Decision 2033/QD-BYT 2018 National Action Plan on advocacy for dietary sodium intake reduction in 2018 - 2025

DECISION

Approving the National Action Plan on communication and advocacy for dietary sodium intake reduction for prevention and control of hypertension, stroke and other non-communicable diseases in the 2018 - 2025 period

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THE MINISTER OF HEALTH

Pursuant to Decree No. 75/2017/ND-CP dated June 20, 2017 of the Government defining the functions, tasks, powers and organizational structure of the Ministry of Health;

Pursuant to Decision No. 122/QD-TTg dated January 10, 2013 of the Prime Minister on promulgating the National Strategy for People's Health Protection, Care and Improvement in the 2011 - 2020 period with a vision to 2030;

At the proposal of the Director of the General Department of Preventive Medicine,

DECIDES:

Article 1. To approve the National Action Plan on communication and advocacy for dietary sodium intake reduction for prevention and control of hypertension, stroke and other non-communicable diseases in the 2018 - 2025 period (hereinafter referred to as the Plan) with the content as follows:

I. OBJECTIVES

1. General objectives

To establish an environment that supports and helps to raise awareness and change the behavior of citizens so that they would reduce sodium intake in their daily diet to prevent and control hypertension, stroke, cardiovascular diseases and other non-communicable diseases, thus contributing to people’s health protection, care and improvement.

2. Specific objectives until 2025

a) Objective 1. To raise awareness and make behavior changes in the population to reduce sodium intake in their daily diet

Targets:

- More than 90% of adults know the harm of excessive sodium intake, identify high-sodium foods and know measures to reduce sodium intake.

- More than 60% of adults implement at least 1 measure to reduce sodium intake in their daily diet.

- The average sodium intake of an adult is reduced to under 7 gram per day.

- More than 90% of primary and secondary school-children understand the harm of excessive sodium intake and identify high-sodium foods; more than 70% of school-children implement at least 1 measure to reduce sodium intake as recommended.

- 100% of boarding schools and semi-boarding schools that serve school meals adopt the low-sodium diets for school-children.

- More than 90% of people detected of contracting hypertension, cardiovascular diseases and other related diseases are counseled and instructed on adopting the low-sodium diet.

b) Objective 2. To strengthen the responsibility of the authorities at all levels, agencies and sectors, and mass organizations for developing and implementing policies and mechanisms to generate sustainable resources for interventions to reduce people's dietary sodium intake.

Targets:

- 90% of relevant ministries, agencies, sectors and mass organizations collaborate with the Ministry of Health to promulgate policies and implement communication intervention plans for reducing sodium intake in the people’s diet.

- 90% of provinces and centrally-run cities allocate funds and implement the health sector’s communication plans and interventions to reduce dietary sodium intake in the localities.

c) Objective 3. To raise the sense of responsibility of organizations and individuals that produce and trade foods, food and beverage establishments to implement interventions to reduce people's dietary sodium intake

Targets:

- More than 30% of food and beverage businesses and establishments implement at least 1 measure to reduce sodium in cooking, processing and provision of foods.

- More than 30% of processed food producers have at least 01 low-sodium product and disclose the sodium content on the product labels that indicate high-sodium foods and make warning about health problems due to excessive sodium intake.

d) Objective 4. To raise capacity and efficiency of surveillance, counseling and guidance on low-sodium diets in health facilities and the community

Targets:

- 90% of relevant health workers in health facilities are fully competent and give consultancy and instructions on low-sodium diets in management and treatment of patients of hypertension, cardiovascular, diabetes and other related diseases.

- 90% of related district- and commune-level health workers and hamlet-level health staff are competent and disseminate information and advise local people on sodium intake reduction.

- To establish a database and collect statistics periodically to manage and monitor the dietary sodium intake, sodium content in common foods and effectiveness of interventions.

II. SCOPE OF IMPLEMENTATION, TARGET AUDIENCE AND DURATION

1. Scope of implementation: The plan is implemented nationwide (63 provinces/cities).

2. Duration of the plan: from 2018 to 2025.

3. Target audiences and key points to be communicated

a) Target audience and key points to be communicated regarding Objective 1:

- Target audience: Communities; school-children’s parents; officers, teachers, school-children, health staff, kitchen staff of schools; high-risk people and patients of cancer, cardiovascular diseases and hypertension.

- Key points to be communicated:

+ What is excessive sodium intake? How to identify high-sodium foods?

+ Harm of excessive sodium intake.

+ Measures to reduce sodium intake.

