Nghị quyết 99/2023/QH15 giám sát chuyên đề huy động nguồn lực phòng chống dịch COVID19

RESOLUTION

OPERATIONAL SUPERVISION OF MOBILIZATION, MANAGEMENT AND USE OF RESOURCES IN PREVENTING AND CONTROLLING COVID-19; IMPLEMENTATION OF REGULATIONS AND LAW REGARDING GRASSROOTS HEALTHCARE AND PREVENTIVE HEALTHCARE

NATIONAL ASSEMBLY

Pursuant to Constitution of the Socialist Republic of Vietnam;

Pursuant to the Law on Supervisory Activities of the National Assembly and People’s Council No. 87/2015/QH13;

Pursuant to Resolution No. 47/2022/QH15 dated June 6, 2022 of the National Assembly on National Assembly's Supervisory Program in 2023 and Resolution No. 51/2022/QH15 dated June 14, 2022 of the National Assembly on establishment of operation supervision team for “Mobilization, management, and use of forces in COVID-19 prevention and control; implementation of regulations and law on grassroots healthcare and preventive healthcare”;

On the basis of Report No. 455/BC-DGS dated May 19, 2023 of supervision team regarding operational supervision results of “Mobilization, management, and use of forces in COVID-19 prevention and control; implementation of regulations and law on grassroots healthcare and preventive healthcare” and remarks of National Assembly members,

HEREBY RESOLVES:

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The National Assembly approves Report No. 455/BC-DGS dated May 19, 2023 of the Supervision team on operational supervision results regarding mobilization, management, and use of resources in COVID-19 prevention and control; implementation of regulations and law on grassroots healthcare and preventive healthcare with the following primary achievements, drawbacks, limitations, and causes:

1. Regarding mobilization, management, and use of resources in COVID-19 prevention and control

a) COVID-19 is a global, unprecedented, complicated, and unpredictable epidemic. Given the urgent demand for protection of lives and health of the general public, social security, and socio-political development, the Communist Party and the Government have aggressively, flexibly, and promptly commanded and adapted strategies with policies appropriate to time and development of the epidemic. Development and improvement of regulations on COVID-19 prevention and control are focused and prioritized; in particular, the National Assembly promulgates Resolution No. 30/2021/QH15 dated July 28, 2021 with aggressive policies, specific regulations and policies that are unprecedented to create important legal basis for the country to mobilize resources and implement COVID-19 prevention and control. The Government and the Prime Minister have extensively directed promulgation of documents elaborating and organizing effective implementation of disease prevention and control.

By December 31, 2022, the entire country has: (1) Mobilized approximately 230.000 billion VND to serve epidemic prevention and control and social security policies, including 186.400 billion VND from state budget and approximately 43.600 billion VND from donations and contribution, mobilized more than 11.600 billion VND for COVID-19 Vaccine Fund to purchase, import, support research and production of COVID-19 vaccines; purchased and received 259,3 million doses of COVID-19 vaccine, among which, 160 million doses are sponsored approximately 150 doses of which are sponsored by governments of other countries, amounting to approximately 24.000 billion VND; (2) Exempted, reduced, and extended deadline of taxes, fees, charges, and land levies for enterprises and household businesses which amount to approximately 451.000 billion VND; (3) Lowered loan interests for customers affected by COVID-19 which amount to 50.000 billion VND; exempted and reduced banking payment service fees which amount to approximately 13.000 billion VND; (4) Provided employees and employers affected by COVID-19 with financial support which exceeds 47.200 billion VND from Social Security Fund, Unemployment Fund; (5) Mobilized millions of volunteers from all classes to participate in disease prevention and control, especially healthcare personnel, officials, and armed forces' personnel; (6) Received support from Vietnamese all over the world, enterprises, other countries, and international organizations which comes in various forms, including donations and contributions that cannot be fully amounted and quantified in monetary value.

