DECISION

APPROVING THE MASTER PLAN ON DEVELOPMENT OF VIETNAM'S HEALTHCARE SYSTEM UP TO 2010 WITH A VISION TO 2020

THE PRIME MINISTER

Pursuant to the December 25, 2001 Law on Organization of the Government;
Pursuant to the June 30, 1989 Law on Protection of the People's Health;
Pursuant to the Government's Decree No. 49/2003/ND-CP of May 15, 2003, defining the functions, tasks, powers and organizational structure of the Ministry of Health;
At the proposal of the Minister of Health,

DECIDES:

Article 1.- To approve the master plan on development of Vietnam's healthcare system up to 2010 with a vision to 2020 with the following principal contents:

1. Under this master plan, the healthcare system covers the network of provision of preventive medicine, grassroots healthcare, medical examination and treatment and functional rehabilitation services, and the network of drug production, circulation, distribution and supply.

2. General objectives: To build Vietnam's healthcare system step by step modern and complete to achieve equality, effectiveness and development; to meet the increasing and diversified demands of the people for health protection, care and improvement; to reduce morbidity and mortality rates, increase life expectancy, and improve living quality; to achieve and overachieve the targets set in the 2001-2010 strategy for the people's health care and protection.

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a/ To invest in developing the preventive medicine network capable of forecasting, monitoring and controlling epidemics with a view to reducing morbidity and mortality rates, covering the following principal contents:

- Proactively and actively preventing and controlling epidemics, preventing the occurrence of big epidemics.

- Forecasting and controlling all dangerous epidemics and epidemic vectors, especially newly appeared epidemics.

- Preventing and controlling non-infectious diseases and injury-inflicting accidents.

- Keeping the rate of people infected with HIV/AIDS below 0.3% of the population by 2010 and afterwards.

b/ To invest in rearranging the medical examination and treatment and functional rehabilitation networks in the direction of:

- Developing the medical examination and treatment network based on residential areas rather than administrative boundaries; local health units shall be managed by the health service to ensure that all the population shall have convenient access to medical examination and treatment services at all levels.

- Ensuring systematic and continued professional operations of each level of treatment and the balanced and rational development between general and specialized hospitals.

- Incrementally relocating establishments that treat dangerous communicable diseases to appropriate places.

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- Striving for the target that by 2010, the number of hospital beds per 10,000 inhabitants (excluding commune health station beds) will reach 20.5 (including two private hospital beds) and by 2020, 25 (including 5 private hospital beds).

- Consolidating and modernizing existing traditional medicine hospitals at the central level to reach grade-I hospital standard; building traditional medicine hospitals in provinces where such hospital do not exist yet, which shall operate as both treatment and practice establishments for health workers studying at traditional medicine and pharmaceutical schools.

c/ To consolidate and perfect the grassroots healthcare network, improve the people's access to essential health services. By 2010, to ensure that most communes will have solidly built health stations and 80% of communes have health stations up to national standard.

d/ To develop pharmacy into a spearhead econo-technical branch. To strongly develop the pharmaceutical industry, increase the domestic drug manufacture capacity, prioritize the manufacture of hi-tech pharmaceuticals. To plan and develop pharmaceutical material areas as well as pharmaco-chemicals production establishments. To strengthen and develop the network of drug circulation, distribution and supply to ensure the proactive, regular and sufficient supply of quality drugs at reasonable prices and stabilize the market of preventive and curative medicines for the people. To step up research into and production of vaccines and medical bio-products. To ensure food hygiene and safety, prevention and elimination of food poisoning and food-borne diseases.

4. Contents of development of Vietnam's healthcare system:

To develop Vietnam's healthcare system along the line of socializing healthcare work in which state-owned health establishments shall play the key role; to incrementally meet the people's demand for health protection, care and improvement with health services of higher and higher quality and suitable to socio-economic conditions; to strive for equality and effectiveness in the provision and use of health services.

a/ To consolidate and develop preventive medicine networks:

- At central and regional levels:

+ To continue developing, and improving the capability of, central and regional preventive medicine establishments in the capacity as leading or regional units so that they shall properly perform the tasks of researching, forecasting, monitoring, detecting and controlling diseases and epidemics, especially dangerous and newly appeared ones.

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+ To upgrade two laboratories for testing insecticidal and germicidal chemicals, one in the north and the other in the south, with complete and modern equipment and facilities up to Vietnam standard by 2010 and to international standard by after 2010.

- At the provincial level:

+ To ensure that 100% of provincial preventive medicine centers shall have testing laboratories up to grade-1 bio-safety standard. In region-representing provinces and some big cities, to build at preventive medicine centers testing laboratories up to grade-2 bio-safety standard, which shall be capable of monitoring and detecting epidemics and performing all tests in service of professional medical activities.

