The Resolution No. 20/NQ-TW dated October 25, 2017 of the Central Committee on enhancement of citizens’ health protection, improvement, and care in new situation

THE CENTRAL COMMITTEE

The Resolution No. 20/NQ-TW dated October 25, 2017 of the Central Committee on enhancement of citizens’ health protection, improvement, and care in new situation

THE 6^THMEETING OF THE 12^THCENTRAL COMMITTEE

ON ENHANCEMENT OF CITIZENS’ HEALTH PROTECTION, IMPROVEMENT, AND CARE IN NEW SITUATION

I-SITUATION AND REASONS

1-After 25 years implementation of Resolution No. 04-NQ/TW of the 7^thCentral Committee and policies of the Communist Party, policies, regulations and laws of the State, the citizens’ health protection, improvement and care (hereinafter referred to as citizens’ healthcare) has recorded great achievements, giving important contributions to the building and defending our country.

The system of policies, regulations and laws has improved progressively. The network of heath facilities has been expanding. Physicians and health workers have increased in quantity and developed in quality. The stage budget and social resources invested in citizens’ healthcare has increased gradually. Health financing policies have many renovations; the coverage of health insurance has expanded gradually. Household spending on healthcare services has declined rapidly. The application of information technology has been steadily accelerated.

Preventive healthcare has been strengthened, successfully prevented dangerous infectious diseases from occurrence of epidemics. Factors affecting health such as environment, food, physical training, spiritual life, etc. have been more concerned. The capacity and quality of medical examination and treatment have been improved, reaching the most advanced techniques in the world. The pharmaceutical and medical equipment has progressed. The model of army-civilian medical services has been accelerated and promoted effectively, especially in remote and isolated areas, border and island areas.

Health indicators and life expectancy have improved. Vietnam is seen as a successful model of implementation of the UN Millennium Development Goals by international organizations. Ethics, manners, attitude, professional qualifications of health staff have been focused and enhanced. Many examples of medical doctors devoted to care and treatment of patients are respectful and recognized by the community.

2 -However, the citizens’ healthcare is still limited and inadequate. The quality of living environment, work, nutrition, physical training, spiritual culture, etc. in many areas has not been paid much attention. Many bad behaviors or habits affecting health have not been fundamentally broken.

The healthcare system is still unstable and the operation is not effective, especially in preventive healthcare, grassroots healthcare and primary healthcare. Quality of services, especially at the lower level, does not meet the requirements. Overcrowding in some higher level hospitals has been slowly being reduced. The bad manners of health workers, a number of incidents, and medical problems cause objectionable and disagreeable feeling in the society. The advantages of traditional medicines and pharmacy have not been well promoted.

The roles of regulatory agencies in private healthcare, supply of drugs and medical equipment are still passive and weak. The work of ensuring food hygiene and safety and environmental hygiene are still limited. Pharmaceutical industry and medical equipment has developed slowly. Renovation of the mechanism of operation and management in public health facilities remains confusing. Training, utilization, structure and treatment of health workers are inadequate.

There is a large difference in the health indicators across regions. The rate of stunting is high. Vietnamese stature is slowly improving. The number of healthy life years has not increased correspondingly with longevity.

3-The above-mentioned limitations and shortcomings are due to objective and subjective reasons, the main causes of which are:

- The capacity of implementing resolutions of the Communist Party and laws of the State is still limited. The awareness of roles and positions of citizens’ healthcare is inadequate and simple in some areas and sometime; this work has not been considered as a pillar in the last and sustainable development of the country.

- In perception and actions, basic healthcare and preventive healthcare has not been considered radical and fundamental. Expectation of subsidies and dependence on the State are still high, there is lack of synchronous and suitable mechanism for the people to participate in health insurance and strongly attract non-state resources to invest in health development.

- The level of economic development of our country is low. Financial resources do not conform to requirements for health development and citizens’ healthcare. The state budget is still tight, the people’s income is low, economic potentials are not strong enough, while the demand for citizen’s healthcare is growing and become more diverse and investment requirements for health is high. Most pharmaceutical products and medical equipment are imported and charged with the international prices

- The renovation of public sector entities is slow with confusion and without drastical direction. Policies on health insurance, services charges, organization, and staff are inconsistent.

