User:Christinetranster/sandbox

Health in Vietnam Article (Area):

Health Issues
As of 2017, Vietnam has a population of 96.1 million people. Drug-resistant tuberculosis, pathogenic influenza, HIV/AIDS, and smoking are continuous problems that impact the quality of health in Vietnam. Health risk factors such as smoking and the lack of quality funding for healthcare attribute to the epigenetic health of the population In 2008, the Government of Vietnam adopted a USAID methadone program that served 50,000 clients. Since 2014, Vietnam is transitioning its country to a universal health care system since 70% of its citizens have to pay out of pocket payments. There is also an inadequate ratio of doctors to patients. There are 8 doctors for every 10,000 patients. Expensive treatments are potential reasons for ineffective preventative treatments that further perpetuate chronic diseases.

.

HIV/AIDS
People who inject drugs, commercial sex workers and potential clients, and men who have sex with other men are the most at risk and susceptible to HIV infections. Since the mid-1990s, the United States Agency for International Development (USAID) has developed programs in Vietnam to combat HIV/AIDS. The USAID collaborates with the Government of Vietnam at the national, provincial, and district levels through delivering preventative care and treatment services, advocacy to strengthen the health system, and providing sustainable long term plans. USAID provides a community based approach by treating patients with antiretroviral treatments. The USAID helps provide funding to achieve Vietnam's "90-90-90" goals which is to ensure 90% of people that have HIV are aware they have HIV, 90% of people diagnosed with HIV will receive antiretroviral therapy, and 90% of people receiving treatment will be able to see the virus suppressed. Most of the testing that occurs amongst the two geographic regions are Hanoi, Quang Ninh, Dong Nai, Tay Ninh, Then Giang, and Ho Chi Minh City.

Pandemics
Vietnam is located in the tropical and temperate zone and prone to zoonotic diseases. I n recent years, the country has been affected by SARS, avian influenza A(H5N1), influenza A (H5N6), and SARS-COVID19. Spillovers of viruses from animals to humans is attributed to the agricultural-centered economy and animal consumption.

The Global Health Security Agenda and USAID addresses the disease surveillance and outbreak response in Vietnam through operational platforms and creating disease portfolios with animal origins. On February 1st, 2020, the Vietnamese government suspended all flights to and from China in order to combat the COVID-19 pandemic. The country then implemented a 21 day quarantine in Vinh Phuc province. Vietnam is a single-party state with a centralized government that is able to utilize its military resources in order to implement surveillance and contact tracing.

Smoking
In Vietnam, 40,000 people die due to tobacco-related diseases. Thirty percent of heart disease deaths are caused by smoking cigarettes. Lung cancer is the third leading cause of death in Vietnam and tobacco risk factors that cause death and disability. Vietnam has reduced the supply of tobacco products through the ratification of the World Health Organization Framework Convention on Tobacco Control. Examples of steps towards tobacco prevention is banning the advertisement of tobacco, requiring health warnings on tobacco packaging, and increasing tobacco taxes. In 2013, Vietnam launched the National Strategy on Tobacco Control which prohibits smoking in indoor public and workspaces in an effort to significantly reduce smoking rates across many demographic groups. The goal is to reduce smoking rates among the youth demographic (15-24 years old) from 26% (2011) to 18% (2020), and adult males 47.4% (2011) to 39% (2020). In 2018, the World Health Organization surveyed that one in two male adults (45.3%) were smoking tobacco. Vietnam's government is incorporating a plan that will utilize the taxes from tobacco and alcohol to cover the cost of universal healthcare and make sure its population is ensured.

Tuberculosis in Vietnam
Vietnam has the 13th highest tuberculosis burden in the world. Approximately 55 tuberculosis related deaths occur in Vietnam each day. Vietnam’s health service system consists of four different levels: the central level headed by the Ministry of Health (MOH), provincial health services, district health services, and commune health centers. In 1989, the Ministry of Health in Vietnam addressed the tuberculosis burden by establishing the National Institute of Tuberculosis and Lung Diseases and implementing the DOTS strategy as a national priority. The National Institute of Tuberculosis supports developing TB- related strategies and managing guidelines for the different levels of healthcare in Vietnam. At the provincial level, there are health centers that diagnose and treat patients. The district health services detect tuberculosis and provide stipends to treat patients. District health services work on detecting TB, providing stipends for treatment, implementing DOTS strategy, and supervising TB programs at the commune level. The commune level provides treatment and vaccination for children. All four levels work together not only to provide ongoing treatment and examination, but also to establish trust in the government health services implemented through community relationships and a close network of doctors, faculty, and patients.

In 2002, Vietnam also implemented a communication plan to provide accurate educational information in order to respond to any barriers or misperceptions about tuberculosis treatment. The government worked with the World Health Organization, Center for Disease and Control Prevention, and local medical non-profits such as Friends for International Tuberculosis Relief to provide information about the causes of TB, sources of infection, how it is transmitted, symptoms, treatment, and prevention.



