HEALTH PLAN FOR 2013

DEPARTMENT OF PLANNING-FINANCE

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Content of the report

•Evaluating the implementation of the 2012 Health Plan:▫General evaluation▫A number of striking results

•2013 Plan▫Background situation▫A number of key objectives▫Main tasks▫Major solutions

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Results of implementation during 2012

Realization of targets assigned by the National Assembly, Government and the Health sector:

- Estimation for completion of the targets assigned by the National Assembly for 2012: (i) The actual achieved number of patient beds over 10,000 people (excluding commune health station) covers 21.5 versus the assigned rate of 21.5; (ii) The rate of malnourished children under 5 yrs old is below 16.6%, estimated rate is 16.3% ;

- Completed 19/20 targets assigned by the Gov+ 01 target is not likely to be achieved, which is the

sex ratio at birth, the assigned rate is <112, the actual realized number in September is 112.5, the estimated number for the whole year is 112.3.

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1. Provision of health services

1.1 Preventive Health work: The National targeted program (NTP): The Gov Prime Minister approved

the 4 Programs period 2012-2015

- The NTP on health

- The NTP on HIV/AIDS prevention & control

- The NTP on population and family planning

- The NTP on food safety

-New feature: Adding 5 Projects on strengthening capacity, communications

and monitoring & evaluation of program implementation (since 2012) and 2

contents in Project 5 (Rehabilitation for people with disabilities, Improving

health of elderly people)

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1. Provision of health services

1.1 Preventive Health work:

- Disease prevention and control:

+ Epidemics: Basically, other contagious diseases have been strictly

monitored and checked. No epidemic incurred.

+The syndromes of palmoplantar keratoderma (Ba To Dist., Quang Ngai

Prov): by the end of 15 Aug 2012, there had been 216 incidents in 05

communes, including 13 deaths. MOH proactively coordinated with

People’s Committee, DOH of Quang Ngai to instruct health units and

people to implement various appropriate and effective solutions and

have controlled and checked the epidemic

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1. Provision of health services (cont.)

1.2. Health check-up and treatment:

• Implement various solutions to improve the quality of health check and treatment and to prevent the overload at a number of hospitals. ▫ Investing in upgrading material facilities from the sources of bonds,

socialization capital sources…▫ Carrying out the Plan of Satellite hospitals, Plan 1806 ▫ Submitting to the Gov. PM the Plan for reducing hospital overload

• Formulate guiding documents: Circular defining decentralization for patients’ care in hospitals; Circular on referral; Circuluar guiding the management of testing quality; Circular guiding the implementation of hospital quality management...

- Other activities such as rehab, medical appraisal, forensic appraisal, psycho-forensic appraisal...continue to develop, meeting demands in the new situation.

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1. 3 . Grassroots health:

• MOH organized Evaluation of 10-year implementation of Directive 06-CT/TW.

• Implemented National criteria for commune health period 2011-2020.

• Some investments for grassroots health during 2012:▫ Targeted support from the State budget: >145 district

hospitals, 46 regional general clinics were completed and brought into operation.

▫ Military-civilian health program : invested for 171 health stations at border areas, key areas of national defense and security; supported with investment budget for health equipment for 05 heatlh beacons featuring combination of civilian-military health on islands.

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1. 4. Maternal - child health care and Population – Family Planning

• The Gov. PM approved the National Strategy on Nutrition; National Strategy on Population – Reproductive Health;

• MOH approved the “National Plan of Action on Reproductive Health Care focusing on safe motherhood and health care period 2011-2015;

• Popu-Family Planning: due to some constraints, a number of targets were not realized or realized at low level. It is estimated that for the whole year of 2012, the sex ratio at birth is 112.3, which fails to meet the 2012 Plan

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Indicators9 months of

2011

Estimated rate for 9 months of

2012

Comparison

Ratio of pregnant women whose pregnancy status is under management (%)

96.2% 96.3% +0.1%

Ratio of postnatal mothers who recieved prenatal check-ups of ≥ 3 times (%)

86.5% 86.7% +0.2%

Ratio of deliveries assisted by trained workers/attendants (%) 97.4% 97.5% +0.1%Ratio of mothers receiving home-based postnatal check-ups (%) 89.2% 89.5% +0.3%Ratio of abortion/100 live births 0.270 0.268 -0.7%Cases of obstetric complications 3713 2692*Cases of maternal deaths due to obstetric complications 61 52*

* Semi annual data 2012

1.5. Food safety and hygiene:- During the first 9 months of 2012, there were 142 cases of food

poisoning with 4,669 affected people; 3,734 hospitalizations and 28 deaths. In comparison with the same period in 2011, the situation of food poisoning has increased in terms of cases, affected number of people, number of deaths. However, it is still under control.

