THE STRATEGY OF HEALTH CARE AND PREVENTION FOR PEOPLE 
IN 2001-2010 PERIOD

- Guideline view-points of Vietnam Communist Party for people health care and protection
- Achievements  
- Evaluation of activity results in 1990 - 2000 period  
- Review the performance of 3 targets of 37/CP resolution  
- Top ten events in 2000  
- Opportunities and challenges  
- Content of 35/2001/QD-TTg Decision. People health care and protection development targets in 2001-2010 period  
- Responsibility for development, follow-up and conduction of strategy  
- 10 focal tasks of health sector in 2001-The first year conducting the strategy  

GUIDELINE VIEW-POINTS OF VIETNAM COMMUNIST PARTY 
FOR PEOPLE HEALTH CARE AND PROTECTION

1. People are the most valuable resource of society, people decide the development of a country, the health is most valuable fund of each inhabitant and of whole society. Investing for the health so that every inhabitant are received health care is just mean investing for socio-economic development of country, improving life quality of each individual and family.

2. Humanistic essence and socialistic direction in market economy requires the equality and efficiency in health care. Perform of equality is ensure that everybody are received fundamental and gradually improved health care, correspond to economic ability of society. In the same time, the State make free-charge and low-charge health care policies for the people who have merit with country, the poorer, the people live in difficult areas and the minority ethnic people. Strengthen use efficiently resources to well perform equal strategy in health care.

3. Active and positive disease prevention is viewpoint which penetrates completely in building-up and developing process of health sector of Vietnam. View point of active prevention must be deeply aware and applied in establishing the civilized and healthy life-style, ensuring that the life, labour and study environment is benefit for disease prevention and health improvement, preventing and control actively risk factors of health in rural developing and industrializing process.

4. Combining modern medicine with traditional medicine. Traditional medicine is valuable heritage of nation, which have to be protected, developed and improved. Developing vigorously the research work to apply and modernize traditional medicine in combination with modern medicine without losing character of Vietnamese traditional medicine.

5. Socialization of health care for people. Health care for people is responsibility of each inhabitant, family and community; of Party committee and government levels; of sectors, unions and social organizations. Multi-formalizing the health care services in which state health services play the key role. Encouraging, conducting and managing activities of private, semi-public and joint venture health facilities. Fighting against any negative appearance in health care services.  

ACHIEVEMENTS

1.       Primary health care network is strengthened and developed.

2.       Epidemic diseases are prevented actively, many epidemic diseases are under control and check; polio was eradicated, neonatal tetanus and leprosy are eliminated; malaria-caused morbidity and mortality are reduced by 50% and 60%, respectively; other vaccine preventable diseases are reduced, compare with 1995. The large epidemics are not occurred.

3.       The health care system is upgraded, more sophisticated techniques are applied in examination and treatment, medical ethics reinforced.

4.       Traditional pharmacy and medicine are strengthened and developed: 70% of provinces have traditional medical hospitals, 50% of institutes and hospitals have traditional medical departments. 20% of communal health centers (CHC) have traditional medical activities (this number is 50% in An Giang province).

5.       Training work has more positive changes.

6.       Pharmaceutical sector met needs in preventive and treatment drugs for people, drug quality is ensured increasingly (rate of marketed low-quality drugs is only 0,12% in year 2000). There are 20 pharmaceutical enterprises reached GMP standard. Value of drug production and sales increase by average 10-15% per year.

7.       9 of 10 vaccines are produced to serve EPI program, in which 5 kinds of vaccine have met needs of EPI program. The health is improved.  

EVALUATION OF ACTIVITY RESULTS IN 1990 - 2000 PERIOD

Public health index improved:

REVIEW THE PERFORMANCE OF 3 TARGETS OF 37/CP RESOLUTION

1.       General review of all provinces showed that 51,91% of communes have doctor (including short-term strengthened doctors); 89,12% of communes have pediat-obtestrical assistant doctor or midwife, and 75,69% of hamlets have health worker;

2.       The provinces which achieved 3 targets of 37/CP resolution (40% of communes have doctor, 100% communes have pediat-obstestrical assistant doctor or midwife and 100% hamlets have health worker) are 9 per 61 provinces (14,75%), including Phu Tho, Vinh Phuc, Bac Ninh, Da Nang, Binh Dinh, Binh Thuan, Binh Phuoc, Ba Ria-Vung Tau, An Giang.

