ProblemThe use of evidence-based policy is gaining attention in developing countries. Frameworks to analyse the process of developing policy and to assess whether evidence is likely to influence policy-makers are now available. However, the use of evidence in policies on caring for people with mental illness in developing countries has rarely been analysed. Approach This case study from Viet Nam illustrates how evidence can be used to influence policy. We summarize evidence on the burden of mental illness in Viet Nam and describe attempts to influence policy-makers. We also interviewed key stakeholders to ascertain their views on how policy could be affected. We then applied an analytical framework to the case study; this framework included an assessment of the political context in which the policy was developed, the links between organizations needed to influence policy, external influences on policy-makers and the nature of evidence required to influence policy-makers. Local setting The burden of mental illness among various population groups was large but there were few policies aimed at providing care for people with mental illness, apart from policies for providing hospital-based care for people with severe mental illness. Relevant changes The national plan proposes to incorporate screening for mental illness among women and children in order to implement early detection and treatment. Lessons learned Evidence on the burden of mental ill-health in Viet Nam is patchy and research in this area is still relatively undeveloped. Nonetheless the policy process was influenced by the evidence from research because key links between organizations and policy-makers were established at an early stage, the evidence was regarded as rigorous and the timing was opportune. Voir page 667 le résumé en français. En la página 667 figura un resumen en español.
There are increasing calls for more child specific measures of poverty in developing countries and the need for such measures to be multi‐dimensional (that is not just based on income) has been recognised. Participatory Poverty Assessments (PPAs) are now common in international development research. Most PPAs have been undertaken with adults and there are still relatively few PPAs with children. The objective of the current study was to understand adults' and children's perceptions of the causes and consequences of child poverty in rural Vietnam using a variety of participatory methods. Poor children are perceived by poor children as those who lack basic needs such as food, clothes, and safe shelter. Poor children feel they do not receive enough attention from their parents, have to work and have no safe place to play.
Palliative care began in Vietnam in 2001, but steady growth in palliative care services and education commenced several years later when partnerships for ongoing training and technical assistance by committed experts were created with the Ministry of Health, major public hospitals, and medical universities. An empirical analysis of palliative care need by the Ministry of Health in 2006 was followed by national palliative care clinical guidelines, initiation of clinical training for physicians and nurses, and revision of opioid prescribing regulations. As advanced and specialist training programs in palliative care became available, graduates of these programs began helping to establish palliative care services in their hospitals. However, community-based palliative care is not covered by government health insurance and thus is almost completely unavailable. Work is underway to test the hypothesis that insurance coverage of palliative home care not only can improve patient outcomes but also provide financial risk protection for patients' families and reduce costs for the health care system by decreasing hospital admissions near the end of life. A national palliative care policy and strategic plan are needed to maintain progress toward universally accessible cost-effective palliative care services.
Symptom assessment and treatment for people living with HIV (PLHIV) cannot only lead to improvements in quality of life but contribute to combination antiretroviral adherence and early detection of virologic rebound. The majority of PLHIV in Vietnam receive their care in HIV outpatient settings, whereas very few clinics provide palliative care. The Ministry of Health has called for palliative care to be incorporated into existing HIV and cancer services, but there is limited guidance regarding how to operationalize integration. An HIV outpatient clinic palliative care intervention was tested in northern Vietnam to explore the accessibility, acceptability, and feasibility of integrated services. Primary outcome measures included changes in identification and treatment of pain and other symptoms, the prevalence of depression and anxiety, and perceived social support. The palliative care intervention included introduction of tools and mentoring to assess and treat pain and other symptoms as well as mental health and social support screening, counseling, and treatment services. The intervention resulted in significant changes in provider practice and service delivery. Providers and patients reported overall satisfaction with the intervention and resulting improvements in quality of care.
IntroductionVery Brief Advice (VBA) on smoking is an evidence-based intervention and a recommended clinical practice for all healthcare professionals in the UK.AimsWe report on experience from the FRESH AIR project in adapting the VBA model and training in three low-resource settings: Greece, Vietnam and Kyrgyzstan.MethodsUsing a participatory research process, UK experts and local stakeholders conducted an environmental scan and needs assessment to examine the VBA intervention model, training materials and recommend adaptations to the local context. Two VBA training sessions were piloted in each country to inform adaptation. A final training tool kit was developed in the local language.ResultsIn each country, the VBA on smoking intervention model remained primarily intact. The lack of a formal smoking cessation system to refer motivated clients in two countries required adaptation of the ACT component of the model. A range of local adaptations to the training resources were made in all three countries to ensure cultural appropriateness as well as enhance key messages including expanding training on nicotine addiction, second-hand smoke and pharmacotherapy.ConclusionsImplementation of VBA requires sensitive, collaborative, local and cultural adaptation if it is to be achieved successfully.Trial registrationTrial ID# NTR5759Critical appraisal toolsThe Standards for Reporting Implementation Studies (StaRI) statement: https://www.equator-network.org/reporting-guidelines/stari-statement/
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