The management, use, payment, and finalization of essential resources have complied with applicable policies and regulations. Aids have been promptly distributed to local governments and entities. By December 31, 2022, expenditure on COVID-19 prevention and control have been distributed and used as follows: more than 87.000 billion VND has been spent to support people, employees, employers, household businesses affected by COVID-19; 4.487 billion VND has been spent to pay for allowance and benefits for frontline workers and other forces participating in disease prevention and control; 15.134 billion VND has been spent to procure COVID-19 vaccine; 4,6 billion VND has been spent to fund research and testing of COVID-19 vaccine; 2.593 billion VND has been spent to procure test kits; 5.291 billion VND has been spent to procure medicine, chemicals, biologicals, medical equipment and materials; 719 billion VND has been spent on examining, providing first-aid, and treatment COVID-19 patients; 89 billion VND has been spent on screening, accepting, and implementing medical quarantine; 403 billion VND has been spent on building, repairing, and upgrading COVID-19 reception and treatment facilities, quarantine facilities, and makeshift hospitals; 96 billion VND has been spent on studying and applying information technology in COVID-19 prevention and control, Program for children's computer and signals, and online classes; approximately 2.600 billion VND has been spent on miscellaneous details. In addition, despite various difficulties, Vietnam still remains responsible, cooperates, and shares with international community by making monetary and material donations to other countries for COVID-19 prevention and control.

Inspection, examination, accounting, and other law enforcement activities are positively implemented thereby allowing advantages to be accurately evaluated and continued, disadvantages to be revealed, and violations in mobilization, management, and use of resources for COVID-19 prevention and control to be rectified and dealt with.

Efforts of the Communist Party, the general public, and entire political system in jointly implementing policies and solutions of the Communist Party and the Government, tremendous physical and mental support from other countries, international organizations, overseas Vietnamese, and results of mobilization, management, use of combined resources, success of vaccine diplomacy, establishment of COVID-19 vaccine fund, and nationwide implementation of COVID-19 vaccination campaign have played a crucial, decisive, and pivotal role in successfully controlling the epidemic and ensuring socio-economic development.

The National Assembly acknowledges and appreciates support, assistance of other countries, international organizations and tremendous efforts of Vietnamese agencies, organizations in Vietnam and outside of Vietnam, cooperation and unification of Vietnamese nationals in and outside of Vietnam. These are significant contributions, great and meaningful messages about unification of the people, love, humanitarianism, tradition and humane ideology of Vietnamese people; motivations and proof for people’s belief in leadership of the Communist Party, management of the Government to overcome the hardest of the country’s moments.

The National Assembly honors individuals and groups who have donated their intelligence, efforts, property, and materials to COVID-19 prevention and control, especially frontline forces in healthcare sector, armed forces, and other forces participating in grassroots disease prevention and control.

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c) Disadvantages and limitations above are caused by a multitude of reasons but primarily by excessively rapid and complicated development of COVID-19 which caused preparation and implementation of response measures to be extremely difficult and rely on trial and error principle. The applicable legal system does not cover every scenario that occurs during COVID-19 prevention and control but is not promptly amended. Several policies are promulgated with urgency and thus have not had their impact promptly evaluated and have not been elaborated. Implementation of several legislative documents is slow and unsatisfactory. Cooperation between agencies from central to local level lacks consistency and adequacy from places to places and from time to time. Due to absolute focus on disease prevention and control, consolidation, monitoring, examination, and acknowledging of mobilization, management, and use of resources have not been regularly exercised and lack consistent criteria for consolidating data accurately and synchronously across the country. Cases where donations are made without documentation, gifting documents, basis for determining value of commodities and property have led difficulty in establishment of public ownership, management, and use.

d) Primary responsibilities for disadvantages and limitations above fall in the hand of organizations, individuals, and heads of agencies, presiding entities which take charge in advising, developing, and promulgating legislative documents, and organizations mobilizing, managing, and using disease prevention and control forces. Ministries and state authorities primarily responsible for promptly providing guidance or requesting competent authority to settle difficulties and issues in implementation of policies on support the general public, enterprises, payment, finalization, transfer of property, establishment of public ownership for property in form of aids, donation. Local governments are slow to promulgate elaborating documents, lack consistency in organizing implementation, and fail to promptly settle difficulties and issues.

2. Regarding implementation of policies and regulations on grassroots healthcare and preventive healthcare

a) During 2018-2022, implementation of policies and regulations on grassroots healthcare and preventive healthcare continues to achieves positive results. Grassroots healthcare and preventive healthcare play an increasingly important role in protecting, caring, improving people’s health, and contributing to disease prevention and control, especially COVID-19. Legislative document system relating to grassroots healthcare and preventive healthcare is slowly improved to fit practical situations and task requirements. Grassroots healthcare and preventive healthcare is invested and effectively utilized.

