Quyết định 4299/QĐ-BYT năm 2016 phê duyệt Dự án chủ động dự phòng, phát hiện sớm, chẩn đoán, điều trị, quản lý bệnh ung thư, tim mạch, đái tháo đường, bệnh phổi tắc nghẽn mạn tính, hen phế quản và các bệnh không lây nhiễm khác, giai đoạn 2016-2020 do Bộ trưởng Bộ Y tế ban hành

DECISION

APPROVING THE PROJECT ON ACTIVE PREVENTION, EARLY DETECTION, DIAGNOSIS, TREATMENT AND MANAGEMENT OF CANCERS, CARDIOVASCULAR DISEASE, DIABETES MELLITUS, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, BRONCHIAL ASTHMA AND OTHER NON-COMMUNICABLE DISEASES FROM 2016 TO 2020

MINISTER OF HEALTH

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

Pursuant to the Decision No. 376/QD-TTg dated March 20, 2015 of the Prime Minister on approving the National Strategy for prevention and control of cancers, cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma and other non-communicable diseases from 2015 to 2025;

At the request of the General Director of Department of Preventive Medicine.

DECISION

Article 1. Approving the project on active prevention, early detection, diagnosis, treatment and management of cancers, cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma and other non-communicable diseases from 2016 to 2020 (hereinafter referred to as “Project”):

I. POINT OF VIEW

1. Cancers, cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma and other non-communicable diseases (hereinafter abbreviated as “NCDs”) have serious impact to the public health and the social and economic development of the country due to a high number of people contract such diseases which result in disability and death. Effective prevention and control of such diseases can reduce the number of people contracting them in the public community, prevent people from disability and premature death, as well as reducing patient overload at the hospitals.

2. The responsibility of levels, sectors and each citizen is to prevent and control NCDs, in which the administration of authorities and Health sector is the key.

3. The active prevention, supervision, early detection, treatment and constant and long-term management at the preliminary health facility is the determinant of prevention and control of NCDs.

4. The investment resources for prevention, supervision, early detection, treatment and management of NCDs shall be mobilized from multiple resources, in which the State Budget shall be mainly used to control the risks of diseases and to prevent, supervise and early detect such diseases.

II. OBJECTIVES

1. General objective

To minimize the increase of the rate of patients who have a history of disease, contract diseases, become disabled and experience premature death in the community. Such diseases are cancers, cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma and other NCDs. The above minimization contributes in achieving the objectives of the Strategy.

2. Specific objectives

a. Objective 1. Increase the rate of patients who are prevented from NCDs or whose diseases are early detected or who receive treatment and be managed for such diseases.

Targets:

- 70% of high school students must attend medical exams, detected if being overweight and receive health management.

- Cooperate in checking and detecting patients who are overweight, have high blood pressure, dyslipidemia and blood sugar disorder of 70% of employees at companies and enterprises, by providing them with medical exams.

- 50% of patients who have high blood pressures must be detected; 30% of patients who contract diseases must be managed and treated in accordance with the specialized guidance.

- 50% of patients who have diabetes mellitus and 55% of patients who have a history of diabetes mellitus must be detected; 50% of patients who are diagnosed with such disease and 60% of those who have a history of such disease must be managed and treated in accordance with the specialized guidance.

- 40% of patients who have chronic obstructive pulmonary disease must be detected and treated before any complication occurs; 50% of patients who are detected with such disease must be treated in accordance with the specialized guidance.

- 40% of patients who have bronchial asthma must be detected and treated before any complication occurs; 40% of patients who have such disease must be treated, in which 20% of them must be controlled completely for their disease.

- 20% of patients who have oral, breast, cervical, ovarian and colorectal cancers must be detected in an early stage.

b. Objective 2. Strengthen and improve the health care system to prevent, supervise, detect, treat and manage NCDs.

Targets:

- 70% of medical employees who participate in the prevention and control of NCDs in provinces and communes must be well trained in prevention, supervision, early detection, diagnosis, treatment and management.

- 80% of preventive medicine centers in provinces and 80% of preventive medicine centers in districts must carry out activities in preventing, early detecting and managing NCDs according to the regulations.

- 95% local health facilities which treat NCDs must provide services of diagnosis, management and treatment of such diseases.

- 70% of commune health stations must carry out activities in preventing and early detecting the risks of NCDs; 40% of commune health stations must participate in the treatment and management of high blood pressure, diabetes mellitus and other NCDs.

c. Objective 3. Develop the information management system and the national surveillance system on NCDs.

