Thông tư 27/2023/TT-BYT ngày 29/12/2023 quy định về tiêu chuẩn, chức năng, nhiệm vụ, phạm vi hoạt động khám bệnh, chữa bệnh và nội dung đào tạo chuyên môn, nghiệp vụ đối với Nhân viên y tế thôn, bản; Cô đỡ thôn, bản do Bộ trưởng Bộ Y tế ban hành

CIRCULAR

ON STANDARDS, FUNCTIONS, TASKS, SCOPE OF MEDICAL EXAMINATION AND TREATMENT ACTIVITIES, AND PROFESSIONAL TRAINING CONTENT FOR VILLAGE HEALTH WORKERS AND VILLAGE MIDWIVES

Pursuant to the Law on Medical Examination and Treatment No. 15/2023/QH15 dated January 9, 2023;

Pursuant to Decree No. 95/2022/ND-CP dated November 15, 2022 of the Government on the functions, duties, powers, and organizational structure of the Ministry of Health;

At the proposal of the Director of the Department of Maternal and Child Health, Ministry of Health;

The Minister of Health hereby issues a Circular on standards, functions, tasks, scope of medical examination and treatment activities, and professional training content for village health workers and village midwives.

Article 1. Scope and regulated entities

1. Scope:

This Circular provides regulations on standards, functions, tasks, scope of medical examination and treatment activities, and professional training content for village health workers and village midwives.

2. Regulated entities:

a) Health workers engaged in primary healthcare services at villages, hamlets, and neighborhoods as prescribed in Article 2 of Circular No. 04/2012/TT-BNV dated August 31, 2012 of the Minister of Home Affairs on guidelines for organizing activities of villages and neighborhoods (hereinafter referred to as village health workers);

b) Village health workers providing maternal and child healthcare services in ethnic minority and mountainous areas, as well as in severely disadvantaged communes in riverine, coastal, and island regions (hereinafter referred to as village midwives);

c) Relevant agencies, organizations, and individuals;

d) This Circular does not apply to collaborators of healthcare programs and projects.

Article 2. Standards for village health workers and village midwives

1. Professional qualifications and training: Village health workers and village midwives must meet one of the following criteria:

a) Successfully complete a training program (certified) in professional and technical skills as prescribed in Article 6 of this Circular;

b) Hold a medical qualification (doctor, physician assistant, nurse, or midwife) at an intermediate level or higher.

2. Voluntarily participate as a village health worker or village midwife.

3. Be physically fit to perform assigned tasks.

Article 3. Functions of village health workers and village midwives

1. For village health workers: Support commune health stations in performing primary healthcare functions at the village level.

2. For village midwives: Support commune health stations in providing maternal and child healthcare services at the village level.

Article 4. Tasks and scope of medical examination and treatment activities for village health workers

1. Tasks of village health workers:

a) Participate in primary healthcare and other healthcare activities at the village level, including:

- Conduct health education, awareness campaigns, guidance, and counseling for villagers on healthcare, disease prevention, environmental sanitation, food safety, malnutrition prevention, HIV/AIDS prevention, non-communicable diseases, and epidemic control in community; as well as control and mitigation of the impacts of climate change and environmental pollution;

- Detect, monitor, and report on the occurrence of infectious diseases, non-communicable diseases, foodborne illnesses, and emerging epidemics within the village;

- Collaborate in the implementation of healthcare programs and projects at the village level;

- Guide villagers on growing and using traditional herbal medicine at home for disease prevention and treatment of common symptoms and illnesses;

- Participate in implementing disease prevention, food safety, and community health promotion initiatives;

- Assist in guiding the establishment of citizen health records and citizen health status management in the locality;

- Attend training courses, professional development programs, and refresher courses to update knowledge and enhance expertise;

- Participate in periodic meetings with commune health stations;

- Ensure timely and complete reporting in accordance with the guidance of commune health stations.

b) Participate in maternal and child healthcare, including:

- Promote awareness and encourage proper hygiene practices for women and prenatal care, advocate for balanced nutrition, and eliminate harmful customs affecting maternal and child health. Encourage pregnant women to register for prenatal management at commune health stations, attend antenatal check-ups, receive tetanus vaccinations, give birth at healthcare facilities, ensure children receive age-appropriate vaccinations, and practice breastfeeding;

- Report the list and number of children in the village; compile lists of pregnant women and children eligible for vaccination according to regulations and monitor post-vaccination complications;

- Guide the use of paper and electronic tools for tracking maternal and child health care;

c) Participate in medical examination and treatment activities at the village level as specified in Clause 2 of this Article.

