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:

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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.

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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;

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- 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;

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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;

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- 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;

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- 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.

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- 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;

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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.

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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

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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./.

PP. MINISTER
DEPUTY MINISTER




Tran Van Thuan

APPENDIX 01

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No.

List of professional techniques

1

Observe, assess, and evaluate the general condition of the patient

2

Measure and record the patient’s vital signs

3

Perform initial first aid for respiratory, circulatory, and cardiovascular emergencies

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5

Perform first aid and temporary immobilization for various fractures

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Administer first aid and initial management of burns

7

Manage snake bites, apply pressure bandages, and immobilize the affected area

8

Provide initial management for bites and stings from animals, etc.

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10

Perform initial first aid for drowning cases

11

Provide first aid for other household accidents, such as electric shock, falls, etc.

12

Safely transport patients

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Manage fever cases

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15

Provide care and counseling for influenza patients

16

Provide care and counseling for patients with conjunctivitis (red eye)

17

Provide initial care and counseling for dengue fever patients

18

Perform initial management of allergic dermatitis, urticaria, and skin rashes

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Perform initial management of mumps cases

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Perform initial management of hand, foot, and mouth disease

22

Provide initial management of abdominal pain

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Provide counseling and guidance on various healthcare practices

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25

Provide counseling and guidance on elderly healthcare

26

Assist the commune health station in providing healthcare counseling and guidance for people with disabilities

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Provide counseling and guidance on mental health care

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Provide counseling and guidance for patients with hypertension

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Provide counseling and guidance for patients with chronic obstructive pulmonary disease (COPD)

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Provide counseling and guidance for patients with asthma

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Provide counseling and guidance for cancer patients

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Provide counseling on nutrition and exercise

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Perform traditional therapies such as coin rubbing (cupping), massage, and acupressure using hands

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Provide healthcare for pregnant women

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Detect and perform initial management of abnormal signs in pregnant women

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Provide emergency assistance for unassisted childbirth

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Provide counseling and postnatal care for mothers during the first six weeks at home

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Provide counseling and postnatal care for newborns during the first six weeks at home

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Bathe newborns

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Provide counseling on breastfeeding and complementary feeding for children

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Provide counseling and guidance on preventing malnutrition in children under 16 years old

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Provide initial care for children with diarrhea

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Assess nutritional status by measuring height, weight, mid-upper arm circumference, and head circumference in children; plot growth charts for children under 5 years old

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Distribute and guide the use of iron/folic acid supplements for pregnant women and mothers under the guidance of the commune health station (if available)

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Assist the commune health station in guiding patients on the safe, rational, and effective use of essential medicines as prescribed and instructed by the commune health station

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)

No.

List of professional techniques

1

Observe, assess, and evaluate the general condition of the patient

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Measure and record the patient’s vital signs

3

Perform initial first aid for respiratory, circulatory, and cardiovascular emergencies

4

Provide first aid and bandage bleeding soft tissue wounds

5

Perform first aid and temporary immobilization for fractures

6

Administer first aid and initial management of burns

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Manage snake bites, apply pressure bandages, and immobilize the affected area

8

Provide initial management for bites and stings from animals, etc.

9

Administer first aid for poisoning, heatstroke, and heat exhaustion

10

Perform initial first aid for drowning cases

11

Provide first aid for other household accidents, such as electric shock, falls, etc.

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Assist in the safe transport of patients to healthcare facilities

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Manage fever cases

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Provide care and counseling for patients with upper respiratory tract infections

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Provide care and counseling for influenza patients

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Provide care and counseling for patients with conjunctivitis (red eye)

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Provide initial care and counseling for dengue fever patients

18

Perform initial management of allergic dermatitis, urticaria, and skin rashes

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Perform initial management of measles cases

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Perform initial management of mumps cases

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Perform initial management of hand, foot, and mouth disease

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Perform initial management of abdominal pain and diarrhea

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Provide counseling and guidance on various healthcare practices

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Provide counseling and guidance on community disease prevention and control

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Provide counseling and guidance on elderly healthcare

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Provide counseling and guidance on healthcare for people with disabilities

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Provide counseling and guidance on mental health care

28

Provide counseling and guidance for patients with hypertension

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Provide counseling and guidance for patients with diabetes

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Provide counseling and guidance for patients with chronic obstructive pulmonary disease (COPD)

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Provide counseling and guidance for patients with asthma

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Provide counseling and guidance for cancer patients

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Provide counseling on nutrition and exercise

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Provide counseling and guidance on rehabilitation

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Perform traditional therapies such as coin rubbing (cupping), massage, and acupressure using hands

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Provide counseling for couples before pregnancy

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Provide psychological counseling for pregnant women

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Provide counseling on tetanus vaccination for pregnant women

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Provide counseling on pregnancy signs

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Provide counseling on safe motherhood and child care knowledge

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Provide counseling for pregnant women on screening tests for mother-to-child transmitted diseases (including HIV, hepatitis B, and syphilis)

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Provide counseling and guidance for pregnant women on pregnancy registration and attending at least four antenatal check-ups during pregnancy

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Guide pregnant women on proper nutrition, monitor, and control appropriate weight gain during pregnancy

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Perform antenatal check-up techniques

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Manage pregnancy, detect high-risk pregnancies, provide initial intervention, and refer to medical facilities

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Provide counseling on signs of labor

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Provide emergency assistance for unassisted childbirth

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Perform initial management of complications in unassisted childbirth

