Covid lays bare Vietnam healthcare system flaws

Since the outbreak began most caretakers faced a mountain load of work, and working without a break was a common ordeal for most doctors and nurses in the larger cities.

Some 60% experienced a significant increase in workload, 40% saw their health deteriorate and 70% suffered from anxiety and depression, the Ministry of Health reported.

Yet they continued to be paid the small salary they were before the pandemic. VND7.36 million ($310) was the average salary paid to healthcare workers in 2021, according to the Vietnam Young Physicians Association.

The allowance for a 24-hour shift was VND115,000 at top hospitals, and less elsewhere.

Nguyen Anh Tri, a member of the National Assembly, said in June, “VND18,600 was what a health worker got for an exhausting night’s duty during the pandemic.”

Apart from rising hospitalizations and new infectors, healthcare workers also had to perform tasks such as vaccination, testing and contact tracing for months.

The poor wages and intense pressure mean healthcare workers are turning their backs on public hospitals and clinics and seeking greener pastures.

Around 10,000 quit the public healthcare sector in the last 18 months, including over 4,000 in the first half of 2022.

Thousands have switched to private hospitals, the Ministry of Health said in a report in September.

Tang Chi Thuong, director of the HCMC Department of Health, admitted Covid-19 was the last straw: “It is obvious that they are exhausted after months of fighting against the epidemic on a meager income. They cannot take it any more.”

Incompetent grassroots health centers

As the first layer in the healthcare system, local health stations failed to cope with the rising number of Covid patients. Officials admitted the main reason for this was the shortage of manpower.

“The community healthcare system has a number of weaknesses in terms of human resources, organizational structure, infrastructure, and equipment,” Nguyen Van Vinh Chau, deputy director of the HCMC Department of Health, told VnExpress in October 2021.

In the worst affected places like HCMC and its neighbor Binh Duong, the strategy of treating patients at home during the lockdown suffered, as examination and treatment, contact tracing, vaccination, supplying food, and other tasks required enormous human resources.

In HCMC, the health department estimated 17,400 Covid cases were reported daily during the peak period in August 2021, a huge jump from the 1,000 reported the previous month.

This wreaked havoc on an already creaking healthcare system.

A shortage of doctors has for long plagued the country’s healthcare system, and has only been exacerbated by Covid.

For instance, before the pandemic began, a healthcare station in HCMC’s Binh Chanh District with 11 personnel had been responsible for 140,000 residents, or one healthcare worker for every 13,000 people.

The average number of doctors per 10,000 population in Vietnam in 2021 was 11.1, far behind Singapore’s 26 and China’s 22, according to Statista.com.

Moreover, experts have expressed concern about the workforce quality in Vietnam, pointing out that many health stations could not handle even fundamental tasks such as minor surgery and first aid.

Doctor Nguyen Lan Hieu, director of the Hanoi Medical University Hospital, told VnExpress: “I visited numerous commune health stations. I asked (the staff) some simple questions about respiratory arrest and anaphylactic shock treatment, but often they failed to give the correct answer or did not answer at all.”

This inadequacy explains why patients in underdeveloped areas go to great lengths to visit higher-level hospitals for health checks and treatment.

“Only 15.9 percent went for treatment to commune and ward health stations in 2018,” Hieu said.

Flawed policies

During the pandemic tons of medical supplies and equipment were sent to HCMC and southern provinces, but they were inadequate considering the huge number of patients.

The deficiency in supply stemmed to some extent from the legal bottlenecks to procurement.

Top officials admit there are many shortcomings in the Law on Bidding like the drawn-out tender and purchase procedures.

Nguyen Phu Cuong, chairman of the National Assembly’s Finance and Budget Committee, at an NA meeting on September 20, blamed the tortuous procedures in contractor selection and protracted selection time for the delay in the public procurement of medical supplies.

Besides, the current system for public procurement often prioritizes price, as Pham Khanh Phong Lan, Deputy Chairwoman of the Vietnamese Pharmaceutical Association, said in a July interview, and hence the warnings by experts about the quality of drugs and equipment.

Speaking about low-priced medical supplies on August 21 Nguyen Tri Thuc, director of Cho Ray Hospital in HCMC, said: “We used to get good scalpels. Today, with a cheap one, you have to make three incisions to cut through the patient’s skin.”

The weaknesses of the law also give rise to violations.

The case of Viet A Company showed how legislative loopholes in the selection of contractors were exploited by wrongdoers for huge profits.

A Covid test kit supplier, Viet A won a contract without bidding, taking advantage of the abbreviated procedures during an emergency.

The company and some individuals pocketed VND4 trillion ($168.28 million) by illegally inflating prices by 45 percent.

So far almost 70 people have been detained, including former Minister of Health Nguyen Thanh Long and former Hanoi chairman Chu Ngoc Anh.

The pandemic also shone a light on the underdevelopment of the Vietnamese pharmaceutical industry: 90 percent of pharmaceutical materials are imported and only 5-6 percent domestically produced.

Deputy Minister of Health Do Xuan Tuyen admitted that some obsolete provisions in the law delayed the supply of medicines during the pandemic and wanted amendments to be considered soon by the government and legislators.