The Interaction Relationship Between The Diversication of Health Care Support Activities and The Health Care Services Outreach: Evidence from Micronance Institutions in Vietnam

Background: One of the main ways to strengthen the health-system capacity by the intersectoral approaches is to promote social health by linking micronance with healthcare support activities. The aim of the study was to discover the interaction relationship between the diversication of health care support activities and the health care services outreach of formal micronance institutions (MFIs) in Vietnam. This study proposes policy measures that could be implemented by the policy makers, managers of MFIs to diversify the health care support activities and to promote the health care services outreach. Methods: This study used the panel data regression method from 2010 to 2019 of all formal MFIs in Vietnam, the study found out the interaction relationship between the diversication of health care support activities and the health care services outreach of formal MFIs in Vietnam. Results: The results showed that number of branches and the health care services outreach had positive relationships with the diversication of health care support activities; productivity had a negative impact on the diversication of health care support activities. The diversication of health care support activities, and productivity had positive relationships with the health care services outreach; number of branches had a negative impact on the health care services outreach. At the same time, this study found bidirectional interactions and the causal relationship between the diversication of health care support activities and the health care services outreach of formal MFIs in Vietnam. Conclusions: This study found bidirectional interactions and the causal relationship between the diversication of health care support activities and the health care services outreach. The study results encourage and provide opportunities to diversify the health care support activities and to promote the health care services outreach of formal MFIs in Vietnam. formal MFIs from 2010 to 2019. This study has developed an in-depth analysis of the health care services outreach and an econometric analysis on the interaction relationship between the diversication of health care support activities and the health care services outreach. The research demonstrated that bidirectional interactions and the causal relationship between the diversication of health care support activities and the health care services outreach. The study results will contribute to the theoretical and experimental. Furthermore, the study offers policy implication and new insights for developing a more the health care services outreach of formal MFIs and further emphasizes optimal policies to formal MFIs management; the managers should make conscious efforts and create a balance in the achievement of the goals of health care services outreach in accomplishing the diversication of health care support activities. Therefore, this study is urgently required to balance the goals of health care services outreach. In particular, this study is helpful to decision-makers and other stakeholders of formal MFIs in Vietnam. This study used regression analysis on a set of panel data, evaluated the uctuations of variables and performed the correlation analysis. The xed effects model (FEM) and the random effects model (REM) are the applied models for panel data analysis in this study. The variance ination factor (VIF) test was carried out on each independent variable of this study model. The research conducted the Hausman test for the model specication for the FEM and REM, and tested for the statistical signicance of difference between the coecients estimates obtained by FEM and by REM, The study chose the result between FEM and REM, and compared them with the pooled ordinary least square model (OLS) to determine the inuencing factors for this model and found the impact of the factors on the diversication of health care support activities, and the health care services outreach. At the same time, the study also conducted testing for a variance change to consider the variance change phenomenon, and checked the autocorrelation to examine serial correlation in this model. study evidence of the impact of factors on diversication of health care support activities and the health care services outreach. This study considered impacts on diversication of health care support activities, and the health care services outreach. The available evidence showed that bidirectional interactions and the causal relationship between the diversication of health care support activities and the health care services outreach. The study results showed that the two factors that had positive relationships with the diversication of health care support activities were the number of branches and the health care services outreach. The two factors that had negative relationships with the diversication of health care support activities were the productivity and the operational sustainability. The three factors that had positive relationships with the health care services outreach were the productivity, the diversication of health care support activities and the operational sustainability. A factor that had a negative relationship with the health care services outreach was the number of branches. The asset growth rate had a insignicant relationship with the diversication of health care support activities, and the equity growth rate had a insignicant relationship with the health care services outreach. At the same time, this study found relationships between the diversication of health care support activities, and the health care services outreach. The study found a positive bidirectional interactions relationships between the diversication of health care support activities, and the health care services outreach. their health Lack of health care instruction prevents them MFIs could be an alternative for the poor be in meet Could the take an full will


Background
One of the main ways to strengthen the health-system capacity by the intersectoral approaches is to promote social health by linking micro nance with healthcare support activities. Up to now, many countries have focused to strengthen the resources for the health system development. At the same time, they have focused on reducing the poverty gap as well as improving health. Therefore, many countries have increased to build their health-system capacity by the intersectoral approaches. One of the main ways that they have promoted social health is by the linking of micro nance with the healthcare support activities. MFIs expand their services to include the health care services. Because, the health care services are the extension of their mission of nancial security and social protection of the customers, and healthier customers better serve the MFIs' goals of growth, and long-term viability. Therefore, the health care services outreach is one of the main ways that they have promoted their operational sustainability.