- Negative impact of market mechanism and unfair competition; there are large disparities in health workers income working for public and private health facilities and among departments in the same facility. Medical ethics education is not paid much attention in many areas. In some areas, the market mechanism gains dominant and absolute position, the patient is solely considered as a customer.

II- VIEWPOINTS AND OBJECTIVES

1- Viewpoints

- Health is the most precious asset of every citizen and the society as a whole. Healthcare is duty and responsibility of every citizen, of the whole political system and the society as a whole, which requires the active participation of Party committees, authorities, the Fatherland Front and unions and agencies, in which the health sector plays the crucial role.

- Investment in citizens’ healthcare means investment in the development The State preferably allocate the budget, adopt policies on mobilization of resources for citizens’ healthcare; provide public services, ensure basic services and motivate public-private partnerships, private investment, and provide services upon requests.

- Develop scientific, national, and mass Vietnamese medicine; Develop a healthcare system that is equitable, fine, effective and internationally-integrated with the guideline “prevention is better than cure”; preventive healthcare is the key, basic healthcare is the foundation; intensive health and community health are consistent and balanced; traditional medicine is associated with modern, military and civilian medicine; develop herbal ingredients, pharmaceuticals industry, and medical equipment.

- Aim to give a comprehensive coverage of healthcare and universal health insurance; all citizens have their health managed and cared; all people have equal rights and obligations to participation in health insurance and benefits of health services. Health services must be charged correctly and adequately, the price and co-payment policies are adopted to develop the grassroots health system firmly.

- Medical profession is a special profession. Each health worker must meet both professional and medical ethics requirements; they must be recruited, trained, utilized, and treated in a special way. The medical network must be wide and closed to citizens; under consistent and centralized direction in terms of profession from the central to local levels nationwide, and under the leadership of Party committees and local governments.

2- Objectives

General objectives

Improve health, both physical and mental health, stature, longevity, and quality of life of the Vietnamese; establish a healthcare system that is equitable, fine, effective and internationally integrated; develop a scientific, national, and mass Vietnamese medicine; all citizens have their health managed and cared. Employ health workers who are kind-hearted towards patients, have skillful professional capacity and attain international standards; improve the competitiveness in the supply chain of pharmaceutical products and health services.

Specific objectives

By 2025:

- Life expectancy reaches approximately 74.5; the number of healthy life years is projected to reach at least 67.

- The rate of purchase of health insurance is expected to reach 95% of the population. The rate of medical expenses paid solely by households is expectedly reduced to 35%.

- The rate of receivers of expanded program on immunization is projected to reach at least 95% with 12types of vaccines. Reduction in child mortality rates: 18.5‰ for children aged under 5; 12.5‰ for infants aged under 1.

- The stunting rate of under-five children is expectedly reduced to under 20%. The prevalence of obesity in adults is expectedly below 12%. The average height of the 18-year-old male is forecast to reach 167 cm and 18-year-old female is forecast to reach 156 cm.

- More than 90% of the population is expected to have their health managed; 95% of health stations of communes, wards, and district-level towns carry out preventive medicine and treat certain non-communicable diseases.

- It is projected to reach 30 hospital beds, 10 doctors, 2.8 bachelors of pharmacy and 25 nurses per 10,000 people. The rate of private-sector hospital beds is expected to reach 10%.

- The rate of people’s satisfaction with health services is projected to reach more than 80%.

By 2030:

- Life expectancy is expected to reach approximately 75; the number of healthy life years is projected to reach at least 68.

- The rate of purchase of health insurance is expected to reach 95% of the population. The rate of medical expenses paid solely by households is expectedly reduced to 30%.

- The rate of receivers of expanded program on immunization is projected to reach at least 95% with 14 types of vaccines. Reduction in child mortality rates: 15‰ for children aged under 5; 10‰ for infants aged under 1.

- The stunting rate of children aged under 5 is expectedly below 15%; the prevalence of obesity in adults is expectedly maintained under 10%. The average height of the 18-year-old male is forecast to reach 168.5 cm and 18-year-old female is forecast to reach 157.5 cm.

