The health burden of many NCDs in Vietnam has increased over the years since the 1990s, with death rate increased up to almost 78% of all deaths that are attributable to NCDs in 2015. A similar situation affects the whole Southeast Asia region ranging from 45% in Timur-Leste to 85% in Brunei Darussalam in 201627. The proportion of DALYs attributable to NCDs in Vietnam since the 1990s as well as the proportion of NCDs mortality is progressing accordingly to an estimated proportion of NCDs DALYs and deaths for countries with middle socio-demographic index28. However, if the tracked progress remains at the same pace, in the category of Good health and well-being Vietnam seems not to be able to achieve the desired threshold by 2030 as committed by United Nations Member States in 201529.
The Vietnam health workforce reform has been underway in Vietnam, which were strongly committed in the master plan for Vietnam’s health system development towards 2025. Vietnam has made significant progress in health workforce development over the last decade. Albeit it still did not meet the World Health Organization (WHO) standard of 1 medical doctor (MD) per 1000 patients30, this ratio increased from 0.66 in 2009 (1518 citizens per 1 MD) to 0.86 in 2016 (1169 citizens per 1 MD). Similar progress has been partially made in the nursing profession, in which nurses started to achieve higher-level education. That could be the reason for the decrease in the number of elementary nurses (EN) in Vietnam. Within economic growth, the establishment of the Joint Coordinating Committee on Nursing in 2007, developing regulatory frameworks, and social demand for quality care and professionalism in Vietnam these settings could empower and support nurses to pursue higher education31. In our analysis, the decrease of EN was in strong correlation with an increase in CVDs, high SBP, and DM type 2 death and DALYs rates. Regarding both medical doctors and nurses as skilled health workers (SHW) and WHO standard to achieve 80% coverage of essential health services, Vietnam lacks more nurses than medical doctors. Nurse to patient ratio in Vietnam (also considering midwives) was 1.45 in 2016 while the WHO standard is set to have at least 4 nursing personnel per 1000 patients32. Achieving the desirable ratio 2.3 of SHW per 1000 population (updated to 4.45 SHW per 1000 population in 2016)33 still poses a challenge and obligation for the Vietnam government to ensure the provision of adequate health care. It also corresponds with a number of medical consultations (MC) per capita in Vietnam, which is much lower than the OECD average of 6.9 consultations per person. There exists a variation of the number of MC between countries in the Southeast Asia region possibly because of differences in the economic development of these countries or the number of their SHW, e.g. number of MC per capita in 2015 in Cambodia was 0.6, in 2013 in Singapore 1.7 or in 2008 in Brunei Darussalam 3.934. Health insurance expenditures per inpatient (HIEpI) in Vietnam significantly increased within the past few years and as such will be needed to handle in the future. In our analysis, the increase in HIEpI was in strong correlation with an increase in CVDs, high SBP, and DM type 2 death and DALYs rates. Such findings can be understood as such utilization of inpatient services is more likely linked with serious NCD-associated conditions and complications. The health financing reform that shifts resources from hospital care to primary care should be developed to improve access to early diagnosis and chronic care and thus mitigate serious NCD-related complications and its associated economic burden of health expenditure on the population.
The increasing CVDs, high SBP, and DM type 2 death rates and DALYs rates since the 1990s in Vietnam become more differentiated between males and females as we go further into the present. Albeit males have significantly higher rates attributable to CVDs and related to high SBP, DM type 2 death rate as well as DALYs are higher in the female population. Even if it has been recognized in the past that the impact of DM type 2 is greater in females than in males for all causes it is not yet fully understood35. Possible explanations could be the different cardiovascular risk profile or quality of provided health care but these need to be further examined36. The pooled prevalence of HT in Vietnam is estimated to be 21.1%37 which is lower than HT overall prevalence 27% estimated for member countries of the South Asian Association for Regional Cooperation38, 37.8% in middle-income countries or 23.1% in low-income countries39. The rate of change in both HT and DM type 2 death rates (increase in these cases) is however much faster than in high-income countries40.
Within the estimated burden attributable to CVDs which is expected to further rise in the Southeast Asia region over the next several decades41, the policymakers will have a fundamental role in tackling its progress in Vietnam. The economic utility in the implementation of preventive measures to reduce the health burden of both HT and DM type 2 has been demonstrated many times in the past42,43,44. Consequently, the Vietnam government has nationally implemented the One Strategic Plan to reduce four main NCDs by 10% between 2017-202145. Similarly, 11 Southeast Asian countries have endorsed national multisectoral NCD action plans to implement the Colombo Declaration on NCDs since 2016, which seems to help to accelerate the necessary progress46. To achieve SDG target 3.4 by 2030, decision-makers in Vietnam as well as in other Asian countries will have to endorse networked governance with strong political leadership oriented towards health capacity building and primary health care as the keystones in reducing the NCDs burden47.
Limits of study
Limits of the study emerged from the type of data used. First, the ecological character of this study limited our inference possibilities about the individuals thus conclusions must be taken with caution and should serve as the basis for further analysis. Second, we were not able to perform a more advanced time trend analysis of HT and DM type 2 because of the lack of monthly (or quarterly) diversification of reported statistical data. Third, the standardization was performed by GBD 2017 researchers using the GBD reference population, which is not often used. Consecutive comparisons and their interpretations were thus limited to assess progress in time rather than a comparison of specific numbers or rates. And fourth, we were limited by the availability of data on health personnel in the past in Vietnam, as the analysis of older data could reveal further differences.