Many MFIs have shown their ability to contribute to improving health care capacity by educating clients, facilitating access to the health care services, providing health nancing options and even directly delivering clinical care. MFIs provide the health care services to many households in support of access to the health care services. Many of them live in rural and remote areas beyond the reach of the hospitals and health agencies. Many MFIs already successfully offer the health care services. Increasing numbers also provide health-related services, such as medical care, health nancing, and establishing links with medical service providers to facilitate access to health care. However, MFIs offer the health care services, admittedly with challenges to employ the infrastructure for delivery of health-related services to those most in need. The poor people bear a hugely disproportionate share of disease and ill-health, and inability to access the health system emerged as key factors inducing and resulting from poverty [1].
In Vietnam, the operations of formal MFIs have reached 25 provinces and cities with 176 branches and transaction o ces in Vietnam. One of the signi cant missions of formal MFIs are the formulation of the policies that are intended to diversify the health care support activities and to promote the health care services outreach to the micro nance customers. However, to diversify the health care support activities and to promote the health care services outreach are quite the toughs, and challenges for MFIs. The challenges have to face as servicing remote and sparsely populated areas, fast-paced growth needs proper infrastructural planning such as branches, transaction points, which can be dangerously ine ciency without a high degree of diversi cation in health care support activities, and the health care services success is limited, etc. The studies of MFIs delivering the health care support activities showed increasing evidence of positive impact. Many studies found that adding health care instruction, health education, usually delivered during the micro nance customers group meetings, improves knowledge, and creates con dence that leads to behavioural change. These behaviours are associated with positive health outcomes in diverse areas that are critically important to achieving the health care services outreach [1]. Addressing this gap, the study's purpose was to examine the interaction relationship between the diversi cation of health care support activities and the health care services outreach. The research approach is based on the diversi cation of health care support activities of formal where micro nance is seen as the health care services outreach. The study used a quantitative approach using panel data from the formal MFIs from 2010 to 2019. This study has developed an in-depth analysis of the health care services outreach and an econometric analysis on the interaction relationship between the diversi cation of health care support activities and the health care services outreach. The research demonstrated that bidirectional interactions and the causal relationship between the diversi cation of health care support activities and the health care services outreach. The study results will contribute to the theoretical and experimental. Furthermore, the study offers policy implication and new insights for developing a more the health care services outreach of formal MFIs and further emphasizes optimal policies to formal MFIs management; the managers should make conscious efforts and create a balance in the achievement of the goals of health care services outreach in accomplishing the diversi cation of health care support activities. Therefore, this study is urgently required to balance the goals of health care services outreach. In particular, this study is helpful to decision-makers and other stakeholders of formal MFIs in Vietnam.

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The diversi cation of health care support activities The diversi cation of health care support activities were de ned as micro nance outreach indicator, it was measured by diversity indicators in micro nance services indicators, and it had been de ned by various researchers differently. The micro nance services diversity was the number of types of micro nance services offered by MFIs [2]. The micro nance services diversity was the number of types of micro nance services contracts supplied. The micro nance services diversity might mean both nancial services and non-nancial services. The MFIs had ample non-nancial services not only because it offered the health care support activities with a variety of terms but also because it offered establishing linkages to health providers to facilitate access to health care, and even directly delivering clinical care [3].