2. Scope of medical examination and treatment activities for village health workers.

a) For residents in the village:

- Identify critical symptoms, provide first aid in emergencies and accidents, and assist in emergency referrals;

- Perform initial care and treatment for common symptoms and illnesses within the community and refer to healthcare facilities when necessary, including: cough, fever, nasal congestion, headache, abdominal pain, upper respiratory infections, acute diarrhea, conjunctivitis, influenza, dengue fever, scarlet fever, allergic dermatitis, urticaria, measles, mumps, hand-foot-mouth disease, and other locally prevalent illnesses;

- Provide guidance and counseling on general healthcare and disease prevention in the community;

- Assist in managing, screening, counseling, and guiding healthcare for the elderly, disabled individuals, people with mental disorders, and patients with non-communicable diseases such as hypertension, diabetes, chronic obstructive pulmonary disease (COPD), asthma, and cancer.

b) For mothers and children in the village:

- Provide antenatal care, detect abnormal signs, offer initial management, and support referral for pregnant women, mothers, and newborns;

- Manage unassisted childbirth for pregnant women unable to reach healthcare facilities in time and notify the commune health station;

- Guide, counsel, monitor, and provide home-based postnatal care for mothers and newborns during the first six weeks after delivery;

- Provide guidance on simple methods for monitoring and caring for children’s health, preventing malnutrition in children under 16 years old. Participate in child nutrition improvement activities such as weighing, measuring, measuring arm circumference, and plotting growth charts for children under five years old. Provide counseling on breastfeeding and appropriate complementary feeding;

- Distribute iron/folic acid supplements for pregnant women and mothers, as well as nutritional supplements for children, according to the guidance of commune health stations (if applicable), while providing household-based monitoring and follow-up;

c) Manage and effectively use village-level medical kits; assist commune health stations in guiding patients on the safe, rational, and effective use of essential medicines.

d) The list of technical procedures for medical examination and treatment applicable to village health workers is specified in Appendix 01 enclosed with this Circular.

Article 5. Tasks and scope of medical examination and treatment activities for village midwives

1. Tasks of village midwives.

a) Participate in maternal and child healthcare and public health activities at the village level, including:

- Educate, guide, and counsel women of reproductive age on reproductive health. Promote women’s hygiene, antenatal care, proper nutrition, and the elimination of harmful practices affecting maternal and child health. Encourage pregnant women to register for prenatal care at commune health stations, receive antenatal check-ups, tetanus vaccinations, deliver at healthcare facilities, and ensure their children receive all age-appropriate vaccinations;

- Provide education and counseling on recognizing danger signs during pregnancy and postpartum, as well as symptoms requiring immediate medical attention. Guide prenatal screening and promote the benefits of breastfeeding, proper infant feeding, and malnutrition prevention for children under 16 years old;

- Participate in implementing healthcare programs and projects at the village level;

- Attend training courses, professional development programs, and refresher courses to enhance expertise;

- Guide the use of paper and electronic tools for tracking maternal and child health care;

- Participate in periodic meetings with commune health stations;

- Ensure timely and complete reporting in accordance with the guidance of commune health stations.

b) Participate in medical examination and treatment activities at the village level as specified in Clause 2 of this Article.

2. Scope of medical examination and treatment activities for village midwives.

a) For residents in the village:

Identify critical symptoms, provide first aid in emergencies and accidents, and assist in emergency referrals.

b) For mothers and children in the village:

- Detect early pregnancy, conduct antenatal check-ups, maintain pregnancy monitoring records, counsel and encourage pregnant women to attend at least four antenatal check-ups per pregnancy, and give birth at healthcare facilities;

- Manage antenatal care, identify high-risk pregnancies, provide initial management, and refer to healthcare facilities promptly;

- Detect danger signs in mothers and fetuses during labor, provide initial management, notify the commune health station for assistance, and mobilize family members or the community to transport the mother to a healthcare facility in a timely manner;

- Perform initial management of complications in cases of unassisted childbirth where the pregnant woman cannot reach a healthcare facility in time for delivery, and support timely referral to a healthcare facility. Conduct normal cephalic delivery for pregnant women in labor who cannot or are unable to reach a healthcare facility in time for delivery. Guide families on appropriate medical waste disposal based on local village conditions;

- Conduct postnatal examination and management, and provide maternal and newborn care at home:

+ For mothers: Observe overall health status and mental condition; measure pulse, temperature, blood pressure, and respiratory rate. Assist mothers in managing nipple inversion, breast engorgement, and blocked milk ducts, and address issues related to breastfeeding. Perform abdominal palpation to check uterine involution. Examine the perineum and assess lochia. Detect any abnormal maternal signs and refer to a healthcare facility when necessary;

+ For newborns: Weigh the baby and monitor growth and development, including breastfeeding status: Conduct a general health assessment by checking pulse, respiratory rate, and breath sounds. Observe for abnormalities or congenital anomalies involving the skin, mouth, ears, eyes, limbs, genitalia, anus, etc. Examine and provide hygienic care for the newborn’s skin. Inspect and care for the umbilical cord. Detect any abnormal signs in the newborn and ensure timely referral to a healthcare facility when needed.

- Provide guidance and counseling on women’s hygiene, reproductive tract infection prevention, and sexually transmitted disease prevention;

- Provide guidance and counseling on appropriate complementary feeding for infants;

- Distribute iron/folic acid supplements to pregnant women and mothers, as well as nutritional products for malnutrition prevention and treatment in children, following the guidance of the commune health station (if applicable), and conduct household-based monitoring and follow-up.

c) Effectively manage and utilize the village midwife’s medical kit. Support the commune health station in guiding patients on the safe, rational, and effective use of essential medicines.

d) The list of technical procedures for medical examination and treatment applicable to village midwives is specified in Appendix 02 enclosed with this Circular.

