Integrating HIV Outpatient Clinics into State Hospitals in Vietnam

  • Published Date: September 2015
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Context: HIV treatment services in Viet Nam are mainly provided at outpatient clinics (OPC). Donors have funded most of the OPCs (74.6%). A study conducted by the Vietnam Administration of HIV/AIDS Control (VAAC) reviewing the HIV/AIDS prevention and treatment system in Viet Nam in 2012 stated that the current system of OPCs played a very important role, has demonstrated its effectiveness, and has contributed to the success of the HIV program in Viet Nam. The OPCs are co-located either in district health centers or in hospital settings, however they are not well integrated into the public health system, both in terms of service provision and management of health professionals.

Approach & Results: The investigation was conducted in three provinces representing three regions of Viet Nam: An Giang, Nghe An, and Dien Bien provinces. The study used qualitative methods. In-depth interviews were conducted with various key informants representing management, including Provincial Department of Health (DoH) and Provincial HIV/AIDS Prevention and Control Center personnel. Focus group discussions were held with personnel at state health facilities (directors, heads of departments, and medical staff of provincial hospitals, district hospitals, and district health centers), and with OPCs at both district and provincial levels (heads of departments and medical staff, and HIV patients).

Conclusions: The integration of the OPCs into state facilities is necessary in light of the limited resources available to maintain the operation of these facilities. However, all three options for OPC integration have several similar challenges, including: (i) difficulty in the organizational structure of departments and infrastructure for providing services to HIV patients; (ii) financial difficulty in balancing revenue and expenditure when providing services to HIV patients, especially at the hospitals; (iii) difficulty in ensuring adequate human resources in the field of HIV, which is a consequence of the limitations of recruitment policies, especially polices for using long-standing OPC staff; (iv) lack of regulations and mechanisms on coordination, integration, and implementation of health care activities for HIV patients among facilities at different levels, and between the preventive and curative sectors; and (v) barriers related to discrimination against people living with HIV in state health facilities.