+ To invest in, develop, and improve the capability of, international medical quarantine centers to meet the requirement of international medical quarantine.

+ To develop and strengthen labor medicine centers of ministries and branches and in provinces and cities where industrial parks exist, which shall all be named Labor Health and Environment Protection Center.

+ To further improve Reproductive Health Protection Centers and Health Communication and Education Centers in provinces and centrally run cities.

+ To maintain and upgrade existing malaria prevention and control centers in provinces with high malaria morbidity and prevalence rates. After 2010, in provinces with under 100 patients newly infected with malaria per 100,000 people annually for at least five consecutive years, their malaria prevention and control centers shall be merged into provincial preventive medicine centers.

+ To step by step merge existing social diseases prevention and control centers into provincial preventive medicine centers or provincial general hospitals.

+ To build and perfect HIV/AIDS prevention and control centers in all provinces and centrally-run cities.

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To build and develop district preventive medicine centers which shall be capable of carrying out epidemiological surveillance, hygiene and epidemiological prevention and control, HIV/AIDS prevention and control, health communication and education, reproductive health care and building of cultured-healthy village.

b/ To develop the networks of medical examination and treatment and functional rehabilitation:

- To form medical examination and treatment networks from lower to higher technical levels to ensure professional level continuity. Each establishment shall be responsible for providing medical examination and treatment for a residential cluster (not based on administrative boundary) and ensure hospital classification standards set by the Ministry of Health for each level:

- Level 1: consisting of grade-III standard hospitals including hospitals of districts and towns (collectively referred to as district hospitals), inter-district general hospitals, some hospitals run by different branches and private hospitals, which provide basic medical examination and treatment services and receive patients from communities or grassroots health stations.

l Each district or inter-district residential cluster shall have a district or inter-district general hospital. Level-1 hospitals shall each have between 50 and 200 hospital beds and, depending on geographical and population conditions, assure one hospital bed per 1,500-1,700 inhabitants.

l To maintain and develop regional general clinics of district hospitals in mountainous, deep-lying and remote areas to ensure the provision of basic health services to local inhabitants.

l By 2010, hospitals of towns and provincial cities shall be transformed into general clinics or specialized hospitals.

+ Level 2: consisting of general and specialized hospitals of provinces and centrally-run cities, private hospitals and some hospitals run by different branches in centrally-run cities, which meet grade-II or higher hospital standards, provide medical examination and treatment services with specialized techniques to meet most medical examination and treatment needs of local people and operate as practice establishments for students of medical and pharmacological schools in the provinces and cities.

l Each province shall have at least one general hospital with 300-800 hospital beds, each serving 1,600-1,800 inhabitants.

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l To develop traditional medicine and pharmacological hospitals in provinces, ensuring that each province shall have one traditional medicine and pharmacological hospital with 50-150 hospital beds.

l To build tuberculosis and lung diseases hospitals in provinces with the morbidity rate of 120 patients per 100,000 inhabitants or higher, with AFB-positive patients accounting for over 50%.

+ Level 3: consisting of hospitals of grade-I or special-grade standard, which provide highly specialized techniques, conduct scientific research and concurrently operate as practice establishments for students of medical and pharmaceutical universities.

l To maintain and develop existing central general hospitals each with 500-1,500 hospital beds. By 2010, central general hospitals which fail to meet grade-I hospital standards shall be transferred to provincial or municipal administrations for management.

l To continue consolidating and upgrading existing specialized hospitals and build new specialized hospitals to meet ever-increasing needs for specialized medical examination and treatment.

- To concentrate investment in perfecting specialized health centers in Hanoi, Ho Chi Minh City, Hue and Da Nang. To actively prepare for the building of a specialized health center in Can Tho after 2010.

- To prioritize investment in building regional general hospitals in Son La, Thai Nguyen, Hai Phong, Nam Dinh, Nghe An, Binh Dinh, Khanh Hoa, Dak Lak, Kien Giang and Tien Giang, each with 500-1,000 hospital beds and capable of meeting local people's medical examination and treatment needs with high professional quality and modern technology.

- To strengthen and develop convalescence and functional rehabilitation hospitals in provinces and cities and those run by ministries and branches so that they shall be able to balance budgets for their effective operations (not applicable to convalescence and functional rehabilitation establishments for wounded and diseased soldiers) in order to meet the population's and laborers' increasing demands for functional rehabilitation.

- To further invest in developing and expanding patient emergency transportation networks in all residential areas.

