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[Vietnam: appropriate management of a pediatric hospital in the context of limited resources].

To cope with problems arising from limited economic resources, the pediatric hospital of Ho Chi Minh City, Vietnam, integrated several primary health care concepts into its overall policy: designation of priority diseases, adaptation of therapeutic modalities, decentralisation, and community funding. These concepts have been in use since 1988. Five diseases were designated for priority, i.e. diarrhea, acute pulmonary infection, dengue fever (DF), malaria, and routine pediatric emergencies, malnutrition. Training courses focusing on these diseases have been organized for hospital staff and health care assistants and education programs have been offered to the families of patients. Outpatient treatment is encouraged to lower the number of unnecessary hospitalizations and use of simple, cost-effective therapies has been developed for priority diseases. Responsibility has been delegated to department heads. Treatment is provided at no cost to the poorest but a small fee is requested from others and funding is also obtained from local authorities and non-governmental organizations. In five years, these concepts have achieved a 40% reduction in overall mortality. Funding from non-governmental organizations has been allocated to training and research programs designed to respond to specific community needs. This experience shows that reducing mortality does not depend only on budgetary increases but also to a great extent on rational spending and managing available resources. These can be effective in any developing countries that cannot increase budgetary spending.