- More than 95% of the population is expected to have their health managed; 100% of health stations of communes, wards, and district-level towns carry out preventive medicine and treat certain non-communicable diseases.

- It is projected to reach 32 hospital beds, 11 doctors, 3.0 bachelors of pharmacy and 33 nurses per 10,000 people. The rate of private-sector hospital beds is expected to reach 15%.

- The rate of people’s satisfaction with health services is projected to reach more than 90%.

- The AIDS, tuberculosis and malaria epidemics are basically ended.

III- TASKS AND PRIMARY SOLUTIONS

1- Enhancing the leadership of the Party and state management, promote the participation of the Vietnam Fatherland Front, socio-political organizations and the society as a whole in the citizens’ healthcare

- The Party committees and governments focus on leading and guiding the citizens’ healthcare as one of the most important political tasks. The awareness and determination of action of both the political system and the people in healthcare for themselves, families and communities must become consistent.

- Raise the capacity, effectiveness and efficiency of state management of citizens’ healthcare; include health objectives and targets and areas affecting health such as the environment, physical training, sports and culture etc. into the socio-economic development programs and plans of branches and agencies; Intensify the supervision, examination and inspection of the implementation of health policies as well as sectors relating to health.

- Strongly promote the role of the Vietnam Fatherland Front, unions and the community as a whole in the citizens’ healthcare. Assign clear and specific responsibilities to each branch, each agency and union in implementing the objectives and solutions to citizens’ healthcare, especially in ensuring food safety and hygiene, environmental protection, physical training, building a civilized lifestyle, participating in universal health insurance and implementing regulations on epidemic prevention, prevention and treatment.

- Renovate and improve the effectiveness of propagation, emulation movements and campaigns with contents and criteria related to the citizens’ healthcare; promote the people s supervisory role and enable social and religious organizations to participate in citizens’ healthcare as per the law.

2- Improving citizens’ health

- Focus on raising awareness, changing behavior, raising the responsibility of the entire political system, the society as a whole and each citizen; formulate and carry out schemes and programs on raising the health and stature of Vietnamese people; pay attention to the living conditions of each citizen to improve their health, especially those in rural, mountainous and island areas.

- Recommend, raise public awareness of nutrition, diet rations suitable for each group of entities, raw materials and taste of the Vietnamese. Packaged food products must contain sufficient information on ingredients, energy and health warnings on the package. Programs of supplementing micronutrients for pregnant women, breastfeeding women, children, and the elderly shall be run.

- Expeditiously complete the system of food safety regulations and standards; control food safety according to risk assessment, supply chain-based business, and traceability.

- Concentrate on directing drug prevention, control and detoxication; adopt measures to reduce consumption of alcohol, beer, and cigarettes.

- Make fundamental changes to physical and psychological education, increase the number of optional physical training courses in the school in close combination with training outside the school; promote physical training movements; strengthen school healthcare.

- Implement measures to minimize negative impacts from environmental pollution and climate change on health; mobilize resources to build and upgrade water supply and drainage systems; enable citizens to use clean water and hygienic latrines; carry out waste treatment; tackle pollution of rivers and production facilities; intensify the improvement of and limit the leveling of the system of canals and ponds; prevent the abuse of chemicals in aquaculture.

- Promote the roles of institutions, accelerate cultural and sport activities; strengthen propagation and advocacy to adopt a civilized, healthy and hygienic lifestyle; eliminate obsolete practices that negatively affect health.

- Synchronously adopt measures to prevent disasters, ensure traffic order and safety and labor safety; prevent and control accidents, injuries, fire, explosion, and occupational diseases.

3- Enhancing the capacity of preventing and combating epidemics associated with grassroots health reform

- Ensure medical security, strengthen and improve the effectiveness of infectious disease prevention and control to avoid occurrence of widespread epidemics; response to emergencies in a timely manner; mobilize domestic resources to serve prevention and combating of HIV/AIDS, tuberculosis, and malaria; firmly strengthen the vaccination system; increase the number of vaccinations in the expanded vaccination program in line with the budget.