The micro nance services diversity referred to the diversity of services and products beings availed by active customers. This included variety of non-nancial services [4]. The micro nance services diversity indicated the number of the types of products and services, and others offered product based on the product lines or the types of product including the number and type of offered product, difference in the number, and the type of the offered voluntary non-nance service [5]. The MFIs promoted the diversi cation ofproducts and services in line with the operation trends and associated with the development of modern technology to meet the customer needs, that contribute to expand the scope of outreach of MFIs [6]. The number of micro nance products and services showed the number of product and service groups, the number of products and services in each micro nance product and service group. The number of micro nance products and services was manifold, the micro nance product and service diversi cation contributed to expand the scope of outreach to the micro nance customers. At the same time, the micro nance services diversity might mean both nancial services and non-nancial services.
The micro nance services diversity within a non-nancial services might mean educating clients, facilitating access to the health care services, providing health nancing options, establishing linkages to health providers to facilitate access to health care, and even directly delivering clinical care [7].
The previous literature showed that the diversi cation of health care support activities can be measured in different ways. In this study, the diversi cation of health care support activities refers to the number ofhealth care support activities offered to the micro nance customers. Accordingly, the diversi cation of health care support activities re ects the number, and type of health education, providing health programs, health promotion programs, adoption of nutrition practices, discussed family planning with spouses, health nutrition knowledge and practice among women, more attention to infant care-nutrition, vaccination, etc., facilitating access to the health care services, providing health nancing options, establishing linkages to health providers to facilitate access to health care, and directly delivering clinical care, and different health care support services offered by MFIs.
The diversi cation of health care support activities is associated with all MFIs' operations, it has been regarded as a prerequisite for continuous improvement the health care services outreach and is in uenced by many factors, including: Firstly, asset growth rate: There was a positive relationship between micro nance services and assets. Thereby, the asset growth rate had a positive relationship with the diversi cation of health care support activities [2]. The asset growth of MFIs would contribute positively to the development of micro nance products and services, which included diversi cation of the health care support activities [8].
Secondly, number of branches: A large branch network ensured customers could access more and more convenient the micro nance services, allowing MFIs to provide the diverse micro nance services, including the health care support activities [9]. Thereby, number of branches contributed to diversify the health care support activities of MFIs. Many MFIs provided micro nance services to millions households worldwide. In particular, they provided the health care support activities a million of these households are very poor, many households are lived in remote areas beyond the reach of health agencies. Micro nance sector increased number of MFIs to offer health-related services, such as instruction, clinical care, healthnancing and linkages to the health providers. This contributed to diversify the health care support activities of MFIs [10]. Some MFIs had increased the number of branches, expanding the scope of the operations that had provided the variety of micro nance services and promoted diversi cation of the health care support activities [11].
Thirdly, productivity: The productivity was one of the indicators in micro nance that measured as a ratio of the number of customers to number of staff. This indicator showed how e ciently the available human resource was utilized [12]. Productivity was measured the numbers of customer per staff of MFIs [13]. The staff productivity positively drove the outreach of MFIs. The results showed that the productivity appeared to be a better predictor of MFIs wider outreach. This provided an incentive for MFIs to provide a wide range of products services, including health care support activities [14]. Hence, the productivity had a positive relationship with diversi cation of the health care support activities of MFIs. Micro nance initiatives have been shown to advance health outcomes. The MFIs always maintain a combination of the productivity and the health care services outreach, and an appropriate productivity growth strategy contributed to diversify the health care support activities of MFIs [15].
