Trust and Global Partnerships

What HMS is learning from a 20-year effort to strengthen Vietnam’s health care system

Photo of a group of medical students in Vietnam looking on as a baby is being examined in clinic.
Medical school students and instructors gather for a pediatric examination in Ho Chi Minh City. Dr. Alev Atalay of Brigham and Women’s Hospital is second from left. Image: Courtesy HAIVN

When Lisa Cosimi first moved to Vietnam 20 years ago, after finishing an infectious diseases fellowship at Harvard, she was interested in studying ways in which southeast Asian countries’ health care systems might be improved and how the quality of health care in resource-limited settings could be enhanced.

Cosimi focused on improving HIV care and treatment, working in hospitals and clinics in Vietnam to train physicians, nurses, and pharmacists on how to provide more comprehensive care for patients and prevent the spread of infection.

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“It was less than 1 percent of the population, but in certain high risk groups, specifically people who used injection drugs, there was a growing epidemic. And it seemed that Vietnam was at an inflection point, where things were about to worsen,” said Cosimi, now an assistant professor of medicine at Harvard Medical School.

After two years in Vietnam, Cosimi joined the U.S. Centers for Disease Control and Prevention to lead the scale-up of HIV treatment in clinics in Vietnam under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

Vietnam is the only country in Southeast Asia to participate in the program, which has spanned two decades, invested more than $100 billion in the global HIV/AIDS response, and saved 25 million lives in more than 50 countries.

During this time, Cosimi continued to work with Harvard physicians, including Eric Krakauer, HMS associate professor of global health and social medicine in the Blavatnik Institute at HMS, and Howard Libman, now HMS professor of medicine, emeritus.

They were training and providing continuing medical education to Vietnamese physicians working in these same HIV treatment clinics and developing closer ties with leadership at the country’s medical schools.

Through the work being done in the HIV clinics, Cosimi and a few others came to the conclusion that real progress would be made in Vietnam not solely by training health care workers in clinics and hospitals, but by helping the country achieve systemic change in its health care sector.

“We increasingly recognized that true, sustainable improvement in health outcomes would need to include much more than education and resources to treat a specific disease: it would require improving the broader health system. That involves improving quality of care for any patient walking into a clinic or hospital and across the system. And that has become the basis of our ongoing work,” Cosimi said.

Responding to multiple diseases

Cosimi’s initial work expanded to developing health systems that could address the whole person, because a patient might be dealing with malaria, heart disease, and hypertension simultaneously. The focus changed to creating person-centered care systems that could provide holistic treatment.

Photo of Lisa Cosimi
Lisa Cosimi. Image: Brigham and Women's Hospital

That meant revamping the country’s medical education system, something the nation’s leadership also wanted to do because Vietnam’s population and economy were rapidly growing, disease patterns were shifting, and population demographics were aging, causing increasing demands for quality health care.

Additionally, medical school curricula hadn’t adapted to the changing needs of new learners and the rapid evolution of medical science.

“Even in the more established universities, you had curricula that hadn’t comprehensively changed in decades. Most classes were delivered with a single lecturer in the front of a classroom, delivering material that hadn’t been changed in a very long time, with class sizes that were getting bigger and bigger,” Cosimi said. “When we talked to both the doctors and educators one-on-one, they all said yes, we need to do this better.”

Cosimi and her colleagues approached David Golan, dean for research operations and global programs and the George R. Minot Professor of Medicine at HMS.

“What they said is, we want to keep doing our HIV/AIDS work, but we’ve also been approached by our Vietnamese university partners to work with the medical schools on medical education curriculum reform, starting with one medical school in particular, the University of Medicine and Pharmacy at Ho Chi Minh City [UMP], to reform their medical education curriculum,” recalled Golan.