- Develop family medicine; synchronously carry out non-contagious disease prevention and control activities; focus on prevention and improvement of capacity for screening, early detection and control of diseases; promote the management and treatment of non-contagious diseases, chronic diseases, long-term care at grassroots health; promote the combination of military-civilian health and medical health in the border areas and islands; connect grassroots health with private clinics, Eastern medicine clinics.

- Strongly reform the mechanism and mode of operation of communal health stations so as to play a leading role in the preventive healthcare; synchronously deploy information technology systems in the management of health stations, vaccination, disease management, citizens’ health records associated with management of health insurance’s cards and payment.

- Set up a system of electronic health books for every citizen; update information and health indicators acquired from medical examination and treatment; adopt appropriate mechanisms and roadmaps to gradually have all citizens’ health monitored, managed, examined and cared on a periodical basis.

- Pay special attention to maternal and child health, especially those in mountainous, remote and isolated areas, border and island areas; take care of elderly people, people with disabilities, people affected by the consequences of the war and the priority entities; develop appropriate elderly care models.

4- Improving the quality of medical examination and treatment, tackling the hospital overcrowding

- Develop a complete system of medical examination and treatment and functional rehabilitation in each province or central-affiliated city as well as the system of hospitals of the armed forces; strengthen military-civilian coordination.

- Complete the system of treatment regimens, procedures and guidelines nationwide; issue evaluation criteria, conduct independent testing and classify hospitals according to their quality in conformity with international practices.

- Implement the roadmap for unrestrictedly intra-provincial medical services (the right to receive medical services at a health facility other than the registered one in the same province/city); the roadmap for connection and accreditation of test results among health facilities in association with raising the quality of services and adopting policies to encourage people to use services right at lower levels.

- Develop the network of satellite clinics; intensify training and rotation of health workers and transfer of technology to lower levels; issue the list of technical services qualified to render for every level, with a vision to ensure the uniform quality of each technical service among the levels.

- Formulate and implement programs on development of traditional medicine, intensively combine traditional medicine and modern medicine in disease prevention, medical examination and treatment, functional rehabilitation and improvement of health.

- Comprehensively develop and create an equal environment for both technical support and transfer among public and private health facilities.

- Make fundamental changes to the service manners and attitude, improve medical ethics; build a green, clean, beautiful, safe and civilized hospital aiming to provide comprehensive care for patients.

- Focus on accelerating administrative reform, applying information technology to hospital management, health insurance assessment and electronic medical records to remote diagnosis, testing and medical examination and treatment.

- Strengthen medical examination and treatment for beneficiaries of incentive policies; promote the medical strength of the armed forces; deploy flexible models suitable to the conditions of each place so as to ensure the provision of medical examination and treatment services for people in remote and isolated areas, border and island areas.

5- Promoting the development of the pharmaceutical and medical equipment sector

- Ensuring medicines in sufficient quantity, good quality and reasonably prices, meeting the demand for preventive and curative care, functional rehabilitation and encouraging the use of domestically-produced medicines.

- Intensify centralized bidding, reduce the prices of drugs, equipment, chemicals and medical supplies, ensure publicity and transparency; improve the mechanism of investment and procurement, strictly control quality, and combat losses and waste.

- - Strictly manage the import of drugs; strengthen the drug distribution system, ensuring discipline, efficiency, professionalism; strictly abide by the law provisions on distribution of medicines, not allowing any non-permitted enterprise to hidden its drug distribution; manage the system of wholesalers, retailers, pharmacies inside and outside hospitals; adopt solutions consistently to trace the origin of drugs, take actions against the sale of drugs without prescriptions; apply information technology, network connection, control origin and prices of drug purchased and sold at each drugstore nationwide.

- Raise the capacity of research and production of drugs and vaccines; invest enough resources in mastering the technology of producing new generation vaccines, combined vaccines, basically meeting the demand for expanded vaccination in the country and proceed to export; encourage businesses to invest in the production of medicines, vaccines, biological, medical equipment and supplies, and to deepen their involvement in the pharmaceutical value chain in the region and in the world.

- Promote research, analysis, grounds for effect of treatment methods, drug-free treatment, traditional remedies and ingredients; detect, register, and recognize intellectual property and making traditional remedies available on the market; honor and guarantee the interests of the famous physicians.