+ Instructions on reading food product packaging labels.

b) Target audience and key points to be communicated regarding Objective 2:

- Target audience: Leaders of authorities, ministries, agencies, sectors and mass organizations at all levels; National Assembly and people’s council deputies, and National Assembly Delegation of provinces/centrally-run cities; domestic and international organizations.

- Key points to be communicated:

+ Scientific evidence on the harm of excessive sodium intake to health.

+ Health and economic benefits obtained if diseases due to excessive sodium intake are prevented.

+ Dissemination of relevant policies and legal documents.

+ Experience of different countries on sodium intake reduction.

+ Mobilization of resources for communication and interventions to reduce sodium intake.

c) Target audience and key points to be communicated regarding Objective 3:

- Target audience: Organizations and individuals engaged in food production and trading; food and beverage establishments.

- Key points to be communicated:

+ Dissemination of relevant policies and legal documents

+ Scientific evidence on the harm of excessive sodium intake to health.

III. KEY ACTIVITIES AND SOLUTIONS

1. Policy and legal solutions

a) To enhance enforcement, revision and improvement of relevant polices and legal regulations on reduction of sodium in the people’s diet:

- To study and propose supplementations to regulations on food labeling, such as: disclosure of the sodium content in products, warning about high-sodium foods, warning about the harm to health of excessive sodium intake and recommendations on the maximum sodium intake per day.

- To propose supplementations to regulations in order to control and limit advertising and marketing of food products containing excessive sodium, especially those for children and high-risk groups.

- To propose, revise and improve policies and regulations on serving school meals and providing low-sodium foods that are good for health of children, school-children and students.

- To propose and make policies to encourage production, supply and consumption of safe, low-sodium and healthy foods.

- To embrace and implement Decree No. 09/2016/ND-CP on fortification of food with micronutrients, especially iodine fortified sodium.

b) To establish a mechanism of inter-sectoral collaboration from the central to local levels and promote involvement of organizations, individuals and the community in conducting activities to reduce people’s dietary sodium intake.

2. Communication and social mobilization solutions

a) To efficiently use the information and communication system from the central to local levels so as to perform information, education and communication activities on low-sodium intake for prevention and control of hypertension, stroke, cardiovascular diseases and other non-communicable diseases.

b) To compile and provide communication messages and materials on sodium intake reduction appropriate to communication modes and target audiences, including: (1) mass media, (2) policy advocacy, (3) community-based communication, (4) communication and guidelines displayed at food and beverage establishments, (5) in-school communication, (6) communication to food producers and traders.

c) To promote communication programs and activities to raise awareness and sense of responsibility of the authorities at all levels, ministries, agencies, sectors, mass media and food producers and traders:

- To organize conferences and seminars to provide information and scientific evidence on the harm of excessive sodium intake and sodium intake reduction measures to managers, policy-makers and related enterprises.

- To conduct study tours and share domestic and international experience on enforcement of dietary sodium intake reduction policies and interventions.

- To conduct advocacy communications on mass media, develop a column in newspapers, and hold television talks on the topic of sodium intake reduction for prevention and control of hypertension, stroke, cardiovascular diseases and other non-communicable diseases.

d) To implement communication programs and campaigns in order to make behavior changes:

- To conduct a national communication campaign annually on the topic of universal sodium intake reduction for prevention of hypertension, stroke, cardiovascular diseases and other non-communicable diseases.

- To conduct sodium intake reduction communication programs and campaigns integrated into annual health days or events such as: World Cancer Day, World Health Day, World Hypertension Day, World Heart Day, World Stroke Day, Nutrition and Development Week, etc.

- To continue to enhance behavior change communication on sodium intake reduction via face-to-face communicators in the communities.

- To develop and broadcast communication messages on sodium intake reduction on Vietnam Television and the Voice of Vietnam; post communication articles on electronic newspapers and traditional newspapers; periodically broadcast communication messages on sodium intake reduction on the provincial/municipal radio and television and on public address systems ò communes/wards nationwide.

- To apply new communication forms such as the Internet, SMS, and social networks by posting articles and messages, constructing a portal on public health with a column on sodium intake reduction guidance, creating fanpages on sodium intake reduction on social networks.

- To design and disseminate communication materials on sodium intake reduction: billboards for provinces/cities, sets of illustrations and communication manuals for commune health stations, and posters for commune health stations, enterprises, agencies and schools.

- To display posters and messages, distribute leaflets on sodium intake reduction in markets, supermarkets, food and beverage establishments.