Tuberculosis Management (Sector) :

DOTS Strategy:
The World Health Organization launched the DOTS program to address the global emergency of increasing tuberculosis cases. The DOTS treatment consists of five strategic elements for administering TB treatment. The first element of DOTS involves creating increased sustainable financial services and a short and long term plan provided by the government, dedicated to eliminating tuberculosis.The World Health Organization helps encourage mobilized funding to reduce poverty standards that will prevent tuberculosis. The second component of the DOTS strategy is case detection, which involves improving the accuracy of laboratory tests for bacteriology and improving communication from labs to doctors and patients. Case detection means that laboratories that detect and test for bacteriology are accurate and communicative to its doctors and patients. The third strategy is to provide standard treatment and patient support. The guidelines to adhere to adequate treatment is to provide pharmaceutical drugs that will help eliminate tuberculosis and follow-up check-ups to ensure that tuberculosis is not a deterring factor in a patient’s life. There are many cultural barriers as many patients might continue to work under unsanitary living conditions or not have enough money to pay for the treatments. Programs that provide stipends and incentives to allow citizens to seek treatment are also necessary. The fourth element to the DOTS approach is to have a management program that supplies a sustainable long term supply of reliable antibiotics. Lastly, the fifth component is to record and monitor treatment plans in order to ensure that the DOTS approach is effective. The DOTS approach not only aims to provide structure for tuberculosis programs, but also to ensure that citizens diagnosed with tuberculosis adhere to protocols which will prevent future bacterial infections.

Dots-PLUS Strategy:
Community engagement is a new approach that is being initiated alongside the DOTS individualized treatment. This new approach is called the DOTS-plus model which creates a community for health workers to give support to patients and hospital faculty. The DOTS-plus model also incorporates psychological structural support treatments to help accommodate patients to ensure completion of treatment. Treatment with the new strategy is a total duration of 18-24 months.

Management in Asia
The Asia‐Pacific region carries 58% of the global tuberculosis burden, which includes multidrug-resistant tuberculosis. Southeast Asia suffers from high burdens of tuberculosis as a result of inefficient and inadequate health infrastructures. According to the World Health Organization, Asian countries with high cases of tuberculosis will invest in new technology to treat patients but it will not be covered by the government.

Philipenes:
From 2005-2009, the IPHO-Maguindanao, a governmental organization in Maguindanao, Philippines, partnered with the Catholic Relief Services to increase tuberculosis awareness. Catholic Relief Services implemented a USAID-assisted project to provide funding for tuberculosis testing. Additionally, they launched an "Advocacy, Communication, and Self-Mobilization" project featuring workshops to encourage testing in communities. Citizens attending religious sermons were able to be distribute information about tuberculosis and inform their communities on where to seek treatment and how to adhere to treatment protocols

The DOTS-plus strategy was successful at removing unfamiliar barriers because the outreach was designed from within the familiar customs that people were used to. By partnering with churches, health officials were able to target the masses and provide accurate information without the fear of getting tested.

India
In 1906, India opened its first air sanatorium for treatment and isolation of TB patients.However, the World Health Organization reviewed the national program in India which lacked funding and treatment regimens that could report accurate tuberculosis case management. By 1945, there were successful immunization screenings due to campaigns that helped spread messages about the prevention of disease. This was also around the same time that the World Health Organization declared tuberculosis to be a global emergency and recommended countries adopt the DOTS strategy.

Bangladesh, Cambodia, Thailand
In Bangladesh, Cambodia, and Indonesia, there is a diagnostic treatment for latent tuberculosis treatment for children below 5 years of age. The IGRA approach (Interferon Gamma Release Assay) is used in these countries. IGRA testing and diagnosis are whole blood cell tests where fresh blood samples are mixed with antigens and controls. A person infected with tuberculosis will have interferon-gammas in the blood stream when mixed with the antigen. It is a highly accurate but expensive test and is technologically complex for immunocompromised patients. These developing countries were unable to get rid of tuberculosis effectively because the national health policies did not cover screening and testing for tuberculosis. There were also no programs in place to educate citizens and provide training for healthcare workers. Without the mobilization of sufficient resources and the backing of  sustainable government funding, these developing countries failed to adequately provide the treatment and resources necessary to combat tuberculosis.