3.       Number of provinces achieved 100% of communes have doctor, pediat-obstestrical assistant doctor or midwife and hamlets have active health worker are 3 per 61 provinces (4,91%), including Da Nang, Ba Ria-Vung Tau, An Giang.

4.       Number of districts achieved 100% of communes have doctor, pediat-obstestrical assistant doctor or midwife and hamlets have active health worker are 53 per 617 districts (8,58%).

5.       The provinces which achieved 40% or more communes have doctor are 45 per 61 provinces (73,77%).

6.       The provinces which achieved 50% or more communes have doctor are 26 per 61 provinces (42,62%).

7.       The provinces which achieved 80% or more communes have doctor are 13 per 61 provinces (21,31%).

8.       The provinces which achieved 100% communes have doctor are 9 per 61 provinces, including Can Tho, Ha Noi, Ba Ria-Vung Tau, Thai Binh, Hai Phong, Thai Nguyen, Da Nang, An Giang, Tay Ninh. (In the past the Ho Chi Minh City had achieved 100% of communes have doctor, but recently due to some communes are separated, this city achieved that in only 302/303 communes).

9.       The provinces which have not achieved 40% of communes have doctor are 16 per 61 provinces (26,23%).

10.   The provinces that achieved 50% or more communes have pediat. obst. assis. doctor or midwife are 61 per 61 provinces (100%)

11.   The provinces that achieved 80% or more communes have pediat. obst. assis. doctor or midwife are 52 per 61 provinces (85,25%).

12.   The provinces that achieved 100% of communes have pediat. obst. assis. doctor or midwife are 23 per 61 provinces (37,7%)

13.   The provinces which achieved 50% or more hamlets have active health worker are 39 per 61 provinces (90,16%)

14.   The provinces which achieved 80% or more hamlets have active health worker are 39 per 61 provinces (63,93%)

15.   The provinces which achieved 100% of hamlets have active health worker are 13 per 61 provinces (21,31%).  

TOP TEN EVENTS IN 2000

1. Polio eradication in whole country.

2. Promoting the movement in which health professionals come to high and remote areas to work voluntarily in short-term achieved good results, (there were 350 health professionals appointed to strengthen for provincial, district and communal levels).

3. Preventing and overcoming actively natural calamities, epidemic diseases are not occurred in long-lasted flood in Cuu Long area.

4. The 3^th Emulation Festival of Health. There were 15 facilities and 10 individuals in health sector were honoured Labour Hero and Army Hero by the State.

5. The fifteenth of January (Lunar calendar) was selected is the Vietnam Traditional Medicine Day

6. Target that 40% of communes have doctor was achieved, in which 9 provinces and cities achieved 100%.

7. The Bach Mai Hospital Construction Project was completed with the support of Japanese government

8. There were 20 pharmaceutical enterprises reached GMP standard.

9.Telemedicine application was developed in endoscopy operation in Obst-Gynecological Hospital, HCM City.

10. The Meeting of Health Care for People in Mountain and Remote Provinces was hold successfully, (the resolution of mountain area health work strategy was established).  

OPPORTUNITIES AND CHALLENGES

1. Opportunities, advantages

- The concern of Party and Government that presented through resolutions, directions, especially 35TTg Decision dated 19/3/2001 issued the People Health Care and Protection Strategy.

- The average economic growth rate is 7,5% per year.

- Rural infrastructure is improved and facilitates health activities.

- Population growth speed and average size of household is decreased gradually, so everybody could be received better health care.

2. Difficulties, challenges

- Performance of equality and efficiency in health care in market economy.

- Health budget is restricted.

- Primary health have to be strengthened and developed to provide basic health care for everybody, in the same time sophistical medical techniques have to be developed and applied to improve the quality of health care.

