Assessing Viet Nam’s Health Research System
Dr. Le Thi Kim Anh is Deputy Head of Department of Scientific Research, Hanoi School of Public Health
In 2006, Viet Nam embarked on a process of national health research system (NHRS) analysis as part of a five-country Western Pacific collaboration. What was the aim of this exercise?
Our aim was to describe the structure of the Viet Nam system for health research and to provide information that decision makers can use to develop a master plan or an intervention for strengthening the system.
We needed to start this process because much as Viet Nam has a health research system it is not managed systematically. The health system still focuses on clinical medicine. Many people including policy makers believe that clinical medicine is more important than research activities. Therefore, the role of research in the system is not strong. Such thinking can lead to insufficient investment in research both in terms of physical and human resources. Hence, the quality of research and its application to the health system is compromised.
The second reason for embarking on the process was because there is limited networking in the health research system in Viet Nam. Research institutions in the country are not collaborating effectively.
The practical significance of some research up to now is not strong. This may be an obstacle on the translation of research into policy and practices and relevant policy impacts. Viet Nam government realizes importance of research to social and economic development.
Following the exercise, we held a workshop for to share results of the exercise with researchers of various institutions. The researchers strongly agreed that there is a need to improve the current research system in the country. Despite this however, the top decision makers have not taken keen interest in this issue. We need to lobby them to use results of the process.
What were some of the significant findings of this study?
The study found that Viet Nam health system does not have a strong health research system. The system had some major limitations:
- Participation of users in setting priorities was insignificant. At the national level, the Ministry of Science and Technology (MOST) is the leading agency managing research activities. Health research priorities were set by both top-down and bottom-up approach. The Department of Science and Training in the Ministry of Health used criteria made by MOST to set annual research agenda. To develop health research priorities, the MOH sends requests to research institutions for submission of research topics that institutions are interested in. The topics then are compiled and selected by the committee of experts that has been identified by the MOH. The priorities are sent back to the research institutions to develop research proposals for bidding. A research institute will receive the priorities from MOH. Then, they will choose requests related to their interests. They will develop requests into research proposals and send them back to MOH. MOH will base on proposals and select the best institute to do the research proposals.
- Policies and mechanisms that enable research demands of users to be developed into research proposals were insufficient. This research found that in the Viet Namese system, over 73% of producers receive demands for research generated by users. Nevertheless, only 17.65% producers have informal mechanisms that enable the research demands to be developed into research proposals.
- The process unveiled that ethical and equity considerations were not among the main issues for evaluating a proposal. The national health research system had limited financial resources, health research networks, and collaboration with other researchers and institutions.
- Researchers were receiving poor salary, benefits, and workspace or equipment.
- The national budget for health research was low.
- There were no appropriate methods for dissemination of health research results and the role of libraries had not been pertinently considered.
- The researchers’ capacity was a weakness of many institutions in health system. For example, their weak skills include proposal development, literature review, research management, data analysis, use of analysis software, and information sharing
Why is users’ participation in priorities setting important?
– Users’ participation in setting priorities is very important. Users’ priorities are practical research needs or real problems which we should deal with. The users will directly use research’s results in practice. Research fund can be raised from users interested in particular fields. User participation in priority setting will improve collaboration among actors in research system.
What are some of the policies and mechanisms that could enable the research demands of users to be developed into research proposals? Are they sufficient?
Some producers receive demands for research generated by users, but only 17.65% producers have informal mechanisms that enable the research demands to be developed into research proposals. This makes it difficult for researchers to follow up on these demands from users.
Does Viet Nam have a criteria and a concrete mechanism to encourage coordination between different actors in research – such as funders, producers, and users on proposal evaluation?
All actors in research such as funders, producers, and users have a criteria and a mechanism on proposal evaluation (e.g. proposal evaluation forms of MOH, Hanoi School of Public Health…). However, their criteria are different from others. For example, producers mainly focus on criteria such as “relevance of research topic to institution’s goals and mission”, “scientific merit (builds on existing knowledge and contributes new knowledge)”, or “capacity strengthening integrated into methods and objectives”. Meanwhile, funders mainly focus on criteria of “policy relevance and implications”.
How are research proposals evaluated? Are issues such as ethics and equity considered when evaluating these proposals?
