Thông tư 38/2016/TT-BYT

CIRCULAR

PROVIDING FOR MEASURES FOR ENCOURAGING THE BREASTFEEDING AT HEALTH FACILITIES

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

At the request of Director of Maternal and Child Health Department;

Minister of Health promulgates this Circular to provide for measures for encouraging the breastfeeding at health facilities.

Article 1. Scope

This Circular provides for measures for encouraging the breastfeeding at health facilities, including “Mười điều kiện nuôi con bằng sữa mẹ” (Ten steps to successful breastfeeding) and “Bệnh viện Bạn hữu trẻ em” (Baby-friendly Hospital).

Article 2. Practice of “Ten steps to successful breastfeeding” at health facilities

1. “Ten steps to successful breastfeeding” consist of:

a) Have a written breastfeeding policy;

b) Train all health care staff in skills necessary to implement this breastfeeding policy;

c) Inform all pregnant women about the benefits of breastfeeding;

d) Help mothers initiate breastfeeding within a hour of birth, maintain exclusive breastfeeding up to 6 months of age and continue the breastfeeding up to 24 months of age or beyond;

dd) Show mothers how to breastfeed and how to maintain lactation;

e) Give newborn infants no food or drink other than breast milk unless medically indicated;

g) Practice rooming-in - allow mothers and infants to remain together - 24 hours a day;

h) Encourage breastfeeding on demand;

i) Give no artificial teats or pacifiers to breastfeeding infants;

k) Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital.

2. Practice of “Ten steps to successful breastfeeding”:

General hospitals having the obstetrics and/or pediatrics, maternity hospitals, children’s hospitals or maternity and pediatric hospitals (hereinafter referred to as hospitals) are responsible for practicing “Ten steps to successful breastfeeding”. To be specific:

a) Promulgate regulations on the practice of “Ten steps to successful breastfeeding” at health facilities in a popular and easily understandable language and communicate them to all health care staff. Post regulations on the practice of “Ten steps to successful breastfeeding” at antenatal care rooms, labour and delivery rooms, postpartum rooms, nutrition counseling rooms or other easy-to-notice places to serve pregnant women, breastfeeding mothers and their families;

b) Organize training classes in or put the following contents into specialized training classes for doctors and health care staff, including necessary skills in counseling, guidelines for correct breastfeeding, expression and storage of breast-milk, maintaining lactation and resolving breastfeeding difficulties as regulated in Decision No. 5063/QD-BYT dated December 05, 2014 by Minister of Health promulgating training materials in infant feeding;

c) Provide counseling and inform all pregnant women who visit the hospitals about the benefits of breastfeeding, early initiation of breastfeeding which means the infant is breastfed within a hour of birth, exclusive breastfeeding for the first six months and sustaining breastfeeding to 24 months of age or beyond;

d) Provide counseling and instructions for mothers on how to initiate breastfeeding within a hour of birth as regulated in Decision No. 4673/QD-BYT dated November 10, 2014 by Minister of Health giving approval for written guidelines for essential care of mothers and newborns in labour and postnatal period;

dd) The obstetrics and pediatrics shall provide instructions for pregnant women, new mothers and mothers breastfeeding infants aged less than 24 months on how to breastfeed, express and store breast milk, and maintain lactation in proper manner;

e) Propagate and provide instructions for mothers to exclusively breastfeed their infants and give their infants no food or drink other than breast milk unless follow-up formula are used as medically indicated by Ministry of Health;

g) Practice rooming-in - allow mothers and infants to remain together - 24 hours a day to ensure that infants are breastfed exclusively;

h) Propagate and provide instructions for postpartum mothers to breastfeed their infants on demand;

i) Propagate and provide instructions mothers breastfeeding infants aged less than 24 months to give no artificial teats or pacifiers to their infants;

k) Establish and maintain operations of “Breastfeeding support groups” at health facilities to provide instructions, counseling and supports for breastfeeding mothers.

Article 3. Accreditation of “Baby-friendly Hospital” title

1. Criteria for accreditation of “Baby-friendly Hospital” title:

Hospitals meet the criteria for successful breastfeeding mentioned in Part E. Specialized criteria of the Criteria for assessing hospital’s quality promulgated under Decision No. 4858/QD-BYT dated December 03, 2013 by Minister of Health on pilot promulgation of the Criteria for assessing hospital’s quality (hereinafter referred to as the Criteria for assessing hospital’s quality) at level 4 or higher.