- Resolving disease pattern that is special for a developing country and have character of an industrialized country.

- Natural calamities and floods occur usually, especially in Center and Cuu Long area are enormous difficulties in epidemic surveillance and epidemic disease resolving in and after floods.

- The knowledge of health personnel, including professional and management personnel has not met requirements of sector development in new situation.

- The subsidy system for health personnel is restricted. In other hand, some health personnel have not performed completely medical ethic regulations, make difficulties for people when they go to seek health care.

- The existence of ununification in concrete policies, the imbalance in directing and investing resources between rich and poverty areas, special health and primary health, health protection and curative care-consultation, traditional and modern medicine, training and using personnel.  

CONTENT OF 35/2001/QD-TTG DECISION  
PEOPLE HEALTH CARE AND PROTECTION DEVELOPMENT TARGETS 
IN 2001-2010 PERIOD

I. General targets

Attempt so that everybody are received primary health care services and facilitated to access and use quality health services.

Everybody live in safe communities, have good mental and physical development.

Reducing morbidity, improving physical, increasing life expectancy and developing race.

II. Concrete targets

1. Targets of health indicators

- Average life expectancy: 71 year of age

- Mother death prevalence is reducing to 70 per 100,000 live births

- Mortality among children under 1 year of age reducing below 25%o live births

- Mortality among children under 5 years of age are reducing below 32%o

- Rate of low birth weight children is reducing below 6%.

- Rate of malnutritional children under 5 years of age are reducing below 20%

- Average height of young adult reaches 1,60m or more.

- There are 4,5 doctors and 1 graduated pharmacist per 10,000 inhabitants.

2. Second target

Reducing mortality and morbidity of epidemicable-communicable diseases, large epidemics are not permitted happen. Restraining mortality and morbidity of cholera, typhoid, dengue fever, malaria, plague, hepatitis B, Japanese encephalitis B, sexual transmission diseases (STDs)... Maintaining results of polio eradication, eliminating neonatal tetanus. Limiting the speed of HIV/AIDS infection rate.

Prevention, control and management non-communicable diseases such as cardiovascular disease, cancer, accident and injury, diabetes, occupational disease, mental disease, suicide and unhealthy lifestyle-related diseases (drug abuse, alcoholism, obese...)

3. Third target

Efficient improvement of equality in accessing and using health care services, especially curative care and consultation services.

Improving curative care and consultation quality in all health levels in prevention, examination and treatment, rehabilitation and health improvement, applying technical-scientific advancements so that health sector of our country is comparable to regional advanced countries.

III. Key policies and resolutions

1. For investment

- Investment of state and contribution of community

- Investment of state plays the key role and increase gradually.

- Priorities: Poverty regions, mountain and remote areas, preventive health, traditional medicine, health care for poorer, mother and children health protection.

- Conducting pilot new final mechanism: receipt and expenditure self-balance

- Regulating hospital cost: in accordance with cost and techniques of each line, contribution of each region, payment of each participant

- Expanding health insurance coverage, moving closer to obligatory health insurance for everybody.

- Increasing mobilization and co-ordination of aid resources

2. For organization strengthening

- Reinforcing and perfecting organization system, network, perfecting sector management mechanism from provincial to primary level.

- Developing regional general hospitals in areas where far from provincial center, improving quality of general clinics in mountain and remote areas.

- Improving ability of preventive health system: Provincial preventive health center, Distric epidemic prevention and hygiene team, occupational disease clinic, Ergonomic health department (of some provinces), food safety control network.

- Strengthen professional inspection system.

- Re-establishing network and upgrading trained facilities, renewing content, improving quality, developing some colleges.

3. Reinforcing the management

- Training managers, decentralizing manage work.

- Improving ability for plan establishment

- Reinforcing temporary personnel

- Combining civilian and military medicine.

- Perfecting medical legal system: Pharmaceutical law, food state law, supplementing the law for private medico-pharmaceutical practice.

- Establishing regulations and policies for health personnel in mountain and remote areas.

