Circular No. 38/2016/TT-BYT dated October 31, 2016 of the Ministry of Health on providing for measures for encouraging the breastfeeding at health facilities

THE MINISTRY OF HEALTH

Circular No.38/2016/TT-BYTdated October 31, 2016 of the Ministry of Health on providing for measures for encouraging the breastfeeding at health facilities

Pursuant to the Government’s Decree No. 63/2012/ND-CP dated August 31, 2012 defining the functions, tasks, powers and organizational structure of Minister of Health;

At the request of Director ofMaternaland ChildHealthDepartment;

Minister of Health promulgates this Circular to provideformeasures forencouraging thebreastfeeding at health facilities.

Article 1. Scope of adjustment

This Circular provides for measures for encouraging the breastfeeding at health facilities, including “Mườiđiều kiện nuôi con bằng sữa mẹ”(Ten steps to successful breastfeeding) and “Bệnh viện Bạn hữu trẻ em”(Baby-friendly Hospital).

Article 2. Practice of “Ten steps to successful breastfeeding” at health facilities

1. “Ten steps to successful breastfeeding”consist of:

a) Have a written breastfeeding policy;

b) Train all health care staff in skills necessary to implement thisbreastfeedingpolicy;

c) Inform all pregnant women about the benefits of breastfeeding;

d) Help mothers initiate breastfeeding within a hour of birth, maintain exclusive breastfeeding up to 6 months of age and continue the breastfeeding up to 24 months of age or beyond;

dd) Show mothers how to breastfeed and how to maintain lactation;

e)Give newborn infants no food or drink other than breast milk unless medically indicated;

g)Practice rooming-in -allow mothers and infants to remain together-24 hours a day;

h) Encourage breastfeeding on demand;

i) Give no artificial teats or pacifiers to breastfeeding infants;

k) Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital.

2.Practice of“Ten steps to successful breastfeeding”:

General hospitals having the obstetrics and/or pediatrics, maternity hospitals, children’s hospitals or maternity and pediatric hospitals (hereinafter referred to as hospitals) are responsible for practicing “Ten steps to successful breastfeeding”. To be specific:

a) Promulgate regulations on the practice of“Ten steps to successful breastfeeding” at health facilitiesin a popular and easily understandable language and communicate them to all health care staff. Post regulations on the practice of “Ten steps to successful breastfeeding” atantenatal carerooms, labor and delivery rooms, postpartum rooms, nutrition counseling rooms or other easy-to-notice places to serve pregnant women, breastfeeding mothers and their families;

b) Organize training classes in or put the following contents into specialized training classes for doctors and health care staff, including necessary skills in counseling, guidelines for correct breastfeeding, expression and storage of breast-milk, maintaining lactation and resolving breastfeeding difficulties as regulated in Decision No.5063/QD-BYTdated December 05, 2014 by Minister of Health promulgating training materials in infant feeding;

c)Provide counseling and inform all pregnant women who visit the hospitals about the benefits of breastfeeding, early initiation of breastfeeding which means the infant is breastfed within a hour of birth, exclusive breastfeeding for the first six months and sustaining breastfeeding to 24 months of age or beyond;

d) Provide counseling and instructions for mothers on how to initiate breastfeeding within a hour of birth as regulated in Decision No.4673/QD-BYTdated November 10, 2014 by Minister of Health giving approval for written guidelines for essential care of mothers and newborns in labor and postnatal period;

dd) The obstetrics and pediatrics shall provide instructions for pregnant women, new mothers and mothers breastfeeding infants aged less than 24 months on how to breastfeed, express and store breast milk, and maintain lactation in proper manner;

e)Propagateand provide instructions for mothers to exclusively breastfeed their infants and givetheirinfants no food or drink other than breast milk unlessfollow-up formula are used asmedically indicatedby Ministry of Health;

g) Practice rooming-in - allow mothers and infants to remain together - 24 hours a dayto ensure that infants are breastfed exclusively;

h)Propagate and provide instructions for postpartum mothers to breastfeed their infants on demand;

i) Propagate and provide instructions mothers breastfeeding infants aged less than 24 months to give no artificial teats or pacifiers totheirinfants;

k) Establish and maintain operations of “Breastfeeding support groups” at health facilities to provide instructions, counseling and supports for breastfeeding mothers.

Article 3. Accreditation of “Baby-friendly Hospital” title

1.Criteria for accreditation of “Baby-friendly Hospital”title:

Hospitals meet the criteria for successful breastfeeding mentioned in Part E. Specialized criteria of the Criteria for assessing hospital’s quality promulgated under Decision No.4858/QD-BYTdated December 03, 2013 by Minister of Health on pilot promulgation of the Criteria for assessing hospital’s quality (hereinafter referred to as the Criteria for assessing hospital’s quality) at level 4 or higher.

