Strengthening upper gastrointestinal endoscopy service in primary healthcare settings in low- and middle-income countries: Proposals from an implementation study in Vietnam.

Vietnam has established favorable policies for upper gastrointestinal endoscopy, providing an opportunity to expand this technology to primary healthcare (PHC) settings. However, the policy dilemma between insurance coverage/supportive regulations and self-financing policy, and the one between intended and unintended outcomes of healthcare decentralization and administrative reform, posed constraints on expanding this technology at the PHC level. In response to these policy dilemmas, we conducted an implementation research study to identify subsequent policy bottlenecks and facilitating and hindering factors affecting the proper and sustainable implementation of this technology. The study was carried out in district hospitals (renamed regional general hospitals after 2025 administrative reform) in two southern provinces, using a qualitative research design based on interviews with hospital staff involved in upper gastrointestinal endoscopy. Data were analyzed deductively using the Consolidated Framework for Implementation Research (CFIR). Based on the identified policy dilemmas, bottlenecks and hindering factors, we propose five policy recommendations: i) mobilizing and redistributing financial resources for PHC-level hospitals; ii) facilitating participation in upper gastrointestinal endoscopy training; iii) establishing accessible professional networks; iv) raising awareness of upper gastrointestinal endoscopy services; and v) promoting adherence to national guidelines. After analyzing their potential constraints and trade-offs, we consider them to be relatively feasible to implement.