Current health cooperation
Cross-border collaborations between Vietnam and China have been operating for decades and are currently mainly negotiated by the two countries’ National Health Commissions. Non-governmental cooperation has continuously expanded, while bilateral government-to-government cooperative opportunities are limited, as expressed by one of our informants: “Cooperation with Vietnam in recent years has been more under multilateral mechanisms and frameworks, including talks at international conferences.” The ever-changing foreign-policy interests were mentioned by the key informants as one of the important influences for further cooperation.
Although health interventions are increasingly used to support foreign-policy objectives, foreign-policy interests may actually have impeded the development of health cooperation. Several key informants believed that funding sources may affect the desire for cooperation. However, scientific cooperation research programs between Vietnam and China researchers have been consistently developed. For example, in the past few years, two of the interviewees have joined a joint research project on maternal and child health. As one interviewee stated: “The similarity of the health system in terms of the development path provides a necessary basis for scientific research cooperation.” Note: hereafter all sentences in italics are quotations from our interviewees.
Being one of the most important organizations in Southeast Asia, the ASEAN framework has provided a good platform for strategic consultation: “The cooperation mechanism provided by ASEAN member countries is mature and perfect which benefits further cooperation.” Two levels of cooperations were mentioned under ASEAN Plus Three (China, Japan and ROK) and ASEAN Plus One (China). One is the ASEAN Health Ministers’ Meeting (AHMM), which is held every two years and which provides a platform for political commitment, highlighting the willingness to continue to strengthen and promote cooperation. The other is the Senior Officials’ Meeting on Health Development (SOMHD) held each year, through which information is shared: “AHMM is more of a political commitment, showing that China and ASEAN countries are very willing to continue deepening and promoting cooperation in the health field. SOMHD plays the role of information sharing, including the sharing the work of each country at an official level, i.e. what they have done for the ASEAN countries, which reflects their influence and ability.” In addition, there are also several technological cooperation mechanisms, for example the ASEAN Expert Group on Communicable Diseases (AEGCD) was formed to work together for the prevention and control of communicable diseases. However, a few participants pointed out that the limited funding provided by the ASEAN may lead to some problems: “A direct reporting network system of communicable diseases has been established, but operations have faced huge problems due to a lack of financing”. Although funding is limited, the existing cooperation mechanism has made it easier to carry out work smoothly and to achieve the ultimate goal: the establishment of mutual trust.
Another important multilateral cooperation mechanism is the Greater Mekong sub-region (GMS), established in 1992 with the assistance from the Asian Development Bank (ADB). Its member countries including Vietnam, China (specifically Yunnan Province and Guangxi Zhuang Autonomous Region), Cambodia, Lao People’s Democratic Republic, Myanmar, and Thailand. In addition, the Mekong Basin Disease Surveillance (MBDS) network was established through a memorandum of understanding signed by the Ministers of Health of these six countries. Interviewees reported that the lack of supervision and funding could make it difficult for the network to ensure normal functions: “The current problem is that we do not have the right leaders. Moreover, the financing ability of MBDS is very poor, which results in huge operational problems. It has raised only 20,000-30,000 US dollars per year, which is only enough to guarantee the existence of the secretariat. Right now the only thing MBDS does is to send regular newsletters to the member countries.” Despite the challenges, interviewees believed that the network could be reactivated by sustainable capital support and effective campaigns. They also perceived that the activated network had a positive impact not only on the cross-border prevention and control of emerging and re-emerging infectious diseases but also on the relations between the member countries: “I think the key factor to solve the problem is ‘money’. Moreover, it requires long-term strategic financial support. In order to reactivate the network and attract members’ attention, several activities are needed. For example, when there is a new infectious disease outbreak, we can share information through MBDS, then information can be transferred to all member countries. Members will then see MBDS as being very useful and share freely information about it.”
The interviewees pointed out that the Lancang-Mekong Cooperation (LMC), a new multilateral cooperation mechanism initiated by China in 2015, showed great potential for development. The member countries include China, Vietnam, Cambodia, Thailand, Laos, and Myanmar. The LMC framework is primarily focused on the management of water resources, but as it is based on mutual trust and benefit, its scope has been extended to people’s livelihood including environmental health, health promotion, and public health: “The control of water resources is closely related to the control of environmental health and infectious diseases, which can win the hearts and minds of local residents. Thus the prevention and control of waterborne infectious diseases are beneficial to the management of water resources.” One of the priorities is the prevention and control of emerging and re-emerging infectious diseases, especially the establishment and improvement of early warnings and joint surveillance mechanisms.
One of the participants highlighted the similarity of and the relationships among these cooperative frameworks. Although involving the same countries and sharing similar cooperation fields, these frameworks are neither exclusive nor in competition, and they differ in terms of the underlying multilateral negotiations.
The key informants all agreed that current cooperations essentially focus on three fields: health security, health development, and health-related innovation. With the development and constant changes in health needs, the priority areas for regional cooperation are also continually changing: “From health emergencies to health systems, and then from conventional chronic diseases, to the overall needs of the population along with healthy aging.”
Health security (prevention and control of infectious diseases and health emergencies)
Several key informants highlighted that there are cooperation projects regarding infectious diseases which are carried out on the borders between the two counties. Current projects involve AIDS, tuberculosis, and cholera. With regard to China, the CDC in the nearby provinces is responsible for the cooperation projects. Activities include seminars on infectious disease monitoring and meetings on the exchange of prevention and control technologies: “At present, China has a cooperation project with Vietnam on the prevention and control of border infectious diseases, which is under the responsibility of Guangxi CDC and Yunnan CDC (border provinces). The project mainly includes personnel training and natural disaster assistance.”
