Abstract
Background: The impact of reorganisation on health services delivery is a recurring issue in every healthcare system.
In 2005 Vietnam reorganised the delivery of health services at the district level by splitting preventive, curative, and
administrative roles. This qualitative study explored how these reforms impacted on the organisation of maternal health
service delivery at district and commune levels.
Methods: Forty-three semi-structured interviews were conducted with health staff and managers involved in the
provision of maternal health services from the commune to the central level within five districts of two Northern
provinces in Vietnam. The data were analysed thematically.
Results: The results showed that 10 years after the reforms created three district-level entities, participants reported
difficulties in management of health services at the district and commune levels in Vietnam. The reforms were largely
perceived to negatively affect the efficient and effective use of clinical and other resources. At the commune level, the
reforms are said to have affected the quality of supervision of the communes and their staff and increased the workload
in community health centres.
Conclusion: The findings from this study suggest that the current organisation of district health services in Vietnam
may have had unintended negative consequences. It also indicates that countries which decide to reform their systems in
a manner similar to Vietnam need to pay attention to coordination between a multiplicity of agencies at the district level.