Grassroots healthcare network has developed on a nationwide scale, 100% districts, towns, city-level towns affiliated to provinces and central-affiliated cities (hereinafter referred to as district-level) have medical centers; 99,6% of communes and towns have healthcare stations (hereinafter referred to as “commune healthcare stations”); 97,3% of commune healthcare stations meet national standards of commune healthcare of the period of 2011 - 2020. Healthcare workers are slowly improved, 92,4% of commune healthcare stations are stationed by doctors; 78,9% of commune healthcare stations are stationed by full-time doctors; the number of highly educated healthcare workers increase on a frequent basis. In addition, active participation of healthcare workers in hamlets, midwives of hamlets, healthcare personnel of schools, healthcare stations of military and people medicine, and healthcare establishments of armed forces. Facilities and equipment are invested, upgraded, and improved; approximately 80% of commune healthcare stations are invested. Capability and quality of healthcare services at healthcare establishments are improved, fulfill functions, tasks, and improve satisfaction of the general public regarding healthcare services.

Preventive healthcare system is slowly improved and reorganized. By 2022, 63/63 provinces and cities have established their own Centers for Disease Control (CDC) on the basis of merging multiple preventive healthcare centers of provincial level. Preventive healthcare personnel receive training and professional training. Prevention and control of infectious diseases, non-communicable diseases have attained various achievements. Approximately 90% of children under 1 year of age are adequately vaccinated with vaccines under expanded program on immunization; dangerous diseases and plagues are controlled and prevented (HIV/AIDS, dengue fever, SARS, etc.), several diseases continue to be prevented (polio, neonatal tetanus, lymphatic filariasis, etc.), tuberculosis, leprosy, malaria, and HIV/AIDS are to be eliminated. 9/11 vaccines under expanded program for immunization have been produced independently. Reduce percentage of undernutrition in children under 5 years of age below 20%, move towards successful implementation of goals in United Nations’ Sustainable Development Goals (SDGs) by 2030. Prevention, control, and management of non-communicable diseases and management of people’s health are slowly implemented in commune level. Awareness and practice of disease prevention, health improvement of people, families, and society are improved.

b) In addition to positive results, implementation of regulations and policies regarding grassroots healthcare and preventive healthcare shows limitations and disadvantages: Legal system regarding grassroots healthcare and preventive healthcare is inconsistent, several documents are not promulgated or amended in a timely manner; organization system lacks stability, consists of issues, and operates in a less than effective manner; management model of district-level medical centers is not consistent; role and advantages of private healthcare and traditional healthcare have not been successfully utilized. Human resources and capacity of grassroots healthcare and preventive healthcare fail to satisfy task requirements in the event of population ageing, changing disease model, and the rise of non-communicable diseases. Percentage of hamlets stationed by healthcare workers drops from 97,5% in 2015 to 71% in 2020, 28% of which have not undergone training. Benefit policies for healthcare officials and workers are lacking, subpar compared to task requirements, responsibilities, and nature of the work, and fail to cover all beneficiaries. During the period of 2018 - 2021, the number of doctors working in commune healthcare stations reduces by 2.238. Provision capability and quality of healthcare services fail to satisfy demand for medical examination and treatment, initial healthcare of the general public which leads to overloading of upper tier hospitals; percentage of medical examination and treatment covered by health insurance in commune healthcare stations relative to total medical examination and treatment covered by health insurance in all tiers across the country drops from 19,8% in 2017 to 14,6% in 2022. Public health management in commune level lacks continuity; data thereof is not synchronized or connected. Frequency of physical activity of the general public remains low. Percentage of malnourished children in areas with disadvantaged socio-economic conditions remains high. Financial regulations on operation of grassroots healthcare fail to be promptly renovated; resources from state budget are limited; percentage of expenditure on medical examination and treatment covered by health insurance in grassroots-level healthcare remains low while healthcare demand of the general public in grassroots level are increasingly high and demand for investment in grassroots healthcare is rising. Issues still remain in payment and finalization of medical examination and treatment costs. Several areas incur expenditure on preventive healthcare which is less than 30% of total state budget expenditure on healthcare as required under Resolution No. 18/2008/QH12 dated June 3, 2008 of the National Assembly. Medicine and medical equipment in commune healthcare stations are insufficient to implement assigned tasks (only 38% of commune healthcare stations satisfy 80% of medicine list and 27,6% of commune healthcare stations implement more than 80% of list of technical services according to specialized referral tier). Several areas lack sufficient vaccine for expanded program for immunization upon completion of target programme on healthcare and population. Percentage of expenditure on grassroots healthcare relative to total expenditure healthcare of society drops from 32,4% in 2017 to 23,1% in 2019. By 2022, percentage of medical examination and treatment covered by health insurance in grassroots healthcare accounts for approximately 75%, percentage of expenditure reaches 34,5% while that in commune healthcare only reaches 1,7%. Infrastructures and information, technology application in grassroots healthcare lack consistency and systemic connectivity. Communication and popularization of knowledge on disease prevention and health improvement for the general public are limited in terms of contents, methods, and resources of implementation.

