title: Primary healthcare system capacities for responding to storm and flood-related health problems: a case study from a rural district in central Vietnam.
abstract: BACKGROUND
  As a tropical depression in the East Sea, Vietnam is greatly affected by climate change and natural disasters. Knowledge of the current capacity of the primary healthcare system in Vietnam to respond to health issues associated with storms and floods is very important for policy making in the country. However, there has been little scientific research in this area.
  
  
  OBJECTIVE
  This research was to assess primary healthcare system capacities in a rural district in central Vietnam to respond to such health issues.
  
  
  METHODS
  This was a cross-sectional descriptive study using quantitative and qualitative approaches. Quantitative methods used self-administered questionnaires. Qualitative methods (in-depth interviews and focus groups discussions) were used to broaden understanding of the quantitative material and to get additional information on actions taken.
  
  
  RESULTS
  1) Service delivery: Medical emergency services, especially surgical operations and referral systems, were not always available during the storm and flood seasons. 2) Governance: District emergency plans focus largely on disaster response rather than prevention. The plans did not clearly define the role of primary healthcare and had no clear information on the coordination mechanism among different sectors and organizations. 3) Financing: The budget for prevention and control of flood and storm activities was limited and had no specific items for healthcare activities. Only a little additional funding was available, but the procedures to get this funding were usually time-consuming. 4) Human resources: Medical rescue teams were established, but there were no epidemiologists or environmental health specialists to take care of epidemiological issues. Training on prevention and control of climate change and disaster-related health issues did not meet actual needs. 5) Information and research: Data that can be used for planning and management (including population and epidemiological data) were largely lacking. The district lacked a disease early-warning system. 6) Medical products and technology: Emergency treatment protocols were not available in every studied health facility.
  
  
  CONCLUSIONS
  The primary care system capacity in rural Vietnam is inadequate for responding to storm and flood-related health problems in terms of preventive and treatment healthcare. Developing clear facility preparedness plans, which detail standard operating procedures during floods and identify specific job descriptions, would strengthen responses to future floods. Health facilities should have contingency funds available for emergency response in the event of storms and floods. Health facilities should ensure that standard protocols exist in order to improve responses in the event of floods. Introduction of a computerized health information system would accelerate information and data processing. National and local policies need to be strengthened and developed in a way that transfers into action in local rural communities.
authors.affiliation: Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam; hoangvanminh@hmu.edu.vn.
authors.forename: Hoang
authors.initials: H
authors.lastname: Van Minh
authors.affiliation: Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam.
authors.forename: Tran
authors.initials: T
authors.lastname: Tuan Anh
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Joacim
authors.initials: J
authors.lastname: Rocklöv
authors.affiliation: Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam.
authors.forename: Kim
authors.initials: K
authors.lastname: Bao Giang
authors.affiliation: Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam.
authors.forename: Le Quynh
authors.initials: le Q
authors.lastname: Trang
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Klas-Göran
authors.initials: KG
authors.lastname: Sahlen
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Nilsson
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Weinehall
mesh_terms: D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration*; D004190:Disasters; D004864:Equipment and Supplies / Q000600:supply & distribution; D055868:Floods; D017144:Focus Groups; D006280:Health Workforce; D061889:Healthcare Financing; D006801:Humans; D008490:Medical Informatics; D011320:Primary Health Care; D036301:Qualitative Research; D019035:Rural Health Services / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D014744:Vietnam
keywords: Vietnam; climate change; disasters; disease outbreaks; emergency medical services/utilization; flood; health problems; health system; public health; storm