20 December 2019

Vietnam: A vision for public health

A grassroots effort to evaluate and improve the public health system of Vietnam has yielded good progress, with potential for long-term impact.

Few people, and even few policymakers, are aware of the difference between medicine and public health. Generally, a doctor of medicine treats individual patients. Public health is concerned with groups of people, and whole populations. Its work ranges from health education and hygiene to mass vaccinations, health screening and health planning. It studies environmental, nutritional and socio-economic risk factors for diseases, as well as preventive, diagnostic and therapeutic medical practice. During the last two centuries public health has been more efficient than medicine in improving the health of a population and in raising life expectancy.

The challenge of how to best organise public health in Vietnam is fundamental to its evolution. Today, hundreds of Vietnamese faculty members are working together on ambitious research to help guide improvements in the system.

In Vietnam, public health permeates all levels of health care, from primary care up to central hospitals and university institutions. But the Vietnamese public health system differs from that of most developed countries. It is supported and guided by faculties of public health, and these exist in every university in which medicine is present. All of them work in training, practice and research. They do not only train future practitioners of public health; every student of medicine attends several modules on public health topics during his or her six years of basic study.

By contrast, public health in developed countries is confined to particular institutions, which may or may not be linked to a university. Most physicians have never attended a course on public health.

I had already had many experiences with public health in Vietnam when the Thaí Bình University of Medicine and Pharmacy asked me in 2005 to help develop its training programme in public health. I was convinced, and still am, that the structure of the public health system in Vietnam was much superior to that in developed countries. However, I soon discovered that its content was of uneven quality. That’s understandable. When the public health faculties within the universities were established, their lecturers were still inexperienced and they had few suitable documents on which to base their courses. Hence they produced their own texts on the basis of foreign ones that were not adapted to the Vietnamese context. 

A year later, in 2006, the Thaí Bình Public Health Faculty and I started a project initially called “Teaching Clear Ideas in a Practical Context”. It was soon expanded to all medical universities and faculties in Vietnam except those in Hanoi and Ho Chi Minh City. However, we rapidly left the narrow frame of teaching and started the present research project, which we may call “Optimal Use of the Vietnamese Public Health Structure”.

Given the existing structure in Vietnam, we initially emphasised the role of the universities. In order to reform the content of the teaching modules and to guide the lecturers to practice and research, we founded in the Medical Publishing House of Hanoi a series of Vietnamese-English texts on the essential subject areas of public health which present the whole field in a coherent way. Six volumes have appeared and a seventh is being written. The first, entitled “Epidemiology – Key to Public Health”, was also published in English by Springer Nature; it is quite innovative.

Regarding the curricula, we developed proposals for many drastic changes. For instance, epidemiology is to be taught right in the beginning as a main topic and not at the end as a minor subject. Many superfluous modules must be discarded and a few new ones inserted.

There were other research problems. Where and how should public health practitioners do their work? What is their role in primary health care? What is the best health information system? What should be the social and financial status of lecturers of public health, compared for example with that of lecturers of medicine? How should a direly needed institute on non-infective diseases look?

Our way of working was not conventional. From 2006 to 2016, we organised ten workshops in universities where all Vietnamese lecturers of public health were invited. There we formed work groups for every issue in question. They did much of the research. Between the workshops and after 2016, we exchanged our ideas by e-mail. In addition, we have a specific work group for every text to be written. It consists of all lecturers in the subject area being treated.

Everything has been done on a pro bono basis. At each step we defined the various research topics to be studied. No organization or administration was involved.

We have not reached all of our goals, but we have made great progress. We are fortunate that the Faculties of Public Health and the Ministry of Health are ready to consider our recommendations. 

Klaus Krickeberg

[Klaus Krickeberg, a citizen of Germany and France, studied mathematics at the Humboldt University of Berlin and served as a professor in various universities. He has been working extensively on public health in addition to mathematics. He was elected a TWAS Fellow in 1994. In 2018, Vietnamese President Trần Đại Quang awarded him the Friend of Vietnam medal for “positive essential contributions to the development of the Vietnamese health sector”. Read his related article, “Maths and Public Health: a Natural Partnership”.]

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