- The Gov promulgated Decree No. 38/2012/ND-CP daed 25 April 2012 detailing the implementation of a number of articles of the Law on Food safety.

- The inspection, examiniation, propagation, advocacy work as well as administrative sanctions have been further reinforced. However, the risks of getting food poisoning tend to develop rather complicatedly. It is difficult to control alcohol, beer of unclear origin, poisonous mushrooms, natural toxic substances, preservatives, ...especially food and fruit that are imported through the border with China.

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1.6. Health environment management work

Some basic targets: the rate of processing medical solid waste is more than 85%; the rate for the liquid waste is more than 65%.

Labour medicine, school medicine, accident and injury prevention and control work have been strengthened.

MOH organized a number of activities in the field of health environment management: The Ceremony launching the Movement of sanitation for the love

of the country, enhancing people’s health in Nam Sach; the 2nd of July every year is chosen as the Day of Sanitation for the love of the country;

The Ceremony launching the National week on occupational health and safety, fire prevention and control for the 14th time in 2012.

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2. Training and development of human resources for health and science-technology sectors MOH ratified the Planning of human resources development for

health period 2012-2020; issued Circular 03/2012/TT-BYT guiding clinical medical trials; formulated the Circular guiding the training and practising prior to conferring practitioner permits in the field of medical check-ups and treatment

Succefully organized a number of important conferences:- Conference on President Council of medical and pharmaceutical

universities, meeting session X;

- XVI Conference on youth science of medical and pharmaceutical universities and colleges;

- The 6th National Conference on IT application of the Health sector;

- Summation Conference on monitoring of training in 2011;

- Online Conference on Enrollment of human resources for health in 2012

Science and technology: Conducted the process of selection and approval of 37 topics and projects

on science & technology, which have been kicked off during 2012;

Identified the list of 59 topics and projects on experimental production at ministerial level to be fed into the implementation plan for 2013;

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3. Pharmacy, health equipment and investment in infrastructure

• The estimated implementation during the first 6 months of 2012, the value of domestically manufactured medicine was around 345,000 ml USD, meeting 41% of the demand. Implemented the Plan “Vietnamese people give priority to using Vietnamese medicine”.

• The quality of medicine has been guaranteed, various business, production, controlled experiment and storage facilities obtained GPs standards.

• Renovated the medicine bidding work, issued Circular 01. Basically, prices of medicine have been stabilized.

• Completed the draft Circular prescribing the issue of Sale Licence and Certificate of Free Sale (CFS) with regard to medical products and equipment manufactured in Viet Nam

• Strengthened investment work from the sources of Development Investment, Government Bonds. Many works have been completed and put into operation.

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4. Health information

MOH ratified the scheme on consolidation of IT organizational system in non-business units of the health sector for the period from 2010 up to 2015. Prepare to establish the IT Department.

Improved capacity for gathering, processing and synthesizing reports; training classes were organized at localities. Strengthening IT application in processing, managing and communicating health information with the improvement and upgrading of existing softwares.

However, the development of the health information system still faces difficulties and shortcomings. The plan for development of HIS has not been issued yet. The strengthened coordination and information sharing within the health sector and with relevant ministries/sectors has not been formed yet.

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5. Health finance

Well completed the allocation and assignment of 2012 budget revenue and expenditure estimates to affiliated units in strict compliance with provided procedures and timeframe.

Advised and submited to the Gov. PM for the issue of Decision No. 14/2012/QD-TTg on the amendments and supplements to Decision No. 139/2002/QD-TTg on medical check-ups and treatment for the poor.

Coordinated with the MOF to develop Joint-Circular No. 04/2012/TTLT-BYT-BTC of the MOH – Organizers on the issue of the maximum rates for price frames of some medical check-ups and treatment services.

25 Central hospitals and 47 provinces approved the new hospital fees.

Renewed payment method: 60/63 localities nationwide have applied capitation payment method, with 778 health check and treatment facilities (mostly at district level), obtaining the rate of 33.8%, an increase of more than twice as compared with in 2011.

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5. Health finance (cont.)

• ODA/NGO:▫ MOH manages 48 ODA/NGO Programs and projects. Total budget:

26,452,670 ml VND (equivalent to 1.44 billion USD), of which the ODA source is: 24,562,501 ml VND, accounting for 92.9%;

▫ A number of big projects: the health system of Central Northern provinces, Northern mountainous provinces, Mekong river delta, VAHIP, HIV/AIDS prevention and control, medical waste processing (WB), South Central Coastal areas, Preventive Health system, Health human resources (ADB), Project on prevention and control of Tuberculosis, malaria, HIV/AIDS, Health system assistance (Global Fund, GAVI)...

