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Providing Primary / Reproductive Health Services in Asian Urban Areas with Attention to Vulnerable Populations, Especially Women and Girls

Section Two - Nine AUICK Associate City (AAC) Reports

13. Danang, Vietnam


Background

Views of Urban Administrators

Data on Maternal and Child Health Care


Ms. Nguyen Thuy Anh
 
Head, International Cooperation Division, Danang People’s Committee (Participant of AUICK Second 2004, Second 2005 and Second 2009 Workshops / AUICK Liaison Officer) 
Mr. Nguyen Van Phat 
Head, Cultural and Social Affairs Division, Danang People’s Committee (Participant of AUICK First 2010 Workshop) 
Dr. Tran Dinh Vinh 
Head of Obstetric Gynecology Department, Danang Hospital (Participant of AUICK Second 2007 and First 2010 Workshops)

Danang Map

1. Background

Danang is the largest city in Central Vietnam, and the third largest city in Vietnam, after Ho Chi Minh and Ha Noi. It covers an area of 1,256 km² and has a population of 887,069 inhabitants (as of 2009), which is estimated to reach one million inhabitants in 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. The new city of Danang consists of the previous Danang, Hoa Vang Rural District and Hoang Sa Island District. Danang’s economic output includes seafood exports, furniture, household goods, clothing and tourism, and some 4,900 factories and production facilities are located in the city. 

Data on the city’s MCH system before the war are not available. Since the country gained independence, the MCH system has been improving with an increasing number of paramedics as well as the services available. The system includes the Department of Obstetrics and Gynecology of Danang Hospital, Reproductive Health Center, 10 other Departments of Obstetrics and Gynecology (six district hospitals, two privately-owned hospitals, one police hospital and one military hospital) and 56 health stations. Maternal and child health care in the city has been greatly improved with the introduction of new hospitals, services and policies for these groups. Obstetrics-gynecology (OB-GYN) departments of many major city hospitals have been equipped with modern equipment and machines, to provide better diagnoses and treatment. New health policies make sure that all children under the age of six can receive free inoculations and health treatment. 

Due to increasing HIV/AIDS cases and low adolescent awareness in 2005, Danang established pilot youth-counseling programs as an AUICK Action Plan. These inform students with the support of the local media hospital leaflets/posters. Reproductive health and HIV/AIDS courses also educate health workers, and the Action Plan is replicated by hospitals and health centers in the city. Save the Children funds help lines at counseling and health centers, Monitoring and sustaining of these programs is done by youth unions and the National Association of Family Planning by quarterly work plans. 

Disaster contingency planning in Danang had lacked maternal and child health components until 2007, when another AUICK Workshop Action Plan informed local authorities on their urgent need, as this required the collaboration of the Health Department. A special City Committee for MCH in Natural Disasters was created within the government’s disaster management organization, which included administration officials, health agencies, and the police and military, which always play a major role in managing natural disasters, like the annual typhoons that hit Danang. Committee members are assigned roles, and an extensive checklist outlines tasks for disaster preparedness. For sustainability, the system is reviewed annually, or after each disaster situation occurs. 

The national rate of newborn tetanus in Vietnam was 1.30% in 2002. From 2003 to 2010, there were no cases of newborn tetanus in Danang, thanks to the program of safe motherhood carried out widely. Other inoculation programs (free of charge) are those against tuberculosis, hepatitis B, and typhoid. The percentage of children inoculated is about 98% to 100%. There are also some voluntary inoculation programs against some diseases such as hepatitis A and chicken pox. (Parents have to pay.) 

In 2007, the Maternal Mortality Rate (MMR) for Vietnam was 16.5/100000, and there was a significant difference between the delta region and the mountain region (8.1/100000 vs. 26.9/100000) (source: UNICEF). The MMR for Danang was significantly lower than MMR nationwide. (MMR in Danang: 2.5/100.000 live deliveries (2003) and 3.3/100.000 live deliveries (2004)). Statistics for 2009 really showed significant improvements in maternal and child care in the city, with the Maternal Mortality Rate (MMR) being 0, the Infant Mortality Rate (IMR) 6.64 and Child Mortality Rate (CHMR) 9.29. 

2. Views of Urban Administrators

To conduct this research, our group interviewed people concerned and gathered data from the Department of Health. 

Interviewees: 

1. Chairman and one Vice-chairperson of the People’s Committee. Meeting with Vice-chairwoman Nông Thị Ngọc Minh (In charge of cultural and social issues) 
2. Meeting with members of the Municipal People’s Council 
3. Director, Deputy Director of the Department of Health. Meeting with Deputy Director Nguyễn Thị Hoa Ban (In charge of public health, women and children health care) 

1. In general, how do you evaluate reproductive health care conditions in your city? 

Need to be upgraded: Despite huge efforts of the city authorities, demands have not been satisfied. It is necessary to invest in infrastructure, human resources and public awareness raising activities, etc., to improve reproductive health care services in the city. It is obvious that awareness raising and education activities are very essential to women, especially those at child-bearing age, to help them with basic knowledge and preparation for giving birth. As no one can play the role of a mother better than the mother herself, good doctors and modern equipment are nothing without good knowledge. 

2. In general, what is the priority level that the city has offered to reproductive health care? 

Medium: Shortcomings are not very serious. The city will be capable of overcoming these difficulties with the support of the Ministry of Health and international organizations. Besides, the city itself must have more specific programmes while other technical departments and mass organizations must be more actively involved in this issue. Everyone also needs to equip themselves with reproductive knowledge. 