- Adopt specific policies on the development of herbal ingredients, especially rare and precious ones; prioritize investment and development of specialized farming areas, forming linkages in the production, storage and processing of herbal ingredients.

- Step up the prevention and combating of smuggling, production and trading of fake and poor-quality medicines and functional foods; strictly control functional foods and goods which may cause harms to health; strengthen control of the quality of imported herbal ingredients; gradually reduce dependence on the sources of foreign herbal ingredients.

6- Developing human resources and health science and technology

- Make fundamental and comprehensive changes to training of health workers in order for them to meet both ethical and professional requirements in conditions of active integration into the world; expeditiously improve the law provisions and implement the framework of the national education system as well as the national level framework in training of health workers, promote responsibilities and roles of hospitals in training and development of university hospitals.

- Set up a national medical council which administers tests and grant practice certificates for a definite period in accordance with international practice; designate an independent agency to grant practicing certificates on a trial basis.

- Improve the capacity of studying health science and technology, pharmacy, and biomedicine; promote the application and transfer of advanced techniques and develop health workers responsible for medical equipment; adopt a mechanism of assigning duties and honoring hospitals, research institutes, doctors, and scientists that have participated in training health workers.

-Give good treatment to health workers; determine the initial pay step in conformity with the training time; introduce incentive policies attracted enough to motivate qualified people to work in grassroots healthcare, remote and isolated areas, border areas, islands and in preventive medicine, forensic medicine, psychiatry, tuberculosis, leprosy, etc.

- Enhance the training and upgrading of professional qualifications and ethics for health workers; strictly take actions against violations of regulations on professional qualifications and ethics, harm of the dignity and health of physicians; ensure that health facilities may operate in security, order and safety.

7- Reforming health service delivery and management system

- Continue reforming and improving the system of health facilities towards more streamlined, effective and internationally-integrated model; ensure the centralized direction in terms of profession from the central to local levels nationwide, and under the leadership of Party committees and local governments.

- Continue assigning centers and units to perform preventive health tasks at provincial and central levels, establish a system of integrated disease control centers at all levels and link them to the disease control network in the world.

- Rearrange units tasked to testing and inspection in order to form a system of agencies responsible for controlling pharmaceuticals and foodstuffs, medical equipment in line with international integration.

- Organize the health service delivery system at 3 professional levels; organize the system of health stations of communes, wards and district-level towns in association with school health and in line with the characteristics of each area; strongly develop the emergency system in the community and before entering the hospital.

- Substantially, Ministries (except for Ministry of National Defense, Ministry of Public Security), ministerial-level agencies do not run hospitals; the Ministry of Health only runs very few hospitals; concentrate on improving the general hospital before establishing new specialized hospitals at the provincial level; adjust and arrange hospitals, enable all citizens to go there conveniently; create a chain of hospitals on a trial basis; strongly promote the development of the system of hospitals, non-public healthcare facilities, especially non-profit facilities.

- Raise the effectiveness and efficiency of the state management, continue improving the legal system on citizens’ healthcare; intensify the inspection, examination and strict actions against violations; promote administrative reform, apply information technology in management, services, reduce troubles, prepare favorable conditions for people.

8. Strongly reforming health finance

- Increase investment and step up the process of restructuring the state budget in the health sector so as to mobilize resources for the comprehensive citizens’ healthcare, especially beneficiaries of incentive policies, ethnic minority people, mountainous, border and island areas.

- Prioritize the budget allocation and the increase of spending on healthcare, which is higher than that of the state budget; allocate state budget funds for preventive medicine, grassroots medical care, hospitals in disadvantaged areas, border and islands, in the fields of leprosy, tuberculosis, mental diseases, etc.; and appropriate at least 30% of the health budget for preventive medicine.

- Increase special excise duties on goods harmful to health such as alcoholic drinks, carbonated drinks and cigarettes to limit consumption.

- Implement the principle of public health primarily funded by state budget; medical examination and treatment will be covered health insurance agencies and citizens. Primary healthcare jointly paid by health insurance agencies, citizens and state budget; health insurance for employees must be jointly contributed by the employers and the employees; state budget shall guarantee primary healthcare for some beneficiaries of incentive policies. Issue "basic health insurance package paid by health insurance agencies" in line with the health insurance fund and the "basic health service package paid by the state" in conformity with the state budget; concurrently, mobilize resources to provide primary healthcare and manage people s health.