Targets:

- 90% of local health facilities shall make an annual report on NCDs according to the regulations.

- 50% of commune health stations must make a report on the number of death due to NCDs according to ICD10.

- The national database for managing the information about the number of people who contract diseases and experience death, risk factors of NCDs and the satisfaction of the health system, must be established and updated periodically.

III. SCOPE, REGULATED ENTITIES AND LIFE OF THE PROJECT

1. Scope: the project shall be executed in 63 provinces and central-affiliated cities.

2. Regulated entities: All citizens

3. Life of the project: within 5 years, from 2016 to 2020.

IV. MAIN ACTIVITIES AND SOLUTIONS

1. Enhance prevention, early detection, treatment and management of NCDs in the community

a. In communes

- Medical employees in villages:

+ Provide information about the methods of controlling and preventing NCDs for the citizens; guide them on how to judge the risks themselves and how to early detect the signs of certain cancers (cervical, breast, ovarian, lungs, liver and colorectal cancers), high blood pressure, cerebral vascular accident, diabetes mellitus, chronic obstructive pulmonary disease and bronchial asthma.

+ Participate in managing the patients. Provide counseling and guidance for those who are vulnerable to the diseases to get medical exams at the health facilities. Manage and supervise the patients, as well as providing counseling and guidance for them to take care of themselves and follow the treatment at home; organize social activities for patients in the community to exchange information and support each other during the process of taking care of themselves and receiving treatment at home.

+ Medical employees at schools must educate students to change their behaviors and life styles. Such employees must keep an eye on the nutritional and development status of these students regularly, detect if they are overweight and provide health counseling and carry out health management for them.

- Commune health stations; clinics at agencies and enterprises:

+ Provide information about the methods of preventing and controlling NCDs; prevent and control the risk factors of NCDs; early detect the signs of such diseases; provide counseling and support for patients to give up smoking and alcohol; provide vaccines against hepatitis B, HPV and other related vaccines for patients.

+ Select opportunities to detect patients with a history of disease by measuring their blood pressure, performing quick blood test, measure peak expiratory flow rate to detect chronic lungs disease; select opportunities to early detect signs of cervical cancer (VIA method) and breast cancer.

+ Provide counseling and preventive treatment for patients with a history of disease, such as being overweight, have dyslipidemia and diabetes mellitus.

+ Give first aid to patients and suggest them to request for a referral if they have myocardial infarction, cerebral vascular accident, and complication of low or high blood sugar, acute asthma.

+ Diagnose, provide treatment and manage the patients who fall into a minor case of high blood pressure; provide treatment for patients who have high blood pressure, cerebral vascular accident, diabetes mellitus and chronic obstructive pulmonary disease after being diagnosed and treated at the upper health facilities; manage and keep patients under observation after treating their pre-cancer.

+ Provide counseling on palliative care and treatment at certain levels for cancers as assigned; observe and supervise patients, as well as providing counseling and guidance for them to take care of themselves, follow the treatment and rehabilitate at home.

+ Carry out management activities for NCDs at the family doctors’ offices.

b. In districts:

- + Provide counseling for patients who are overweight, have dyslipidemia and diabetes mellitus; manage those who are vulnerable to cardiovascular disease; provide counseling for those who are vulnerable to cancers; provide counseling and help patients to give up smoking and reduce the adverse impact of alcohol; provide vaccines against hepatitis B and HPV and other related vaccines for patients.

- Perform medical exams to early detect and manage patients who have high blood pressure, diabetes mellitus, chronic obstructive pulmonary disease and bronchial asthma; perform cancer screening to detect cervical cancer (VIA, HPV, PAP), breast cancer, ovarian cancer; cooperate in combining early detection and management of NCDs with health examination and management at schools, agencies and enterprises. Provide deep counseling for patients.

- Provide diagnosis and treatment services according to the referral for patients who have cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease and bronchial asthma; diagnose and determine diabetes mellitus and provide treatment for patients who have such disease but do not have a serious complication; diagnose and determine myocardial infarction, cerebral vascular accident, stage 1 or stage 2 high blood pressure; diagnose and provide treatment for patients with pre-cancer according to the regulations, as well as providing them with palliative care and treatment; legal action with sanction of forging title; diagnose, provide treatment and manage patients with chronic obstructive pulmonary disease and bronchial asthma.

- Provide first aid for patients, refer them and provide feedbacks on such referral.

c. In provinces:

- + Provide deep counseling about nutrition and physical activities, prevention of obesity, dyslipidemia, pre-diabetes mellitus; manage patients who are vulnerable to cardiovascular disease; detect and provide prevention counseling for patients who are vulnerable to cancers; advise and help patients to give up smoking (provide treatment with drugs), reduce the adverse impact of alcohol; provide vaccines against hepatitis B, HPV and other related vaccines for patients.