3. Professional and technical solutions

a) Interventions to reduce sodium intake in schools

- To organize seminars/training courses to raise awareness and guide communication for education managers, teachers, school health staff; training cooking and waiting staff on measures to reduce sodium intake in the course of selecting and processing foods and serving meals to school-children.

- To conduct communication and training activities for school-children and students to have low-sodium diets and minimize fast foods, processed foods and snacks.

- To serve low-sodium school meals with proper nutrition to semi-boarding and boarding school-children, including: selecting low-sodium foods; reducing salt when preparing meals; reducing salt, spices and sauce on the dining table; providing and disseminating messages, warnings, and instructions on sodium intake reduction at kitchens, dining tables, restaurants and canteens in schools.

- To manage the operation of school canteens and catering services to limit school-children’s access to high-sodium foods; enforce regulations on banning sales of unhealthy foods at school gates.

- To perform counseling on health, nutrition and sodium intake reduction with school-children, their parents; periodically monitor the nutrition and growth status and perform health checks for school-children in order to early detect health risks and diseases.

b) Interventions to reduce sodium intake of high-risk people and patients

- To develop knowledge dissemination materials, use electronic portals to provide information and guidance on low-sodium diets for patients of hypertension, cardiovascular diseases and other non-communicable diseases.

- To develop professional guidance documents, hold training courses to enhance capacity for health workers at all levels on nutrition counseling, sodium intake reduction in treatment, care and management of patients, especially for grass-root health workers.

- To provide counsels and guidance on low-sodium diets in treatment of hypertension, cardiovascular diseases and other related diseases in health facilities.

- Commune health workers shall provide counsels and guidance on sodium intake reduction to patients of hypertension and cardiovascular diseases receiving outpatient treatment at health stations; hamlet health staff shall visit families to measure blood pressure and monitor and encourage hypertension patients to apply low-sodium diets and adhere to treatment at home.

c) Interventions to reduce sodium intake in households and the community

- To provide training courses on sodium intake reduction communication and counseling to hamlet health staff, collaborators and commune health workers; organize seminars to raise awareness and seek support and involvement of local authorities and mass organizations in the community-based sodium intake reduction programs.

- To broadcast communication messages and articles on commune/ward public address systems.

- To arrange hamlet health staff’s and collaborators’ visits to households to distribute communication materials, give counsel and guidance on sodium intake reduction practice to the people focusing on the following aspects: (1) the harm of excessive sodium intake to health and recommendations on sodium intake reduction, (2) how to identify high-sodium foods, (3) how to reduce sodium in cooking/preparing foods, (4) reduction of fish sauce, salt and salty condiments on the dining tables. To visit households to measure blood pressure, give counsel to suspected hypertension patients and persuade them to visit health stations for diagnosis and treatment.

- Commune health staff shall collaborate with hamlet health staff and collaborators to organize community meetings and public talks, which can be integrated into hamlet meetings, women’s meetings, elderly meetings, authorities’ meetings and other community meetings, to provide sodium intake reduction messages.

- To implement and roll out clubs and gatherings of Women’s Unions to share knowledge and experience on low-sodium recipes for households.

- To consolidate and maintain clubs of diabetes patients, hypertension patients, cardiovascular disease patients, etc. at the commune/ward level.

d) Interventions to reduce sodium intake at food and beverage establishments (restaurants, food shops and canteens, etc.)

- To collaborate with food and beverage establishments to take measures to reduce sodium intake in their menus.

- To provide materials, guidance and training to chefs, cooks and restaurant staff on techniques and measures to reduce sodium intake reduction in their menus.

- To apply sodium intake reduction measures in restaurants, including: selecting low-sodium foods; reduce salt in preparing and cooking foods; reduce the types and quantities of condiments, fish sauce and salt available on tables.

- To provide warning messages on the harm of excessive sodium intake to health and recommendations on sodium intake reduction for customers: (1) displaying posters in restaurant precincts, (2) displaying messages and instructions in kitchens, (3) displaying warning messages and advice on tables, (4) marking and noting high-sodium foods in the menus.

dd) Interventions to reduce sodium intake at food production and trading establishments

Food producers and traders shall implement measures to reduce salt in packaged foods; and for the immediate future, select certain common high-sodium foods:

- To supplement details of food on labels, including: (1) disclosing the sodium content added to the foods, (2) giving warning about high-sodium foods, (3) give warning about the harm of excessive sodium intake to health and recommendations on the maximum sodium intake per day.

- To reduce the sodium content in foods for certain types of packaged foods.

- To apply scientific and technological measures to produce low-sodium salt or sodium replacements ensuring proper nutrition and food safety.