Health development (strengthening health systems, maternal and child health, health assistance and traditional medicine)
Some key informants mentioned that the two countries have long-established maternal and child health cooperative projects as both countries follow a family planning policy: “The Office for Population and Family Planning of Vietnam, which is responsible for Vietnam’s family planning policy, is in close contact with us (China). After the health reform in Vietnam in 2013, the health and family planning authorities in Vietnam and China have exchanged visits every year. In recent years, due to financial constraints, the contacts have been less frequent.” In addition, participants reported Vietnam’s interests in the Chinese experience of health care reform: “Every year, Vietnam’s government sends one or two delegations to China to study health care reform policies, covering a wide range of fields, including rural health, maternal and child health and human resources.” They also mentioned that traditional Chinese medicine has won high recognition from ASEAN countries and cooperation projects on the subject have already been launched.
Health related innovation (joint research and health industry)
Some key informants considered health-related innovations, including joint research projects and health industry, as future development priorities. Several companies have set up a number of projects across Southeast Asia countries. “The Beijing Genomics Institute has started health-related innovation projects mainly related to public welfare, and its genetic sequencing products are used for the early screening of thalassemia and deafness in Southeast Asia.”
Suggestions for future collaboration
The interviewees felt that promoting health development strategies should be the first step in any collaboration process, followed by a willingness to set priorities in order to decide the exact fields of collaboration. In fact the informants emphasized that it would be significantly easier to collaborate if both sides share the same interests and needs.
SDGs were mentioned as the collaboration priorities from the Chinese perspective: “The ultimate goal of China’s contribution is to achieve global SDG. We maintain bilateral cooperation in order to support the achievement of global goals.” Interviewees indicated that China’s Belt and Road (also called the Silk Road) Initiative was an effective way to achieve SDGs globally: “Under the Belt and Road Initiative, the “Belt and Road High Level Meeting for Health Cooperation: towards a Health Silk Road” was launched and the implementation plan was designed to achieve the goal of SDG and contribute to global development.” Also, NCDs and aging problems were identified as priority cooperation objectives. “Infectious diseases are staged problems, and chronic diseases are long-term problems. In addition, issues regarding aging need to be added.”
The SDG strategy in Vietnam was mentioned by our informants as the national partnership cooperation framework, specifically including universal health coverage and health system establishment. In terms of health priorities in Vietnam, most respondents reported that the problems of NCDs including cardiovascular disease, cancer, diabetes, and chronic respiratory diseases were urgent and that collaboration with China was important, especially for management at the community level.
The Vietnamese still have various health problems related to smoking and drinking, especially men: “Vietnamese men like drinking beer and alcohol. Vietnam is one of the countries with the highest level of alcohol consumption. And also there is a problem with smoking. Smoking is still very high among men.” Current NCD related problems mentioned by interviewees included community-level health care services and two-way referrals between hospitals and community healthcare systems. “The problem of NCDs is becoming more urgent. In particular, the population is aging in Vietnam as fast as it is in China. So the government really needs to focus on strategies. People with hypertension, metabolism diseases and conditions, diabetes, mental health, need to come to the clinic or health facility many times each month to get their medicine, and for check ups. So the government set up the system to manage the whole thing, they want to transfer the task from the hospital to the community. I think the situation is very similar in China.”
In addition to the priority cooperation areas from Vietnam’s perspective, the most frequently mentioned topic during the interviews was the public health system. It was also noted that Vietnam has focused on establishing the CDC for years and is interested in China’s CDC model: “I think there is a huge need [for this to happen](by merging some departments to become the CDC). This issue was already discussed 20 years ago, but it takes some time for the government to change.” For instance, at the end of 2017, a national Vietnamese team visited the Chinese CDC to learn about the construction of China’s disease control system. “They learnt about your model in terms of the CDC, in terms of the management. But maybe now they don’t go up to the ministry level, they go directly to the institutions. They learn the CDC model.”
Forms of cooperation
A common perception was that health personnel training was effective: “I advocate capacity training in the early stages of cooperation, which can cover different fields in various forms on a voluntary basis.” Agency visiting, experience sharing and course discussions were all the suggested forms of long-term or short-term health personnel projects. Participants also suggested that medical consultation services provided inspiration for involvement and that their value in terms of long-term cooperation was immense. “I also advise expert consultation to solve specific problems. If the partners agree with the solutions and methods proposed by the experts, we can go ahead with subsequent projects.” There were concerns that without the guarantee of funds and close cooperation, pilot projects may not fully succeed.
The triangular cooperation among China, IOs/NGOs and Vietnam was recommended as an effective approach to future collaboration: “China - partner countries - IOs is now basically recognized at the official level.” “The NGOs represented by the Bill & Melinda Gates Foundation have developed very fast in the past decade, and their investment in health cooperation is even more than that in many countries.” It seems that triangular cooperation was not yet well developed but has demonstrated its potential. Many interviewees saw triangular cooperation as a new trend deserving further exploration. One participant mentioned that the Bill & Melinda Gates Foundation cooperates with the International Health Exchange and Cooperation Center NHC PRC to support international health cooperation related research.