Amy Dao: From HIV/AIDS to Health Systems: Laying the Groundwork for New Ideas for Future Research in Vietnam

While driving through the Mekong delta this summer, I looked out onto the interweaving rivers while crossing the towering Mỹ Thuận bridge. The bridge evoked an image of western modernity for my cousin who had lived through Vietnam’s period of political isolation from the “West” after the war. For me, the bridge has always symbolized the range of rapid changes that has occurred since my first visit to Vietnam over fifteen years ago. From the skyscrapers in Ho Chi Minh City, to the conspicuous increase of cars on the street, nothing seemed untouched by the effects of Đổi Mới (Renovation), the economic and social reform program in 1986 that signaled Vietnam’s transition from a centrally-planned economy to a market economy.

One effect of liberalization has been the government’s decree for healthcare reform in 1992, with the goal of providing universal health coverage. As a relatively new concept, health insurance has been met with some success and opposition. At this unique time, the study of health insurance in Vietnam provides an arena for the social analysis on issues of risk, inequality, and the social determinants of health.

With the help from the Sasakawa Young Leaders Fellowship Fund from the Weatherhead East Asian Institute, I was given the opportunity to spend a significant amount of time in Vietnam working and exploring its culture. During the summer, my time was divided between two research projects. The first was an internship with the Social Science Training and Research (STAR) Partnership, an NICHD-funded social science and research capacity building project carried out in collaboration with the Department of Sociomedical Sciences and Hanoi Medical University (HMU) in Vietnam. The second aspect of my time in Vietnam was to start some preliminary research on what I hope will become the topic for my dissertation. I wanted to investigate health insurance reform and evaluate what role local perceptions play in enabling or undermining the state’s efforts at implementing universal health coverage.

While working at HMU, I was stationed at the Center for Research and Training on HIV/AIDS. I reviewed the literature on social science research that has been conducted thus far on HIV/AIDS in Vietnam. Several themes became apparent, such as the preponderance of studies that present rich descriptions of behavioral patterns in relation to the HIV epidemic and its spread throughout the urban areas of Vietnam. While this provided useful insight for reviewing the adequacy of knowledge within the particularity of Vietnam, there appeared to be an absence of research that investigated the political, economic and cultural drivers of the epidemic. Exploring the political, economic, and cultural factors of the HIV epidemic would add more theoretical substance to current research and could contribute to improved HIV/AIDS prevention in Vietnam. I presented my research at the second National Symposium on Sexuality and Health in Vietnam with colleagues from the STAR Partnership. In addition, I participated in a training course where I was able to mentor early career researchers on social science data analysis and help them develop these analyses into a publication for a Vietnamese academic journal.

For my own independent research project on health insurance in Vietnam, I began the groundwork for my future time in the field. With the help of my contacts at HMU and the STAR Partnership, I was able to establish connections with key government stakeholders in the world of Vietnam’s nationalized health insurance. Not only did I meet with professors and research teams interested in studying and improving the health system in Vietnam, but I also spent my time traveling throughout the country, where I learned about the everyday life experiences of people using health insurance. I learned that there are several issues at all levels of the health system that impede the health insurance initiative, including but not limited to: the disagreements between health care professionals and the Ministry of Health on fees and practices for medical services and health care delivery, the limited ability the government has in enforcing health insurance law, and the low public perception of the quality of care for those who have health insurance.

This summer research fellowship has allowed me to obtain direct experience living and working in Vietnam, while helping me establish connections that will undoubtedly contribute to the present and future research on health insurance reform.

For more information on the Sasakawa Young Leaders Fellowship Fund (SYLFF) fellowship, please contact Kim Palumbarit at kp2449@columbia.edu.