Difficulties in getting treatment for injuries in rural Vietnam

Summary

Objectives

Knowledge about the health-seeking behaviour of injury patients is important for the improvement of community health services. The aims of this study were: (1) to describe the healthcare-seeking behaviour of injury patients; (2) to examine factors associated with injury patients seeking care at health facilities; and (3) to describe the costs of health care for injury patients.

Study design

This study took place in Bavi District, northern Vietnam within a longitudinal community surveillance site (FilaBavi). All non-fatal unintentional injuries occurring in a sample of 24,776 people during 2000 were recorded.

Method

The injury questionnaire included information on care-seeking behaviour, severity and consequences of injury. Both univariate and multivariate logistic regression models were used to find associations between sociodemographic factors and utilization of any health services, as well as for each type of health service used, compared with the group who did not use any health services.

Result

Of 24,776 persons living in the study area, 1917 reported 2079 new non-fatal debilitating injuries during the four 3-month periods of observation. Health-seeking behaviour relating to the first 1917 injuries was analysed. Self-treatment was most common (51.7%), even in cases of severe injury. There was low usage of public health services (23.2%) among injury patients. Long distances, poor economic status and residence in difficult geographic areas such as highlands and mountains were barriers for seeking health services. A large proportion of household income was spent on treating injury patients. Poor people spent a greater proportion of their income on health care than the rich, and often used less qualified or untrained private providers.

Conclusions

These results demonstrate the logistical and financial difficulties associated with the treatment of injuries in rural Vietnam. This suggests the need to make public health subsidies available more efficiently and equitably. Whilst this study looked at the situation specifically in the context of injury treatment, it is likely that similar patterns apply in other areas of health care.

Introduction

In poorer countries, individuals face considerable logistical and financial barriers to seeking health care, even when in obvious need.¹ Lack of formal referral structures results in many healthcare options being available, and choices may depend on type and severity of illness, costs and perceptions of available care, and accessibility.

Vietnam has a national primary healthcare system, intended to provide for all. A process of economic renovation known as ‘doi moi’ was initiated in 1986, moving the country rapidly from a centrally planned to a market-oriented economy, with both positive and negative effects on the health system. User fees were introduced, with exemptions for young children, certain diseases, ethnic minorities, the poorest, etc. Simultaneously, the concept of private health service providers operating alongside the public system was introduced.² Many private facilities opened and most government health workers also work privately.³ Witter⁴ suggested that this had an adverse effect on the Vietnamese healthcare system, making it less accessible and affordable for the poor. However, this has not been widely studied in Vietnam, and not specifically for injuries. Since injuries affect all ages and require wide-ranging care, these patients are key to understanding difficulties associated with obtaining appropriate health care. The aims of this study were therefore: (1) to describe the healthcare-seeking behaviour of injury patients; (2) to examine factors associated with injury patients seeking care at health facilities; and (3) to describe the costs of health care for injury patients.