AUICK Newsletter Issue 56, September 2011

Mr. Nguyen Van Phat
Chief, Social and Cultural Affairs Division Danang People’s Committee, Vietnam

Ms. Nguyen Thuy Anh
Head, International Cooperation Division Danang People’s Committee, Vietnam

The City

Danang, is the largest city in central Vietnam, after Ho Chi Minh and Ha Noi. It covers an area of 1,283 km², and has a population of 887,000, which is estimated to reach one million by 2014. Danang is on the end of the East-West Economic Corridor (EWEC), which stretches over Vietnam, Laos, Thailand and Myanmar. It was separated from the previous Quang Nam-Danang Province in 2007, and it is now directly responsible to the central government. Its economic output includes seafood exports, furniture, household goods, clothing and tourism, and some 4,900 factories and production facilities are located in the city.

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Reproductive Health Services

Danang’s Maternal and Child Health (MCH) system consists of the Obstetrics-Gynecology Department of Danang Hospital, a Reproductive Health Center, and 10 other Obstetrics-Gynecology Departments (of six district hospitals: two private, one police and one military hospital), 56 health stations and a new Obstetrics-Gynecology hospital. 

A total staff of 450 persons administer MCH services, including 80 doctors, 100 nurses, 120 midwives, 30 medical and 40 radiation technologists. The figure is expected to increase to 850 under current programs. Of 700 deliveries per month, around 25% are C-section (caesarean operations) due to abnormal delivery. There are an average of 10 cases of Vacuum Extraction (VE), 3-4 stillbirths and 75% normal deliveries. 

Obstetrics-Gynecology departments of major hospitals have modern equipment, and Danang has achieved the rate of 100% of visits to hospitals, medical centers or private clinics by pregnant women, an average of once a month before delivery. The City has also developed many new and modern facilities both at the city and district levels, has improved medical staff qualifications, and has made significant improvements to the care and survival of critically ill neonates. Incredibly, Danang achieved a zero rate of maternal mortality in 2009, and its infant and child mortality rates were 6.64 and 9.29, respectively. There were no cases of newborn tetanus in the City from 2003 to 2010. 

Eighty five percent of the reproductive health care budget is covered by the city government from its budget, patients’ fees and health insurance. Ten percent is covered by the central government, and five percent by other sources, such as charities or NGOs. 

Lessons learned by the City in reproductive health care implementation include the positive changes brought about by increased involvement of city leaders, the diversification and “equitization” of RHC services, the promotion of training for both intensive medical staff and general staff, and getting the involvement of the community by raising awareness through the mass media. 

For child heath care, malnourishment has been eliminated by getting the involvement of teachers at nurseries in children’s feeding, as 60% of children under the age of five have been sent to nurseries. The best ways to raise awareness on children’s nourishment have been found to be through the media and direct examination when children are taken to doctors. Group consultations are not effective, as many mothers are busy everyday with their work. 

Maintaining a database on the number of the children under five years of age will be very good for undertaking activities like weighing children, checking they receive sufficient Vitamin A, and ensuring that malnourished children are well-treated.

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Challenges and Recommendations

Challenges include the provision of services to increasing numbers of immigrants, a lack of resources (funds, equipment and staff), figures of neonatal cases remaining high, providing reasonable salaries for medical staff, and finding effective ways for information dissemination, especially among men. 

In the views of urban administrators, the City’s reproductive health conditions need to be improved, through more infrastructure, human resources and public awareness, especially RH information and education for women. The priority level for RH is medium, and more specific programs are needed, with the involvement of more specialized agencies. Privatizing health care is considered as an option for improving the situation of inadequate resources available for reproductive health care. 

The RH issue seen as most important by administrators is birth control methods to improve mothers’ health. In order to improve preliminary RH services, more financial resources are necessary, as is increasing numbers of skilled staff, modern equipment, facilities such as consultation rooms, and establishments for care provision. In terms of institutional assistance, it is deemed necessary to push ahead with socialization or privatization. Increased education and communication on RH is also required for persons of all ages and sexes. 

The slums in Danang have been completely cleared and replaced with houses for persons with low income. There are still 19,356 poor households though, among which 825 are considered very poor. 

Immigrants number 110,000 people (11,000 per year from 2000 to 2010), and this is projected to continue over the coming years. The City does not have health care or social welfare programs for its immigrant population, due to their unfixed location. 

To improve the health of newborns, Danang has the following objectives:

- develop the Neonatal Intensive Care Unit (NICU) at the new Obstetrics-Gynecology department) to be comparable to the best NICUs in Vietnam, and to work toward international standards; 
- enhance regional staff capacity in women and newborn care; 
- minimize community-acquired newborn infections and hospital-acquired newborn infections; 
- improve neonatal resuscitation at delivery rooms and theatres, and safe neonatal transport in Danang and surrounding areas; and 
- encourage all governmental organizations, non- governmental organizations, individuals and the community to support neonatal health missions.

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