'Health system stewardship and regulation in Vietnam, India and China’ (HESVIC) was a multidisciplinary and multi-partner project implemented over three and a half years (July 2009 – December 2012) with the financial support from the European Commission FP7. It investigated regulation as it relates to wider governance in policy and practice of health systems in maternal health for Vietnam, India and China.
HESVIC used maternal health as a particular critical case study to investigate health regulation and to support policy decisions that would improve accessibility, affordability, equity and quality coverage of health care in the three countries.
HESVIC used maternal health as a particular critical case study to investigate health regulation and to support policy decisions that would improve accessibility, affordability, equity and quality coverage of health care in the three countries. This research focus was captured in one overarching and five individual research questions.
The study was carried out in a challenging context where the health systems studied have become more complex, characterized by increasingly dominant private sectors, public sectors adopting revenue generating methods and varied arrangements for decentralisation of health care. We set up a mixed method, multidisciplinary and multi-partner study, and sought convergence between diverse conceptual research views, as well as ways to deal with heterogeneous governance approaches and health regulations in the three countries.
To do so, we identified an overarching framework to conceptualize and critically analyze health regulation and governance. We improved our understanding of regulation processes, and through them of determinants for governance. We developed an integrated approach to assess regulation, with scope for variation in evaluation strategy and instruments. Our research indicates that the effects of the studied regulations on access to quality maternal health care were weak in the three countries, under the circumstances prevailing at the time of study. Failures to regulate healthcare delivery had potentially major consequences on avoidable mortality and morbidity. Factors explaining regulatory failure or success related to the content and structure of those regulations as well as their implementation.
Finally, in order to develop motivated support for policy decisions, we compared country case studies and country contexts between Vietnam, India and China. This comparison, using alternative characteristics for a taxonomy of regulations, allowed us to summarize our evaluations of regulation, and through it governance, to draw out common problems in developing and implementing regulation as well as factors facilitating their ability to contribute to improved access to quality of care. Our research evidence contributed to ongoing thinking and regulation review by policy makers. In addition, we were able to make recommendations for improving quality of regulation in relation to health.
Specific research-related objectives were:
The HESVIC achievements in terms of research process and research findings were:
Overall, in the wider health policy field, HESVIC research suggests that regulatory control is constrained under current conditions in LMIC settings, with the possible exception of services that are centrally planned. In the three countries, regulation of private outlets is met with reluctance, leading to public authorities generally not being able to list private practitioners operating in their area. We found that regulation-hampering mechanisms are related to historical, socio-political and administrative conditions in LMIC. This confirms that to date there is a lack of field evidence on whether mechanisms exist in LMIC to intervene and control health markets and, ultimately, redistribute wealth and disease. It is believed that this perpetuates the inequitable delivery and financing of care interventions and control mechanisms.
HESVIC project engaged particularly with national and regional policy makers dealing with health governance and (maternal) health regulation of Vietnam India and China.
Our results, as we summarised to policy makers, were that regulations should be nested in larger health policies because:
These messages were communicated to policy makers through numerous channels during and at the end of the project through consultation meetings and dissemination workshops; conferences; policy briefs; short courses; project web-sites and development of peer reviewed journal articles for publication in national and international journals.
HESVIC contributes hypotheses for future studies regarding the impact of regulations on access to and quality of care in public and private health facilities and regarding the place of regulations in health policies within the academic community
In addition, the research deliverables comprising the HESVIC country studies and comparative study (which can be found here.) makes policy recommendations for national standards to policy makers, health managers, regulation administrators and members of professional and users’ associations.