COVID-19 has made disadvantages and limitations of healthcare system in general and grassroots healthcare, preventive healthcare in specific ever more apparent.

c) The disadvantages and limitations above are caused by various reasons, primarily by: Awareness regarding position and role of grassroots healthcare, preventive healthcare is insufficient, fails to emphasize that grassroots healthcare and preventive healthcare are the base and foundation of people’s health protection, care, and improvement. Financial and management regulations fail to enable grassroots healthcare and preventive healthcare to successfully implement their functions and tasks or to create sufficient drive to operate and develop. During the period of 2020-2022, most resources serving grassroots healthcare and preventive healthcare must be redirected towards COVID-19 prevention and control. Allowance policies are insufficient to attract and allow healthcare workers to work and attach to grassroots healthcare, preventive healthcare. Monitoring, guidance, statistical data report, examination, and supervision of implementation of policies, regulations and law on grassroots healthcare and preventive healthcare are not executed on a regular basis.

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Article 2. Tasks and solutions

In order to rectify any and all disadvantages and limitations in management and use of resources in COVID-19 prevention and control, improve and successfully implement regulations and policies on grassroots healthcare, preventive healthcare, effectively and promptly respond to similar diseases, the National Assembly hereby request the Government, Prime Minister to command ministries, ministerial agencies, and local governments to learn from experience and implement propositions under Report No. 455/BC-DGS dated May 19, 2023 while focusing on:

1. Study and request the National Assembly to amend or promulgate new Law on Health Insurance, Law on Pharmacy, Law on Prevention and Control of Infectious Diseases, Law on Medical Equipment, Law on Food Safety, and laws relating to grassroots healthcare, preventive healthcare, and state of emergency. Develop and finalize schemes for execution of tasks assigned under documents of the Communist Party relating to grassroots healthcare and preventive healthcare. Annul, amend, or promulgate new legislative documents on grassroots healthcare and preventive healthcare; documents elaborating and guiding implementation of procurement of medicine, medical equipment, materials, and chemicals that are consistent with the Law on Bidding and the Law on Prices. (List attached).

2. Review, consolidate, classify, and promulgate guiding documents within their competence to exhaustively deal with difficulties and issues in management, use, payment, and finalization of resources serving COVID-19 prevention and control, which focus on:

a) Payment and finalization of COVID-19 test service fees depending on actual workload in regard to testing services that utilize order placement principles where order unit price or order placement contract is unavailable;

b) Procurement of medicine, chemicals, biologicals, medical equipment, materials, and other commodities at a higher quantity that what is required in practice as provision for complicated development of COVID-19; the transition of the use of medicine, chemicals, biologicals, medical equipment, and materials procured using state budget from COVID-19 examination and treatment where patients are not required to incur to regular medical examination and treatment incurred by patients or health insurance fund as per applicable law; difficulties in payment and finalization of procurement of medicine, chemicals biologicals, medical equipment and materials serving COVID-19 prevention and control that is implemented by advance payment, loan, borrow, mobilization, sponsors, donation from January 1, 2020 to December 31, 2022 inclusive;

c) Establishment of public ownership for sponsored, donated, gifted, awarded property for COVID-19 prevention and control from January 1, 2020 to December 31, 2022 inclusive that have been received, managed, and used by state authorities and public service providers without sufficient documents; whose value cannot be identified or sponsorship value under sponsorship records is higher than value of equivalent commodities on the market or website of authorities;

d) Dissolution and disposal of property when dissolving mobile medical stations, makeshift hospitals, COVID-19 acceptance and treatment establishments;

dd) Exhaustive completion of solutions under Clause 2 Article 5 of Resolution No. 80/2023/QH15.