▫ In general, ODA projects have been well implemented (however, some are delayed in progress), the set objectives and targets have been achieved, contributing a significant part in activities of the health sector;

▫ The MOH is formulating a number of projects: HR development for health, Renovation of the Provision of health services, Red River Plain areas and North-Eastern Areas (WB), Health system in the Central Highlands 2 (ADB)…

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5. Health finance (cont.)• Health Insurance (HI) : • MOH developed and submitted to the Politburo the Resolution of

the Politburo on development of Social Insurance (SI) and HI. • Submitted to the Gov. the scheme for implementation of the

roadmap for HI for all periods 2012-2015 and 2020; • Issued a number of Circulars: the list of consumable medical • Ban hành một số Thông tư: on the List of medical cosumables,

guiding screening check-ups, early diagnosis of some diseases; List of medical supplies covered by HI Fund

• It is estimated by the end of 2012, the HI coverage will have been around 68%. ▫ The HI coverage in some localities is still low, 7 provinces have the

coverage of below 50%. ▫ The portion of people who voluntarily participate in HI is still low, 55% of

employees in non-state sectors and 25% of near-poor people participate in HI.

▫ The localities are requested to include HI targets in the targets for socio-economic development of their localities.

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State management on health

• Formulated and issued the plan for formulation of legal normative documents on health in 2012, Plan for tracking law implementation situation of MOH in 2012.

• A great number of key legal normative documents have been enacted: Resolution 63 on functions, tasks and organizational structure of the MOH; the National Strategy on Nutrition; population – family planning; food safety and hygiene; medical check-ups and treatment for the poor...

• Continued strengthening of public administration reforms. Reinforced autonomy, strict monitoring over public expenditure.

• Strengthened international cooperation, MOH successfully hosted the WHO 63rd Western Pacific Region Conference:▫ Held in Hanoi from 24-29 Sep 2012 with the participation of

350 delegates from 35 nations, territorial regions, 22 ministers, 4 vice ministers.

▫ Adopted 10 Resolutions of Wstern Pacific region in specialized fields, finance, nutrition and some other fields.

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A NUMBER OF STRIKING RESULTS

1. Estimated to achieve 19/20 targets assigned by the National Assembly, Government in 2012.

2. A great number of documents were approved by the Government, Gov. Prime Minister (Decree 63/ND-CP; Decree on renovation of operational mechanism, financial mechanism; Population-Reproductive health Strategy; HIV/AIDS Prevention and Control Strategy; Decision on amendments and supplements to the Decision on provision of health check-ups and treatment for the poor…) and the promulgated Circulars (Circular 04/TC-YT on service prices, payment of HI…).

3. Organized the health network to be gradually stable; highly effective investment for health (from the sources of state budget, government bonds, ODA).

4. The policies on health service prices started being implemented in close linkage with raising the quality of health check-ups and treatment and HI.

5. The situation of overload in some hospitals have initially improved

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A NUMBER OF STRIKING FEATURES IN IMPLEMENTATION OF THE 2012 PLAN (cont.)

6. The quality of health services have been raised, some new techniques have been successfully implemented.

7. Prevention and control of epidemics, HIV/AIDS…have been reinforced, proactively monitored epidemics, no large-scale epidemic incurred.

8. The prices of medicine are basically stable, ensuring the supply of adequate medicine for the need of disease prevention, check-ups and treatment

9. Health inspection work has been strengthened, more radically dealt with petitions and complaints to avoid unsolved and long lasting cases.

10. Health communications – education has been expanded with diversified and quality forms of communications.

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-Background situation: Advantages, disadvantages- Principles of developing the 2013 Plan and the Plan for investment capital period 2013-2015-Major health objectives and targets-Focal tasks in 2013-A number of solutions to implement the 2013 Plan

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Background situation: advantages• The Party, National Assembly and the Government are paying

more and more attention to the Health sector, have clearly defined the significant role of health in the process of the country’s industrialization and modernization, consider investment for health as the direct investment for sustainable development.

• The legal system related to health care has been increasingly completed; many laws, decrees, guiding circulars of various ministries have been issues, creating legal corridors for the process of establishing and developing the health system.

• Organization of the health network has changed after a period of time and is now gradually stable, which is the conditions for growth in the coming time.

