Progress on Viet Nam Universal Health Coverage for People Living With HIV

Aspiring to further expand inclusive and affordable access to quality HIV healthcare across Viet Nam, a policy dialogue on the implementation of Universal Health Coverage for HIV was convened in September 2019 by National Assembly’s Social Affairs Committee (PCSA) and relevant Government authorities in collaboration with the Joint United Nations Team on HIV (UNAIDS and UNWOMEN). Members of the Government, PCSA, the communities and United Nations reflected on progress, challenges and further committed to expand more inclusive social health insurance coverage of HIV treatment with removal of stigma and discrimination in HIV healthcare services.

“Institutionalizing the Social Health Insurance (SHI)-funded antiretroviral (ARV) drugs for People Living with HIV (PLHIV) is a remarkable progress of national HIV response. Next year, amending the HIV Law to further strengthen the HIV response with a more enabling environment will be another key milestone in  our fast-track commitment to end AIDS as a public health threat in Viet Nam.”, said Mr. Dang Thuan Phong, Deputy Chairman of PCSA, in the opening of the policy dialogue.

Newly Available Social Health Insurance Funded Antiretroviral Drugs

Supply of SHI-funded ARV is newly available in Viet Nam starting from March 2019. This is a new landmark for fast tracking progress on the Prime Minister’s Decision No. 2188 (2016) and Resolution 20 of the Party’s Central Committee on Healthcare (2017), with the commitment to have 95% of the Vietnamese population covered by the national health insurance by 2025 and ending AIDS as a public health threat by 2030. Viet Nam Social Heath Insurance’s coverage of HIV treatment is an essential avenue for a sustainable national HIV response given the decline of external funding.

Mr. Nugyen Tat Thao from Vietnam Social Security reported that, thanks to careful planning and preparation, progress with the drug procurement, delivery and use of the new SHI-funded ARV, by March 2019, 91% of PLHIV on HIV treatment were enrolled in the SHI scheme, a significant increase from the 50% level of 2016. In the first 3 months of SHI-funded ART (by June 2019), about 40,000 of PLHIV benefited from it in a total of 180 health facilities. The transition is expected to continue at a fast pace in the second half of 2019 and in 2020 with  continuous monitoring of progress to proactively address any challenges. This is where the regular feedback from the community of PLHIV and key population at high risk of HIV is central to leave no one behind.

Maintain PLHIV sustainable access to HIV Treatment thanks to Social Health Insurance

“It is very encouraging to hear that SHI coverage has reached a large proportion of PLHIV on HIV treatment and minimized our out-of-pocket payments, said Phạm Thị Huệ, sharing feedbacks on behalf of the PLHIV community from Hai Phong. Sharing the dreams of the PLHIV community, Huệ also shed light on confidentiality issue which remains a major concern of the community.  Stigmatization, discrimination and some administrative requirements shade PLHIV with fear of breach of personal information, consequently, undermining their trust in using the health insurance scheme and HIV treatment in public health facilities. For instance, employed PLHIV find it challenging to request leave for medical examination to get their ARV each month and let the large number of officials access their medical file. Privacy protection can be reinforced through simplifying the procedure for and moving to multi-month ARV prescription, training healthcare workers and SHI staff, and enforcing confidentiality guidelines of handling medical records and prescriptions.

Equal Rights to Access quality and friendly healthcare 

“Every day, I struggle to strip off the labelling and stigma. Living truly and authentically is my simplest dream, still, I do not know how to pursue it……”

Transgender person

Sharing examples from other countries’ legal framework protecting the rights of transgender people, Mr. Dang Thuan Phong from PCSA mentioned, “We should work out better solutions to enable PLHIV, key populations with different sexual and gender orientations and at risk of HIV to overcome the barriers, access services and fully contribute to the society as any other Vietnamese citizen. It is a prominent investment in social development.” The dialogue also included an update on gender-based violence and how it affects and further increases vulnerabilities of communities at risk of HIV. Transgender people (TG) who are at high risk of HIV voiced out their daily challenges. Because of who they are and usually from a young age, transgender people still face high social exclusion and lack of legal recognition leading to a vicious cycle affecting their lives and health, as well as limiting their access to health services as well as SHI which are designed for men or women..

No complacency and new opportunities to shape the next decade

The dialogue was also an occasion to present Viet Nam’s progress against the 10 global commitments of the UN General Assembly Political Declaration on HIV. “While much progress has been made with declining HIV infections among some population groups in Viet Nam,  new HIV infections are sharply increasing among men who have sex with men. No complacency and fast tracking both HIV prevention and treatment and further improving the enabling environment especially for key population at risk of HIV to equally and safely access HIV, health and social services with a human-rights based approach, remain essential for Viet Nam to each its targets’. said Ms. Marie-Odile Emond, UNAIDS Country Director.

“Viet Nam’s new Social Economic Development Strategy (2021-2030), the national HIV strategy (2021-2030) and amendment of the HIV Law are unique opportunities to shape the next decade toward ending AIDS as a public health threat in Viet Nam and leave no one behind”, she added. The UN HIV Thematic Group will continue to support Viet Nam’s to achieve its vision and commitments and further contribute to the global AIDS response.

Green One UN House, 304 Kim Ma, Ba Dinh, Ha Noi, Viet Nam