- + Give judgment, early detect the risks of and provide prevention counseling about certain types of cancers (cervical, ovarian, breast, lungs, liver and colorectal cancers); high blood pressure, cerebral vascular accident, diabetes mellitus, chronic obstructive pulmonary disease and bronchial asthma for the citizens in the community.

- Select the opportunities to early detect the following diseases: high blood pressure, diabetes mellitus, chronic obstructive pulmonary disease and bronchial asthma, as well as providing counseling about them and managing them; perform cervical cancer screening (PAP, HPV) and breast cancer screening; cooperate in combining early detection and management of NCDs with health examination and management and medical services at schools, agencies and enterprises; provide deep counseling for patients; provide deep treatment for patients to help them give up smoking and alcohol.

- Provide comprehensive diagnosis services and comprehensive and deep treatment services according to the referral. Such services are provided for patients with cancers, cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease and bronchial asthma; provide deep treatment for patients to help them give up smoking and alcohol.

d. In central cities:

- The preventive healthcare facilities shall carry out activities in preventing and controlling NCDs according to the tasks assigned to them; provide non-communicable disease prevention services; provide training, carry out inspection, conduct research and manage the information about the NCDs under their management.

- The health facilities shall provide diagnosis and deep treatment services for the patients, as well as high technical services; conduct deep research on cancers, cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease and bronchial asthma.

2. Strengthening and enhancing the network capacity and improve the policy mechanism

a. Strengthen the network organization

- In central cities: establish offices/departments to prevent NCDs according to the functions and tasks at Institute of Epidemic Prevention/Pasteur, Institute of Nutrition, National Institute of Occupational and Environmental Health. Strengthen and develop the medical service system network according to the plan.

- In provinces: establish the Department of Nutrition and NCDs, Preventive Treatment Counseling Office or General Clinic at the Preventive Medicine Center in the province to provide early detection services, counseling, management and prevention treatment for outpatients who have NCDs. Strengthen the specialized departments at the health facilities in order to improve their medical quality and cooperate in directing, supervising and providing such facilities and the preventive medical field with specialized technical support.

- In districts: establish Department of disease and HIV/AIDS control at the Medical Center in the district in order to play the key role in preventing and controlling NCDs within the area. Strengthen the specialized departments at health facilities in order to improve their medical quality and cooperate in directing, supervising and providing the medical stations in the communes with specialized technical support.

- In communes: the health stations in communes must have specialized officials who are in charge of prevention and control of NCDs in the community; integrate the tasks in preventing and controlling such diseases into the normal tasks of the medical employees of the village.

b. Improve the potential

- Develop the training documents and specialized guidance documents on prevention, supervision, detection, management and treatment of NCDs for the health facilities in districts and communes. Focus on developing the training documents and documented guidelines for the health stations in communes and family doctors' offices; documented guidelines for counseling and for prescribing nutrition and physical activities for patients.

- Develop NCDs kit and documented guidelines for helping the citizens to give judgment themselves about the early signs of certain NCDs; develop software to evaluate the risks of diseases; develop documented guidelines for helping patients and caregivers to manage the diseases at home; develop documents and tools for supporting medical employees in providing counseling for patients and those who are vulnerable to the diseases; develop documented guidelines for helping patients to give up smoking, etc.

- Train the lecturers in provinces in order that they will provide trainings on prevention, supervision, detection, management and treatment for NCDs for the medical employees in provinces, districts and communes. Such training and guidelines shall focus on the health facilities in communes and family doctors' offices; provide trainings on the provision of counseling and prescription of nutrition and physical activities for patients; train the medical employees in provinces, districts and communes to provide counseling on alcohol and smoking cessation.

- Support the health facilities in communes with essential equipment, such as blood lipid and glucose measuring device and peak flow meter to serve the detection, diagnosis and management of patients who contract NCDs in the community.

c. Improve the policy mechanism

- Develop and improve the regulations and policy mechanisms of finance, health insurance, medical services in order to support the detection, management and treatment for NCDs at the health facilities in communes and in the community.

- Build Preventive Medicine Center and District Medical Center that both satisfy the National Standards, from 2016 – 2020. Amend and develop the Circular on issuing medical license for preventive medicine centers.