- Conducting the democratic regulation.

4. Developing the health personnel resource

- Standardizing the health personnel for each line.

- Personnel training: according to specialty, ensuring the quantity per inhabitant, balancing between special fields.

- Post-graduated training and oversea training.

- Personnel circulation.

- Performing the serve duty in mountain and remote areas.

5. Strengthening and developing the foundamental health

- 100% of communes have health center

By 2005: 100% of general clinics are solid and have doctors.

- 65% of communes have doctors (mountain area: 50%)

-100% of communes have midwives (60% in which are middle-level midwives)

By 2010: 80% of communes have doctors (mountain area: 60%)

- 80% of communes have middle-level midwives.

- 100% of communes have assistant pharmacists and traditional medical personnel.

- 100% of hamlets have primary or higher level health workers.

6. Accelerating the prevention work, improving the health

Continuing targets of national program to eradicate some deadly social and epidemic diseases.

Non-communicable disease control and preventive program.

Epidemic prevention: large epidemics are not permitted occur

Projects for quickly overcome disasters, natural calamities.

Control and protection against traffic accident injuries.

Health, labour environment and garbage treating surveillance.

7. Curative care and consultation

Upgrading synchronically the curative care and consultation system, delimiting technical-special lines, regulating the line reference, curative care and consultation network, increasing number of beds for insufficient areas, standardizing route equipment and techniques, exhausting capacity.

Establishing appropriate drug list. Using inner drugs. Rehabilitation, prevention of complications.

Developing the hospital regulation, ensuring the essential demands in curative care and consultation facilities.

Multi-formalizing the curative care and consultation activities.

8. Developing the traditional medicine and pharmacy.

Performing continuously the 25/1999/CT-TTg instruction for traditional medicine.

9. Drug and health equipment

- National drug policy: Ensuring provide sufficiently quality drugs and efficient, safe and sensible drug use.

- Reinforcing pharmaceutical manage system.

- Scheme and reorganization of pharmaceutical industry: centralization and professionalization, investment with focus and efficiency. By 2010 all of enterprises reach GMP, modernizing the drug delivery system.

- Completing legal document system for medical equipment, investing modern medical equipment, developing medical equipment industry.

10. Developing scientific technology and health information

- Applying modern techniques, build-up a standard laboratory and 3 specific health centers for food safety and quality.

- Developing the biotechnology and automatization.

- Building-up regional specific health centers.

- Developing information technology and manage statistics.

11. Socializing the health work

- Performing continuously the 90/CP resolution dated 21/8/97 about health work socialization: incorporating works

- Multi-formalizing health care patterns.

- Establishing advanced symbolic personnel.

- Strengthening and developing the health education and communication.  

RESPONSIBILITY FOR DEVELOPMENT, FOLLOW-UP AND CONDUCTION OF STRATEGY

1. Based on directive view-point in the strategy of health care and prevention for people in 2001-2010 period, striving targets by 2010, Departments, Services and Office of Health Ministry, Health Departments of provinces and cities need to study establishing projects to develop each problem, plan out detailed act-scheme for every 5 year and every year.

1.1. Planing: Establishing projects to improve management ability, investment, civilian-military combination in health care.

1.2. Personnel organizing: Establishing project to strengthen the health organization and network, arranging health personnel resources.

1.3. Curative care activity: Completing the curative care and consultation network, establishing regulations for technical delineation of areas and conduction-management of hospitals.

1.4. Prevention: Establishing the project to improve the preventive system, supervising the performance of target programs and environment health problems.

1.5. Scientific-training work: Establishing the project to re-arrange network of training facilities, standardize personnel training for each line, establishing project to modernize techniques in diagnosis, bio-physics, immunology, genetics and molecular biology.

1.6. Mother and child health protection, family planning: Establishing the detailed plan to develop strategy of reproductive health care, family planning services, child health care.

1.7. Legislation, inspection: Completing the health legal system, establishing the project to strengthen professional inspective system.

1.8. Traditional medicine: Conducting the development to perform 25/1999/CT-TTg instruction. Establishing the project to develop medical traditional activities in CHCs.