Fourthly, the health care services outreach: Services outreach was the term that was used to re ect the health services that mobilized health resourses to provide health services to the population in in remote and rural areas [16]. Therefore, the health care services outreach aimed towards promoting health care services by enhancing health care delivery in communities. Through the health care service providers, communities can improve innovative approaches to challenges related to their speci c health needs. Services outreach was the term that was used to re ect the health services that mobilized health resourses to provide health services to the population in remote and rural areas [16]. Therefore, the health care services outreach aimed towards promoting health care services by enhancing health care delivery in communities. Through the health care service providers, communities can improve innovative approaches for the challenges related to their speci c health needs. There are many the research on the outreach of MFIs, the outreach of MFIs was measured by the number of people a micro nance institution has extended their services over a speci c period [17]. The outreach of MFIs was related to the actual number of micro nance customers [18]. The outreach of MFIs was related to the actual number of poor people reached with services of MFIs [14]. The outreach of MFIs concerned with the efforts to widen service for those who receive inadequate service. The indicators refer to the number of customers, the shifting percentage of served clients and either the types of products or programs [5]. The outreach of MFIs the larger the number of customers the better the outreach of MFIs. Therefore, the health care services outreach could be measured by many ways. This study used the number of customers to measure the health care services outreach [15]. The increase in outreach was undoubtedly to some extent the result of an increase in the services of MFIs. The outreach included the health care services outreach that refered to the goal of extending as many services as possible of MFIs [19]. Many MFIs have increased the outreach to meet the services needs of customers and members, The outreach of MFIs contributed to expand their operations and diversify the health care support activities of MFIs [20].
Fifthly, operational sustainability: Sustainability in the operations was the goal of many sectors and elds, each sector would rely on economic and social characteristics to plan the most suitable strategy for sustainable development. The MFIs would have operational sustainability if their revenue generated from the operations that covered the operating expenses, nancing costs and loss provisions. The ability of the organizations to meet their operating cost was de ned the sustainability [21]. Sustainability generally meant the ability of an ongoing program to perform activities and services in pursuit of the planned objectives. Operational sustainability of MFIs referred to the ability of MFIs to cover all of its costs through their income, and this was a tangible parameter that was measured continuously to monitor the level of income to cover all costs to ensure that MFIs would develop in long-term [15]. MFIs provided the poor with social services such as the health care service activities and health care instruction. They have increased social sustainability, which provided additional services to particular clientele in remote and rural areas. As a result, the operational sustainability of MFIs contribute to diversify the health care service activities to meet the growing demand of their members and customers [22]. The delivering high-quality care and improved public health were the results of the sustainable health, and care systems. It was easy to imagine a sustainable health and care system, the sustainability of everything that impacted on the health care services such as health promotion, health care instruction, and developing more diversi cation and sustainable models of health care [23]. This showed operation sustainability had a positive relationship with the diversi cation of health care support activities. The Health Care Services Outreach The health care services outreach was one of the possibilities to increase access to health services, and better mobilization of health resourses to provide health servicesto the population in remote or underserved areas. The health care services outreach was measured by the number of customers of MFIs [16]. The health care services outreach is associated with all MFIs' operations, it has been regarded as a prerequisite for continuous increasing the diversi cation of health care support activities and is in uenced by many factors, including: Firstly, number of branches: The distribution, making sure that the products and services was available where and when it was wanted. This included such options such as outreach agents, branches. From the customer's perspective, place refered to convenience and accessibility of the product or service being offered by MFIs. Therefore, the number of branches was one of the factors that positively affected the outreach of MFIs [24]. The number of branches was one of the delivery channels for micro nance products and services. Expanding this delivery channels generated convenience and increased accessibility of the product or service being offered by MFIs. At the same time, MFIs were often to improve delivery channels to increase the outreach, and thanks to its distribution network such as the branches and transaction points, many MFIs promoted the health care services outreach [20] Secondly, productivity: The breadth of outreach was the size or scale of micro nance institutions. The focus on outreach to the customers involved increasing the customers base in MFIs. The staff productivity was signi cantly positive correlated with micro nance services outreach measure of micro nance institutions. This showed that the productivity had a positive relationship with the health care services outreach of MFIs [25]. The staff productivity positively drove the breadth of outreach of MFIs. The results showed that using the number of customers appeared to be a better predictor of MFIs wider outreach [14]. Thereby, the productivity had a positive relationship with the health care services outreach of MFIs. The increasing in the productivity resulted into more the number of micro nance customers. The fact that MFIs had higher the productivity that obtained better the breadth and there was the interactive relationship between the MFIs' productivity and breadth of outreach in a positive trend. This showed the MFIs always maintain a combination of the productivity and the health care services outreach, and an appropriate productivity growth strategy contributed to improve the health care services outreach of MFIs [15].