- Develop the Circular on prevention, early detection and management of NCDs in the community. Provide additional information to the specialized technical guidelines and develop them. Such guidelines are applicable to all health stations nationwide; develop the basic package of services to prevent certain NCDs, cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease and bronchial asthma.

d. Direct, guide and support all activities.

- The health facilities in provinces and communes shall support, inspect and supervise the following activities: prevention, early detection, treatment and management of NCDs; and support patients in managing such diseases themselves at the commune health stations and in the community.

- Carry out pilot models of prevention, detection and management of the combination of NCDs in the community (based on the preventive medicine network and health facilities network) at certain provinces/cities.

- Organize meetings and seminars to share experience, disseminate and provide guidelines for the system development policies; summarize the evaluation report on models; develop plans and give mid-term or final reviews on the implementation results according to each field.

3. Develop national information and supervision system for NCDs

a. Develop and apply the patient management system at the commune health stations. This system shall be connected with the upper health facilities and shall ensure that patients are managed and observed during their stay in such stations.

b. Develop the system for managing information and supervising NCDs and their risk factors.

- Develop guidelines for supervising NCDs; establish the key factors for supervising such diseases from central to local.

- Update and improve the national indicator for supervision of NCDs; the medical kit and process of surveillance of NCDs (STEPwise); the surveillance kit which is used for supervising death in the community, based on the death statistics of the commune health stations; the potential evaluation kit which satisfies the requirements for non-communicable disease prevention activities of the medical system.

- Promulgate the form of periodic statistical report which is applied for the medical network from central to communes; develop statistical software to report NCDs.

- Provide trainings on surveillance of NCDs for medical employees of preventive healthcare system from central to local, including trainings on making regular statistical report and death record according to ICD 10, as well as cancer record.

- Organize a national survey on the risk factors of NCDs (STEPS) in 2020; global school-based student health survey (GSHS) in 2018. Carry out inspection and conduct specific research on alcohol, nutrition, food and consumption of salt; carry out inspection and conduct deep research on cardiovascular disease, diabetes mellitus, chronic lungs disease and cancers; conduct research on the disease management model in the community and at schools, agencies and enterprises.

- Carry out death surveillance for cases of NCDs in the community on the basis of information collection which comes from the death statistics system at the commune health stations. During the first stage, improve the NCDs kits, forms, and potential of medical employees in the communes and apply pilot this improvement in certain provinces and regions.

- Inspect, monitor and improve the quality of data of Cancer Recording Centers. Collect periodical information on cases where patients contract NCDs or experience death due to such diseases from the statistical report system of the hospital.

- Conduct periodical survey on the medical system’s capability to satisfy the standards for NCDs kit of WHO (2016 and 2020).

- Develop database for collecting, storing and managing the information and data; develop websites and medical journal columns in order to disseminate and exchange information about the activities; periodically publish the statistical report and data on the risk factors of NCDs.

4. Enhance communication activities, mobilize resources and participate in international cooperation in preventing and controlling NCDs

a. Information, education, communication

- Promote communication work to support advocacy, with the aim to raise the responsibilities of the authorities, ministries, boards, sectors and organizations in developing and operating the policy mechanism, create a sustainable resource to prevent and control NCDs and improve people's health.

- Effectively use the communication information network from central to local in order to disseminate, guide and advise people to prevent and control NCDs.

b. International cooperation

- Take charge to actively cooperate with other countries, institutes, schools and associations of the region and the world in conducting research and provide trainings to develop and improve the quality of human resources for prevention and control of NCDs.

- Enhance comprehensive cooperation with the World Health Organization and other international and domestic health agencies and organizations, in order to support and promote the execution of the project; combine international cooperation projects with the activities of the project in order to achieve the objectives of the National Strategy.

c. Ensure a sufficient resource which is derived from the State Budget at a maximum level; cooperate in mobilizing the contributions from domestic or foreign non-governmental agencies, enterprises and organizations and other international organizations to carry out the project.

V. FUNDS FOR THE PROJECT

The funds for the Project include:

1. State Budget, in which there is a fund from the Health-Population Target Program, from 2016 to 2020 of the Ministry of Health.

2. Funds mobilized from the community and domestic organizations.

3. Supportive funds of international organizations.

4. Other legal funds.

VI. PROJECT EXECUTION

1. In central cities:

a. Department of Preventive Medicine

- Is the standing agency which is responsible for coordinating and managing the execution of the project.

- Take charge and cooperate in developing the legislative documents, policies, regulations and specialized documented guidelines for preventing and controlling NCDs in the field of preventive healthcare.

- Direct and carry out the activities in improving potential to develop the network of preventive healthcare system in the field of prevention and control of NCDs.

