needs to be prepared.

You also need to know where you will give birth. Hospitals do come at a cost, but they are the safest place to give birth, which is why it’s important to have some money saved.

The best thing a mother can do, which is sometimes forgotten, is breast-feeding. Studies worldwide show that breast milk is essential for an infant’s development and immune system. For the first six months, WHO recommends exclusive breast-feeding. Nature works in such a harmonious way that the more a mother breast-feeds, the more milk she will produce. Then after six months, she can begin to supplement the infant’s diet with healthy food. Vaccination is also another important, protective measure.

Good preparation, a good environment and of course, a supportive, well-prepared husband are essential. — VNS