4. Resource solutions

a) To develop human resources

- To strengthen and enhance the capacity of nutrition staff and grass-root health workers, especially hamlet health staff and nutrition collaborators on communication and counseling for people in the community to reduce dietary sodium intake.

- To enhance the capacity of nutrition and dietetics staff and clinical physicians in health facilities to develop menus and give guidance on nutrition and low-sodium diets for treatment and management of patients of hypertension, cardiovascular diseases and other related diseases.

b) To ensure financial resources

- To provide adequate finance for sodium intake reduction interventions, which shall be covered by various sources: central and local State budget, health insurance, socialization and other legal sources, in which the State budget shall be used with priority for communication, surveillance and interventions for community-based sodium intake reduction.

- To mobilize and seek contribution from enterprises, organizations and individuals to provide resources for applying technological solutions, developing community-based sodium intake reduction models and enabling people to practice healthy behaviors.

5. Scientific research, monitoring and surveillance solutions

a) To enhance capacity and promote scientific research in sodium intake reduction interventions:

- To study and initiate production and trading of low-sodium salt, fish sauce and spices.

- To study and apply technology in production of different types of processed foods and common low-sodium nutrition products or those with sodium substituted by other non-sodium salty condiments that ensure nutrition quality and food safety.

- To study the habit of consuming high-sodium foods of the people and related factors to propose appropriate interventions.

- To develop a pilot model of sodium intake reduction interventions in households, schools, agencies, factories, restaurants, enterprises, etc., to evaluate, improve and popularize the effective model.

b) To establish a population sodium consumption surveillance system integrated into the surveillance system of nutrition and risk factors of non-communicable diseases:

- To finalize the national indicator set and surveillance processes and tools to be uniformly applied nationwide in order to monitor sodium intake in the community and at food producers and suppliers, monitor disease patterns and factors related to excessive sodium intake, evaluate results of sodium intake reduction interventions. To develop standard evaluation methods to measure and monitor the sodium content in some processed foods.

- To conduct periodic national surveys on population sodium intake integrated into surveys of risk factors to non-communicable diseases.

- To periodically survey and collect data to monitor the sodium content in packaged foods and the trend and level of high-sodium food consumption.

- To assess the progress of implementing the plan’s targets and objectives.

- To build up a database, to manage and disclose information and data on the people’s dietary sodium intake and related health matters.

- To enhance inter-sectoral examinations and supervisions at all levels on implementation of the plan to reduce dietary sodium intake.

6. International cooperation solutions

a) To proactively and actively seek cooperation with different countries, institutes, schools and associations in the region and the world for research, training and professional, technical development in sodium intake reduction interventions.

b) To enhance cooperation with World Health Organization (WHO) and other international and domestic agencies and organizations to support and promote implementation of sodium intake reduction interventions; integrate international cooperation projects with the plan’s activities to meet the intervention objectives.

c) To enhance study tours, information exchanges and experience sharing events on sodium intake reduction intervention models of countries in the region and the world.

IV. FUNDS FOR IMPLEMENTATION OF THE PLAN

Funding sources to fund the implementation of the plan include:

1. Central and local State budgets

2. Funds mobilized from the community and domestic organizations.

3. Supports from international organizations.

4. Other lawful sources.

V. ORGANIZATION OF IMPLEMENTATION

1. The Ministry of Health

a) The Vietnam General Department of Preventive Medicine (VNCDC) shall:

- Act as the standing body in charge of coordination and management of the plan implementation.

- Lead, guide, implement and check interventions to reduce sodium intake; enhance the capacity for sodium intake reduction intervention of the preventive medicine network.

- Coordinate ministries, agencies, sectors and mass organizations in communication and social advocacy to conduct community sodium intake reduction interventions.

- Act as the body to monitor, supervise and evaluate the implementation thereof.

b) The Department of Communication and Emulation, Commendation:

- Assume the prime responsibility for, and coordinate with related units in, developing legal documents, policies and regulations in communication and social advocacy to conduct sodium intake reduction interventions.

- Assume the prime responsibility for, and coordinate with other agencies in, providing press agencies with information on sodium intake reduction interventions to protect health as well as prevent and control diseases.

