Rehabilitation Module Law on Examination and Treatment

Incorporating rehabilitation care into the Vietnam Law on Examination and Treatment (LET) offers strong evidence of Vietnam's commitment to progressive realization of the UN Sustainable Development Goals (SDG) through continued development of its universal health care delivery system. A sustainable universal health care system also contributes significantly to other SDG development such as education, gender equality, decent work and economic growth, reducing inequalities, and working to create sustainable cities and communities. The focus of rehabilitation care has been traditionally categorized within a field of silos, each with its own separate disability designation. These silos have also worked to misrepresent rehab care as a clinical model in the context of handicap mobility service delivery only, concentrating on physiotherapy or orthotic/prosthetic devices such as wheelchairs and replacement limbs. The practice of placing disability in silos has only served to diminish the comprehensive capacity of rehabilitation care as a recovery service to all. Vietnam's rehabilitation system structure is a highly institutionalized and centralized model. There are aspects of a Community-Based Model (CBR) at the commune/station level, but it can still be classified as a modified institutionalized model as many of the actual services and therapies are based out of facilities such as the Day Centers, Commune Health Station, District or Province level facilities. Currently, there are 63 rehabilitation hospitals/centers, including 38 rehabilitation hospitals/centers managed by the health sector, 25 rehabilitation hospitals/centers managed by other related sectors. The healthcare services and delivery models found in modern universal health care systems in developed countries have restructured to focus more on decentralized delivery models, including supported discharge and more home-based care as possible. At the forefront of this restructure are the benefits of a flexible and well-trained, para-professional workforce, or practitioners other than doctors. From a range of physician assistants, nurse practitioners, to a group known as Allied Health Practitioners (AHP) and assistants, this healthcare workforce has been key to the development of a sustainable universal health system in developed countries and will be key to UHC development within Vietnam over the next 10 years. Non-Communicable Diseases (NCDs) are the next wave of health conditions to increase disability and mortality-related conditions. NCDs include conditions such as neurological injuries, stroke, cardiac events (i.e., heart attacks), hypertension (high blood pressure), and diabetes. Rehabilitation planning and development will be a vital role in preventing or limiting the disabilities associated with these NCDs. The World Health Organization (WHO) Model for Rehabilitation Care emphasizes that rehabilitation care is an integral component of any health system that directly affects aspects of society, including the burden of care, reduction in workforce, and economic diminishment of communities, families, and limitations of the affected individual. The WHO has identified a 4-Pillar approach to incorporate rehabilitation care as part of an overall universal health system development. The 4 Pillars are: Availability and Quality, Governance and Finance, Healthcare Workforce, and Rehabilitation Data and Research. As Vietnam continues to develop its model of UHC, the direction of its treatment law (LET) focus is on workforce development; facilities and services applicable to rehabilitation care. WHO has identified that new approaches to NCDs will be needed to meet these demands as the focus turns from institutional care to integrated aspects of primary health, community-based care, and educating patients as drivers to an integrated health system.