2.Responsibility to practice the“Baby-friendly Hospital”title:

Each hospital’s head has the responsibility to instruct the hospital s units to implement contents specified in Article 2 herewith and conduct self-assessment based on the criteria for successful breastfeeding mentioned in Part E. Specialized criteria of the Criteria for assessing hospital’s quality. To be specific:

a) After the self-assessment of the hospital’s quality, hospitals affiliated to Ministry of Health and hospitals affiliated to Health Authorities of Ministries/relevant regulatory bodies shall send reports on self-assessment results of the satisfaction of the criteria for successful breastfeeding mentioned in Part E to Ministry of Health (viaMaternal and Child Health Department).

b) Hospitals affiliated to Departments of Health shall send reports on self-assessment results to Departments of Health. Departments of Health shall assume responsibility to verify self-assessment results of the satisfaction ofthe criteria for successful breastfeeding mentioned in Part E. Specialized criteria of the Criteria for assessing hospital’s qualityby their affiliated hospitals and announce the list of hospitals eligible for the “Baby-friendly Hospital”title as regulated in Clause 1 Article 3 herewith. In addition, Departments of Health must send the list of hospitals eligible for the “Baby-friendly Hospital”title to Ministry of Health (viaMaternal and Child Health Department) for consolidating into the annual list of hospitals eligible for the “Baby-friendly Hospital”title.

3. Accreditation of “Baby-friendly Hospital” title:

a)With regard tohospitals affiliated to Ministry of Health and hospitals affiliated to Health Authorities of Ministries/relevant regulatory bodies: TheMaternal and Child Health Departmentshall, based on reports on self-assessment results of the satisfaction of the criteria for successful breastfeeding mentioned in Part E submitted by the hospitals, consider, consolidate and submit the annual list of hospitals eligible for the “Baby-friendly Hospital”title to Minister of Health for approval.

b) With regard to hospitals affiliated toDepartmentsof Health:Ministry of Health shall, based on the list ofhospitals eligible for the “Baby-friendly Hospital” titleannounced by Departmentsof Health, consolidate accredited hospitals into the annual list of hospitalseligible for the “Baby-friendly Hospital” titlefor monitoring.

c) The accreditation of the“Baby-friendly Hospital” titleshall be the basis for evaluating the hospital s performance and considering giving annual emulative title and reward to that hospital.

d) Ministry of Health establishes an inspection team to conduct irregular inspection of the satisfaction of the criteria forthe “Baby-friendly Hospital” title, notify the hospitals if they fail to maintain the satisfaction of the criteria forthe “Baby-friendly Hospital” titleand report to Departments of Health ofcentral-affiliated citiesor provinces of unqualified hospitals. In addition, propose removing unqualified hospitals from the annual list of hospitals eligible forthe “Baby-friendly Hospital” title. The inspection team is composed of heads and specialists of theMaternal and Child Health Department,the Legal Departmentand the Agency of Health Examination and Treatment. The head of theMaternal and Child Health Departmentshall act as the leader of the inspection team.

Article 4. Implementation responsibilities

1. Maternal and Child Health Departmentshall take charge and coordinate with the Agency of Health Examination and Treatment in providing professional instructions, supervising and monitoring the fulfillment of duties by health facilities, doctors and health care staff working in health facilities as regulated in Article 12 and Article 13 of the Government’s Decree No.100/2014/ND-CPdated November 06, 2014 providing for trading and use of nutritious products for infants, feeding bottles and teats; consolidating and submitting the annual list of hospitals eligible for the“Baby-friendly Hospital” titleto Minister of Health; inspecting the satisfaction of criteria for the“Baby-friendly Hospital” titleby hospitals.

2.The Agency of Health Examination and Treatment shall take charge and coordinate with theMaternal and Child Health Departmentin organizing the implementation of thecriteria for successful breastfeeding mentioned in Part E. Specialized criteria of the Criteria for assessing hospital’s quality, and inspecting the satisfaction of criteria for the“Baby-friendly Hospital” titleby hospitals.

3.Departments of Health ofcentral-affiliated citiesor provinces shall assign Centers forReproductive HealthCare to take charge of assisting Departments of Health ofcentral-affiliated citiesor provinces in verifyingself-assessment results of the satisfaction of the criteria for successful breastfeeding mentioned in Part E. Specialized criteria of the Criteria for assessing hospital’s quality by their affiliated hospitals. Departments of Health ofcentral-affiliated citiesor provinces shall send annual consolidated reports thereof toMaternal and Child Health Departmentdirectly under Ministry of Health.

Article 5. Transitional provisions

If documents referred to in this document are replaced or amended, the new ones shall apply.

Article 6. Effect

1.This Circular takes effect on January 01, 2017.

2.Director ofMaternal and Child Health Departmentshall take charge and coordinate with relevant authorities in consolidating and inspecting the implementation of this Circular, and send annual report thereof to Minister of Health.

Any difficultiesarising in the course ofimplementation of this Circular should be reported to the Ministryof Health (via theMaternal and Child Health Department)for consideration./.

For the Minister

The Deputy Minister

Nguyen Viet Tien