3. In general, how do you evaluate resources for reproductive health care in your city? 

Rather inadequate. As analyzed in questions 2 and 3, resources of the city are insufficient for real needs. Besides the attempts of local and central government and international community, it is necessary to socialize reproductive health care to increase the resources. Privatizing this sector is also an option to which the city leaders should pay attention. 

4. In reproductive health care, what aspects and conditions are considered the most important? 

Birth control methods to improve the mother’s health: this is the most important as no one can be better at child bearing than the mother. She is needed for her child since he\she was a fetus until he/she was born. Thus, the mother takes an active role in giving birth and preventing herself and her child against sexually transmitted or mother-to-child diseases. 

5. Needs of the city to improve preliminary reproductive health care services 

Shortage of services and needs in terms of the following: 

- Financial resources - inadequate, especially to ensure good payment worth the effort of health staff. 
- Human resources - lack of good professionals and administrators. Must raise salaries for health staff and educate them about medical ethics, so that any doctor will become as caring as a mother. 
- Equipment - not much modern equipment is available in the city. 
- Facilities such as consulting room - need more establishments. 
- Institutional assistance - need to push ahead the socialization or privatization of this sector. 
- Other needs (clearly specified) - communications and reproductive health education need to be strengthened for all ages and sexes. 

6 - 8. Slum population and services

Since 2000, the city has completely cleared all slums and replaced them with a series of small houses for low income households. Danang City has no concept of “slum” at present any more. There are only “temporary houses” and “deteriorated houses that need to be upgraded”. However, according to authorities’ reports on the first six months of 2010, Danang still has 19,356 poor households accounting for 11.37 percent of total households in the city (about 112, 638 people). Those households have an average income of below $1 per day (nearly 600,000 VND each month). Among 19,256 poor households of the City, 825 are considered to be especially poor. All of these 112,638 poor people have been already granted with free health insurance, making about 40 billion VND per year in total. Additionally, in order to lower the birth rate, most of those are now instructed about health care service access, especially for reproductive health care ( e.g.: IUD fitted, free condoms, etc.). 

Seventy-two percent of these poor households are estimated to be taught about reproductive health care. In the next few years, the city’s standard of poverty will be elevated (to about below $2 per day). Therefore, the number of poor households will also increase, leading to an increase in reproductive health care service demand. One of our main targets is to eradicate completely those 825 especially poor households. They will receive help from the community, such as capital, solid houses, school fee remission, free health insurance, means for better living to abandon poverty and easy access to reproductive health care services. 

9-10. Immigrant population and services 

According to a report by the Statistics Office, from 2000 to 2010, the total number of immigrants to Danang is 110,000 people, which are 11,000 people per year on average. This growth speed is expected to remain the same until 2020 and 2025. 

Very few reproductive health care services can be accessed by these floating people because of their unstable dwelling. Until the present, the city has not had health care and social welfare programs for these floating migrants. However, once they stabilize their own accommodation, they will be encouraged to buy health insurance in their residential area. Other services are under open market rules. 

11. The city’s budget for RHC 

Cost covered by the city government (as percentage): 85% taken from the city’s budget and revenues from patients’ fees and health insurance. 

Cost covered by the Vietnam central government (as percentage): 10% including:
- Expense for Anti-malnourished program 
- Project on reproductive health care service (to improve management capacity and operation, and quality of family planning program) 
From other sources: 5% including aid from charities or non-governmental organizations. 

Note: We have also tried to collect data on the Crude Birth Rate (CBR) in the years 1970, 2000, 2005, 2009 and 2010. However, the data of 1970, 2000 and 2010 are not available because of the following reasons: 
- From 1970 to 1975 the health section was under another regime, so the data was not transferred to us in 1975; 
- Our data saving bank is not strong enough, so the data from 1976 to 2000 was not saved. 

For the data of 2010: because at the time of writing, the year of 2010 had not ended, the Department of Health had not yet calculated the figures. The CBR of 2005 was 15.18%, and that of 2009 was 15.15%. 

3. Data on Maternal and Child Health Care

Danang Data on MCH / Mortality Rates

Danang numbers of Children Inoculated

Other inoculation programs (free of charge) are those against tuberculosis, hepatitis B, and typhoid. The percentage of children inoculated is about 98% to 100%. There are also some voluntary inoculation programs against some diseases such as hepatitis A, chicken pox. (Parents have to pay)

Danang Health Care Services / Population and RH RatesDanang RH DataDanang RH Data (Continued)Danang RH Data (Continued)

CONTENTS

Top

Foreword

Section One

The New Urban Challenge for Primary and Reproductive Health Care

Executive Summary

1. Background: Urban Growth and Urban Primary / Reproductive Health (RH) Services

2. An AUICK Research Project Report

3. Regional Findings

4. Individual City Findings

5. Summary and Implications

Section Two

Providing Primary / Reproductive Health Services in Asian Urban Areas with Attention to Vulnerable Populations, Especially Women and Girls:

Nine AUICK Associate City (AAC) Reports

6. Kuantan, Malaysia

7. Khon Kaen, Thailand

8. Weihai, China

9. Surabaya, Indonesia

10. Olongapo, Philippines

11. Chennai, India

12. Faisalabad, Pakistan

13. Danang, Vietnam

14. Chittagong, Bangladesh

Annex I.
Research Instrument: AUICK Research Project Outline

Annex II.
AUICK Research Project Participants


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