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a) Grassroots healthcare can adequately provide initial healthcare, medical examination and treatment, disease prevention and control, and health improvement and ensure that the general public have access to community healthcare. Promote implementation of public healthcare coverage goals. Renovate financial regulations and payment regulations of healthcare insurance fund by increasing expenditure on grassroots healthcare. Regulate functions, tasks, and organization of healthcare stations appropriate to scale, composition of population, socio-economic conditions, people’s access to healthcare services from place to place. Organize operation of commune healthcare stations associated with comprehensive personal health management, chronic disease management, non-communicable disease management, community nutrition, and medical examination and treatment in form of family medicine model, combining traditional medicine and modern medicine, combining military medicine and people medicine; associate school healthcare operations with commune healthcare stations. Mobilize private healthcare establishments, workplace healthcare, corporate healthcare, other organizations and individuals to participate in provision of initial healthcare services and preventive healthcare services as per the law and connect to grassroots healthcare in personal health management. Organize appropriate medical examination and treatment establishments in industrial parks and export-processing zones to care for employees’ health.

b) Preventive healthcare continues to prevent and control infectious diseases, non-communicable diseases, and diseases with unidentified causes, control risks, improve health, food safety, community nutrition, environment sanitation, school healthcare, and healthcare for employees, the elderly, mothers, children, the population, healthcare education communication.

4. Renovate policies and methods of training, improving grassroots healthcare and preventive healthcare personnel, especially employees working in commune healthcare stations, hamlet healthcare employees; continue to apply direct admission for learners who are ethnic minorities. Improve capability of grassroots healthcare workers; mobilize and rotate doctors, healthcare employees in grassroots healthcare, especially commune healthcare stations. Study regulations on downsizing appropriate to the specifics of healthcare sector.

5. Study on assurance of salaries, allowances, and benefits worthwhile for healthcare employees and workers in general, grassroots healthcare and preventive healthcare in specific corresponding to task and work requirements according to Resolution No. 27-NQ/TW dated May 21, 2018 of the Central Executive Committee. Encourage local governments to develop policies to attract healthcare officials and employees to work in grassroots healthcare and preventive healthcare.

6. Improve epidemic and disease prevention and control, provide training and improve human resources in healthcare sector, especially in manufacturing vaccines and treatment medicines domestically; ensure medicine, vaccine, medical equipment and materials to protect, care, and improve public health; allocate central government budget to continue expanded program for immunization in a consistent and effective manner on a nationwide scale; improve capability of grassroots healthcare and preventive healthcare in responding to diseases; study and develop scheme for establishment of Central Disease Control.

7. Develop solutions to allow every person's health to be comprehensively monitored and managed in accordance with roadmap under Resolution No. 20-NQ/TW dated October 25, 2017 of the 12^th Central Executive Committee of the Communist Party. Synchronously implement information technology system in managing operations of grassroots healthcare, preventive healthcare, and managing personal health dossiers. Develop and implement health communication and education campaign to increase awareness of the general public; develop synchronous solutions to enable every person to protect, care, train, and improve their own health. Exercise the role of commune healthcare stations in communicating public health improvement and disease prevention, control.

8. Unify district medical centers affiliated to People’s Committees of districts; ensure comprehensive management of local management, especially in terms of human resources and facilities, closely and effectively integrate with operation and specialty management of healthcare sector in order to successfully protect, care, and improve people’s health.

9. Evaluate implementation results and propose demand for investment in grassroots healthcare and preventive healthcare by 2030. Provide guidelines on identifying scope and purpose of expenditure in order to reserve at least 30% of healthcare budget for preventive healthcare according to Resolution No. 20-NQ/TW dated October 25, 2017 of the 12^th Central Executive Committee of the Communist Party and Resolution No. 18/2008/QH12 dated June 3, 2008 of the 12^th National Assembly.

