Abstract

Health authorities in developing countries must often cope with rapid changes in the administrative, policy and socioeconomic contexts in which they work. Changes in this external environment have important implications for the roles that health planners can effectively play and the leverage they exercise throughout the system. This paper examines the challenges associated with reorienting ministry roles from administrative fiat to overall orchestration and strategic steering, using health workforce management in transitional Vietnam as a backdrop. Decentralization, commercialization of services and rising inequalities have reduced the efficacy of the administrative controls and standardized strategy on which Vietnam's Ministry of Health has traditionally relied. Reorientation, in Vietnam and elsewhere, depends on bridging significant capacity and strategy gaps, notably in the strengthening of information, planning and accountability systems that respect both the limitations of central control and the diversity of local conditions.