after controlling for a higher health need among the
poorer population, health s
ervices provided by district
health systems still dispro
portionately concentrated
among the poor [15].
The pro-poor government health spending is homoge-
neously distributed across four geographical regions; this
is a result of the homogeneity of district health systems
development nationwide. The
rural mandatory services
are enforced to the whole country with financial incen-
tives such as hardship allowance, lump sum per diem,
non-private practice incenti
ves and workload allowance
as well as other non-financial incentives such as housing
and social recognition. These interventions are effective
and recommended by WHO for rural retention [16].
Countries with high level of out of pocket payment
and no effective policies protecting the poor from health
payment have benefit incidence is in favour of the rich.
For example the poorer groups in Vietnam [17] get
much less than their population share of hospital-based
care and other public care but more than a proportion-
ate share of care provided at commune health centers