Vietnam:
According to the WHO, Vietnam ranks 13th on the list of 22 countries with the highest tuberculosis burden in the world. Nearly 400 new cases of TB and 55 deaths occur each day in Vietnam. In 1989, the Ministry of Health in Vietnam addressed the tuberculosis burden by establishing the National Institute of Tuberculosis and Lung Diseases and implemented the DOTS strategy as a national priority. Vietnam’s health service system consists of four different levels: the central level headed by the Ministry of Health (MOH), provincial health services, district health services, and commune health centers”. These departments worked with the National Institute of Tuberculosis and Lung Diseases to ensure that there were treatment and prevention plans for long term reduction of tuberculosis. In 2002, Vietnam also implemented a communication plan to provide accurate educational information in order to respond to any barriers or misperceptions about tuberculosis treatment. The government worked with the World Health Organization, Center for Disease and Control Prevention, and local medical non-profits such as Friends for International Tuberculosis Relief to provide information about the causes of TB, sources of infection, how it is transmitted, symptoms, treatment, and prevention. The National Tuberculosis Control Program works closely with the primary health care system at the central, provincial, district, and commune levels which has proven to be an incredibly imperative measure of success.

Tuberculosis Non-Profit
Friends for International TB Reliefis a small non-governmental organization whose mission is to help assist in tuberculosis prevention and the spreading of TB. FIT not only diagnoses patients, but also provides preventative tuberculosis detection in order to pilot a comprehensive patient-centered TB program that aims to stop TB transmission and reduce suffering. The organization focuses on island screening due to the high level of risk and burden the population faces. Through its method of search, treat, prevent, and integrative sustainability, FIT is working closely with most of the population on the island (roughly 2022 patients), and partnered with the Ho Chi Minh City Public Health Association on a pilot that provides active community outreach, patient-centric care and stakeholder engagement.

Located in Ha Noi, the National Institute of Tuberculosis and Lung Diseases is responsible for the direction and management of TB control activities at the central level. The Institute supports the MOH in developing TB- related strategies, and in handling management and professional guidelines for the system. The provincial level centers diagnose, treat, and manage patients, implement TB policies issued by the NTP, and develop action plans under the guidelines of the Provincial Health Bureau and the provincial TB control committees. The districts are capable of detecting TB and treating patients. All districts have physicians specializing in TB, laboratories, and X-ray equipment and have either a TB department or a TB-communicable diseases department in the district hospital. The district level is also responsible for implementing and monitoring the NTP, and the supervision and management of TB programs in the communes. The commune level provides treatment as prescribed by the district level, administering drugs, and vaccinating children. In TB control, village health workers play critically important roles in identifying suspected TB patients, conducting counseling for examination and tests, paying home visits to patients undergoing treatment, and reporting problems in monthly meetings with the CHC.

TB Allianceis a non-governmental organization that is located in South Africa and was discovered in the early 2000s. The NGO is a leading non-profit for global tuberculosis research and development of new TB vaccines. To advance TB development, TB Alliance creates partnerships with private, public, academic, and philanthropic sectors in order to develop products in underserved communities. In 2019, TB Alliance became the first not-for-profit organization to develop and register an anti-TB drug. TB Alliance also works closely alongside the World Health Organization (WHO), U.S FDA, and the European Medicine Agency (EMA) to endorse regulative policies and treatments that are affordable.

FHI 360is an international tuberculosis non-profit organization funded by USAID to treat and support patients in Myanmar, China, and Thailand. The organization developed an app called DOTsync in order for healthcare staff to administer antibiotics and monitor the side effects of patients. This is incredibly imperative to eliminating tuberculosis because it allows healthcare workers to have follow-up checkups with patients in order to ensure that tuberculosis treatments are effective.

Operation ASHAis a TB nonprofit organization that was founded in 2006. Located in India and Cambodia, Operation ASHA focuses on the development of "e-Compliance," which is a verification and SMS text messaging system where patients can use their fingerprints to access their medical records and be reminded daily via text when to take their medication. According to Operation ASHA, the e-Compliance treatment successive rate is 85%.

Debate: DOTS vs Community Approach
Structural violence perpetuates suffering and poverty because it renders systemic issues in impoverished countries to be indoctrinated in the countries’ ideologies, thus making them unsolvable. Our willingness to accept these social differences in cultures sustain “illusions that most notably [conflate] poverty and cultural differences”. Structural violence addresses how tuberculosis, social inequality, healthcare inaccessibility, and poverty are interconnected. Tuberculosis is a preventable and curable disease but structural conditions continue to affect populations and the quality of life. For example, according to the World Health Organization, “there are 3 million unreported cases of national tuberculosis patients”. Although the DOTS approach has dramatically reduced the amount of people suffering from tuberculosis, the disparity between developing countries and first-world countries is too vast to go unnoticed and unconfronted.

Criticism of the DOTS strategy typically notes its failure to address structural issues developing countries face These core issues are what perpetuate unsanitary working conditions which allow for microorganisms to manage the daily lives of people. Paul Farmer, a physician dedicated to eradicating tuberculosis, argues that  “the global spread of TB and its drug-resistant strains by pointing to the dispositions of individual patients amounts to ‘immodest claims of causality’ that do not address the true roots of disease and suffering” Farmer shifts the blame for the prevalence of tuberculosis amongst marginalized populations as a result of ‘social forces’ which aims to restructure the sociological, cultural, and economic factors that a patient coexists in.