1.9. Pharmaceutics - Equipment: Establishing the project to re-enforce and strengthen the pharmacological manage system of the State, completing the pharmacological development plan.

Standardizing the route equipment and techniques, building-up health technical-equipment service centers, developing the automatic technology in major health equipment manufacture.

1.10. Food safety and hygiene: Establishing some feasible studying projects to invest some standard laboratories and 3 professional centers in 3 areas for testing quality and safety of food.

1.11. Disaster and natural calamity prevention: Establishing the ways to prevent and overcome positively the consequences of disasters and natural calamities.

1.12. International co-operation: Establishing the cooperation strategy and the way for searching and exploiting investment resources from funding organizations.

1.13. Finance - account - health insurance: Establishing the project to determine investment proportion, balancing the budget between areas, sectors, exploiting inner investment resources. Project of pilot development for new financial regulation and mechanism (hospitals account the usual receipts and expenses by self). Project for expanding the coverage of voluntary and forced health insurance.

2. Based on situation of each region, Health Departments of provinces and cities need to establish prior targets, concentrating resources to resolve.

- Establishing detail health targets for each region by 2005-2010.

- Indicators of reduction of epidemic and disease morbidity and mortality.

- Targets of personnel resources.

- Establishing ways to mobilize resources for health.  

10 FOCAL TASKS OF HEALTH SECTOR IN 2001-THE FIRST YEAR CONDUCTING THE STRATEGY

1. Positively preventing epidemics, larger epidemics are not permitted happen. Positively preventing natural calamities. Developing biotechnology, concentrating to invest, research and manufacture some new generation vaccines and biological products for diagnosis and treatment. Upgrading test laboratories of some epidemic and hygiene/Pasteur institutes and preventive health centers.

2. Strengthening and developing the primary health system, ensuring the appropriation of health workers for helmets, increasing positioning doctors for communes, especially communes in mountain and remote areas.

3. Speed up vigorously the constructive investment of 3 special health centers (Ha Noi, Ho Chi Minh City and Central areas), developing regional health centers and expanding some novel and modern medical techniques in health curative and consultation. Developing actively the application of information technology into professional and manage works of sector.

4. Increasing the management of hospital to improve professional quality and medical ethic, resolving efficiently environmental problems of hospitals (including patient service, hospital sewage, building-up gradually nice-clean-green hospitals); developing a pilot self-account hospital in Ha Noi or Ho Chi Minh City.

5. Setting up 4 new universities (the Dental University, the Nursing University, the Traditional Medico-Pharmaceutical University and the Public Health University); ugrading 2 Central Medical Technique High Schools into 2 Medical Colleges.

6. Developing vigorously the National Health Target Program (10 targets); National strategy for Reproductive Health Care. Maintaining steadily the reductive trend of birth, morbidity and mother, neonatal and child death rate.

7. Developing synchronously health care resolutions for poorer, for people in mountain and remote areas; increasing the combination between civilian and military medicine, especially in borderlands and islands. Well performing the Decisions N^o 135/1998/QD-TTg and N^o 1196/CP-KTTH dated 28/12/2000 of Primer Minister for delivery free charge drugs in CHCs and provide free charge health care for poverty areas.

8. Improving the quality of inner-manufacture drugs and equipment, by the end of 2001 there are 25 pharmaceutical enterprises reached GMP standard (ASEAN), 3 drug public stores reached GSP standard, ensuring the economic growth rate in Vietnam pharmacological sector is more than 12%; 50% of health equipment manufacture and service facilities reach ISO 9002 standard, the economic growth rate is more than 10%.

9. Expanding the coverage of health insurance, increasing voluntary health insurance certificates by 10%; developing the health care services which under the cover of health insurance at communal level of provinces and cities.

10. Establishing the detail guidelines for managing and performing aid projects and programs. Speed up qualitatively and efficiently the development of projects with loan and aid capital. Focus on projects with the aid of EC, ADB, WB, JICA... in which ensuring to pay up to 70% of budget of National Health Support Project.