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- To further consolidate and perfect the grassroots healthcare networks in terms of material foundations, medical equipment and personnel, improve the quality of grassroots health services to meet the basic healthcare needs of the entire population, which shall also be able to perform certain simple techniques in examining and treating ophthalmological, dental, orthohinopharyngological diseases and diseases affecting reproductive health and child health.

- To consolidate the organization, network and professional activities of commune health stations. By 2010, most communes and wards shall have solidly built health stations suitable to economic, geographical and eco-environmental conditions and meeting local inhabitants medical examination and treatment needs.

- To ensure that 80% of commune health stations shall have medical doctors, of which 100% of health stations in delta communes and 60% of health stations in mountainous communes shall have medical doctors; 100% of commune health stations shall have midwives or assistant doctors specializing in obstetrics or pediatrics, of whom 80% are intermediate-level midwives; 80% of commune health stations shall have traditional medicine or pharmacological staff; on average, one commune health station worker shall serve 1,000-1,200 inhabitants. To ensure that each commune station shall have at least five health workers as prescribed by the Ministry of Health. In big cities, the number of health workers working at health stations shall be arranged to ensure that there shall be one ward health station worker per 1,400-1,500 inhabitants. To strive for 80% of communes nationwide reaching national standards on commune health stations by 2010.

- To ensure that each hamlet or village shall have one or two working health workers with an elementary or higher degree in medicine.

- Enterprises employing between 200 and under 500 workers must have one to three health workers in service. Enterprises employing 500 workers or more must establish their own health stations.

- To ensure that each general education school shall have one to two health workers in service. Each university, college or intermediate professional school shall have a health station.

d/ To consolidate and improve the capability of state management of pharmacy, develop the system of drug production, circulation, distribution and supply. To ensure food and cosmetics safety and hygiene.

- To strengthen and improve the capability of state management of pharmaceuticals, food safety and hygiene and cosmetics from the central to local level.

+ To strengthen management agencies in charge of pharmaceuticals, food safety and hygiene and cosmetics; to build, and perfect the functions and tasks of, centers for testing of pharmaceuticals, food safety and hygiene and cosmetics under provincial/municipal Health Services.

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+ To establish the National Institute of Testing of Food Safety and Hygiene on the basis of the Center for Testing of Food Safety and Hygiene now located at the Nutrition Institute. By 2010 to build three GLP standard centers for testing of food safety and hygiene in the northern mountainous region, Central Vietnam and the Mekong River delta and Ho Chi Minh City.

+ To strengthen state management agencies at all levels in charge of pharmaceuticals, food safety and hygiene and cosmetics.

- To plan and develop pharmacy into a spearhead econo-technical industry toward industrialization and modernization.

+ To plan and develop in a comprehensive manner the industries of preparation and manufacture of drugs from pharmaceutical materials, key pharmaceutical material zones, and the industry of manufacture of pharmaco-chemical materials and antibiotic materials for manufacture of drugs.

+ To plan, reorganize and develop the system of drug distribution and supply, ensuring a stabilized drug market with reasonable prices and quality medical examination and treatment services for the people.

5. Major solutions:

a/ Financial solutions:

- To create a breakthrough in accelerating state budget investment in the health sector to upgrade health establishments, with priority given to consolidating and perfecting the networks of grassroots healthcare and preventive medicine establishments, provincial-level and district-level general hospitals, especially those in the Central Highlands, northern mountainous region, Central Vietnam and Mekong River delta. To ensure funds for the implementation of state policies on medical examination and treatment for people with meritorious services to the revolution, the poor, under-six children and social policy beneficiaries.

- To adjust the norm of regular state budget expenditures on the health sector toward giving greater priority to mountainous provinces and deep-lying, remote and difficulty-hit areas.

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- To study, supplement and amend policies on collection of charges and fees for preventive medicine services as permitted by the State on the principle of offsetting part of basic expenses so as to generate revenues for additional investment in preventive medicine.

- To increase investment from the source of preferential credit capital in enterprises manufacturing drug materials, essential drugs and drugs for national target health programs. To develop policies to encourage investment in research and manufacture of specific drugs.

Investment projects on healthcare and drug manufacture shall enjoy the State' development investment credit supports according to regulations. To adopt policies on capital, land, tax and technology preferences for establishments conducting research into drugs and equipment for the pharmaceutical industry, especially for those researching and manufacturing drugs and equipment of types which cannot yet be manufactured in the country.

- To enhance international cooperation so as to make use of investment capital for the health sector.

