Cambodia, the Lao People’s Democratic Republic and Viet Nam have achieved remarkable
economic growth and social development over the last few decades. The health status
of people in these countries has also improved to a large extent since 1980s. And while
economic performance indicators, such as gross domestic product (GDP) per capita, are
similar, these countries have had significantly different health sector input and outcomes.
To reduce disparities among the countries and accelerate health development by
mutual learning, especially based on subregional cooperation, it is necessary to identify
potential determinants of varied input and outcomes in the health sector. Aside from
national policies and strategies, experiences in implementation and operational actions
at the subnational level offer countries opportunities to learn from one another.
Based on this rationale, the objectives of this study were formulated to: (1) investigate
the extent to which each country’s respective health outcomes and health system input
and process indicators are different; (2) identify the factors that potentially contribute to
the performance of policy implementation at the subnational level; and (3) formulate a
set of regional and county-specific recommendations that summarizes future steps that
must be taken to improve policy implementation and narrow the gaps among countries.
The research method incorporated five steps: (1) formulation of an analytical framework;
(2) selection of a policy; (3) data collection—literature review and field study;
(4) data analysis; and (5) synthesis of findings. The research team was comprised of principal
investigators, three country co-investigators, and WHO staff from the Regional Office
of the Western Pacific and WHO country offices. The team worked together to develop
the analytical framework, research design, and questionnaire and interview guides. The
country teams piloted the interview guide and collected data from August 2012 to February
2013. Adapted from an analytical framework developed by Bhuyan, Jorgensen and Sharma
(2010), this study formulated six dimensions that influence health policy implementation:
(1) policy implementation structure; (2) leadership and advocacy; (3) stakeholder involvement;
(4) resource mobilization and allocation; (5) operation and management; and (6)
monitoring and feedback.
This study reveals the challenges in not only developing health policies at the national
level, but also implementing these policies at the subnational level. The findings suggest
that adequate economic and human resources are not always in place for effective policy
implementation. Cambodia and the Lao People’s Democratic Republic are spending less
on health than Viet Nam and need to invest in increasing the number of qualified nurses,
midwives and medical doctors at the district level.
All three countries are operating within decentralized health systems that require
clearly defined institutional roles and responsibilities among national, provincial and local
governments. The private sector and non-state providers are increasingly prominent in
health service delivery, while the involvement and oversight of non-state service providers
continue to be weak.