Thirdly, equity growth rate: Equity growth rate contribute to improve the nancial capacity of MFIs, and nancial capacity understood as long-term effects had impact on the micro nance services. Thereby, an improved nancial situation was one of the vital factors that contributed to achieving better service diversi cation, including the health care support services [26]. Many MFIs had a low equity and faced many di culties in attracting the members and customer. Therefore, the less equity growth rate compared to other nancial sources, the fewer improvements in the health care services outreach of MFIs [15].
Fourthly, the diversi cation of health care support activities: The MFIs diversi ed to offer the services, i.e, product diversi cation. The results showed that product diversi cation by MFIs had a positive impact on the outreach. Thereby, this showed the diversi cation of health care support activities contribute to advance the health care services outreach of MFIs [27]. Many MFIs diversi ed to offer the services, i.e, product diversi cation such as type of different non-nancial services offered by formal MFIs. The formal MFIs promoted the diversi cation of products and services in line with the operation trends and associated with the development strategies, that contribute to increase the outreach of MFIs. In other words, the diversi cation of health care support activities had a positive impact on the health care services outreach of MFIs [20].
Fifthly, operational sustainability: There was a positive association exists between outreach breadth and sustainability of MFIs. This showed the operational sustainability contributed to expand the services outreach of MFIs [28]. The operational sustainability had a positive relationship with the outreach breadth of MFIs. Many MFIs increased in operational sustainability and lead to advance the health care services outreach of MFIs [15].  (1) and (2), respectively.

Methods
The coe cient α and coe cient β are the correlation coe cients of the independent variables with the dependent variables, which are the error terms of the model. For simplicity, indicator i represents the number of observations and indicator t represents the number observed year. This study uses Stata 15.0 software, the de nitions of variables and expected signs are presented as can be seen in Table 1. FEM and REM, and compared them with the pooled ordinary least square model (OLS) to determine the in uencing factors for this model and found the impact of the factors on the diversi cation of health care support activities, and the health care services outreach. At the same time, the study also conducted testing for a variance change to consider the variance change phenomenon, and checked the autocorrelation to examine serial correlation in this model.