- To socialize the health sector under the Government's Resolution No. 05/2005/NQ-CP of April 18, 2005, on stepping up socialization of education, healthcare, cultural, physical training and sports activities. To encourage the development of non-public health service establishments under the Government's Decree No. 53/2006/ND-CP of May 25, 2006. To promote propaganda and communication to mobilize contributions from organizations and individuals at home and abroad to healthcare activities.

- To give greater autonomy and accountability for the operation, organizational apparatus, payroll and finance to public health establishments under Decree No. 43/2006/ND-CP of April 25, 2006, with a view to bringing into full play their dynamism, creativity, sense of responsibility and operational efficiency.

- To enhance the management and use of financial sources invested in healthcare for proper purposes and with high efficiency.

b/ Human resource solutions:

To develop balanced and rational human resources for the health sector. To ensure the achievement of the following substantial targets: over 7 medical doctors per 10,000 inhabitants by 2010 and over 8 medical doctors per 10,000 inhabitants by 2020; one university-level pharmacist per 10,000 inhabitants by 2010 and 2-2.5 university-level pharmacists per 10,000 inhabitants by 2020, with at least 01-03 university-level pharmacists at district level. To ensure the ratio of 3.5 convalescence workers to 1 medical doctor at medical examination and treatment establishments. To develop a highly qualified medical human resources and postgraduate health personnel for health establishments. To increase the payroll norm on assistant pharmacists for commune health stations so as to ensure sufficient human resources for the supply of drugs at the commune level.

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To build two health workers training centers in Hanoi and Ho Chi Minh City up to the standards of those in advanced regional countries. To formulate an operation mechanism to enable these centers to pair up with foreign universities in conducting medical and administration training.

To draw up a plan on upgrading selected intermediate medical and pharmacological schools in some provinces and cities into colleges.

To promote training in various forms so as to fully supply qualified pharmaceutical officers for state management agencies in charge of pharmacy, non-business health establishments and pharmacy enterprises.

To organize short-term training courses on managerial work for health officials, especially hospital managers.

To formulate a scheme on training health personnel with high professional qualifications and technical skills for health service establishments at provincial and central levels.

To formulate a scheme on training ethnic minority people in the northern mountainous region, Central Vietnam and the Mekong River delta, who shall be selected through nomination. The People's Committees of the provinces in these regions shall be responsible for creating the source of such people and provide them with all necessary conditions so that they shall be trained in response to local requirements and with appropriate professional levels.

To continue properly implementing the scheme on selection and training of medical doctors for the Central Highlands.

To develop and propose policies on the selection, training, employment and preferential treatment of health personnel with high professional qualifications. To step up the overseas training of health personnel with state budget scholarships and foreign financial donations; to encourage health personnel to attend training with their own funds to improve their professional level.

To issue preferential policies for health workers, especially those at grassroots level, working in mountainous, deep-lying, remote, difficulty-hit and border areas and islands. To make and implement plans on health personnel rotation and an obligatory regime of health service in mountainous, deep-lying and remote areas for application to newly graduated medical doctors. To ensure appropriate allowances and benefits for health workers who are dispatched to work at lower levels.

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c/ Scientific and technological development:

To build national and international standard testing laboratories in Hanoi and Ho Chi Minh City for bio-safety, drug testing, food safety and hygiene, testing of vaccines and medical bio-products, and calibration of medical equipment.

To develop genetic and molecular bio-technologies, multiplication and tissue culture technologies to serve the production of drugs, vaccines and medical bio-products.

To develop and apply information technology to management and medical and pharmaceutical activities.

To attach importance to environmental sanitation. To research, apply and acquire modern technologies to treat hospital waste, invest in medical sterilization work in order to prevent the spread of disease germs from medical examination and treatment establishments, preventive medicine establishments and drug and bio-product manufacture establishments to the surrounding environment.

d/ Supply of medical equipment for health establishments:

- To expand the manufacture of common medical equipment and accelerate the manufacture of hi-tech medical equipment.

- To encourage investment in joint-ventures, cooperation and technology transfer with prestigious medical equipment manufacturers in the world.

- To build up an industry to manufacture medical equipment with priority and concentrated investment with a view to satisfying domestic demands and improving the quality of products for export.

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e/ Promotion of international cooperation:

To promote multilateral and bilateral cooperation with international organizations, non-governmental organizations, international banks and foreign governments which have implemented and are implementing policies to support and cooperate with Vietnam.

To perfect the mechanisms of receipt, use, supervision and inspection of foreign aid sources so as to make the best use thereof. To formulate key investment schemes to call for investment in and develop healthcare activities at regional, provincial and district levels and those in different domains in each period of development.

To mobilize non-refundable aid sources for medical examination and treatment of the poor, children and the disabled and for the prevention and combat of such dangerous diseases and epidemics as tuberculosis, malaria, HIV/AIDS and newly appreared diseases and epidemics.