- Direct, guide, monitor and carry out the activities in preventing and controlling the risk factors; preventing and controlling NCDs in the community.

- Develop a plan for carrying out the surveillance activities for NCDs and their risk factors, as well as directing, guiding and carrying out such plan.

b. Agency of Health Examination and Treatment

- Take charge and cooperate in developing the legislative documents, policies, regulations and specialized documented guidelines for preventing and controlling NCDs in the field of medical services.

- Direct, guide, monitor and carry out the network development activities, improve the potential in diagnosing, treating, preventing and controlling NCDs in the field of medical services according to the technical referrals.

- Collect and manage the information about NCDs at the health facilities.

c. Department of Planning and Finance

Take charge and provide guidelines on the regime for managing the project's funds; allocate resources for the execution of the project from State Budget, Health-Population Target Program from 2016 to 2020 and other legal resources in order to achieve the objectives of the approved project. Take the initiative to provide consultancy for the Heads of Ministries in creating resources and using resources derived from State Budget and for domestic or foreign organizations in preventing NCDs.

d. Department of Health Insurance

Take charge and cooperate in reviewing, developing, supplementing and improving the legislative documents, policies and regulations on health insurance in the field of prevention and control of NCDs.

dd. Agency of Administration of Environmental Health

Organize and execute the project as assigned; direct, guide and combine early detection activities with management activities regarding NCDs while diagnosing and managing the health of employees at the agencies and enterprises.

e. Hospitals: Bach Mai, K, National Hospital of Endocrinology

- Carry out the programs as assigned: prevention and control of cardiovascular disease, chronic obstructive pulmonary disease and bronchial asthma; prevention and control of cancers; diabetes mellitus.

- Make an annual plan based on the contents of this project in order to carry out the activities of the Health-Population Target Program from 2016 to 2020 as assigned.

- Develop specialized documented guidelines and provide trainings to improve the employees' potential in specialized diagnosis and treatment at the health facilities according to the technical referrals.

- Cooperate in directing, supervising, training and providing technical support for the local health facilities to carry out detection, treatment and management over NCDs.

g. Specialized Institutes and Institute of Epidemic Prevention/Pasteur

- Carry out the activities of the project as assigned.

- Direct the health facilities and provide trainings to improve the employees' potential at lower health facilities, as well as carrying out the activities in preventing and controlling NCDs in the community.

- Conduct scientific research and participate in international cooperation in the field of prevention and control of NCDs.

- Participate in the activities in supervising NCDs and their risk factors as assigned.

h. Departments and related units

Execute the project as assigned.

2. Provinces and central-affiliated cities

a. Department of Health

Direct the medical units in the provinces to carry out the activities as assigned.

b. Preventive Medicine Center in the province

- Is the standing unit which helps the Department of Health to coordinate the execution of the project in the province or city.

- Direct, guide, monitor and carry out the activities in preventing and controlling the risk factors; preventing and controlling NCDs in the community.

- Is the key agency which develops the plan for carrying out the activities in making statistical report and supervise the NCDs and their risk factors, as well as directing and guiding such activities.

- Provide services of prevention and control of NCDs.

c. General/specialized hospital in the province

- Carry out the activities of the project as assigned and provide medical services for patients with NCDs according to the technical referrals.

- Cooperate in directing, supervising, training and providing the local health facilities with specialized technical support to carry out detection, treatment and management over NCDs in provinces or cities.

- Manage the information and make statistical report on the NCDs at the hospitals.

d. Medical Center in the district

- Is the key agency which executes the project in the district.

- Direct, guide, monitor and carry out the activities in preventing and controlling the risk factors; preventing and controlling NCDs in the community.

- Provide services of prevention and control of NCDs.

- Make statistical report and supervise the NCDs.

dd. District hospital

- Carry out the activities in detecting, diagnosing and treating NCDs; inspecting, supervising and providing specialized guidelines for the commune health facilities as assigned.

- Make statistical reports according to the regulations.

e. Health station in the commune

- Disseminating the information about health education and prevention of NCDs in the commune.

- Manage and treat certain NCDs at the health station in the commune.

- Make statistical reports and carry out surveillance on causes of death due to NCDs in the community.

Article 2. This Decision shall come into force from the date on which it is signed and promulgated.

Article 3. Chief of the Ministry Office, Chief Inspector, Director General of Department of Preventive Medicine, Director Generals, Director General of the Ministry of Health, Heads of entities affiliated to the Ministry of Health, Director of Department of Health, Heads of related agencies and units shall implement this Decision./.

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