• Awareness and participation of the people, various levels of party committees and authorities in health care work has been deeper and broader; inter-sectoral collaboration in health care has obtained positive changes.

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Disadvantages and shortcomings• The status of epidemics is developing complicatedly on many

facets, many localities nationwide.

• The situation of hospital overload has gradually been improved, but still quite grave. Addressing the situation of hospital overload requires various combined solutions, satisfactory resources and takes time for implementation.

• The investment budget for health has been much reduced due to economic declination, inflation, public debts, high interest rates…

• Regime and policies for health activities and for health workers have not been completed yet. The quality and allocation of health HR are still limited.

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Overall objective

To continue establishing the Vietnamese health system towards fairness, effectiveness and development; raise quality of health services, meeting increasingly greater and diversified demands of the people with regard to health protection, care and improvement; reduce the ratio of disease contraction, morbidity and mortality, increase life splan, improve population quality, positively contributing to socio-economic development of the country.

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A number of major targets in the 2013 Plan

Comprising 20 targets, 4 of which were assigned by the National Assembly:

1. hospital beds/ten thousand people (excluding commune health stations): 22.0 beds2. Proportion of population participating in HI (%): 71% 3. The rate of birth ratio reduction (%o): 0,1 4. The rate of malnourished children under 5 yrs old (weight/age): 16%

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Focal tasks in 2013 Consolidate organizational apparatus of the health sector from central to local

levels Develop and implement an important strategy, policy, scheme such as:

Strategy, Planning of the health sector 2011 - 2020; Population – Reproductive Health Strategy, malnutrition prevention and control; Scheme for reduction of hospital overload, Scheme for development of HI for all, Scheme for development of sea and island medicine.

Proactively monitor epidemiology to early detect, prevent and control so that large-scale epidemics will not incur, especially new-arising epidemics…Effectively expedite National Programs.

Strengthen communications, education and comprehensively implement various solutions to reasonably check/control the rate of population growth, sharply reduce sex imbalance at birth and enhance the quality of population. Conduct reproductive health care work, health care for the elderly.

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Focal tasks in 2013 (cont.)

Coordinate with ministries, agencies, localities to strictly perform the mechanisms and policies on controlling food safety and hygiene and environmental protection with regard to imported goods. Strengthen the implementation of policies and laws on quality management, food safety and hygiene; monitor the situation of food contamination, prevent food poisoning

Implement the Scheme for combating hospital overload once approved by the Government PM. Continue to effectively carry out the Program of Action for raising the quality of health check-ups and treatment. Strictly manage the quality of health check and treatment activities, especially in private sectors, prescription, usage of medicine, prevent abuse of medicine/drugs, abuse of testing, of hi-tech services to seek profits, causing wastefulness, which adversely affects patients’ health.

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Focal tasks in 2013(cont.) Expand forms of training in order to ensure the HR for health

facilities in the coming time. Focus on intensive training, training to meet high technical requirements, technology transfer, raise management levels. Continue implementing and expanding the technology transfer from the higher levels to the lower levels (top-down transfer) to improve the quality of treatment, contributing to reducing the overload for hospitals of higher levels; promote the implementation of full autonomy for public non-business units

Implement Government Decree on renovation of operational mechanisms, financial mechanism of public hospitals; apply new hospital fees associated with the enhanced service quality, particularly in large urban areas. Perform appropriate mechanisms and policies so that prices of health services will step by step follow the market mechanism , coupled with reasonable policies to support the poor and policy beneficiaries; promote socialization, improve quality, efficiency of health service s and the sector’s performance.

Implement the scheme for universal health insurance (HI for all) once approved by the Government PM.

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Focal tasks in 2013(Tiếp)

Ensure adequate essential drugs/medicine for treatment, take various measures to stabilize drug prices, manage the import, sale/circulation and supply of medicines; controlling the bidding, purchase and use of medicines; conduct tight control over drug prices, quality of medicines; Formulate the planning for manufacture development and sale/distribution of drugs.

Promote the state management on health, continue to complete the legal normative documents in accordance with the new situation; enhance the application of information technology (IT) in management and administration; expedite administrative procedure reform, practise thrift and combat wastefulness.

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A number of major solution for implementation of the 2013 Plan

1. Proactively prevent and combat diseases and epidemics, timely detect and check epidemics to allow no outbreak.

• Consolidate and enhance capacity of the system of forecasting, warning and surveillance of epidemics.

• Effectively expedite National targeted programs on health; eradicate polio, eliminate neonatal tetanus; control the rate of HIV/AIDS infection in population community at less than 0.3%.