Article 6. Contents of professional and technical training

1. For village health workers: The professional and technical training contents are specified in Appendix 03 enclosed with this Circular, with a minimum training duration of three (03) months.

2. For village midwives: The professional and technical training contents are specified in Appendix 04 of this Circular, with a minimum training duration of six (06) months.

3. For village health workers who also serve as village midwives: The professional and technical training contents are specified in Appendix 05 enclosed with this Circular, with a minimum training duration of three (03) months.

4. Vocational education institutions authorized to provide training in nursing, midwifery, and general medicine at an intermediate level or higher shall, based on the professional and technical contents specified in Clauses 1, 2, and 3 of this Article, develop, review, approve, and issue training programs and materials, organize training sessions, and issue training certificates in accordance with the laws on vocational education.

Article 7. Implementation

1. Responsibilities of the Department of Maternal and Child Health: The department shall act as the focal point for disseminating, guiding, implementing, inspecting, and supervising the enforcement of the provisions of this Circular in accordance with its assigned functions and duties.

2. Responsibilities of the Departments of Health of provinces and centrally affiliated cities:

a) Act as the focal point for coordinating with relevant departments, agencies, and organizations in advising and submitting proposals to the competent authorities of the province or centrally affiliated city for organizing the implementation of this Circular;

b) Based on the characteristics, situation, and actual conditions of the locality, the Department of Health shall coordinate with relevant departments, agencies, and organizations in advising and submitting proposals to the competent authorities of the province or centrally affiliated city to determine legal funding sources and monthly allowances in accordance with the provisions of Decree No. 33/2023/ND-CP dated June 10, 2023 of the Government on commune-level officials and civil servants and part-time public staff at the commune level, in villages, and neighborhoods for village health workers and village midwives;

c) Lead and coordinate with relevant agencies in advising and submitting proposals to the competent authorities of the province or centrally affiliated city to determine the list of ethnic minority and mountainous villages, as well as particularly difficult communes in coastal, island, and disadvantaged areas in maternal and child healthcare, to assign one village midwife per village;

3. District-level health centers, commune-level health stations shall manage, direct, guide, and supervise professional and technical support for village health workers and village midwives;

4. People’s Committees of districts, communes, and village heads shall manage and supervise the activities of village health workers and village midwives.

Article 8. Entry into force

1. This Circular comes into force as of January 1, 2024.

2. Circular No. 07/2013/TT-BYT dated March 8, 2013 of the Minister of Health on the regulations on standards, functions, and duties of village health workers shall cease to be effective as of the effective date of this Circular.

Article 9. Reference provisions

In cases where the legal documents cited in this Circular are amended, supplemented, or replaced, the amended, supplemented, or replaced documents shall apply.

Article 10. Transitional provisions

Village health workers and village midwives working before the effective date of this Circular shall continue to perform their functions, duties, and scope of medical examination and treatment as specified in this Circular.

Article 11. Responsibilities for enforcement

1. The Chief of the Ministry Office, the Chief Inspector of the Ministry, the Director of the Department of Maternal and Child Health, the Directors of relevant departments and agencies under the Ministry, the Heads of units affiliated with the Ministry, the Directors of the Departments of Health of provinces and centrally affiliated cities, and relevant agencies, organizations, and individuals shall be responsible for implementing this Circular.

2. During the implementation process, if any difficulties arise, agencies, organizations, and individuals shall promptly report to the Ministry of Health (Department of Maternal and Child Health) for review and resolution./.

APPENDIX 01

LIST OF PROFESSIONAL MEDICAL EXAMINATION AND TREATMENT TECHNIQUES FOR VILLAGE HEALTH WORKERS
(Enclosed with Circular No. 27/2023/TT-BYT dated December 29, 2023 of the Ministry of Health)

APPENDIX 02

LIST OF PROFESSIONAL MEDICAL EXAMINATION AND TREATMENT TECHNIQUES FOR VILLAGE MIDWIVES
(Enclosed with Circular No. 27/2023/TT-BYT dated December 29, 2023 of the Ministry of Health)

APPENDIX 03

TRAINING CONTENT FOR PROFESSIONAL AND TECHNICAL SKILLS OF VILLAGE HEALTH WORKERS
(Enclosed with Circular No. 27/2023/TT-BYT dated December 29, 2023 of the Ministry of Health)

APPENDIX 04

TRAINING CONTENT FOR PROFESSIONAL AND TECHNICAL SKILLS OF VILLAGE MIDWIVES
(Enclosed with Circular No. 27/2023/TT-BYT dated December 29, 2023 of the Ministry of Health)

APPENDIX 05

TRAINING CONTENT FOR PROFESSIONAL AND TECHNICAL SKILLS FOR VILLAGE HEALTH WORKERS WHO ALSO SERVE AS VILLAGE MIDWIVES
(Enclosed with Circular No. 27/2023/TT-BYT dated December 29, 2023 of the Ministry of Health)

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