To expand bilateral and unilateral cooperation in the development and application of advanced medical and pharmaceutical technologies. To promote training of health personnel in developed countries so as to quickly acquire and apply in an effective manner world advanced medical scientific achievements.

To encourage receipt of non-refundable aid for the formulation of policies to develop the health sector and for scientific research.

To expand joint venture and cooperation with foreign organizations and individuals to invest in the development of all aspects of the domestic health sector, striving to export certain medicines and health services.

f/ Management solutions:

To step up administrative reform, perfect the legal framework on healthcare suitable to the nation's socio-economic development situation.

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To raise the knowledge of state management and the sense of observance of law for health personnel. To properly implement the Regulation on democracy at all medical establishments, to launch and promote emulation campaigns, especially in the building of units and individuals as exemplary models in the sector.

6. Roadmap for realization of the planning:

a/ The 2006-2007 period:

- To concentrate efforts on consolidating and rearranging existing units and establishing new units, namely HIV/AIDS prevention and control centers in provinces and cities and district preventive medicine centers.

- To invest in upgrading district hospitals and regional general hospitals under the Prime Minister's Decision No. 225/2005/QD-TTg of September 15, 2005.

- To formulate a scheme on investment in the building of regional and provincial general hospitals. To prioritize capital for investment projects already approved by competent authorities.

- To make plans to relocate communicable diseases treatment hospitals to appropriate areas.

- To formulate a scheme on enhancing the capacity of sterilization work at hospitals.

- To concentrate investment in three specialized health centers.

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- To formulate schemes on establishment and upgrading of central and provincial laboratories for testing bio-safety and food safety and hygiene.

- To establish two or three regional centers for testing pharmaceuticals, food safety and hygiene and cosmetics.

- To establish two or three regional centers for testing bio-equivalence and assessing bio-availability of drugs.

- To establish some regional centers for drug information and monitoring of adverse and side effects of drugs in big cities.

- To formulate a detailed plan on development of the pharmaceutical industry and submit it to the Prime Minister for consideration and decision.

- To strengthen the organization, functions and tasks of the system of central and local management agencies in charge of pharmaceuticals, food safety and hygiene and cosmetics.

b/ The 2008-2010 period:

- To complete the construction of district hospitals and regional general hospitals. To accelerate investment in the building of regional general hospitals and provincial hospitals and three specialized health centers.

- To continue upgrading provincial preventive medicine centers.

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- To continue investing in projects which are not yet completed in the 2006-2007 period and invest in other projects included in the master plan up to 2010.

- To perfect and develop the drug distribution and supply system.

c/ The 2011-2020 period:

- To invest in the development of Can Tho specialized health center.

- To continue investing in further improving specialized health centers, regional hi-tech health centers and central and local health establishments to meet the people's demands for health protection, care and improvement.

Article 2.- Organization of implementation

The Ministry of Health shall assume the prime responsibility for, and coordinate with concerned ministries, branches and provincial/municipal People's Committees in, formulating programs and plans on, and organizing the supervision of, the implementation of the master plan; periodically review the implementation results and report them to the Prime Minister.

To assign the Ministry of Health:

- To assume the prime responsibility for, and coordinate with concerned ministries, branches and agencies in, formulating and submitting to the Prime Minister for approval a plan on development of medical examination and treatment networks.

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- To coordinate with the Ministry of Home Affairs and concerned ministries and branches in formulating a scheme on organizational consolidation and improvement of the capability of state management of pharmaceuticals, food safety and hygiene and cosmetics, and submitting it to the Prime Minister for consideration and decision.

The Ministry of Planning and Investment shall be responsible for allocating and balancing investment resources for the implementation of the master plan according to schedule; and supervise the implementation of the master plan nationwide.

The Ministry of Finance shall be responsible for assuring state budget sources for the health sector according to five-year and annual plans. Together with the Ministry of Health to balance the budget for the entire health sector and for prioritized domains already identified in the master plan.

Ministries and branches shall have to collaborate with the Ministry of Health in arranging their respective resources for the development, consolidation and improvement of the quality of their attached health establishments.

Presidents of provincial/municipal People's Committees shall be responsible for directing and organizing the implementation of the master plan on development of the healthcare system in their localities.

Article 3.- This Decision shall take effect 15 days after its publication in "CONG BAO." It shall not apply to the healthcare systems of the Ministry of Defense and the Ministry of Public Security.

Article 4.- Ministers, heads of ministerial-level agencies, heads of government-attached agencies, and presidents of provincial/municipal People's Committees shall have to implement this Decision.