Descriptive statistics
This study performed descriptive statistics of both the dependent and the independent variables, which are presented in Table 2. The results found that the AGR, BRA, CSR, NHT, OSS variables had smaller standard deviations than the average, this indicated that values tend to be close to the mean of the variables. The asset growth rate reduced in some MFIs, due to restructure their operations. The number of branches increased in many MFIs, and 72 branches was the highest. The productivity of MFIs improved over the years, and it achieved over 663 customers per staff. Many MFIs expanded their operations, and the number of health care support product and service types had the highest level of 19 products and services. The operational sustainability always was maintained and improved in many MFIs. The EGR, NAC variables have uctuations. This indicated that values are spread out over a wider range, due to the large difference in the equity growth rate, and the health care services outreach between the MFIs. Many MFIs increased the health care services outreach and the equity growth rate every year to meet the needs of members and customers, but some of them reduced the equity growth rate due to restructure their operations. This study tested the multicollinearity, and the multicollinearity occurred when two or more independent variables are highly correlated in the regression model. The analysis results of correlation between variables in the model indicated a very low degree of correlation among the variables, so the presence of any multicollinearity was neglected Table 3. NHT, but this last variable was not statistically signi cant in the model as can be seen in Table 4. checking the autocorrelation of the model, P-value = 0.0322 was smaller than 0.05 so this model did have serial correlation. This study performed to overcome the and serial correlation. The results in REM (xtgls) showed that the variables CSR, NHT and OSS had positive impacts on the variable NHT at the signi cance level of 1%, 1% and 10%, respectively; the variable BRA had a negative impact on the variable NHT at the signi cance level of 10%; the variables EGR had a positive impact on the variable NHT, but this last variable was not statistically signi cant in the model as can be seen in Table 5.  Notes: ***, **, * denote signi cance at the level of 1%, 5% and 10% Source Compiled from data processing results of Stata software

Discussion
The results of REM (xtgls) in Table 4 indicated that variable BRA had a coe cient 0.0949 with the signi cance level of 1%. This result showed that for one unit increased in the number of branches, the diversi cation of health care support activities was anticipated to improve by 0.0949 units, when the remaining variables in the model were kept constant. As expected, this result was broadly in harmony with the expected sign and hypotheses, this meant that MFIs focused to expand the number of branches goal was likely to increase the the diversi cation of health care support activities. This meant that MFIs focused to expand the number of branches that were likely to increase the diversi cation of health care support activities. This helped to diversify the health care support activities for the members and customers, the expansion of more and more the branches and transaction points of MFIs contributed to increase in many the health care products and services, thereby better meeting the health care needs of the members and customers.
The outcome of the regression analysis indicated the variable CSR had a coe cient − 0.0138 with the signi cance level of 5%. This result showed that for one unit increased in the productivity, the diversi cation of health care support activities was anticipated to decrease by 0.0138 units, when the remaining variables in the model were kept constant. Some MFIs had a high productivity over the years. A high productivity meant that MFIs focused on the numbers of customers on numbers of staff ratio to provide some common health care products and services. Therefore, they lacked the opportunities to expand the operations for the diversi cation of health care support activities to meet the needs of diverse customers populations, that included prevention, diagnostics, treatment instruction, nursing care and midwifery, improving the experience of care, improving the health of populations, etc.
The model result exhibited a very signi cant effect of NAC on the diversi cation of health care support activities, and the coe cient was positive and statistically signi cant at the 1% level. This result showed that for one unit increase in the health care services outreach, the diversi cation of health care support activities was anticipated to increase by 0.0000549 units, when the remaining variables in the model were kept constant. As expected, this result was broadly in harmony with the expected sign and hypotheses, and there was a complement relationship exists between the health care services outreach and the diversi cation of health care support activities. The increase in the health care services outreach contributed to promote the diversi cation of health care support activities. Beside some common health care products and services, many MFIs met the needs of customers in the health care support activities to achieve the goal of extending as many products and services as possible of MFIs. Thus, the formal MFIs achieved dual goals including the health care services outreach and the diversi cation of health care support activities over the years.
The regression result indicated a signi cant effect of the operational sustainability on the diversi cation of health care support activities with the coe cient was negative and statistically signi cant at the 10% level. This result showed that for one unit increased in the operational sustainability, the diversi cation of health care support activities was anticipated to decrease by 0.0138 units, when the remaining variables in the model were kept constant. As unexpected, this result was not broadly in harmony with the expected sign and hypotheses, and there was a trade-off between the operational sustainability and the diversi cation of health care support activities. The operational sustainability was not one of the suitable conditions to promote the diversi cation of products and services. Many MFIs have not taken the advantage of operational sustainability to expand operations, providing a wide range of products and services to customers. Beside they met the needs of some common health care products and services, many MFIs did not meet the needs of customers in the health care support activities to achieve the goal of extending as many products and services as possible of MFIs.
