What Drives Utilization of Primary Care Facilities in Vietnam?

Abstract

Objective: This analysis aims to assess the association between commune health station (CHS) service readiness and health service utilization to inform the design of a World Bank project and policies to strengthen primary health care in Vietnam. Method:Using data drawn from the 2015 Vietnam District and Commune Health Facility Survey (DCHFS), a series of multivariate negative binomial regressions was estimated to measure the association between domains of service readiness and CHS utilization rates (average number of visits per capita).Findings: First, the average number of CHS visits per capita is highest in the more remote and disadvantaged areas, that is, Zone 3 (1.04 visits per capita per year, 95% confidence interval [CI] [0.8,1.3]) and substantially lower in the urban / peri-urban Zone 1 (0.39 visits per capita, 95% CI [0.7, 1.0]). However, there is substantial variation in the average number of CHS visits per capita within each zone. Second, among the domains of service readiness explored, the difference across zones is starkest for infrastructure, with only half of the CHSs in Zone 3 meeting the standards, compared to almost four-fifths in Zones 1 and 2. Third, three domains of service readiness are significantly associated with higher CHS utilization rates: health infrastructure (whether the building area and number of rooms in the facility meet national benchmark standards), basic equipment availability (facility has at least 70 percent of surveyed equipment), and capacity to deliver services for noncommunicable diseases (hypertension and diabetes). Fourth, simulations suggest that if all three statistically significant modifiable CHS characteristics were to be improved from their current level, and the assumptions of the model are correct, then the predicted utilization rate of the CHS could be 3.3 to 3.7 times (depending on the CHS zone) as high as current levels.Recommendations: Investments in improving facility infrastructure (especially ensuring that facilities have the mandated number of rooms and building area), making available essential equipment items, and enabling the CHS to provide hypertension and diabetes services, whether made independently or together, would all likely increase CHS utilization. Investment in CHSs in Zone 3 and Zone 2 should be prioritized over investments in Zone 1, since investments in the former would result in the highest utilization rates.