- Coordinate with the Ministry of Information and Communications to provide consistent guidance to mass media and local information and communications agencies on collaborating with the health sector to conduct communication and social advocacy for sodium intake reduction interventions.

c) The Department of Planning and Finance shall assume the prime responsibility for guiding a mechanism to manage the funds for the Plan; allocating funds from health - population target programs and other lawful sources to ensure the achievement of the approved objectives of the Plan. Proactively provide counsel to the leadership of the Ministry of Health on sourcing and utilization of funds allocated from the State budget and donated by domestic and international organizations for communication of sodium intake reduction interventions.

d) The Vietnam Food Administration (VFA) shall:

- Act as the body to coordinate related units in establishing standard norms of salt to be added to packaged foods; regulations on information and warning about the harm of excessive sodium intake to health, and recommendations on the maximum sodium intake per day and warnings about high-sodium foods on food labels.

- Coordinate with other agencies in supervising and evaluating the implementation of the Plan.

dd) The National Center for Health Communication and Education shall:

- Coordinate with related units to create communication messages; develop and disseminate communication materials to the community.

- Provide training to enhance communication capacity for Central-level communicators and support the enhancement of communication capacity of local communication networks regarding sodium intake reduction interventions.

- Give guidance to the health communication and education system and related units in provinces/cities to implement communication activities regarding sodium intake reduction interventions.

e) The National Institute of Nutrition (NIN) shall:

- Develop professional guidance, provide training to enhance capacity of nutrition staff in health facilities on counseling and guidance on low-sodium diets in treatment and care of patients.

- Develop professional materials, provide training to enhance capacity of nutrition staff at all levels, especially the grass-root level, on counseling and guidance on low-sodium diets for the people, high-risk groups and patients in the community.

- Coordinate and organize surveys and studies on sodium intake and factors related to excessive sodium consumption.

- Give guidance and implement community-based sodium intake reduction interventions within its scope of management.

g) Departments, administrations and related units shall implement the Plan within their respective scope of management.

2. Related ministries and sectors shall

a) The Ministry of Education and Training shall:

- Coordinate with the Ministry of Health and related ministries and sectors to make and implement policies, regulations and guidance on serving low-sodium school meals, providing low-sodium, healthy foods for children, school-children and students in educational institutions.

- Lead the effective implementation of behavior change communication and education activities regarding sodium intake reduction, proper nutrition and care of the health of children and school-children in educational institutions.

- Lead the management of school canteens and services to restrict school-children’s access to high-sodium, unhealthy foods.

b) The Ministry of Trade and Industry shall improve management of high-sodium packaged foods within its scope of management in order to minimize risk factors for health; coordinate the formulation and promulgation under its authority the policies in order to promote socialization and encourage enterprises to invest in trading of low-sodium, healthy foods.

c) The Ministry of Information and Communications shall collaborate with the Ministry of Health, ministries and local authorities to give guidance to information and communications agencies, telecommunication enterprises and related entities to implement activities within their respective scope of management; lead press and broadcasting agencies to prioritize posting articles and spend appropriate airtime for sodium intake reduction communication.

d) The Ministry of Labor, Invalids and Social Affairs shall coordinate with the Ministry of Health and related ministries and sectors to communicate and instruct heads of agencies, organizations and workers regarding dietary sodium intake reduction; coordinate with the Vietnam General Confederation of Labor (VGCL) to serve low-sodium meals with proper nutrition to workers.

e) The Vietnam Women’s Union shall closely coordinate with the health sector to communicate and disseminate knowledge on dietary sodium intake reduction to its members and mothers; mobilize individuals, organizations and the community to actively participate in community-based sodium intake reduction activities, especially sodium intake reduction practices in processing and cooking foods in households.

3. Authorities of centrally-run cities and provinces

a) People’s Committees of provinces and centrally-run cities shall lead their Departments of Health and related departments and sectors to coordinate with each other in implementing communication activities and interventions to reduce dietary sodium intake; incorporate dietary sodium intake reduction indicators into related programs and plans; allocate adequate funds, human sources and facilities to implement the Plan in their respective localities.

b) Provincial-level Departments of Health shall lead local Preventive Medicine Centers/Centers for Disease Control to coordinate with related local authorities in:

- Formulating and implementing the Plans for dietary sodium intake reduction communication and intervention in their respective localities.

- Organizing capacity enhancement activities regarding on sodium intake reduction interventions for the preventive medicine network and health facilities.

- Conducting examinations and supervisions, reporting on the progress and results of the implementation of the Plan in accordance with regulations.

Article 2. This Decision takes effect from the date of its signing for promulgation.

Article 3. The Chief of the Ministry Office, the Chief Inspector of the Ministry, the Director of the Department of Preventive Medicine, directors/general directors of departments, agencies, administrations under the Ministry of Health; Heads of units under the Ministry of Health; Directors of provincial-level Departments of Health; Heads of relevant agencies and units are responsible for the implementation of this Decision./.