The evolution of HIV policy in Vietnam: from punitive control measures to a more rights-based approach.
OBJECTIVE
Policymaking in Vietnam has traditionally been the preserve of the political elite, not open to the scrutiny of those outside the Communist Party. This paper aims to analyse Vietnam's HIV policy development in order to describe and understand the policy content, policy-making processes, actors and obstacles to policy implementation.


METHODS
Nine policy documents on HIV were analysed and 17 key informant interviews were conducted in Hanoi and Quang Ninh Province, based on a predesigned interview guide. Framework analysis, a type of qualitative content analysis, was applied for data analysis.


RESULTS
Our main finding was that during the last two decades, developments in HIV policy in Vietnam were driven in a top-down way by the state organs, with support and resources coming from international agencies. Four major themes were identified: HIV policy content, the policy-making processes, the actors involved and human resources for policy implementation. Vietnam's HIV policy has evolved from one focused on punitive control measures to a more rights-based approach, encompassing harm reduction and payment of health insurance for medical costs of patients with HIV-related illness. Low salaries and staff reluctance to work with patients, many of whom are drug users and female sex workers, were described as the main barriers to low health staff motivation.


CONCLUSIONS
Health policy analysis approaches can be applied in a traditional one party state and can demonstrate how similar policy changes take place, as those found in pluralistic societies, but through more top-down and somewhat hidden processes. Enhanced participation of other actors, like civil society in the policy process, is likely to contribute to policy formulation and implementation that meets the diverse needs and concerns of its population.
Nguyen Ha
Pham
P
Department of Public Health Sciences, Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
Pharris
Anastasia
A
Huong
Nguyen Thanh
NT
Chuc
Nguyen Thi Kim
NT
Brugha
Ruairi
R
Thorson
Anna
A
Lancet. 2007 Feb 24;369(9562):679-90
17321313
Lancet. 2008 Feb 23;371(9613):682-684
18295026
Lancet. 2009 Oct 3;374(9696):1186-95
19801097
AIDS. 1999 May 7;13(7):741-9
10357372
Rev Panam Salud Publica. 2006 Jun;19(6):423-31
16968598
BMC Infect Dis. 2007 Nov 09;7:130
17996109
Trans R Soc Trop Med Hyg. 2009 Jun;103(6):549-58
18992905
Health Policy Plan. 2008 Sep;23(5):308-17
18701552
BMJ. 1990 Apr 7;300(6729):932-4
2140064
Health Policy Plan. 1996 Jun;11(2):184-97
10158459
Int J STD AIDS. 2005 Jul;16(7):459-64
16004623
Health Policy Plan. 2008 Sep;23(5):328-38
18658197
Int J STD AIDS. 2001 Apr;12(4):277-8
11319984
Health Care Anal. 1994 Nov;2(4):287-95
10139420
Health Policy Plan. 1994 Dec;9(4):353-70
10139469
Cell Res. 2005 Nov-Dec;15(11-12):903-7
16354567
AIDS Educ Prev. 2004 Jun;16(3 Suppl A):137-54
15262572
Rev Panam Salud Publica. 2009 Jul;26(1):78-86
19814886
PLoS Med. 2009 Oct;6(10):e1000163
19823569
Health Policy Plan. 2007 Mar;22(2):95-102
17299023
Soc Sci Med. 2004 Sep;59(6):1251-61
15210096