10. Increase health insurance premium according to roadmap appropriate to balance capacity of state budget and payment capability of the general public; study and expand the list of medical examination and treatment services, list of medicine, medical equipment and materials incurred by health insurance fund corresponding to the increase in health insurance premium. Promptly resolve difficulties in payment and finalization of medical examination and treatment costs incurred by health insurance.

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12. Relevant organizations and individuals shall strictly implement conclusions and propositions of inspecting, audit, and examining authority. Regarding COVID-19 prevention and control tasks implemented in accordance with regulations, policies, and formats under Resolution No. 30/2021/QH15, inspection, supervision, audit, payment, finalization, and other law enforcement activities of these tasks must be based on Resolution No. 30/2021/QH15.

Exhaustively deal with issues in management and use of resources for COVID-19 prevention and control, especially violations and cases relating to Viet A Technology Corporation in accordance with regulations of competent authority regarding classification and actions against violating organizations and individuals.

Article 3. Organizing implementation

1. The Government shall:

a) By 2025, present the National Assembly with projects on laws relating to grassroots healthcare, preventive healthcare, and state of emergency under annual Program for law and ordinance development approved by the National Assembly, Plan No. 81/KH-UBTVQH15 dated November 5, 2021 of the Standing Committee of the National Assembly; study and develop scheme for establishing Central Disease Control; request ministries and central departments to implement proposition of supervision teams under Report No. 455/BC-DGS dated May 19, 2023;

b) Fulfill tasks and solutions under Clause 2 Article 2 hereof and report implementation results to the National Assembly at the 7^th meeting of the 15^th National Assembly. In case of issues within competence of National Assembly or the Standing Committee of the National Assembly, the Government shall report to the Standing Committee of the National Assembly prior to implementation.

c) Request ministries and central departments to promulgate documents guiding payment, finalization of non-state budget mobilized amount, collectibles, expenditure, contributions serving COVID-19 prevention and control; local governments to cooperate with Committee of Vietnamese Fatherland Front in reviewing and recording expenditure serving COVID-19 prevention and control from non-state budget sources. Consolidate and report mobilization, use, payment, and finalization results of total expenditure on COVID-19 prevention and control of 2020 - 2022 to the National Assembly, including expenditure from state budget and non-state budget at the 7^th meeting of the 15^th National Assembly;

d) Review and provide guidance on managing and using residual funding sources used by organizations and individuals to support medical establishments in disease prevention and control as per the law;

dd) In 2023, promulgate plans and roadmap, organize implementation of Clauses 3, 4, 5, 6, 7, 9, and 10 Article 2 hereof; strive to finish priority, urgent tasks in 2023 and 2024;

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g) Focus on implementing investment projects for construction, renovation, upgrade, and modernization in healthcare sector; promote disbursement of public investment which has been and is allocated from funding sources of Program for socio-economic development and recovery under Resolution No. 43/2021/QH15 of the National Assembly, introduce structures and projects into use, and increase quality and effectiveness of public healthcare;

h) Request ministries, central departments, and local governments to promptly review, consolidate, and commend individuals and organizations, especially frontline forces attaining achievements in COVID-19 prevention and control;

i) Once every 2 years, the Government shall submit reports on implementation results of provisions regarding grassroots healthcare and preventive healthcare under this Resolution at the year-end meeting.

2. Assign the Government, Supreme People’s Court, Supreme People’s Procuracy, State Audit, ministries, central departments, People’s Committee of provinces and central-affiliated cities, within their tasks and powers, to direct, examine, and organize implementation of Clause 12 Article 2 hereof.

3. The Standing Committee of the National Assembly, the Ethnic Council, National Assembly delegations, National Assembly members, People's Councils of all levels, Vietnamese Fatherland Front, within their tasks, responsibilities, and powers, shall organize implementation and supervise implementation of this Resolution.

This Resolution is approved by the 15^th National Assembly of the Socialist Republic of Vietnam in the 5^th meeting on June 24, 2023./.

CHAIRPERSON OF THE NATIONAL ASSEMBLY




Vuong Dinh Hue

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