Strengthening synergy between primary healthcare providers and communities for prevention and control of hypertension and diabetes in Vietnam

Background

As one of the world’s fastest ageing populations, but with a relatively low per capita income, Vietnam faces numerous challenges in community healthcare, especially in the area of noncommunicable diseases (NCDs). In 2019, NCDs accounted for 73.7 percent of Vietnam’s total disease burden and mortality nationwide. Among NCDs, hypertension and diabetes mellitus are the most prevalent chronic diseases. However, rates of detection, treatment, and access to healthcare services to treat hypertension and diabetes mellitus are still limited. According to the Ministry of Health in Vietnam, up to 56.9 percent of people with hypertension and almost 70 percent of people with diabetes mellitus remain undiagnosed, and only 13.6 percent of those diagnosed with hypertension and 28.9 percent of those diagnosed with diabetes mellitus are managed at healthcare facilities.

Comprehensive approach 

The Scaling-Up NCD Interventions in South-East Asia (SUNI-SEA) project, funded by the European Union, developed a comprehensive approach, linking community groups, health facilities and decision-makers in a joint programme to improve prevention and management of NCDs.

There are four action areas:

• local health authorities, enhancing commitment
• local health providers, improving capabilites
• communities, enhancing engagement
• community volunteers, developing skills for prevention and screening

Intergenerational Self-Help Clubs and Commune Health Stations

In Vietnam a community-based intervention model has been put in place. It promotes coordination between Commune Health Stations in communes, wards, and towns and Intergenerational Self-Help Clubs (ISHCs) in hypertension and diabetes mellitus prevention and management activities. ISHCs are equipped with the knowledge and skills to conduct general screening for hypertension and diabetes mellitus risk factors, provide health education, classify risk levels, and refer individuals at high risk to healthcare facilities. The clubs promote healthy lifestyles and the self-care of members.

Health staff from primary healthcare facilities, specifically Commune Health Stations and district health centres, are trained to enhance their knowledge about hypertension and diabetes mellitus. The facilities strengthen their connection with ISHCs through screening and communication sessions about NCDs, held at the clubs. They also receive and manage high-risk community members who are advised by the ISHCs to consult a health facility. 

Collaboration with NGOs and government

The Vietnam Association of the Elderly, supported by HelpAge International in Vietnam, actively met and discussed with leaders of the Department of Health to propose the collaboration to strengthen support for health care activities which are implemented in ISHCs. In August 2022, Ninh Binh Association of the Elderly and the Department of Health officially signed a Joint Collaboration Agreement where specific roles and tasks of each party and indicators for each level of staff were clearly stated. The agreement aims to maintain and scale up the healthcare activities of ISHCs for club members and other community members. The agreement also states commitment to provide screening and health examination for ISHC members for early detection and proactive prevention of NCD risk factors, promotion of communication, health education to raise awareness on self-care and physical exercise, strengthening the monthly monitoring of blood pressure and weight, and home care. The Ninh Binh Association of the Elderly also signed a joint programme with the Department of Population and Family Planning to support communication sessions at the ISHCs; organising media events and developing communication materials. A short video shows the activities in NCD prevention and control.

Next steps

In the future there are still gaps that will need to be addressed. For primary healthcare facilities, coordination will be more effective if financial mechanisms are put in place to encourage health workers to strengthen screening, prevention, and management of NCDs in their community. More medicines to treat hypertension and some co-morbidities must be made available. At the community level, formal connections between ISHCs, Association of the Elderly and the health sector must be established. 

SUNI-SEA presents a future outlook in a policy brief. This brief presents the synergy model in Vietnam, intervention activities and results, gaps in the implementation and recommendations to strengthen synergies between primary healthcare providers and communities for the prevention and control of hypertension and diabetes.

Although the SUNI-SEA project has come to an end, other organisations replicate the project model and establish new ISHCs across the province, in accordance with Decision 1336 on replicating the ISHC model and the Prime Minister’s Decision 1579 on the health care programme for older people in 2021-2030. The Government of Vietnam is apply the model now in 6,000 other ISHCs.