- The state budget and health insurance agencies pay for basic services; service users pay for excess amounts. Provide service charges and adopt an appropriate co-payment mechanism in order to encourage people to have medical examination and treatment at lower levels, and higher-level health facilities provide services which cannot be provided by lower levels.

- Strongly reform the management and organization of public health service units; promote the autonomy of professional tasks, organizational structure, personnel and finance in association with accountability, publicity and transparency; apply governance model to public health service units in self-covering recurrent expenditures and investment expenditures like corporate governance; adopt preferential policies on land, credit, etc. to encourage health facilities to expand, upgrade, modern, and meet the citizens’ demand for medical examination and treatment, including high-income earners, foreigners.

- Step up the private sector involvement and mobilization of resources for the development of the health system; diversify forms of public-private partnership, ensuring transparency and fair competition, regardless of public-private services in the provision of health services; encourage organizations and individuals to invest in building health facilities (including primary healthcare), focusing on providing high quality services as required. Health facilities and elderly-care establishments operating for non-profits shall be entitled to tax exemption or reduction as per the law.

- Strengthen the state management, create and implement synchronous solutions to prevent, combat, prevent and stop the abuse of private sector involvement policy to abuse public resources to bring benefits to advocacy groups and cause inequalities in access to health services.

- Steadily transfer recurrent expenditures from the state budget which have been allocated to the health facilities to the health insurance participants in joining the roadmap to calculate medical services accurately and adequately; raise the efficiency of the fund for medical examination and treatment for the poor; step up the state-assigned tasks, commissioning order and adopt the policy that prices is associated with the quality of services and encourage the use of health services at the lower levels.

- Initiate comprehensive solutions to implement universal health insurance; adjust the amounts of contribution suitable to the conditions of economic development, income of people and quality of service; diversify health insurance packages; strengthen linkages and cooperation between social health insurance and commercial health insurance; raise the capacity and quality of health insurance assessment to ensure impartiality and transparency; carry out solutions against abuse, self-seeking interests, ensuring the balance of the health insurance fund and the interests of participants in health insurance and health facilities.

9- Actively integrating and enhancing the efficiency of international cooperation

- Strengthen cooperation and active integration, take advantage of technical assistance, training and finance of countries, international organizations; strengthen international cooperation in the prevention and combating of crimes in the medical field.

- Actively negotiate and implement bilateral and multilateral medical cooperation agreements in an effective manner; actively participate in preparing policies, addressing regional and global health issues, and enhancing the role and international status of Vietnamese medicine; promote the spread of traditional medicine and pharmacy to other countries in the world.

- Harmonize health-related procedures of Vietnam with those of ASEAN and the world; strengthen the development and application of Vietnam’s health standards updated with those of the world and regions; strive to achieve the UN s sustainable development goals for health; attain certain goals ahead of schedule.

IV- IMPLEMENTATION

1-The Party sub-committee of the National Assembly, the Party sub-committee of the Government shall lead the improvement of the legal system relating to citizens’ healthcare; intensify the supervisory activities of the National Assembly, the National Assembly Standing Committee, the Nationality Council and the Committees of the National Assembly in this field.

2-The Party executive committees of provinces/cities, the Party groups, Party sub-committees, the central-affiliated Party committees shall plan specific tasks, solutions and road map in line with their functions and responsibilities to implement the Resolution.

3-Central Propaganda Department of the Central Committee of the Communist Party of Vietnam shall take charge and cooperate with Party sub-committee of the Ministry of Health, Party sub-committee of the Ministry of Information and Communications in heightening awareness of contents and implementation of the Resolution.

4-Party sub-committee of the Government shall take charge and cooperate with Party groups, Party sub-committees, and central-affiliated executive committees shall monitor, inspect, and then send preliminary and final reports on implementation of the Resolution to Political Bureau and Secretariat on regular basis.

For the Central Committee of the Communist Party of Vietnam
The General Secretary

Nguyen Phu Trong