ILO is implementing the project on “Support the Extension of Social Health Protection in Southeast Asia”. What is its focus?
The ILO project “Support to the extension of Social Health Protection in South East Asia” is a 42-month project funded by the Grand Duchy of Luxembourg. The project focuses on three target countries: Viet Nam, Lao PDR and Myanmar. As its name indicates, the aim of the project is to support women and men to have access to adequate social health protection so they can access quality health care services, when needed, without financial hardship. The project contributes to the implementation of existing national policies and strategies and to the achievements of SDG 1 (No poverty), 3 (Good health and wellbeing), 5 (Gender equality), 8 (Decent work and economic growth), 10 (Reduced inequalities).
The first specific objective of the project is to help to strengthen the institutional capacity and financial sustainability of social health insurance schemes. To that purpose, the project supports in each country in three areas, namely: first, strengthening of management and administration of social health insurance schemes; second, policy reforms, including generation of evidence, social dialogue, technical support; and third, capacity building on social health protection, through short and long-term training.
The project also has a regional dimension, aiming at expanding the regional knowledge base on social health protection, feeding the global knowledge available to be used in other regions. This is the second specific objective of the project.
Here, the project particularly supports the establishment of the regional association called CONNECT for social health protection. The mandate of CONNECT is to strengthen the capacity of countries in Asia and the Pacific to develop and implement strong, sustainable and comprehensive health policies, strategies and systems for social health protection, as a contribution to the achievement of universal health coverage. The core objective of CONNECT is to promote knowledge development and capacity building on social health protection in South-East Asia. CONNECT also aims to implement innovative awareness raising and communication campaigns geared towards advocacy, social mobilization and behavioural change on social health protection. The founding members of CONNECT are Mahidol University (Thailand), Viet Nam Health Policy and Strategy Institute, Korean Institute on Health and Social Affairs, Seoul National University and the ILO. Through its members, CONNECT is already delivering technical assistance services, capacity building (such as this regional course on health actuarial modelling), and provide research opportunities.
In Viet Nam, the project focuses on supporting the revision of the Health Insurance Law, including generation of evidence, support to consultation and dialogue, and impact assessment. We also focus on capacity building, through the provision of short course on social health protection, short course on health actuarial modelling, full scholarship to Mahidol University (Master on Primary Health Care Management, focusing on Social Health Protection) for instance. Last but not least, we work closely with workers and employers’ organizations. For instance, we are currently supporting the Viet Nam General Confederation of Labour to increase workers awareness raising on their entitlements to health, maternity and sickness benefits.
As a developing country in Southeast Asia, Viet Nam has now the Social Health Insurance coverage of 89.7 per cent. What do you think about this figure?
In 25 years of implementing social health insurance, Viet Nam has made enormous progress towards universal health coverage. With the recognition of the right to social security, health protection and care in the 2013 Constitution of the Socialist Republic of Viet Nam, the country has reaffirmed the priority given to universal health coverage. Currently, the Government of Viet Nam is targeting 90.7 per cent participation in social health insurance by 2020, with 100 per cent coverage of the poor, elderly and other vulnerable groups. Viet Nam is therefore in very good track.
The challenges ahead will mainly consists in maintaining this achievement, ensuring that people who are now benefiting from State’s subsidies will continue to contribute after graduating out of poverty, and further expanding coverage to the missing middle so that universal social health protection becomes a reality in Viet Nam.
Despite its high population coverage, Viet Nam faces multiple challenges to ensure that the population will continue to access quality health care without financial hardship. Among these challenges, the financing of health sector is particularly important, in a context of increasing costs of care, which is due to a combination of multiple factors. Although increased life expectancy is of course a major achievement for Viet Nam, the rapidly ageing population gives cause for concerns on the provision and financing of long term care.
What challenges do you think Viet Nam will face in the future despite its high social health insurance coverage?
Development also brought changing life style, sometimes negatively impacting people’s health, particularly on the prevalence of smoking and obesity. Increased morbidity and mortality due to air pollution is also a major concern which needs to be addressed. Continuation of Government’s efforts on health promotion and prevention are therefore essential to ensure healthy population and cost control.
To ensuring financial sustainability of a social health insurance scheme (not specific to Viet Nam), it is first of all crucial to know where the health insurance scheme stands in term of financial equilibrium. To that purpose, undertaking regular actuarial analysis to assess the present and future financial situation of the scheme, as well as benefits adequacy is essential for the good governance of the scheme. This should be done every five years at least.
In your opinion, what measures should Viet Nam take to have a more sustainable social health insurance development?
In addition, appropriate evidence based policy responses must be formulated to ensure costs control and adequate revenue generation, through social dialogue and closely involving all stakeholders through an entire-government approach, beyond the health sector. Continued commitment to universal health coverage and social security at highest political level (as this is already the case in Viet Nam) is of particular important in this context. Last but not least, pursuing investment in health promotion and prevention so that people don’t get sick in the first place, will not only ensure a healthy and productive nation but will also allow to control medical and sickness benefits expenditures.
*The interview was published on the Viet Nam Social Security Magazine.