Nga Le Thi
HealthBridge Foundation of Canada, Vietnam
Dr. Le has more than 20 year experience with international organizations in public health covering nutrition; immunizations; Integrated Management of Childhood Illnesses; reproductive, maternal and child health; tuberculosis; malaria; and health system strengthening. Dr. Le’s expertise is in international research bioethics; implementation research; public health programming and management; communication for behavior change; monitoring & evaluation (M&E); capacity building; and advocacy for health policies and strategies. She has Master of International Research Bioethics degree from Monash University (Australia, 2008), Master of Public Health from the University of Queensland (Australia, 2005), and Medical Doctor degree from Hanoi Medical University (Vietnam, 1990).
Village-based ethnic minority midwives (EMMs) is a human resource strategy for strengthening maternal and child health in hard-to-reach areas in Vietnam. Regulated financial support is essential to maintain their performance.
This review analysed EMM’s relevant policies, strategies, plans, published papers, unpublished reports and plans.
The maternal and infant mortality rates in hard-to-reach areas are 3-4 times higher than those of the country. The percentage of home delivery and delivery without skilled-birth attendants are double the country’s (2016). Customarily many ethnic groups don’t allow male village health-workers attending the delivery.
The EMMs’ official role was recognized by the Ministry of Health's Circular 07 in 2013. The circular directed that each trained-EMM has a monthly allowance of 0.3-0.5 of the local minimum wage set by the State (US$14-$23 a month). However, the Prime Minister’s Decision 75/2009/QD-TTg (2009) decided that the national budget covers only one health-worker a village. A hard-to-reach village that needs an additional EMM should have allowance from province.
By 2017, nearly 40% of 2331 trained EMMs had no allowance. Many hardly maintained working as EMMs. Only 3 of 51 provinces with special difficult villages planned for EMMs allowance from local budget. Several provinces used to have international support (UNICEF, EU) stopped paying EMMs when projects ended.
To maintain the EMMs, we recommend: 1) review the Decision 75/2009/QD-TTG; 2) include EMMs in government salary scheme; 3) apply minimum local wage for EMMs (USD120); 4) set a specific portion of tax to cover the EMM’s allowance; 5) establish an EMM foundation.