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Provide care and monitoring for women in labor

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Deliver normal vertex presentations for women in labor who cannot reach or are unable to get to a medical facility for childbirth

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Perform initial management of postpartum hemorrhage during and immediately after childbirth

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Deliver the placenta and inspect the placenta

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Examine, manage, care for, and monitor the mother and newborn within the first six hours after birth at home

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Examine, manage, care for, and monitor the mother within the first six weeks after birth at home

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Examine, manage, care for, and monitor the newborn within the first six weeks after birth at home

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Care for and monitor perineal sutures after childbirth

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Provide initial management for nipple inversion, breast engorgement, and blocked milk ducts in postpartum mothers

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Perform initial management of abnormal and dangerous signs in pregnant women and during labor

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Assess newborns immediately after birth, perform initial management, and refer when danger signs are detected

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Provide kangaroo mother care for low-birth-weight infants

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Counsel on breastfeeding and manage milk aspiration in infants

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Bathe newborns

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Provide newborn skin care

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Provide umbilical cord care for newborns

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Examine and observe to detect certain external congenital abnormalities in newborns

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Monitor the height and weight of children and record growth charts

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Provide child health care

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Guide and counsel on appropriate supplementary feeding for children

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Counsel on expanded immunization programs

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Assist in counseling and caring for children with acute respiratory infections

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Assist in counseling and caring for children with fever and febrile convulsions

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Assist in the safe transport of mothers and newborns to healthcare facilities

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Distribute and guide the use of iron/folic acid supplements for pregnant women and mothers under the guidance of the commune health station (if available)

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Distribute and guide the use of nutrition prevention and treatment products for children under the guidance of the commune health station (if available)

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Assist the commune health station in guiding patients on the safe, rational, and effective use of essential medicines as prescribed and instructed by the commune health station

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Record and report maternal and child healthcare data in both paper and electronic versions

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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)

No.

Training subjects

1

General human anatomy and physiology

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Essential medicines and their usage

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Health communication and education

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Prevention and control of climate change impacts and environmental pollution

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Recognizing general and critical health signs

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Basic first aid and emergency response

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Assisting in the safe transportation and referral of patients to healthcare facilities

10

Emergency childbirth management in the community

11

Maternal and newborn care, including postpartum care for mothers and infants within the first six weeks at home

12

Child healthcare

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Expanded immunization programs

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Community health management, disease prevention, and control (including the application of traditional medicine, rehabilitation, and nutrition in healthcare. Early detection and initial management of local endemic diseases)

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Screening, counseling, and healthcare for patients with non-communicable diseases

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Application of information technology, medical statistics, and reporting

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Clinical practice at medical examination and treatment facilities

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Community-based practical training

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)

No.

Training subjects

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General anatomy and physiology of the female reproductive system

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Roles and responsibilities of village midwives in maternal and child healthcare

3

Infection control in providing reproductive healthcare services in the community

4

Essential medicines and their usage

5

Prevention and control of climate change impacts and environmental pollution

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Recognizing general and critical health signs

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Basic first aid and emergency response

8

Initial management of common symptoms and illnesses

9

Antenatal care

Counseling for couples before pregnancy

Characteristics of pregnancy

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Abnormal signs during pregnancy

Clinical practice at healthcare facilities on antenatal care

10

Labor and delivery care

Signs of labor and monitoring labor

Preparation before delivery assistance

Assisting in normal delivery using a clean delivery kit

Emergency childbirth management in the community

Initial management of postpartum hemorrhage and immediate post-delivery bleeding

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Clinical practice at healthcare facilities on labor and delivery care

11

Postpartum maternal and newborn care within the first six weeks at home

Postpartum maternal care within the first six weeks at home

Newborn bathing, skin care, and umbilical cord care

Provide kangaroo mother care for low-birth-weight infants

Breastfeeding and managing milk aspiration in infants

Clinical practice at healthcare facilities on maternal and newborn postpartum care at home

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13

Child healthcare

14

Nutrition for children and infant feeding

15

Expanded immunization programs

16

Assist in the safe transport of mothers and newborns to healthcare facilities

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18

Guidance on using tools for monitoring maternal and child healthcare in both paper and electronic versions

19

Community health management, disease prevention, and control (including the application of traditional medicine, rehabilitation, and nutrition in healthcare. Early detection and initial management of local endemic diseases)

20

Community-based practical training

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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Training subjects

1

General anatomy and physiology of the female reproductive system

2

Roles and responsibilities of village midwives within the healthcare network

3

Infection control in providing reproductive healthcare services in the community

4

Antenatal care

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Prenatal examination

Abnormal signs during pregnancy

Clinical practice at healthcare facilities on antenatal care

5

Labor and delivery care

Signs of labor and monitoring labor

Preparation before delivery assistance

Assisting in normal delivery using a clean delivery kit

Unassisted childbirth management in the community

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Delivering the placenta and inspecting the placenta

Clinical practice at healthcare facilities on labor and delivery care

6

Postpartum maternal and newborn care within the first six weeks at home

Postpartum maternal care within the first six weeks at home

Newborn bathing, skin care, and umbilical cord care

Provide kangaroo mother care for low-birth-weight infants

Breastfeeding and managing milk aspiration in infants

Clinical practice at healthcare facilities on maternal and newborn postpartum care at home

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Health communication on maternal and newborn care in the community

8

Safe transport of mothers and newborns to healthcare facilities

9

Community-based practical training

Thông tư 27/2023/TT-BYT 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