The results of REM (xtgls) in Table 5  This result showed that for one unit increased in the productivity, the health care services outreach was anticipated to improve by 406.0 units, when the remaining variables in the model were kept constant. As expected, this result was broadly in harmony with the expected sign and hypotheses. Some MFIs had a high productivity over the years. A high productivity meant that MFIs focused on the numbers of customers on numbers of staff ratio to provide some common health care products and services.
Therefore, they lacked the opportunities to improve the health care services outreach to meet the needs of diverse customers populations.

Conclusions
Micro nance is seen as a key health care services development tool, and despite the current deepening di culty within the industry, it continues to grow in Vietnam. The study systematically reviewed the evidence of the impact of factors on diversi cation of health care support activities and the health care services outreach. This study considered impacts on diversi cation of health care support activities, and the health care services outreach. The available evidence showed that bidirectional interactions and the causal relationship between the diversi cation of health care support activities and the health care services outreach.
The study results showed that the two factors that had positive relationships with the diversi cation of health care support activities were the number of branches and the health care services outreach. The two factors that had negative relationships with the diversi cation of health care support activities were the productivity and the operational sustainability. The three factors that had positive relationships with the health care services outreach were the productivity, the diversi cation of health care support activities and the operational sustainability. A factor that had a negative relationship with the health care services outreach was the number of branches. The asset growth rate had a insigni cant relationship with the diversi cation of health care support activities, and the equity growth rate had a insigni cant relationship with the health care services outreach. At the same time, this study found relationships between the diversi cation of health care support activities, and the health care services outreach. The study found a positive bidirectional interactions relationships between the diversi cation of health care support activities, and the health care services outreach.
The members, customers and poor lack access to the health care services, hence reducing their capability to meet their health requirements. Lack of health care instruction prevents them from maintenance sustainability life. MFIs could be an alternative for the poor to be in a position to meet the demand for health services. They Could bene t the poor's access to health, and need to take an integrated approach to provide a full health care support activities package. This study will help researchers and managers develop their expertise on key factors of the diversi cation of health care support activities, and the health care services outreach, and the relationship between the two. Based on the research results, the article recommends the following to increase the diversi cation of health care support activities, and the health care services outreach: Firstly, this study found a positive bidirectional causal interactions between the diversi cation of health care support activities and the health care services outreach, so that the immediate policy recommendation is for MFIs to focus more on the diversi cation of health care support activities, and the health care services outreach. In order for MFIs to succeed they must promote to maximize health care support activities, and attract more members and customers. At the same time, MFIs should have many combined and synchronous solutions. Because, single solutions continue to be inadequate in confronting the prevalent problems of the diversi cation of health care support activities, and the health care services outreach.
Secondly, the members, customers and poor need access to a coordinated set of the diversi cation of health care support activities to have better the health care services outreach. MFIs should take the advantage of operational sustainability to expand the appropriate health care support activities, they should increase the opportunities to expand the operations for the diversi cation of health care support activities to meet the needs of diverse customers populations, that included prevention, diagnostics, treatment instruction, nursing care and midwifery, improving the experience of care, improving the health of populations, etc. At the same time, they need appropriate solutions to restrict the trade-off between the operational sustainability and the diversi cation of health care support activities.
Thirdly, integrated micro nance and health interventions leverage networks of the members, customers and poor to improve livelihoods, promote health care and safeguard against highly cost illnesses. Nonintegration of the diversi cation of health care support activities, and the health care services outreach can be highlighted as a limitation factor to the health care support-promoting capacity of the MFIs' operations in Vietnam. Therefore, MFIs should expand the other delivery channels generated convenience and increased accessibility of the health care support activities being offered by MFIs. MFIs need to improve the delivery channels to increase the health care services outreach, and thanks to the other distribution networks such as providing online services, contacting households, etc.
Fourthly, the diversi cation of health care support activities were to be integrated on a massive scale with micro nance services for the members, customers and poor, then the true potential of micro nance to improve the health care services outreach and offer a digni ed route out of care could be realized.