By Stephen Robson
As with other Third World countries, Vietnam has had a long struggle just to establish some basics of medical care that are taken for granted in industrialised countries.
Take the problem of trachoma for example, an issue brought to attention within Vietnam when Professor Fred Hollows organised a team to work on this.
Prior to 1945, trachoma affected between 30-60% of the population. Past decades of active work in the liberated north have seen this drop to 20-25%. But with Vietnam's population now nearing 70 million we are still talking about 12 million persons affected by this disease!
The Vietnam war itself, not surprisingly, put enormous strain on the country's limited medical resources and left a legacy of hundreds of thousands of invalids.
The US trade embargo, imposed after Vietnam liberated the Cambodian people from Pol Pot's genocidal regime in 1979, blocks the import of important medical supplies. And even when VIetnam can get access to such supplies, the multinational drug companies charge the Vietnamese the equivalent of a month's wages for what sells in the West for a few dollars.
One of Vietnam's important strengths has been the network of grassroots medical care based at the commune level that was established in the north and extended to the south after the country was reunified in 1975.
According to Dr Suki Allen, in a paper on heatlh care delivered at the Vietnam Update conference held in Camberra last month, only about 10% of health expenditure is raised from central government funds — the bulk being raised at the provincial level.
Allen is a medical health specialist with extensive experience in Bac Thai province in Vietnam.
With the opening up of market relations in Vietnam from the middle '80s, the role of the village commune has been severly diminished. In the past, the village commune had been the key linchpin in the country's social infrastructure, providing creches, schools and cultural activities, as well as large numbers of health workers at both health centres and in work brigades.
In 1989, in an effort to shore up the communes' health resources, the Vietnamese government directed that province and district sources would fund three healthworkers in each commune with the commune itself being responsible for providing equipment, drugs and buildings.
Allen reported that with "the virtual demise of the cooperative structures," the communes have been unable to continue to fund this infrastructure. Brigade nurses are returning to fulltime agriculture staff are working second jobs to supplement their income.
Allen reported that, despite the significant improvements in food production and income since 1986, surveys still show a high rate of malnutrition among children.
Measured by weight-for-age, 19.6% of those up to age 11 were malnourished according to figures from the National Institute of Nutrition in 1986-87. Measured by height-for-age, some 28.2% were malnourished.
Figures for the period of 1988-89 indicate an increase in these amounts. Primarily, this malnutrition is not caused by starvation but prolonged undernutrition.
In Vietnam there is no national nutrition program with communes lacking both equipment and training to carry these out.
There has been 200% increase in reported deaths due to malaria in the past five years. Other infectious diseases include diarrhoea and respiratory infections.
Allen proposed that there is "considerable need for further efforts to improve the quality of water and sanitation." Less than half the urban population have access to piped water and less than 10% of the rural population have access to a safe and adequate water supply.
Allen was cautious though in attributing all the problems of the health system to the economic reforms of the late 1980s. She cited the costs of reunfication and the cutting off of foreign aid following Vietnam's military aid to Cambodia in 1979 as important factors. The ending of Soviet and Eastern European aid should be added to this.
Allen also suggested that "in some areas at least, commune level health services and conditions are now perceived by both health workers and community representatives as improving."
Nevertheless, in spite of all these problems Vietnam has made progress in health care. Today, life expectancy in Vietnam is 65 years, slightly ahead of Indonesia and the Philippines. By comparison, industrialised countries like Australia have a life expectancy of 76 years. Vietnam's infant mortality rate of 45 per 1000 is significantly better than the Philippines (54 per 1000) or Indonesia (73 per 1000) . In Vietnam there is one doctor per 2694 inhabitants. This is way ahead of Indonesia, where there is one doctor for every 9460 people.