Review or evaluation committees often use concrete criteria to evaluate research proposals. These criteria and their relative importance vary from institution to institution. Most producers focus on scientific criteria for evaluating research proposals such as scientific merit, policy relevance and implications, or relevance of research topic to institution’s goals and mission. Criteria relating to ethics, equity, and gender were not considered in the review process. Only some agencies such as Ministry of Health and HSPH have (IRBs (Institutional Review Board).
Who funds the bulk of the research that is conducted in Viet Nam? Is government funding adequate?
Research projects under the national research priorities are directly funded by the government through MOST. The Ministry of Health funds research projects of ministerial agencies including hospitals, medical universities, health centers, and others. The budget for research and technology development from the Ministry has increased significantly in recent years, especially in the 2004 – 2007 periods.
Although the national budget for health research has increased in recent years, funding for research from international organizations is still significantly higher than the national budget. The National Health Research System Analysis stated that budgets for research activities and projects are still low (less than 20 percent of full budget for all agencies’ activities) for most institutions, even for research producing institutions. The budget for research allocated from the MOH is not adequate when compared to other funding sources. Funding is mainly provided by international organizations including non-government organizations, bi- or multilateral committees, and foundations and councils.
Are there some measures to positively deal with these challenges by learning from health research networks, and collaboration with other researchers and institutions?
The health research system in Viet Nam is still weak. It is has so far not been effective in implementing research, sharing information and bringing research’s results to practice.
We also have some measures to deal with the challenges by setting network such as Viet Nam Public Health Association (VPHA), Viet Nam HIV/AIDS Prevention Association, Injury working group and others. However they are still official except the VPHA, which has done many studies in collaboration with its provincial members. However, role of the associations is not strong enough in developing health research network.
Does Viet Nam have appropriate means to disseminate health research results to different users?
We still lack some of the best methods of disseminating research findings. The NHRS analysis found that users of research results often access research results by looking for original research articles or systematic reviews in journals (international and national). The other source of research findings is through searching databases by subscription or Internet access, and other papers in journals. Research producers communicate usually report their results in scientific seminars or workshops at the institutions; scientific conferences (national).
Forums aimed at exchanging research results and research needs between researchers and other users are also held. However, it is apparent that there is a gap between how users’ access and how producers disseminate research results. In addition, most institutions have their own library on site, but theses library usually lack internet access, web-based catalogues and research databases.
This is clearly a few resources to establish these services yet the analysis revealed that most researchers use the internet regularly: 100% of researchers have daily access to the internet and 97.2% conduct and download searches on the internet at least once a month. Moreover, the percentage of institutions having a professional information specialist (i.e. librarian with an advanced degree in the library science) is very low (about 30%). Most libraries do not participate in interlibrary loan (i.e. service whereby a user of one library can borrow books, microfilms, or photocopies of articles in journals that are owned by another library). This research has clearly shown that the role of the library is not strong.
What plans does Viet Nam have to build researchers capacity?
In health system, doctors and nurses in clinical institutions mainly undertake medical care; therefore, it is difficult for them to allocate time to research. Therefore, while clinical institutions constitute an important part of the national health research system, in practice, they are not primary research agencies. The difference between health workers (medical doctors, nurses, public health workers…) and health researchers has not been clearly defined.
In most institutions, researchers are also medical practitioners or public health workers. To improve researchers’ capacity, the majority of institutions have formal training programmes for their researchers. These training programs primarily consist of postgraduate courses such as PhD and Master degree programmes (Over 85% institutions are involved in these programmes). In addition, institutions conduct short courses for improving their researchers’ skills (about 65% institutions). This indicates that health institutions do have significant interest in improving the human capacity of their staff and students.
We have promulgated several policies related to research improvement. For example, the Prime Minister signed Decision No 171/2004/QÐ – TTg approving the “Proposal on the reform of the science and technology management mechanism” of the Ministry of Science and Technology (MOST). The MOST also announced “Directions, objectives and key science and technology tasks for the five-year period (2006 – 2010)”. In 2005, Government Decree 115/2005/NÐ-CP addressed the issue of self-control of governmental science and technology agencies.
The decree stated that science and technology agencies or organizations should determine their own missions and implementation methods. However, despite these decisions and announcements, no concrete policies and/or action plans related to the development of health research system and researchers’ capacity were formulated.