2. Responsibility to practice the “Baby-friendly Hospital” title:

Each hospital’s head has the responsibility to instruct the hospital's units to implement contents specified in Article 2 herewith and conduct self-assessment based on the criteria for successful breastfeeding mentioned in Part E. Specialized criteria of the Criteria for assessing hospital’s quality. To be specific:

a) After the self-assessment of the hospital’s quality, hospitals affiliated to Ministry of Health and hospitals affiliated to Health Authorities of Ministries/relevant regulatory bodies shall send reports on self-assessment results of the satisfaction of the criteria for successful breastfeeding mentioned in Part E to Ministry of Health (via Maternal and Child Health Department).

b) Hospitals affiliated to Departments of Health shall send reports on self-assessment results to Departments of Health. Departments of Health shall assume responsibility to verify self-assessment results of the satisfaction of the criteria for successful breastfeeding mentioned in Part E. Specialized criteria of the Criteria for assessing hospital’s quality by their affiliated hospitals and announce the list of hospitals eligible for the “Baby-friendly Hospital” title as regulated in Clause 1 Article 3 herewith. In addition, Departments of Health must send the list of hospitals eligible for the “Baby-friendly Hospital” title to Ministry of Health (via Maternal and Child Health Department) for consolidating into the annual list of hospitals eligible for the “Baby-friendly Hospital” title.

3. Accreditation of “Baby-friendly Hospital” title:

a) With regard to hospitals affiliated to Ministry of Health and hospitals affiliated to Health Authorities of Ministries/relevant regulatory bodies: The Maternal and Child Health Department shall, based on reports on self-assessment results of the satisfaction of the criteria for successful breastfeeding mentioned in Part E submitted by the hospitals, consider, consolidate and submit the annual list of hospitals eligible for the “Baby-friendly Hospital” title to Minister of Health for approval.

b) With regard to hospitals affiliated to Departments of Health: Ministry of Health shall, based on the list of hospitals eligible for the “Baby-friendly Hospital” title announced by Departments of Health, consolidate accredited hospitals into the annual list of hospitals eligible for the “Baby-friendly Hospital” title for monitoring.

c) The accreditation of the “Baby-friendly Hospital” title shall be the basis for evaluating the hospital's performance and considering giving annual emulative title and reward to that hospital.

d) Ministry of Health establishes an inspection team to conduct irregular inspection of the satisfaction of the criteria for the “Baby-friendly Hospital” title, notify the hospitals if they fail to maintain the satisfaction of the criteria for the “Baby-friendly Hospital” title and report to Departments of Health of central-affiliated cities or provinces of unqualified hospitals. In addition, propose removing unqualified hospitals from the annual list of hospitals eligible for the “Baby-friendly Hospital” title. The inspection team is composed of heads and specialists of the Maternal and Child Health Department, the Legal Department and the Agency of Health Examination and Treatment. The head of the Maternal and Child Health Department shall act as the leader of the inspection team.

Article 4. Responsibility for implementation

1. Maternal and Child Health Department shall take charge and coordinate with the Agency of Health Examination and Treatment in providing professional instructions, supervising and monitoring the fulfillment of duties by health facilities, doctors and health care staff working in health facilities as regulated in Article 12 and Article 13 of the Government’s Decree No. 100/2014/ND-CP dated November 06, 2014 providing for trading and use of nutritious products for infants, feeding bottles and teats; consolidating and submitting the annual list of hospitals eligible for the “Baby-friendly Hospital” title to Minister of Health; inspecting the satisfaction of criteria for the “Baby-friendly Hospital” title by hospitals.

2. The Agency of Health Examination and Treatment shall take charge and coordinate with the Maternal and Child Health Department in organizing the implementation of the criteria for successful breastfeeding mentioned in Part E. Specialized criteria of the Criteria for assessing hospital’s quality, and inspecting the satisfaction of criteria for the “Baby-friendly Hospital” title by hospitals.

3. Departments of Health of central-affiliated cities or provinces shall assign Centers for Reproductive Health Care to take charge of assisting Departments of Health of central-affiliated cities or provinces in verifying self-assessment results of the satisfaction of the criteria for successful breastfeeding mentioned in Part E. Specialized criteria of the Criteria for assessing hospital’s quality by their affiliated hospitals. Departments of Health of central-affiliated cities or provinces shall send annual consolidated reports thereof to Maternal and Child Health Department directly under Ministry of Health.

Article 5. Transitional clause

If documents referred to in this document are replaced or amended, the new ones shall apply.

Article 6. Effect

1. This Circular comes into force as of January 01, 2017.

2. Director of Maternal and Child Health Department shall take charge and coordinate with relevant authorities in consolidating and inspecting the implementation of this Circular, and send annual report thereof to Minister of Health.

Difficulties that arise during the implementation of this Circular should be reported to the Ministry of Health (via the Maternal and Child Health Department) for consideration./.