• Ensure store adequate drugs and chemicals for combating epidemics.

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2. Reduce hospital overload: comprehensively implement the solutions specified in the Scheme for reduction of hospital overload

Increase the number of patients’ beds; develop second hospitals at suburban areas of Hanoi and HCMC. Tumour hospitals, obstetrics and pediatrics hospitals, nursing and rehabilitation hospitals...,

Invest in satellite hospitals, facility No. II of Cho Ray Hospital; Raise quality of provincial and regional hospitals.

Provide for referral and bypass Adjust prices of health services in close linkage with service

quality Strengthen investment for material facilities, equipment

(Government bonds, ODA) and capacity for staff in grassroots health (constant training, 1816...)

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3. Continue to apply controlling measures to ensure the stabilization of drug prices:

• Review and strictly control the granting of drug importing license; manage drug sale/circulation and supply; publicly publish the registered prices and prices that win the bidding of various drugs. Improve procurement methods and direct various units to well conduct the bidding for purchase of drugs as prescribed.

• Conduct planning and restructuring of the system for manufacturing and sale of drugs, renovate the methods for calculation of discounts to further sustain a stable pharmaceutical market and in accordance with the common development of the economy.

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4. Coordinate with ministries, agencies and localities to strictly implement the mechanisms and policies on checking food safety and hygiene, environmental protection with regard to imported goods

• Promote communications and education on food hygiene and safety for the people or facilities that cultivate and supply food; enhance training, training for the units with collective kitchens/canteens; establish the warning system for food hygiene and safety to users.

• Regularly inspect and monitor food hygiene and safety at the production and business establishments, border gates, restaurants, food stalls, etc. Strictly punish violations.

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5. Renovation of public health financial mechanism (the principle is that the health service prices are correctly and adequately computed/calculated)

Implement the Decree on renovation of operational mechanism, financial mechanism; Circular 04 on service prices at hospitals

Renovate budget allocation, priorities given to preventive health, grassroots health, the poor, the near poor, children below 6 yrs old... (Resolution 18 of the National Assembly)

Classify hospitals to apply new and appropriate mechanisms.

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6. Review and accelerate the disbursement rate of investment works:

• Difficulties: Development investment capital for health has been going down (it is likely for MOH alone to be reduced by 20% as compared with 2012)

• It is necessary to proactively review and adjust the investment capital from the State budget and Government bonds in 2012 to focus on speeding up the key works, projects to be urgently completed in 2012/2013; Newly launch the works that are especially important only.

• Accelerate disbursement rate from various sources of capital, especially FDI, ODA for infrastructure works, high-tech projects.

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7. Implementation of the HI Law, roadmap for universal HI

• Implement the scheme for universal HI• Support for the near poor is 70% in 2012• Consolidate the organizational apparatus of HI and SI; • Reform the HI regime towards compulsory insurance according to the

minimum rate for all;• Develop mechanisms and policies for private sectors to be engaged in the

provision of HI services• Coordinate with ministries and sectors to formulate the scheme for

amendments and supplements to a number of articles of the HI Law and amendments to some documents guiding the implementation of HI.

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8. Strengthening grassroots health network (districts, communes), including material facilities, equipment and health HR for implementation:

• Primary health care: adding the task of managing non-communicable diseases: asthma, high blood pressure, ... perform home-based health care, family doctors ...; deploy national targets for commune health, national standards on preventive medicine/health.

• Increase investment in preventive medicine, organize the local system of preventive medicine ...;

• Improve capacity of health check and treatment for commune and district levels

• Expand health insurance, traditional medicine treatment and care at the commune level.

• Increase training for health workers, collaborators, traditional birth attendants ... in the work related to population and family planning and reproductive health

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9. Health HR development Gradually ensure the basic needs of HR at various levels

(CHS with working doctors, structure the staff and distribute staff by region, area)

Policies for health workers, protect interests and provide insurance for occupational risks.

Train high-quality health workers; conduct intensive training; training on capacity for planning, hospital management and financial management ...

Increase the number of village medical staff, health volunteers.

Increase investment and upgrade training facilities

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10. Enhance capacity for health management Strengthen the health information system for the planning

and management Renew health planning work Strengthen the supervision and inspection over policy and

regulation implementation at localities and units

11. Enhance the effectiveness of IEC for behaviour change on health care

Promote health education and communications Strengthen inter-sectoral coordination and mobilization,

associations, social organizations in communications. Diversify health education and communication work, improve

the forms and contents of communications, direct communications to the target audience.

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THANK YOU VERY MUCH!

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